Knock Knock, Hi! with the Glaucomfleckens

I failed my very first standardized patient encounter in medical school because I saw a 49-year-old woman with abdominal pain and did not order a pregnancy test — immediate fail, well-earned shame, lesson learned — and it turns out that story is actually a pretty good entry point to this episode about what standardized patient education is, what it's missing, and what Ashira Greenberg and Shauna Ikahihifo are doing to fix it. Ashira is a full-time mobility device user and disability advocate who grew up loving hospitals because, as her kid brain correctly reasoned, hospitals are built for people on wheels; Shauna is an autistic woman who was diagnosed at 33 after an 11-year diagnostic odyssey in which she lost the ability to speak for weeks during a burnout episode and was told it was just the worst anxiety her doctors had ever seen. They're co-founders of the disability Special Interest Group within the Association of Standardized Patient Educators (ASPE), and their Lived Experience Project is specifically about getting neurodivergent and disabled standardized patients into medical training encounters so students hear actual feedback from people who know what it feels like to be on that side of the room — because 42% of medical schools have zero disability content in their curriculum, 80% of physicians don't believe their disabled patients have a good quality of life, 1 in 4 disabled people has no regular PCP, and putting a medical student in a wheelchair for an afternoon and calling it disability education is not the answer. The further I get into my career, the more I believe communication is at least as important as diagnosis, and this conversation made that feel more true than ever.

Takeaways:

• Pain scales are almost unusable for many neurodivergent patients
• 80% of physicians don't believe disabled patients have a good quality of life
• The social model of disability reframes the question
• Simulating disability is not the same as understanding it
• 1 in 4 disabled people has no regular primary care physician

—

Want more Ashira Greenberg and Shauna Ikahihifo?

https://www.linkedin.com/in/ashira-greenberg/

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠⁠

Head to https://cozyearth.com and use my code KNOCKKNOCK for an exclusive 35% off on home and sleepwear through December 3rd!

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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Halloween is around the corner, so here is a little housekeeping. I open with the saga of my HOA fining me for window units during a 117°F Portland heat wave, including the time I taped a photo of Brad Pitt to one to make it “more beautiful.” Then our family’s Star Wars Halloween plan: I was going to hide inside an inflatable Jabba the Hutt until Kristin called me on it, so I’m compromising with a Jawa.

After the break, the real news. The FDA just approved Brightly (Alcon’s apraclonidine 0.125%), the newest over-the-counter redness reliever. I walk through why Visine is the worst thing ever invented, why Lumify is still my go-to recommendation if you absolutely must use one, and why I’m cautious about Brightly, especially around kids. And a reminder: if your eye redness comes with any other symptom, don’t mask it. Go see an eye doctor.

Takeaways:

• Visine’s tetrahydrozoline is a potent vasoconstrictor that causes rebound redness and chronic irritation, and ingesting it can cause life-threatening cardiovascular effects.
• Lumify (brimonidine 0.025%) has been the preferred over-the-counter option since 2017, but overuse can trigger allergic reactions that force patients to stop.
• Brightly (apraclonidine 0.125%), approved October 16, 2026, is Alcon’s new low-dose alpha agonist redness reliever indicated for ages 12 and up.
• Will remains cautious about Brightly for pediatric exposure risks, since full-dose apraclonidine can cause CNS depression in children.
• Age-related eye redness without associated symptoms generally doesn’t need treatment, but redness with burning, discharge, blurry vision, or light sensitivity should be evaluated by an eye doctor.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠⁠

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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Dr. Rachel Zoffness is a pain psychologist and assistant clinical professor at UCSF and Stanford, and she came on to do something I desperately needed, explain what I actually did not learn in medical school about pain, which turns out to be most of it. The thing I absorbed is apparently what 96% of medical schools teach as their entire compulsory pain curriculum, and it's missing about two-thirds of the actual story because pain is not made in your skin, it's constructed by your brain, which means it is always biopsychosocial: biological inputs, psychological inputs, and social inputs, and you cannot treat chronic pain by ignoring any of them.

We go through the tale of two nails, why Usain Bolt's S-curved spine and unequal leg length are a really compelling argument against doing back surgery before you've exhausted every other option, how loneliness chemically amplifies pain the way social connection suppresses it, what central sensitization actually is and why chronic pain patients are not imagining anything, and how "pain as the fifth vital sign" was literally a big pharma campaign to sell OxyContin that caused enormous damage to how medicine prescribes opioids. Kristin also gets a professional consult on being a Highly Sensitive Person, which Rachel frames as being a more accurate seismograph than other people.

Takeaways:

• A nociceptor is not a pain receptor
• The "tale of two nails" proves that hurt and harm are not the same thing
• Chronic pain is a disease of the central nervous system
• Loneliness is a direct pain amplifier
• "Pain is the fifth vital sign" was a big pharma invention

—

Want more Dr. Rachel Zoffness?

Instagram @therealdoczoff

Facebook @ Dr. Rachel Zoffness

LinkedIn Rachel Zoffness

Bluesky @drzoffness

Twitter @drzoffness

The Zoffness Team

Pain Science and Education

Tell Me Where It Hurts

http://zoffness.com/

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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This week I get into the No Surprises Act, starting with my own $20,000 out-of-network bill after my cardiac arrest and the nine-month fight to resolve it. The law was supposed to prevent exactly that, and from the patient side it works. But the arbitration system behind it is now processing millions of claims per year (not the 22,000 the feds expected), doctors are winning about 85% of the time, and insurance companies are lobbying hard to rewrite the rules.

Then the drama at the American Diabetes Association. The ADA published an editorial in Diabetes Care criticizing proposed NIH cuts, then invited NIH head Jay Bhattacharya to keynote their June meeting. Twelve members handed out reprints of that same editorial outside the keynote, five got escorted out by Louisiana State Police, and Dr. Khan was denied re-entry to his own panel. A CEO apology video, blocked editorials, and a growing boycott later, we’re watching a case study in physician collective advocacy.

Takeaways:

• Will’s own $20,000 surprise bill after his cardiac arrest came from out-of-network physicians inside an in-network hospital, and took nine months of fighting to resolve.
• The No Surprises Act’s arbitration system was projected to handle 22,000 claims per year but now handles millions, with physicians winning roughly 85% of disputes.
• Insurance companies are lobbying for amendments to the arbitration system and routinely delay payment of settled claims by six to nine months to continue floating the money.
• The American Diabetes Association had five members escorted out by Louisiana State Police in June for handing out reprints of an editorial published in the ADA’s own journal criticizing NIH funding cuts.
• A growing boycott of the ADA journal Diabetes Care illustrates the increasing willingness of physicians and researchers to use collective action against their own professional organizations.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠⁠

Go to ⁠⁠cozyearth.com⁠⁠, and use code KnockKnock, for up to 20% off home and sleepwear. And when they ask where you heard about them at checkout, let them know you heard about them right here on Knock Knock, Hi!

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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Dr. Lindsey Fitzharris is back and she brought her best book yet. Sleuth Hound: The Case of the Real Sherlock Holmes, out October 20th, which tells the story of Joseph Bell, the Edinburgh surgeon who was the actual inspiration for Sherlock Holmes.

We cover optography (the Victorian belief that eyeballs record the last thing a person sees before death, which murderers took seriously enough to destroy their victims' eyeballs), Bell's diagnostic party tricks (dipping his middle finger in a flask and tasting his index finger while students drank whatever was in it), how the Chantereau poisoning case connects to Robert Louis Stevenson and Dr. Jekyll and Mr. Hyde, why much of 19th century forensics was built on the brutalized bodies of women killed by their husbands, and the extraordinary case where Bell and Conan Doyle defended a man they personally believed was guilty because the body had been embalmed before autopsy and the physical evidence was compromised, which Lindsey correctly identifies as the "if the glove doesn't fit" moment of the 1890s.

Takeaways:

• Joseph Bell worked as an actual consulting detective
• Victorian forensics advanced largely on the bodies of women killed by their husbands
• Optography was a real and widely believed forensic theory
• Bell and Conan Doyle once defended a man they believed was guilty
• The death of the physical exam has a 150-year precedent

—

Want more Dr. Lindsey Fitzharris?

https://www.facebook.com/DrLindseyFitzharris/

IG: @drlindseyfitzharris

X: @drlindseyfitz

Bluesky: @drlindseyfitz

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠

Go to ⁠cozyearth.com⁠, and use code KnockKnock, for up to 20% off home and sleepwear. And when they ask where you heard about them at checkout, let them know you heard about them right here on Knock Knock, Hi!

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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The weight of the healthcare system has been sitting heavy. Our practice officially dropped UnitedHealthcare after they offered a 0.8% rate increase, and I’m feeling genuine empathy fatigue for the first time since I came back to clinic after my cardiac arrest. I talk about what that feeling actually is, how to spot it, and what finally helped me through it last time. Also, Dr. Oz is pushing to eliminate modifier 25, which would effectively end same-day procedures in private practice.
Then some actual good news: the 2026 Nobel Prize in Physiology or Medicine went to Peter Hegemann, George Nagel, and Karl Deisseroth for optogenetics. I walk through the 2021 Nature Medicine case of a man with 40 years of retinitis pigmentosa who regained the ability to locate and touch objects after an AAV-delivered opsin was injected into his retinal ganglion cells. It’s mutation-agnostic, it’s low-resolution, and it’s one of the most exciting developments in vision science in a long time.

Takeaways:

• After years of negotiation, Will’s practice has fully dropped UnitedHealthcare over a 0.8% rate increase offer against a 3% request.
• Empathy fatigue is real, often follows personal medical trauma, and requires time off, honest conversations, and self-awareness to work through.
• Dr. Oz and CMS are pushing to eliminate modifier 25, which would effectively end same-day E&M visits combined with procedures and devastate private practice.
• The 2026 Nobel Prize in Physiology or Medicine went to the discoverers and developers of optogenetics, which has already shown promise restoring partial vision in retinitis pigmentosa.
• Optogenetics is mutation-agnostic because it installs light sensitivity in surviving ganglion and bipolar cells rather than repairing dead photoreceptors.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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We did back-to-school night for our ninth grader and I came away wanting to re-enroll myself. The CS teacher (28 years in the classroom) convinced me that what computer programming really teaches is attention to detail, one misplaced space breaks the whole thing, and the Spanish teacher, who grew up under Franco with his left hand literally tied to his chair for writing right-handed, had a philosophy so good I almost asked if I could come on Monday. After the break, I get into the AI mathematics controversy. OpenAI announced their agents solved the Navier-Stokes equations using 10,000 agents over 88 hours on a problem humans have worked on for 60 years, but an NYU mathematician and an Anthropic researcher claim OpenAI trained on their ongoing unpublished work without attribution, which is a more acute version of the IP argument that's followed AI from the start, and it bugs me in a way I don't have a clean answer for.

Takeaways:

• Computer programming teaches attention to detail above almost everything else
• OpenAI's Navier-Stokes announcement is a sharper version of AI's ongoing IP problem
• The AI regulation debate keeps hitting the same wall
• Franco's Spain was still enforcing Catholic baptism within 72 hours of birth and banning left-handedness well into the 1970s
• High school is wasted on teenagers

—

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠⁠http://aka.ms/knockknockhi ⁠⁠

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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The Blue Cross Blue Shield Association put out a truly hilarious study complaining that AI tools drove nearly $1 billion in extra costs for their insurers over two years, blaming hospitals and doctors for using AI to code more accurately. This from the industry that pioneered using AI to deny claims. It's an arms race now, and the only people who actually lose are patients, premiums keep going up regardless of who wins.

Then two big eyeball wins. The AMA House of Delegates finally reclassified myopia as a disease, which should push pediatric progression treatments like Stellest lenses, ortho-K, and atropine drops onto medical insurance instead of cash pay. And Dr. Morgan Micheletti's team sent 135 intraocular lenses to the International Space Station for six months to see if cataract surgery could survive deep space travel, most held up remarkably well.

Takeaways:

• Blue Cross Blue Shield Association is complaining that AI tools have driven ~$1 billion in extra insurer costs, ignoring that insurance companies pioneered using AI to deny and downcode claims.
• The healthcare AI arms race is a battle for a fixed pot of money, and patients always end up paying via higher premiums.
• The AMA House of Delegates has adopted a resolution formally classifying myopia as a disease, opening the door for medical insurance coverage of progression treatments.
• Stellest lenses, orthokeratology, and atropine eye drops are the current options for slowing pediatric myopia progression, with Stellest showing about 70% reduction over two years.
• Dr. Morgan Micheletti's ISS study found that most acrylic intraocular lenses survived six months exposed to space, suggesting cataract surgery in space may eventually be feasible.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠

Cozy Earth almost never does 30% off, and they're doing it right now through the 11th. Go to ⁠cozyearth.com⁠, use code KnockKnock, and get 30% off home and sleepwear. Cozyearth.com, code KnockKnock

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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This week Kristin and I sat down with Dr. Sasha Hamdani, a board-certified psychiatrist, ADHD expert, and author of the new book Too Sensitive: Rejection, Resilience, and the Science of Feeling Deeply. Sasha breaks down the actual neuroscience behind why some of us feel emotions so intensely, and gave us some genuinely useful tools for dealing with it. We also got a proper medical explanation for hangxiety, which, as someone who has experienced it, I found extremely validating.

Sasha also walked us through rejection sensitive dysphoria, its connection to ADHD, and her own long and slightly chaotic road to getting diagnosed at 40. And look, I'll admit that by the end of this conversation I may have lost an ongoing argument with Kristin about whether or not I have anxiety.

Takeaways:

• Emotional sensitivity has a neurological basis involving a hyper-responsive amygdala and an under-responsive prefrontal cortex.
• Cyclic sighing, a specific breathing technique, can help calm the nervous system and re-engage logical thinking during moments of panic.
• Rejection sensitive dysphoria is closely linked to ADHD and can be one of the most limiting aspects of the condition for many people.
• "Hangxiety" occurs because alcohol interacts with GABA receptors similarly to anti-anxiety medications, leading to a rebound anxiety effect the next morning.
• Delaying your response to conflict or bad news allows alarm chemicals to subside, leading to a calmer, more rational reaction.

—

Want more Sasha Hamdani, MD?

@thepsychdoctormd

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠⁠http://aka.ms/knockknockhi ⁠⁠

Cozy Earth almost never does 30% off, and they're doing it right now through the 11th. Go to http://cozyearth.com/, use code KnockKnock, and get 30% off home and sleepwear. Cozyearth.com, code KnockKnock

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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I'm back in the corporate practice of medicine content cycle, this time on the Stop Corporate Takeovers of Physicians Act, a new federal bill modeled on Oregon's landmark CPOM law. It closes the MSO / PC ""friendly physician"" loophole that corporations like Apollo MD use to get around existing laws in 34 states, and it kills non-competes and non-disparagement clauses so hospital-employed doctors can finally speak out. It's not perfect, nonprofit hospitals are exempt, but I support it. My answer to declining reimbursement isn't to sell to private equity, it's to work together: merge practices, form IPAs, unionize where employed. Physicians are terrible at group projects, and it's costing us.
After the break, an update on GLP-1s and NAION now that the lawsuits are hitting mainstream media. The correlation is real, the causation isn't proven, and the comorbidities overlap heavily. Don't stop your GLP-1 based on a news story, talk to your doctor about your specific risk factors. But if you have sudden painless vision loss on the medication, see an eye doctor immediately.

Takeaways:

• The Stop Corporate Takeovers of Physicians Act closes the MSO / PC "friendly physician" loophole that corporations use to circumvent existing corporate practice of medicine laws in 34 states.
• The bill also eliminates non-competes and non-disparagement clauses, freeing hospital-employed physicians to speak out about harmful practices without fear of retribution.
• The critique that killing private equity gives nonprofit hospitals free rein misses the point, hospitals and PE are aligned on profit motives, not competitors.
• Will's answer to declining reimbursement isn't selling to PE, it's merging practices, forming independent physician associations, and unionizing where employed.
• On GLP-1s and NAION, the current signal is correlation, not causation, don't stop the medication based on news coverage, but seek immediate care for sudden painless vision loss.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠⁠http://aka.ms/knockknockhi ⁠⁠

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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This episode kicks off with a listener email from someone facing a conundrum: she finds out about getting tenure within a few weeks of turning 40, all while wondering if she should ditch academia and go to medical school instead. Kristin and I dig into what it would actually take to start med school at 40: the family logistics, the physical toll of taking overnight call as you get older, the financial reality of avoiding debt at that age, and whether it's even possible to "test drive" medicine before committing.

From there, we get into an update on the health systems behaving badly that I've been calling out, including why I keep getting cease and desist letters from hospital systems but never from insurance companies, and what's really going on when hospitals fire independent doctors and replace them with more expensive locums. We wrap up with a couple extra questions: whether it's weird for a doctor to use their iPhone flashlight during an exam, and a genuinely tough one about whether you'd want to get tested for a fatal genetic disease like Huntington's if it ran in your family.

Takeaways:

• A listener asked whether it's worth pursuing medical school at 40 instead of pursuing tenure, prompting a discussion of the financial, physical, and family challenges of a late-career switch to medicine.
• Independent medical practices are increasingly being pushed out by hospital systems in favor of contracts with private equity-backed groups, sometimes at a higher cost.
• Corporate Practice of Medicine (CPOM) laws, like Oregon's, are gaining momentum in more states as a way to limit corporate control over medical practices.
• Will has received cease and desist letters from hospital systems for his content but has never received one from a health insurance company.
• Will and Kristin discuss whether they'd want to get genetic testing for a fatal disease like Huntington's if it ran in their family.

—

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠http://aka.ms/knockknockhi ⁠

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

Head to http://www.cozyearth.com and use my code KNOCKKNOCK for an exclusive 20% off.

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Coming to you from a hotel patio in Lebanon, New Hampshire, this week I dig into the ACGME's newly released revisions to resident work-hour restrictions. We walk through what's actually being proposed: eliminating the mandatory 8-hour rest period between ordinary shifts, cutting required rest after a 24-hour call from 14 hours down to 12, and loosening call frequency from every third night to every second night. Despite some pushback that current restrictions have made residents "soft," I think these changes go too far and put both patients and physicians at risk.

Then it's back to more familiar territory: eyeballs. After getting my own eyes irritated in the indoor hotel pool, I break down the actual science behind why your eyes turn red around chlorine. Spoiler: it's not (directly) pee, it's a gas called chloramine that forms when chlorine reacts with body oils, sweat, and other impurities, stripping the protective oil layer off your tear film.

Takeaways:

• The ACGME has proposed eliminating the 8-hour rest period between ordinary scheduled shifts for residents, with a public comment period open until October 22nd.
• The proposal would also reduce required rest after a 24-hour in-house call from 14 hours to 12, and change call frequency from every third night to every second night.
• I oppose the proposed changes, arguing that sleep-deprived residents make more medical errors and that the current 80-hour work restrictions strike a reasonable balance.
• Red, irritated eyes after swimming aren't caused by direct contact with urine, but by chloramine gas, formed when chlorine reacts with sweat, body oils, and other impurities in the water.
• Chloramine gas strips the protective oil layer off the eye's tear film, causing redness, burning, and dryness.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠http://aka.ms/knockknockhi ⁠

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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This week Kristin and I are talking business; specifically, how doctors go from having a great idea to actually building a company around it. We're joined by Dr. David Lortscher, a board-certified dermatologist, co-founder of Curology, and author of Why Doctors Win: The Doctor's Guide to Creating or Joining a High-Impact Startup. David breaks down why so many of the most successful healthcare companies of the last few decades, including Intuitive Surgical, Gilead, Regeneron, UpToDate, were founded or co-founded by physicians. He makes the case for why more doctors, nurses, PAs, and other clinicians should be in the room when healthcare companies get built, instead of leaving it entirely to people with zero patient care experience.

We get into the real differences between venture capital and private equity, what VCs actually look for before funding a startup, and the story behind how David built Curology, including the surprisingly counterintuitive pay structure that helped it scale to treating millions of patients. Kristin and I also talk about our own version of this, how she basically became CEO of Glaucomflecken so I could keep doing what I actually want to do, which is make dumb videos and still practice ophthalmology four days a week.

Takeaways:

• Over half of the top 100 most successful healthcare startups founded in the last four decades had a physician founder or co-founder.
• Venture capital funds early-stage companies with high growth potential, while private equity typically buys existing businesses and tries to make them more efficient, often through cost-cutting.
• A successful startup needs both a transformational product and a clear path to winning the market, not just a clever idea.
• Physicians don't need to quit clinical practice to start a company if they have a good support system and trusted co-founders.
• The two things every successful startup needs are a truly transformational product and a clear path to winning over the market.

—

Want more Dr. David Lortscher?

LinkedIn: https://linkedin.com/in/DavidLortscherMD

X (Twitter): @DavidLortscher

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠http://aka.ms/knockknockhi ⁠

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

To get your Henson Razor go to ⁠hensonshaving.com/knockknockhi⁠ and use code knockknockhi to receive 100 blades for free with the purchase of a razor.

Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠

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This week I'm tackling two things that have been on my mind. First, I saw a piece of content from another physician creator explaining why they left private practice, and the framing bothered me: the idea that private practice is inherently about squeezing as much money out of patients as possible. I get where that creator is coming from, but I think that's simply a culture problem at that practice, and I don't want med students or residents seeing that content and writing off private practice entirely. I talk through why financial pressure and reimbursement cuts are real, how to spot when a doctor is actually upselling you, and what to look for in a practice that shares income and actually operates like a partnership.

Then I get into something a little heavier: an angry, anonymous email I got accusing me of tanking a hospital's reputation and making it harder for them to recruit, just for reporting on the neonatologists who were fired there. I break down why I make these videos, how seriously I take sharing information on my platform, and why I think doctors get blamed for administrators' decisions.

Takeaways:

• Financial pressure in private practice can be real, largely driven by declining reimbursement, but it doesn't have to dictate individual clinical decisions.
• A key sign of a healthy private practice is one that shares a significant percentage of income among partners rather than paying doctors only for what they individually bring in.
• Patients who feel like they're being upsold on elective procedures should trust that instinct and seek a second opinion.
• I stand by my hospital accountability videos, arguing that I'm amplifying stories from healthcare workers who can't speak publicly themselves due to non-disparagement agreements.
• I explicitly condemn any threats or violence directed at hospital administrators or CEOs.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

⁠http://aka.ms/knockknockhi ⁠

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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This week I'm sitting down with Dr. Fran Heydanek, OBGYN, mom, and one of the biggest medical content creators out there fighting misinformation. We start with the wildly common experience of getting scammed by fake podcast invites (yes, it's happened to both of us), then get into her actual path to medicine: integrated arts classes, a rejected dentistry detour, a brief love affair with pathology, and a med school that apparently banned water in the lecture halls.

From there we go deep on the business of being a doctor who also makes social media content: how she films, edits, and posts everything herself, how she decides which brand deals are worth it (spoiler: no liver detoxes), how she balances a full clinical schedule with content creation, and more.

Takeaways:

• Podcast scam emails targeting content creators are common; both Will and Dr. Fran have nearly fallen for fake booking requests.
• While Dr. Fran shoots, edits, and posts nearly all of her own content herself, it can be challenging to balance with a full clinical schedule.
• She still works as a full-time OBGYN and has no plans to leave clinical practice, even as her content career has grown, not only because she loves her job but also because it is important for credibility.
• Not all brand deals should be accepted. Dr. Fran turns down brand deals for products she wouldn't personally use, and I agree that most offers aren't worth the credibility hit.
• Dr. Fran's early career included a fashion blog that helped fund her wedding and car payments before medical school and before she started posting medical content.

—

Want more Dr. Fran Heydanek?

@pagingdrfran - Instagram, TikTok, Facebook, YouTube

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

To learn more about Microsoft Dragon Copilot, visit:

http://aka.ms/knockknockhi

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠

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Welcome back to Knock Knock Eye, my one-stop shop for all things eyeball related. This week I'm taking a quick break from corporate practice of medicine talk (just this once, I promise) to dig into a mailbag question from a listener named Gina, who fainted during a routine gonioscopy exam. We get into what a vasovagal reaction is, why the eye seems to be such a common trigger for fainting, and what you can actually do in the moment to keep your blood pressure from tanking.

From there I go into the oculocardiac reflex, which is a genuinely wild phenomenon where manipulating the muscles around your eye can drop your heart rate enough to cause cardiac arrest, plus how it shows up clinically when someone has a trapped eye muscle from an orbital fracture.

As always, send me your hospital horror stories, and also your hospital success stories, at knockknockhi@human-content.com.

Takeaways:

• Passing out during an eye exam is usually a vasovagal reaction, not a sign anything went wrong.
• Clenching your muscles while breathing slowly and calmly can help prevent a fainting spell if you know you're prone to one.
• The oculocardiac reflex is a real drop in heart rate triggered by pulling on the eye muscles, and in rare cases it can lead to cardiac arrest.
• A sudden heart rate drop when a patient looks up can signal a trapped eye muscle from an orbital fracture.
• Persistent dry, itchy eyes could actually be Demodex blepharitis rather than simple dryness.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠

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This week we go down a bit of an emotional rabbit hole, starting with a Mad Men clip about nostalgia. This leads to us reading some genuinely fascinating research on nostalgia; why it exists, what it does to our brains, and why it might actually be an evolutionary survival mechanism. We talk about looking back at old photos of our kids, why parenthood memories tend to get rosier over time, and whether millennials are uniquely nostalgic given everything we've lived through.

Then we get back to more medical Spanish lessons with phrases sent in by listeners. I butcher "pupilas" more times than I'd like to admit, learn how to say cataracts and retinal detachment, and Kristin gently points out that maybe I should learn the Spanish alphabet before continuing to just wing it phrase by phrase.

Takeaways:

• Nostalgia isn't just a pleasant feeling, research suggests it can reduce our perception of pain and help regulate emotional and psychological stress.
• Consumption of nostalgia-inducing media tends to increase during times of crisis or uncertainty, as seen during the COVID-19 pandemic.
• Memory naturally tends to filter out the harder parts of past experiences, especially around parenthood, which researchers believe may serve an evolutionary purpose.
• Nostalgia activates brain regions associated with self-reflection, autobiographical memory, emotional regulation, and reward processing.
• Millennials may experience heightened nostalgia in part because major formative life events, like 9/11, the 2008 financial crash, and the pandemic, repeatedly disrupted a sense of stability.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

To get your Henson Razor go to ⁠⁠hensonshaving.com/knockknockhi⁠⁠ and use code knockknockhi to receive 100 blades for free with the purchase of a razor.

Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠

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So last episode I made the case that medical student research should be banned, and I clearly touched a nerve. I got flooded with angry messages arguing against me, and honestly, I expected some backlash since it was a genuinely spicy take. But I want to be clear, I was being facetious, obviously nobody's going to actually ban med student research. What I actually want to unpack this episode is why this topic clearly struck such a nerve, and what's really driving the explosion in med student publications.

I walk through some new data, including a study that found roughly a quarter of recent ophthalmology journal articles may contain AI-generated text, and another from Yale showing a real gap between the publications applicants claim on their residency applications and what's actually verifiable in PubMed. I also get into Goodhart's Law, the idea that when a measure becomes a target, it stops being a good measure, and how that applies perfectly to what's happened since Step One went pass-fail. I share some thoughts on what might actually help, including capping how many publications students can list, and I make it clear I'm not trying to lead some crusade here, I just think this conversation needed to happen.

Takeaways:

• Since Step One became pass-fail, medical students have shifted their focus to research output as a differentiator, and reported publication numbers have risen sharply as a result.
• A recent study found that roughly 26% of ophthalmology journal abstracts and 22% of commentaries screened in 2025 scored as likely containing AI-generated text.
• A Yale-affiliated study found that applicants to ophthalmology residency claimed an average of 4.9 publications, while only 2.4 were actually verifiable in PubMed.
• Goodhart's Law suggests that once a measure like publication count becomes a target used for residency selection, it stops accurately reflecting research quality or applicant ability.
• Starting with the 2027 application cycle, the AAMC is renaming the ERAS publications field to "scholarly works" in an attempt to shift emphasis from quantity to quality.

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

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If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://anatomywarehouse.com/?aff=14⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

Head to http://www.cozyearth.com and use my code KNOCKKNOCK for an exclusive 20% off.

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This week we start by discussing our daughter's summer geometry crash course, and I forgot how much I hate proofs. I also tell the story of getting stuck at the Salt Lake airport with the Portland Thorns professional soccer team, which hit me with a wave of nostalgia for my old Ultimate Frisbee team days, followed by Kristin's late-night ladder saga trying to fix a chirping smoke detector on our vaulted ceiling while I was useless from the airport.

Then we get into something a little more serious: the whole Hank Green AI situation, where he admitted to using ChatGPT to help write video scripts and got a wave of backlash from his own audience. I get into my personal line in the sand with AI, which is that I don't want it anywhere near my creative work, and we touch on something Hank said that I hadn't really considered before: that interacting with LLMs might be giving people unhealthy dopamine hits. We talk about where this all might be headed, why creativity feels different from other tech advancements, and why I think this whole AI conversation deserves more nuance than a 60-second hot take.

Takeaways:

• Interacting with LLMs may trigger dopamine responses similar to social interaction, which could make them more habit-forming than people realize.
• AI tools can be genuinely useful for research and administrative tasks, but using them to generate creative content removes the human decision-making that gives creative work its meaning.
• The backlash Hank Green received for using AI in his video scripts sparked a broader conversation about where the line should be drawn between helpful tool and creative shortcut.
• Historically, people have expressed similar fears and backlash toward new technologies, from the printing press to photography to typing, though AI raises unique concerns around creative authorship.
• AI models are trained on human-created content, so widespread reliance on AI to create that content going forward could gradually dilute the human originality models depend on.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

Head to http://www.cozyearth.com and use my code KNOCKKNOCK for an exclusive 20% off.

Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠

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I just wrapped my second call week of the year, and honestly, getting older has made overnight pages so much harder than they used to be. At 30 I could wake up from a dead sleep and immediately have a coherent medical conversation, and now, ten years later, I basically have to be walked through who I am and what hospital I'm even at before I can function. I also tell the story of getting completely lost in a big Portland hospital after hours, which honestly just confirms the stereotype that ophthalmologists get lost in hospitals.

Then I get into something a lot more serious: my latest deep dive into hospital administrations behaving badly, this time at Asante Rogue Regional Medical Center in Medford, Oregon. Nine neonatologists, an incredibly stable, highly skilled group who'd been building this NICU program for two decades, were told in January they were being let go, with shifting and frankly contradictory explanations from the hospital. I walk through the timeline, including the hospital's decision to bring in a private equity-backed locums staffing company, a VP's misleading public comments about the firing, and the deleted panel video that followed once I called it out. I explain why I keep making these videos, even when people ask what the point is, because these decisions affect real patients, and communities deserve to know why their care is changing.

Takeaways:

• Turns out being a doctor and getting woken up at 3 AM hits different in your 40s than it did in your 30s.
• Asante Rogue Regional Medical Center fired all nine of its neonatologists in January despite the group having no departures since 2021 and meeting national quality benchmarks.
• The hospital's stated reasons for the firings shifted over time and were contradicted by a hospital VP's own public comments about ongoing retirements.
• Locum staffing companies are typically meant to bridge short-term staffing gaps, not replace an entire well-functioning department, and often cost hospitals significantly more per hour than the doctors they're replacing.
• Physicians who raise patient safety concerns internally can face professional and legal pressure that discourages them from speaking publicly, even after losing their jobs.

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

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If you are interested in buying a book from one of our guests, check them all out here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amazon.com/shop/dr.glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://anatomywarehouse.com/?aff=14⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

Head to http://www.cozyearth.com and use my code KNOCKKNOCK for an exclusive 20% off.

Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠

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