Podcasts about patients

In December 2025, Governor Kathy Hochul reached an agreement with the New York state legislature to pass the Medical Aid in Dying Act, which would legalize what proponents call "death with dignity" and what critics call physician-assisted suicide. About a dozen other states already permit doctors to prescribe lethal medication to terminally ill patients who request it. The state of Oregon pioneered this practice in 1994 and it has since spread across the Western world. Now, there are people who have an ailing parent or grandparent or, God forbid, a child who is genuinely suffering—suffering in agonizing ways that make the cessation of that suffering seem like the only humane response. It would be inhuman not to acknowledge the enormous emotional, psychological, and physical burdens of that pain, or to minimize it. But the question of physician-assisted suicide ultimately is one about medical ethics as upheld by the physician, the distorting market effects of this practice, and social policy. What happens when the state makes it possible for large numbers of people to receive this option from the very person whose profession calls on him to heal and not harm? What happens to the moral foundations of our culture when assisted death becomes something we learn to abide? The evidence from places like Canada and the Netherlands begins to answer those questions in deeply disturbing ways. What started as a carefully limited option for the terminally ill has expanded dramatically. In Canada, deaths from medically assisted dying rose from 4,480 in 2018 to over 10,000 in 2021—and by 2022 accounted for 4 percent of all deaths in the country. Patients are now approved for reasons of poverty, loneliness, and mental illness. Veterans seeking PTSD treatment are sometimes offered death instead. The physician and educator Leon Kass warned nearly 30 years ago that once we break the ancient taboo against doctors killing patients, the practice would prove "in principle unregulable." The evidence now seems to vindicate that warning. To discuss this topic, Mosaic's editor Jonathan Silver is joined by Aaron Rothstein, a neurologist at the University of Pennsylvania and a fellow in bioethics and American democracy at the Ethics and Public Policy Center. They discuss the origins of the modern euthanasia movement, and the disturbing reality of how euthanasia functions once legalized. This episode of the Tikvah Podcast is generously sponsored by David Bradlow. If you are interested in sponsoring an episode of the Tikvah Podcast, we invite you to join the Tikvah Ideas Circle. Visit tikvah.org/circle to learn more and join.

Re-releasing a DAT listener favorite! The Dental A-Team is joined by Dr. Nate Tilman! Fascinating history aside (read his bio below), Dr. Tilman talks with Kiera about his unique dental practice situation, how he's managed to merge five different practices into his own, and a strategy for doing so. He also speaks to the shifting of culture in his practice, what it took for him to recognize, and the success it's brought. More on Dr. Tilman: Originally from Salisbury, Maryland, Dr. Tilman attended Wake Forest University for his undergraduate degree. He was awarded his Doctor of Dental Surgery from the University of Maryland where he graduated Summa Cum Laude in 2001. Dr. Tilman served in the U.S. Navy Dental Corps for four years, including two years forward deployed aboard USS Ashland (LSD 48). Following his military service, Dr. Tilman moved to Newport, Rhode Island, in 2007 and opened Newport Family and Cosmetic Dentistry. He has had the pleasure to work with an amazing team and amazing patients in creating a state-of-the art, caring, and comfortable dental practice. His commitment to incorporating advanced technologies and techniques allows Dr. Tilman and his team to provide dental treatment in fewer visits and more comfortably than with traditional techniques. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: speaker-0 (00:05) Hey everyone, welcome to the Dental A Team podcast. I'm your host, Kiera Dent, and I have this crazy idea that maybe I could combine a doctor and a team member's perspective, because let's face it, dentistry can be a challenging profession with those two perspectives. I've been a dental assistant, treatment coordinator, scheduler, filler, office manager, regional manager, practice owner, and I have a team of traveling consultants where we have traveled to over 165 different offices coaching teams. Yep, we don't just understand you, we are you.   Our mission is to positively impact the world of dental. And I believe that this podcast is the greatest way I can help elevate teams, grow VIP experiences, reduce stress, and create A-Teams. Welcome to the Dental A Team Podcast.   Hello, Dental A Team listeners. This is Kiera and you guys. I love podcasts where I get to bring on offices that I just think are fantastic. So this is an office that we have worked with in the Dental A Team. Also fun fact, he is in the smallest state in the entire United States. So you all know me and my state traveling. His state is one of my hardest states to get to every year, because it's so tiny and it's so far away from me. But he's just one of the best people I've ever met. He's an incredible leader, incredible dentist, incredible just   good human. So I'm so glad and so excited to welcome Dr. Nate Tilman to the show. How are you today, Nate?   speaker-1 (01:27) I am great. Thank you. Thank you. I'm super excited to be here. ⁓ as you know, I've been a fan of the podcast for, know, pretty much since you started. And it's kind of like, it's kind of surreal being, you know, being on, being on the podcast. So I appreciate, appreciate the offer.   speaker-0 (01:44) Well, I love it. love to one it's fun. Thank you for being a podcast fan I mean it's almost coming up on three years of the podcast since we created it and I never would have thought that the podcast could connect me with such cool people so one thank you for being a podcast listener and two things are just being a rad person I I liked the podcast has become a fun passion project for me to meet people to hear their stories   So I kind of alluded to it. You're also doing something similar to Dr. Dave Mogadon, who was on the podcast about those chart ⁓ mergers and buyouts that's kind of helped with your growth, but kind of just tell the listeners like how you even got into dentistry and kind of what your growth trajectory has been, just so they kind of know as a background to today's podcast.   speaker-1 (02:28) Yeah, I'll try not to ramble too much about it. yeah, I went to always wanted to do something in healthcare. My grandfather was a public health physician is a big inspiration for me. So kind of I think it's midway through college decided dentistry is gonna be a really good fit, you know, for a number of reasons. Went to University of Maryland for dental school, loved it decided to stay in general dentistry for   you know, all the variety of what we do. was on a Navy scholarship, so I was able to spend the first four years as a practicing dentist in the Navy. ⁓ Two years I was on a ship as the only dentist. So it was a really good, didn't realize like how helpful an experience that was for like running us an organization, even though it was an organization of three.   speaker-0 (03:14) Yeah, but I also feel like let's just talk about the Navy real fast because I didn't know this about you and my husband and I were literally talking probably two days ago and he said I don't think I ever could do the Navy like put me on a ship with these people for so long and dump me in the middle of the ocean like nowhere to go no hiking like what do you even do? How how was that? feel like more than anything it would teach you mental stamina is what I think I would learn from being on the Navy. But how was it for you? Maybe maybe you guys go swimming every day. I don't know like what do you do all day?   speaker-1 (03:43) Definitely not at all. it was, the two years on the ship was very, it's a super unique experience. And we were a small ship, 400 sailors. We transported Marines. So I was responsible for pretty much 400 patients. had, it was me, I had an administrative assistant and I had two dental technicians that could do some basic hygiene, not a hygienist, but it was me. ⁓   So having to learn like managing supplies and, know, managing appointments and all of that stuff. But the unique thing as a, as a dentist, and mean, this is one year out of a, you know, my GPR. still I was safe, but didn't really know necessarily all what I was doing, but I love to get myself out of jams because middle of the ocean, like. Mid procedure. I'm not going to be the guy calling a helicopter, you know, you got to work through it. So.   speaker-0 (04:40) They're like awesome because it's gonna push your limits and you've got to just figure it out Which I think so many dentists when they do own they don't learn that stamina that stress like hey, it's you figure it out But you're like the odds are even stacked more you're in the middle of the ocean and I mean it would been a pretty cool story for me maybe not for you to hear like a helicopter to come get a patient because you botched a root canal or something like you'd have to figure that out, but that that doesn't definitely up your odds of intensity   for sure being out there and nobody else is there to help you. You're the man. You got to figure it all out.   speaker-1 (05:13) Yeah. And I think it's, while it would have been nice to, you know, if I'd had a situation like, know, where I had a mentor, another dentist I was working with, you know, to be able to bail out, like it have been helpful, but it really, it did, it gave me a lot of, a lot of confidence, um, you know, early on for like, can work my way through this. And then also like what things I don't want to do. Cause I don't want to get stuck in that position again. Yeah. And it was, and yeah, while I didn't have to helicopter anybody out, one of the things I did do, and I don't think at the time, nobody had ever really.   speaker-0 (05:34) True.   speaker-1 (05:42) done it from a small ship or the even smaller ships around us that there were two times where people had some dental emergencies that I was able to fly out to their ship and take care of them.   speaker-0 (05:52) No way. Well, you do have like built in planes. You travel anywhere. So it's like quick, like fly you in, but that's crazy. Cause you ma I can't even imagine the stress that those poor other dentists were feeling of like we're in the middle of here. Like what am I supposed to do? ⁓ I guess call someone else. So, I mean, we talk about dentistry and I've said this so many times, like, feel like dental practices are like these solo islands out there. All y'all just kind of hang in your own area. You literally were in the middle of the ocean flying solo.   speaker-1 (06:22) Yeah. That's crazy. It was fun. There wasn't a ton of dentistry to do. I, know, cool thing with the Navy, they give you other jobs. So I became an air traffic controller. So I was in charge of, you know, all of the flight operations on the ship. so between that and dentistry, it me pretty busy. And then I played a of video games, you know,   speaker-0 (06:41) I'm like, I would be pulling pranks. mean, just throughout COVID, my husband, he makes fun of me. I feel like a roaming tiger in these four walls of our house. Like sometimes I'm like, just let me out of here. Like I can't even handle it. I'm like, I gotta go for a run. I gotta go for a hike that I can't even imagine being on a ship. would be like, I know I'd be pulling pranks on every single person on that ship and just like running for my life. Cause I probably would torment everybody, but air traffic control that like you really went for all the things, Nate, dentistry and air traffic controller.   What don't they say those are the top two suicide jobs? Like you really went for the whole extreme there. Nice job.   speaker-1 (07:15) Well, that's that's like when they selected me to go to the school for our traffic control. What are you guys trying to tell me? You already know I'm a dentist.   speaker-0 (07:23) Gosh, that's crazy. So you were in the Navy and then you went, got out of the Navy. Did you go straight to private practice? Did you go in and be an associate?   speaker-1 (07:32) So I was an associate for a year, still in the Virginia Beach area and then moved to Rhode Island. My wife is, we met in college, I'm two years older, so she was awesome for following me around. then, ⁓ so when she was done with her residency, she's from New England, so we kinda, that's where we looked up here. And I'll tell you, Virginia Beach area, super easy to get a job as an associate, tons of positions around, I figured it'd be the same thing coming up here and there was nothing.   speaker-0 (08:00) mean,   Rhode Island is like the size of a dot on a map. I mean, it's itty bitty, which I makes you a celebrity just because you live there. Like, not many people even live there, so.   speaker-1 (08:11) Yeah, it's in and it's there's there's a number of dentists, but it's it's all solo guys and it's tough like restricted covenants. You know you get a two mile radius. That's the whole state.   speaker-0 (08:21) Exactly   exactly that is you definitely have to look at your associate ships of their contracts really closely Otherwise, you might be booting out of that state just because like you said two mile radius is not far in Rhode Island   speaker-1 (08:34) Not at all. So I ended up having an opportunity to a it's like a four operatory practice, like three, I think two and a half, three days a week. The guy was definitely like on the decline of practice. So jumped into that, had no idea what I was doing. And then six months later, was approached by another dentist who was moving from the area. I think it was a family thing too. And he was having trouble getting somebody to buy   his practice Rhode Island. It's not many dentists moved to the state for a number of reasons. So again, I was still trying to figure out how I was paying my initial loan and how I was running this practice or whatever. the opportunity to buy, to merge this, the patient base. So I did that and it was definitely the best thing I did because it brought in a whole new group of patients. I was able to go from like two and a half days a week to four days a week.   I was able to add another hygienist at the time. so it wasn't super intentional, but the growth was happening. just kind of fell in my lap. I'm like, I'll do this. And looking back, it is where I realized what a good thing it was.   speaker-0 (09:48) For sure. And I hope people listening, ⁓ I am a firm believer that opportunity doesn't always knock on the door and say, I'm opportunity. Sometimes it looks like pure chaos. Sometimes it's stretching you beyond. Sometimes it's really just showing up. I remember the day that I was asked to work with DSI as a consultant. Guys, I had one consulting client before Mark asked me to be a consultant. And overnight, I had 45 clients in my lab. I didn't know what the heck I was doing. But I people listening realize like,   For you, you're struggling. just bought your practice. Don't know what you're doing. Yes, you've had quite a bit of experience, but at the same time, running a practice is very different than being an associate or I'm sure even in the Navy. And so now, and then, hey, by the way, there's all this other patient base wanting to come in. And I love that you just, jumped, you took that opportunity. And I think again, so many times in life, opportunities show up. It's just a matter of, we willing to take them and figure it out or are we too scared and just let them pass by? ⁓   You brought those patients in and you were mentioning pre record that adding in patients from other practices has really been a great way for you to get new patients. ⁓ which people are constantly looking for new patients. was just talking to, there's a guy out here. He's a pathiatrist guys. I'm like, I don't know. I just can't help myself, but help business owners. Like I love it. Podiatry is not that much different than dentistry. Y'all see patients like dentistry, we work on the mouth, but I treat work on the foot. Like   Basically, it's kind of like pediatric. You go to your surgery centers, they come in, you see these patients for their adjustments. But I was talking to him and he's a solo podiatrist and there are two podiatry offices around him that have just shut down doors. So he's like, yeah, it's just great. Like people are finding us and I'm like, did you call those people and ask them for their charts, buy those charts? that is two practices worth of patients that you're just hoping maybe one day will Google you when they're seriously sitting right in front of you. So   I'm super curious. I love this topic. know Dave's talked about it as well, but Nate, how do you buy charts successfully? How do you make that transition? Like Dave was talking about buying so many charts, but kind of from your experience, how do you buy these charts? How do you merge these patients in successfully? And other than just good luck and being in the right place at the right time, finding more of these opportunities. I'm super curious.   speaker-1 (12:04) Yeah, yeah. So for this one, know, having no idea what I was doing, I did have some, think, good advice from a transition attorney that I worked with. initially, the guy that was selling his charts, wanted X number of dollars for his, I think he said, 1,000 active records.   speaker-0 (12:26) And what's like X number of dollars like just give me a ballpark you don't have to say the exact amount but I'm like is it five dollars a chart ten dollars a chart thirty dollars a chart like what   speaker-1 (12:35) If I remember, this was probably 10 years ago, so I believe it was 60 a chart is what he wanted. So I think he wanted 60 million, right? And, you know, I, again, not knowing too much, I definitely knew that those 1,000 people were not gonna come over, right? So I was worried about like, what's the risk? Like, are 10 people gonna come or are 800 gonna come? I have no idea.   Yeah. So the attorney I was talking to, he said, he'd never done it this way. said, but maybe what you want to do is offer a little bit more per record, but only for like a small percentage at first. And then keep track of it over time. And that's what I think I did. It was either a hundred or 120 a chart. And I prepaid for like 300. But then for the next year, I kept track of all the, like once I got above that 300, I kept track of it.   So the nice thing is it limited my, it limited my risk. It put more, I guess, importance or motivation on the seller to really like push his patients to come. Cause the more you make more, the more people that came to see me. So it was a win-win that way. And it also, it let me kind of control that the influx too, because I think if all of sudden I was getting, you know, 800 patients calling all at once, it'd be a little bit trickier to merge this all in.   So that worked out really well.   speaker-0 (14:00) And I'm just curious on that, because this is something else I've been really wondering. After talking to Dave, now meeting this podiatrist, guys, I just love this type of stuff. This is cool business stuff that I feel a lot of people don't talk about. I'm curious, how long was the arrangement? Was it for a year that you would pay him? Was it for five years you'd pay the selling doctor? Because I'm curious, how is the motivation? for me as a business owner, I wouldn't want this to go on forever. I'd want an end date of when I don't have to pay you $120 per patient.   So how is that kind of arrangement set up?   speaker-1 (14:32) It actually, was nine months is what we had set. And I think it could work either, but I certainly wouldn't go more than a year, because it is, it becomes a major pain. And then, honestly for me, as I got close to that nine months, we sort of started slowing down. We strategically scheduled those last few patients in the nine months, but I still had all the records.   speaker-0 (14:54) That's what curious. So did you get all the records? So like you paid this, all the charts come to you, and then the other dentist has good faith that you're going to be honest? Or do they get access to it? Was that what it was?   speaker-1 (15:04) He could have like, had it written. If you wanted to send somebody to audit it, like absolutely. He had access to do that. He just never did. and yeah, we had an initial wave of a lot of people and then it slowed down a bit. And you know, it's, um, I think, I think it ended up, maybe we got 450 out of that thousand. Um, and it and it was close and it was close to that nine months. You know, we were getting close to like 400 and again, I just.   We slowed down a little bit, ⁓ just whatever. But as soon as that nine months hit, then we started re-marketing to the people we hadn't seen.   speaker-0 (15:43) 100   % because then it's like you've got basically 400 patients on recall that haven't been in and so did you guys win it happened and of course you might say things you'd do differently or whatnot but did you have that selling doctor send a letter to all of his patients like hey I'm no longer seeing it come see Nate like he's fantastic or did you guys just pick up the phone and start calling these people what was kind of the strategy of the how-to for you?   speaker-1 (16:07) So he, so he wrote, we both wrote a joint letter, which was good. And then I was able, I actually brought on his, he didn't have an office manager, but it was like his lead front desk and scheduler. So we brought her on. She wasn't a, she wasn't a great, perfect culture fit, but she knew the patients. So that worked. I think she was with us for probably about the nine months.   speaker-0 (16:26) Exactly.   Cause in my mind I was thinking like, that's genius. Maybe you can do like a little like sweetheart deal where it's like, Hey, I'm buying your charts and also your scheduler upfront. Can I just have them like help me call these patients? I'll pay them for a couple of months or whatnot. I don't know. Like there's a piece of me that's like, I could see the pros and the cons of that, but you're right. It's me calling that person who's known these patients for years calling to get them scheduled and help out with that. That's probably again, even if it wasn't a great culture fit, it probably did get more patients in your door.   speaker-1 (16:59) For that initial, yeah, absolutely for the initial. Because they already had the patients pre-scheduled, so they were able, and they know them, it was really helpful having that familiar voice.   speaker-0 (17:09) Totally. Yeah. Clever. Okay. So you went higher than what they're doing, ⁓ which I tell everybody, I'm like these people who are shutting their doors, pretty much any offer you give them is, mean, don't be like a low ball and completely have it feel ridiculous, but they, have no option to sell. There are no options for them to sell. They're not going to make any money. Like that's gotta be a hard reality for that selling doctor to realize like, Hey, I built this business up, but it's not even a sellable product.   So I have no asset anymore. So I'm like, honestly, any money that they can get for these charts, I do think is a good deal and something great for the selling doctor as well. So I don't think it's a ⁓ vicious, like you're taking advantage. I just think again, opportunity shows up in different ways. And I think for the selling doctor, it also was an opportunity that they got probably way more than they were expecting to get when they closed the doors of their practice.   speaker-1 (18:02) Yeah. Cause honestly, it hadn't been for new, he'd been trying actively to sell it somewhere. And I was like, I think I was like the last person, you know, had I not been able to step up and, and, work something out, it would have just been all those patients out into the ether. And, know, probably who knows how many of those, you know, 450 would have shown up with us anyway. But it's, it's, know, again, being younger, not knowing what I was doing, like it was intimidating for me. But as I look back, like he'd never done that either.   speaker-0 (18:22) Yeah   speaker-1 (18:30) You know, so was all, it was new for both of   speaker-0 (18:33) Well, and also thinking about, I'm sure some listeners might think like, Nate, that's a bad deal, though, spending $120 per patient chart. And if you are a wise business owner and you know the cost of acquisition of a new patient, yes, I would say that that probably is on the higher end of a patient. However, I think the perk of this is these are most likely patients who have been active patients in a dental practice that are going to be good patients that are coming. And odds are they also might be, I call them sleeping.   patients in the fact that this dentist was on the retiring side, odds are that dentist was just slowing down with dentistry. Every dentist will have this happen to where odds are these patients actually have a lot more treatment available since their selling doctor was slowing down in their career. while it might be more expensive, you're probably also paying for it with the dentistry available with an older doctor selling. So got it. Okay.   speaker-1 (19:22) Yeah. Yeah.   And then yeah, like, and then fast forward, you know, another five years or so from then, it's not five, about five years ago. I had a dentist moonlighting with me who was in the Navy. It was getting out, wanted to stay in the area. Awesome, awesome dentist, really good friend of mine now. And he wanted to stay, but again, at that point I wasn't busy enough to really support another.   an associate and I'd never really never had an associate either. And again, opportunity I had, was having, it was like a county dental society meeting. I was talking to a friend of mine as well, who was a little bit older dentist and she was like, I'm thinking about slowing down. maybe this guy could work for you for a couple of days a week and me a couple of days a week. And kind of light bulb went off my head. I was like, or I could buy your practice if you're open to it. And then you can slow down whatever you want. ⁓   be an associate with me and he could work at the two. I kind of saw the writing, like the potential if he did that, what happens if now he wants to buy that practice and then it's, you know, so that actually.   speaker-0 (20:29) You would be training up your competition. So good job on seeing that and not letting that happen.   speaker-1 (20:35) Yeah. And, uh, and it worked and that worked out great around the, again, just weird timing around the same as I was closing on that deal. One town over those, dentist who unfortunately had a terminal, uh, terminal cancer and was looking for somebody to help take over his practice. So I was able to take over his patient base, which another bonus of being able to help, you know, get this new associate, you know, even busier.   speaker-0 (21:01) So really your practice is a makeup of four practices. Did I count my?   speaker-1 (21:06) And then I had one more a little bit later. There's like five, five, nine into two locations now. So yeah. Yeah. And with that one, was the, um, I was able to bring one of the hygienists on board. Um, which again, that familiar, familiar face, familiar voice, um, was a big, was big and she's still with us and she's awesome. So, um, so that's been, that's been really good.   speaker-0 (21:07) Okay, so   Clever. love it.   awesome.   Have you guys heard? But like really have you heard? And are you the type of person that loves to take massive action? Well, if you are, I would love to invite you to Dental A Team's Virtual Summit, April 22nd through 23rd. And yes, right now guys, it's early bird. That means it's $200 off the normal ticket price. You guys are going to learn how to optimize your practice this year. We know it's been a rough year. People have quit. We've had COVID, we've had changes. So we want to teach you guys how to optimize within your practice now and execute.   Friday is full team, Saturday is all things leadership. So bring your team, get some CE, take massive action, head on over to TheDentalATeam.com. Coupon code is summit early bird, and it's valid until March 31st. That's summit early bird, all one word, and it's valid until March 31st. So guys, head on over. I can't wait to have you take massive action, optimize your practice, and execute. Let's make 2022 your best year. I love it.   I love how much you have, ⁓ I think if anything I'm taking is don't be afraid to take those risks, don't be afraid to look at opportunities and also I think you just kind of have also positioned yourself to be well known within your community and I feel like so many dentists, like yes even within big cities like New York, Denver, guess what? People are always retiring. I just had a student from Midwestern reach out to me and was mentioning how like.   Hey, care, do you know of anybody to buy a practice? And I'm like, what is going on? I don't know all the details, but I'm like, this is somebody who's been graduating for maybe a couple of years looking to sell a practice. so I think it's just important to get to know the doctors around you to build those friendships. Because when I think it's often like you're putting yourself in a position to be ready for that opportunity, it's kind of like right now they say have a lot of cash on hand. We know something's going to be shifting in the economy.   So just be ready for when opportunities there. And I think getting to know your neighbors, getting to know those dentists, hey, great, you also as a dentist might need them as a resource in the future as well. So I think it can go both ways, but I love that you've done that. So now I'm curious, Nate, because I selfishly want to talk to you about this. You've got these two practices, you've got these dentists.   Who knows, you're gonna like probably add on like four more practices of charts in the next five years. I mean, based on your record, like let's just start piling them all on. You'll be the only dentist in Rhode Island. You're just gonna last. But I know culture is something you and I off air. Nate is one of my favorite clients. I don't even come to your practice, Nate, and you and I will just chat business, talk shop. You are somebody that I will say publicly is someone who's just been.   a really great influence in my life. Periodically, you will just send me a random text of like, just tell me that we're doing a good thing. And I will say, and you know, as an owner, those kudos and those like good vibes, they don't happen as often because you're the one who's giving all that out to your team and to your clients and to your patients. And so Nate, I will say publicly, like how much you've just been an influence in my life as well. Something I just have appreciated with you as a client, as a friend, as a mentor. So I'm excited to chat. You've got all these things going.   I know culture has been a piece that you and I both have been talking about of developing this culture. So kind of what spurred you into realizing you wanted to shift your culture of your practice. And then let's talk about the nitty gritty, but like how did you as a business owner know you needed to do a shift within your culture? Because I think that that's humility. And I'm just curious, like what tipped you off? How are you able as a dentist to own that, that you wanted to shift that?   speaker-1 (25:03) Yeah, I mean, I think for me it was noticing, you know, sort of the patterns over the years of the just the ups and downs of culture, you know, and it's, you know, whether you call it the vibe or how everybody's getting along. ⁓ And there, I mean, it's over the years, like we've had some pretty painful, painful times and times where it's like, nobody likes being here. That's way better, you know, in the last few years and it had been in the past, but.   It's, I was realizing I didn't really know how to, I didn't realize I had, that I could have influence on, on how to change that. It's, you know, some of it, I'm not a confrontational person. I'm pretty laid back and I want every, you know, I want to be the one that's liked. I want to be everybody's friend. And it's hard. It's, mean, whatever 13 years into practice ownership. And I still, you know, struggle with that.   kind of not being able to be everybody's best friend. Like I actually own the boss and like I have to own that. So it's, know, again, I finally got like just really got so exhausting of the ups and downs of like, is this going to be a good month or is this going to be a good week or who's going to be upset and all that. that it's like, you know, it's not just on me, but it's like, creating that environment that people, you know, that people want to be here. You know, people are happy people.   playing well together and trying to manage all that. it's, you know, it's certainly I haven't figured it out completely, but it's, you know, just trying to work on little things.   speaker-0 (26:41) Yeah, well and I love that you said that because incidentally I'm like, ⁓ Nate, why didn't I even think about this? I know why you and I are good friends. We're eyes on the disc profile. We both love to be liked. We're both very outgoing. We're like, you know life at the party have a good time. We're also okay to like let other people be the life of the party, but just really that and I do think a lot of dentists have that personality. ⁓ I was thinking about dentists last night actually while I was falling asleep and I'm like gosh you guys have to charm and dazzle and wow all day long.   Like you walk in and you have to make friends quickly and it's in an uncomfortable like, hey, let me like get real up and close and personal, like look in your mouth. And I got to like win you over and make you like me. I want to say yes to treat Mike. That's a lot of output of energy all day long for you guys. And so for you to realize that you also have to be a boss, I think one takes humility and two, also is ownership. And I would agree. I think it's like you get to a spot where I'm like, all right, being friends is fun.   But we got to have this like even kill because this up and down is just causing me to feel like I'm in whiplash all day long. So what were some of the things that you started to shift again? You and I chatted in December and I know we both like I've taken this from our conversation of culture is a slow burn. It is not something that happens overnight. It is not something that is instantaneous and I am an instantaneous person. Like I will figure it out. I will come up with it like we will find the solution and culture is like, all right.   Cool, I'm here for the journey. So what were some of the things you started to shift that you've been able to see? know Tiffanie's been helping you guys in your practice quite a bit as well, but I think ultimately at the end of the day, consultants can only help as far as the leaders are willing to go. And so for you to be willing to shift and change is why your team's been shifting and changing too. So what were some of those specifics?   speaker-1 (28:26) One of the, I would say the hardest thing for me and I still like, it still gives me anxiety and trouble is having difficult conversations. And while, you know, it's   you wouldn't think it would necessarily play toward helping with culture, having difficult conversations. I think it really does because I think it resets some of that, ⁓ like where the expectations are, what kind of the clarity on what needs to be done. But I think that's part of, on my ups and downs, I, again, wanting to be agreeable and being pretty laid back, if there was some...   trouble happening or there's some conflict between the team. Like a lot of my default for years was, it'll just blow over. Like, let's it work itself out. And it would work itself out by exploding after a drink or two. And then everybody would hug it out after a drink or two, and then we're fine for a while. But like, was no way to operate, right? So for me, getting over my fear and my anxiety of having those hard conversations, you know, and that's actually, that's one of the things that Tiffanie has been super helpful.   with on helping me through some of those. And I think one of the biggest skills that I've gotten with working with the Dental A Team is that, to have those conversations. They're not fun. People don't like them. I don't like them. But I think it makes a big difference and means a lot once people, like once you get through that.   speaker-0 (30:02) For sure. And you're lucky to have Tiff. think Tiff is one of the best at it. Tiffanie is very masterful on being able to, I say word ninja it. She's also just very direct, which is odd because she's so lovable and so nice. But something her and I have chatted a lot. And to your exact point, when team members have those uncomfortable conversations and they know their employer is willing to do it, everybody actually feels safe.   and that safety can create stability, which also creates like easiness. So my husband and I felt like I used to be a people pleaser with him. And just this week, he and I had a really big decision, a really awesome opportunity, and we ended up turning it down. And I was so frustrated. Like, I'm such a like driver and doer and like, this is an opportunity. We've been working for five years for this and we're just gonna like walk away from it. And I was not my most polished Kiera. ⁓   Thankfully, I would never do this with my team, but my husband, was just like full on expressive on like, and not anger at him, just the frustration of the situation. Like we've worked for this for five years and we're still not going to go through with it. And he made a comment to me, said, Kiera, I love that we've worked on our relationship so much to where you can feel comfortable and confident to have this conversation, to express your true feelings and we can work through it and find a solution. And I use that example because I feel like it's very similar with teams with   bosses that are willing to have these uncomfortable conversations because there's a there's a trust and a confidence that I can come to you. I know we can go toe to toe. I know we can work through this even though it's not fun in the moment per se. There's so much beauty and ease and flow that happens because we're not just always like holding it inside trying to like charm everybody else around us.   speaker-1 (31:47) Yeah. And what I have sort of seen ⁓ as I'm doing that more often and as I'm getting more comfortable with it, I'm seeing my team do the same thing with each other, in a, you know, in a respectful way. And they're confronting things before they become like these underlying deep seated issues. So yeah. So that's been good. ⁓ Working on gratitude is another, is another big one. Yeah. It's funny. It's, it's, ⁓   That's been, that's taken me a little bit to get used to and kind of coming up with a pattern of how to do it because it doesn't necessarily come naturally to me. You know, I think it all the time in my head, you know, how appreciative I am, but it's expressing it is what's hard and finding the way that resonates because everybody's different. What, you know, what lights everybody up is different. So it's trying to, I'm still trying to figure that out for everybody individually.   speaker-0 (32:42) But I think it's awesome that you're taking that on and like you said and I will say kudos to male doctors that are willing to share their appreciation because I'm not a male, but I have heard from several male colleagues that it's very uncomfortable. They're like, I'm just not somebody like you said, I think it, but I don't necessarily say it I don't know how to say it and sometimes it's an awkward thing. But I will say as a team member, I worked only with male doctors, except for one time I had a female doctor. But most of the time males were the doctors I would work with.   And as a team member, especially a female team member, it meant the world to me when they would share that appreciation. it just would, most women are very much ⁓ people who love those words of affirmation that are genuine and sincere. And so I think that that's a great thing that you've taken on. And I know that that's shifting because you shifting that way is shifting your entire team as well. Very cool. Okay. I just want like a quick highlight list as we wrap up, Nate, I appreciate you so much. What are some of the things working with Tiffanie that you've   that you guys have implemented in your practice or some things that you've seen, like we've talked about chart mergers, which gosh, it's just so fun. And we talked about culture shifts, but what are some of the things over the last year? I think you guys are just wrapping up your heading into year two. What are some of the things you guys have implemented with her this last year that were really just impactful for you?   speaker-1 (33:59) Yeah, it's, it's, it's, it's a, we've done a bunch of like small things, you know, and, and, that's what I think has been great is like they, they're easy concepts, but communicating ⁓ better handoffs from front to back and committing to that. ⁓ It's, one of the first things that she introduced with us. And, you know, it seemed like such a simple thing, but it's made a huge difference in. ⁓   and just having consistency of communication and then also it helps the teamwork. ⁓ That's been really good. She's helped a lot with trying to ⁓ have us have a better of sense and strategy around our revenue cycle. Just little things that we didn't necessarily know that we weren't doing, you know, as efficiently as we could. But what I love the most is the process and the accountability part that's put in. ⁓   there, you know, I, in previous years, you know, I've worked with other coaches and consultants and things. Um, and it's always been like a kind of a cookie cutter type thing. And it's, you know, it has been helpful, but what I really love about Dental A Team is how. Yeah. She's able to look and see exactly what it is that we do and how we do it and tailor those systems to us. Um, uh, but also that holding us like holding us accountable to do it. Like we had a, we had a call.   this week, I think it was. we've been looking at outsourcing things for, and I think we've probably been talking about it for a month, two months or so. And it was kind of funny because she has, she's like the sweetest person in world, but she was like, all right guys, I'm tired of talking about this. You're going to buy the end of it. And we're going to, we're going to make a decision on this in my head. This is on Tuesday. I was like, all right, by the end of Thursday, we'll have this done. She's like today, like today that you've done this and tell me who you're going with. And I was like, all right.   But sometimes that's what we need, know, cause we were stuck in this little cycle. So she, you she's good with that. And then sort of same thing with, you know, those are one of the difficult kinds of conversations I needed to have, but was Tuesday was funny. She was, she like really lit a fire under us. Cause like three or four things are like, you're getting this stuff done today and it's happening. that's the push we need, but there's other, know, there's, it's not always that intense. You know, there's also, ⁓ you know, if we need a little help with, you know, with things and,   It's process. She's there each step of the way.   speaker-0 (36:25) awesome. I love it. Well, I think that other no, go ahead.   speaker-1 (36:28) Sorry, it's   been really, it's been really good that I haven't seen with anybody else I've worked with before is she's totally accessible to my team. And I have a couple of the people on my team who are like very growth mindset, growth oriented with us. And, know, they, I think they talked to her more than I realized. And it's, it's one of like, felt initially like when she, you know, gave everybody her contact information, she like, I don't know, I hope that doesn't get abused. And she's like, I love it. That's what I'm here for.   and not knowing the specifics of what she's helping some people with. Like I've had a couple of people on my team, they're like, is so great to be able to reach out to Tiffanie and get this advice on this. And she's helping them just as much as she's helping me. That's awesome.   speaker-0 (37:09) That's huge and I appreciate that Nate because one it's fun to hear how our consultants are doing and I love like a few pieces you said which makes me happy because like as an owner and I'm sure as dentists we have this great vision of what we want our company to be what we want our practice to be and then to hear a patient experience to hear a client experience I'm like we will never be cookie cutter I refuse like forever because no practice is cookie cutter so to hear that it's systems that are customized to you guys where it's what's gonna work with you and also like you said   that accountability. Tiff and I, will say kudos to Tiff because at first, you know, we were like, how do you consult offices? And most of time we'll just kind of go through with you holding you accountable. But there are times when we will need to like laser in, lay it down and be like, guys, here's the reality. Just like a coach at the gym. I'm like, I don't want you like high five. I mean, that was a great workout when my squats look terrible. Like tell me to get my booty down, get my back out. Like   make sure I'm actually doing the work if I'm going to put in the work. And so I love that she did that. And like you said, that is something that we are so pro having those team members elevate rising them around you. That's something like we have kind of, I have a three prong approach and it's making sure you are profitable as a business. Cause if we're not profitable, fantastic. And to hear that TIF is helping you guys with that revenue cycle, making sure that's there at the handoffs, but then also growing people themselves.   You with those hard conversations, you making sure, I mean, we were just talking, you're having time off and your whole team is like killing it and you're not even there, which is awesome. ⁓ Also elevating team members. So it's not just the dentists themselves, but the team and then putting in those systems and team development top to bottom. So to hear it from a client experience, and we didn't even rehearse this prior to it, but to really hear the, and I didn't even prep you Nate. I didn't tell you to like, Hey, think of the last year and the highlights before we get on it. And I purposely did that because I wanted to hear.   what really stood out to you over this last year? What were the things that, because sure, you could go back and reread the emails and prep for it, but I'm like, that doesn't actually matter. What matters is what sticks in the moment. And so I just appreciate that. I love you as a client. know Tiff loves you as a client. You're just a, you're a great example of execution, of humility, of seeing opportunities and executing on them. And I hope people realize that success in my opinion doesn't just happen by chance. It is methodical. is...   Executed on sometimes you get sprinkled with that good luck charm But I also think that good luck charm is only good luck if you actually execute on it So Nate, you're just a dream. I love it. I love what you've done. I appreciate you being on the podcast you're just such a happy human and You're you're a great person who's doing great things in this world and your team's super lucky to get to work with you and learn from you as well   speaker-1 (39:48) Oh, thank you so much. And I feel so, you know, so lucky to have come to come across the Dental A Team, you know, three years ago and, and, and gotten to know you, gotten to know your team and all of you thought, you know, to me, my team and my life, it's awesome.   speaker-0 (40:00) Totally.   Well, it's, you know, we said yes, because you're in Rhode Island first. That was the first like initial yes. then you know, so but no, I appreciate it, Nate. So guys, if you if you have questions on mergers, or how to buy these charts, like please reach out, we'll connect you in with Nate. And if his story and the successes he's had resonate with you, email us, we'd love to chat with you. Hello@TheDentalATeam.com. And Nate, thanks for being here today. Thanks for just being a good human in this world that we need more people like you. So thanks for being here today.   Thank you. Awesome, guys. All right. As always, thank you all for listening, and I'll catch you next time on the Dental A Team Podcast.   wraps it up for another episode of the Dental A Team Podcast. Thank you so much for listening and we'll talk to you next time.  

What To Do With a Frustrating Employee In Your Clinic In this episode, Doc Danny breaks down one of the hardest parts of owning a clinic: dealing with a talented but frustrating employee. You know the type. Great with patients, solid outcomes, but sloppy with systems, notes, and follow through. Danny walks through the three real options you have, why "letting it slide" destroys culture, and how to use a performance improvement plan to either turn things around or coach someone out. In This Episode, You'll Learn: The classic pattern of the friendly, high-output clinician who struggles with systems Why tolerating mediocrity from one person lowers the standard for your entire team The three options you have with a frustrating employee (and the one most owners avoid) How to build and run a simple, effective performance improvement plan (PIP) Why leadership and standards matter more than any one hire How "coaching people out" protects your culture and your A-players Questions to ask yourself about your onboarding, training, and systems Claire: Get Your Attention Back on Patients Danny opens with a reminder of how fast documentation can pull your attention away from patients. As PTs, we pride ourselves on building rapport and relationships, but it is hard to do that when you spend half the session staring at a laptop. Claire, the AI scribe built specifically for physical therapists, lets you give patients 100% of your attention while it writes your notes for you. No more "split attention" between EMR and patient Better engagement and outcomes because you are actually present Notes drafted for you based on the session so you can review and finalize Try Claire free for 7 days: https://meetclaire.ai The Talented but Frustrating Employee Danny describes a very familiar pattern in service businesses. You hire someone you like. They are a good culture fit. Patients love them. Outcomes are strong. But behind the scenes, they: Drag their feet on notes and documentation Ignore or half-follow systems and processes Show up a little late, miss small details, or respond slowly to emails and Slack They are not a disaster. They are not a clear liability. But they are not meeting the standard either. That gray area is exactly where most owners get stuck. First, Own Your Part as the Owner Before you blame the employee, Danny challenges you to look in the mirror. Have you: Actually trained them on your EMR, project management tools, and communication systems? Explained why those systems matter (data, tracking, meetings, outcomes, marketing)? Given them clear expectations, examples of "done right," and time to practice? Most owners are busy and rush onboarding. They throw people into the deep end with a few screen-share videos and hope they figure it out. Then they get mad when the systems are not followed. Your Three Options With a Frustrating Employee Once you are honest about your own role, you really have three options: Let it go. Accept that this person is just this way. They are good with patients, weak with systems, and you live with it. Let them go. Fire them for not following processes and creating extra work for others. Create a performance improvement plan. Sit down, define what needs to change, and track progress over a set period. Danny explains why the first option is the most dangerous. When you tolerate one person ignoring standards, everyone else sees it. Your A-players start to wonder why they are working so hard. Support staff quietly resent the extra work. The real standard becomes "we say we care about systems, but we do not enforce them." How to Build a Performance Improvement Plan The go-to approach in Danny's companies is a structured performance improvement plan (PIP). It usually looks like this: Define the specific problems (late notes, missing CRM updates, slow responses, etc.). Clarify why each behavior matters to the business and the team. Decide what is truly necessary for the role and remove anything redundant. Set clear, measurable expectations for the next 4–6 weeks. Meet weekly to review progress, answer questions, and coach them on better workflows. Make it clear this is a non-negotiable standard if they want to keep the role. This is not about punishment. It is about support, clarity, and accountability. The PIP gives the employee a real chance to succeed with your help. What Usually Happens Next Once you run a real PIP, you tend to see one of two outcomes: They turn the corner. With training and clear expectations, they improve their systems work, become more efficient, and turn into a strong long-term hire. They opt out. They resist change, make excuses, and realize this is not a place where they can do whatever they want. They often resign on their own. Either way, you win. You either save a good clinician by giving them structure or you protect your culture by making it clear that standards are real. Leadership, Standards, and A-Players Danny points out that your best people are always watching how you handle situations like this. A-players want: Clear standards and consistency Leaders who follow through, not just talk about culture Teammates who pull their own weight When you avoid hard conversations and let someone slide, your A-players lose respect and start looking elsewhere. When you hold the line, they respect you more and see your clinic as a place worth investing their energy. The Hard Work of Real Leadership Leading people is often the limiting factor in whether a clinic ever scales. It is not manual skills. It is not marketing hacks. It is your willingness to: Have tough, honest conversations Take responsibility for training and support Set standards and enforce them consistently Spend time coaching people, even when you feel "time poor" That work is uncomfortable, but it is the difference between a team that drifts into mediocrity and one that grows with you for years. Want Help Navigating This as a Clinic Owner? If you are facing a frustrating employee, wondering how to hold standards, or trying to grow from being the only producer to running a real team, Danny and the PT Biz advisors can help you work through it. Talk through your situation with an advisor: https://vip.physicaltherapybiz.com/discovery-call Try Claire free to buy back documentation time: https://meetclaire.ai Still part time and trying to go full time in your own practice? Join the free 5-Day Part Time to Full Time Challenge here: https://physicaltherapybiz.com/challenge

Episode Description In Part 2 of this two-part conversation, we move from theory into the real-world details that quietly put dentists at risk every single day. My guest, Evan Sampson, is a healthcare attorney who has served as general counsel to one of the largest dental support organizations in the country. He brings a rare and invaluable perspective at the intersection of dentistry, law, payer audits, and regulatory enforcement — and in this episode, we get very specific. We unpack what actually makes certain procedures, CDT codes, and clinical scenarios high-risk from a fraud, waste, and abuse standpoint, even when there is no malicious intent. Evan explains how dentists inadvertently get flagged as outliers, why payer audits are often data-driven rather than complaint-driven, and how documentation gaps — not clinical skill — are what ultimately create exposure. This conversation goes deep into: Why up-coding, unbundling, and weak surgical extraction documentation are some of the most common (and expensive) pitfalls How payer audits are triggered, what auditors look for, and why Medicaid claims carry disproportionate risk Why dentists should write progress notes as if a regulator, payer, or board investigator will read them later — because one day, they might The legal realities of fee-for-service, out-of-network billing, professional courtesy, discounts, and when "good intentions" can still create compliance problems We also spend significant time on a topic every dentist encounters but few are trained to manage: difficult and high-risk patients. Evan shares how to identify red flags that may not be obvious at first, when it is appropriate to terminate the doctor-patient relationship, and how to do so without exposing yourself to allegations of abandonment. We discuss unruly patients, non-payment, mid-treatment dismissals, refunds, releases, and why protecting your license sometimes means making uncomfortable — but strategic — decisions. This episode is ultimately about risk reduction, professionalism, and self-preservation. Not practicing defensively, but practicing deliberately. Tightening the details. Building a culture of compliance. And understanding that most dentists who get into serious trouble never thought they were doing anything wrong. If you care about protecting your license, your livelihood, and your future — this is an episode you don't want to skip.

[ICYMI, here's a rerun of a show released earlier this year. We'll be back with new shows starting next week!] How the system pays doctors can change healthcare outcomes—sometimes in scary ways. The way docs are paid can make patients sicker…or can lead to healthier ones. The payment schemes most docs work under incentivize them to fix patients, while others motivate them to prevent illness—and geriatrician Dr. Jonathan “Nathan” Flacker is here to explain why. This episode rips the curtain off RVUs, fee-for-service traps, and the real reason your doc is rushing through your visit (hint: it's not personal, it's math). We dig into ChenMed's wild idea: what if clinics got paid to keep you out of the hospital? Turns out, when money flows toward health instead of procedures, everyone wins. Except maybe the $400M proton beam facility (for the record, we love proton beams, but you might not need them if you can avoid cancer altogether). Is concierge-style medicine only for the wealthy? What happens when you build “rich person care” for low-income seniors? And how many patients can a doc see well before it all breaks? If you’re dreaming of a career where you actually help people instead of just clicking boxes—this one’s a wake-up call. Also: Love calls, RVU debt, and why pajama time should be illegal. Episode credits: Producer: Jeff Goddard Co-hosts: Riley Behan-Bush, Zach Grissom, Alex Nigg Guest: Dr. Jonathan “Nathan” Flacker, ChenMed We Want to Hear From You: YOUR VOICE MATTERS! We welcome your feedback, listener questions, and shower thoughts. Do you agree or disagree with something we said today? Did you hear something really helpful? Can we answer a question for you? Are we delivering a podcast you want to keep listening to? Let us know at https://theshortcoat.com/tellus and we'll put your message in a future episode. Or email theshortcoats@gmail.com. We need to know more about you! https://surveys.blubrry.com/theshortcoat (email a screenshot of the confirmation screen to theshortcoats@gmail.com with your mailing address and Dave will mail you a thank you package!) The Short Coat Podcast is FeedSpot’s Top Iowa Student Podcast, and its Top Iowa Medical Podcast! Thanks for listening! We do more things on… Instagram: https://www.instagram.com/theshortcoat YouTube: https://www.youtube.com/theshortcoat You deserve to be happy and healthy. If you’re struggling with racism, harassment, hate, your mental health, or some other crisis, visit http://theshortcoat.com/help, and send additions to the resources there to theshortcoats@gmail.com. We love you. Music provided by Argofox. License: bit.ly/CCAttributionDOCTOR VOX – Heatstroke: youtu.be/j1n1zlxzyRE Catmosphere – Candy-Coloured Sky: youtu.be/AZjYZ8Kjgs8Hexalyte – Wandering Hours: youtu.be/FOAo2zsYnvA

In this segment, we hear the stories of two contemporary hospital social workers who describe encounters with patients looking for a way to explore important life questions that can arise in times of challenge. To see additional resources and our other programs, please visit humanmedia.org . Humankind specials are  heard on NPR and PRX member-stations, in association with GBH Boston.

Send me a question or story!Recurrent infections can be so difficult in our allergic patients. Learn how to minimize severity of frequency of pyoderma on this week's episode of The Derm Vet podcast!1. Work up the underlying allergies2. Support the skin barrier3. Adjust topical therapy accordingly4. Recognize historical patterns5. Refer to a dermatologist early in the disease00:00 – Intro02:24 – Working up the underlying allergies04:53 – Support the skin barrier07:36 – Adjust your topical therapy accordingly10:27 – Recognize historical patterns13:02 – Referring these patients early13:56 – Overview14:32 – Outro

On this episode of DGTL Voices, Dr. Junaid Kalia shares his journey to becoming a neurologist and entrepreneur in the field of AI in healthcare. He discusses his pivotal moments that shaped his identity as a healer, scientist, and entrepreneur, and the creation of SaveLife.AI, a platform aimed at improving healthcare access in low-income countries. Dr. Kalia emphasizes the importance of patience, resilience, and continuous learning in both personal and professional growth.

This week, we explore new options in cardiovascular prevention, fish-oil supplementation in dialysis patients, RSV vaccination, and cutting-edge cellular therapy for leukemia. We discuss advances in lung cancer treatment, approaches to functional dyspepsia, and a complex case of severe infection after travel. Perspectives examine access to and cost of weight-loss drugs, the promise and risks of AI in clinical care, and what it means to care for others while carrying personal loss.

This week the gang talked about Dewey's gallstones, Smiling Friends, Stranger Things Season 5, Station 11, Pragmata “Sketchbook” Demo, Marty Supreme and more!Follow us on Instagram Leave us a voicemail at (804) 286-0626 and consider supporting us through our Patreon Check out the Discord! Theme song remixed by Poisonfrog News Links: Dragon Quest VII Reimagined Demo PS5 bootROMs leak Sony patents AI that will play your game Megaman golf game canceled 

John A. Richardson, Jr. (Richardson Nutritional Center) joins Integrative Cancer Solutions with Dr. Karlfeldt in an episode featured on the Cancer Breakthroughs 3.0 Summit 2025, sharing the personal legacy behind his mission to educate the public about Vitamin B17—also known as amygdalin/laetrile—found in apricot seeds. As the son of Dr. John A. Richardson, MD, who faced intense backlash for using nutritional and alternative approaches, John offers a rare inside look at why this conversation remains so relevant for patients seeking integrative options.In this discussion, John and Dr. Karlfeldt break down the proposed mechanism behind Vitamin B17, why supporters believe it may target cancer cells differently than healthy cells, and how integrative strategies often include diet changes and supportive therapies. John also shares a recent, high-pressure hospital experience where he was urged toward major colon surgery and aggressive follow-up treatment—only to recover after stepping away and focusing on a natural, inflammation-reduction approach. Along the way, they explore how fear-based timelines can drive medical decisions, why taking time to educate yourself matters, and what patient empowerment can look like in real life.If you're navigating a diagnosis, supporting a loved one, or focused on prevention, this summit-featured conversation challenges the “only one path” mindset—and encourages thoughtful, informed choices rooted in clarity rather than panic.Key Topics CoveredJohn Richardson's family history with Vitamin B17 (amygdalin/laetrile) and apricot seedsDr. John A. Richardson's clinic, public advocacy, and the persecution he facedWhy integrative cancer patients often feel pressured into rapid chemo/radiation/surgery decisionsThe proposed mechanism of B17: amygdalin, enzymes, and the “selective activation” claimPrevention vs. treatment: using nutritional strategies before disease progressesThe role of enzymes and diet changes in integrative protocols (including reducing certain burdens on digestion)John's recent hospital experience: being told he needed colon surgery and chemo/radiation, then recovering without itConcerns raised about colonoscopy economics, false positives, and procedure risks (as discussed in the episode)Using supportive therapies mentioned in the conversation: ozone, infrared approaches, IV injections, methylene blue (as referenced)Patient empowerment: slowing down, seeking counsel, and making informed choices under pressure -----------------------------------------------A Better Way to Treat Cancer: A Comprehensive Guide to Understanding, Preventing and Most Effectively Treating Our Biggest Health ThreatGrab my book here: https://www.amazon.com/dp/B0CM1KKD9X?ref_=pe_3052080_397514860 Unleashing 10X Power: A Revolutionary Approach to Conquering CancerGet it here: https://store.thekarlfeldtcenter.com/products/unleashing-10x-powerPrice: $24.99100% Off Discount Code: CANCERPODCAST1 Healing Within: Unraveling the Emotional Roots of CancerGet it here: https://store.thekarlfeldtcenter.com/products/healing-withinPrice: $24.99100% Off Discount Code: CANCERPODCAST2-----------------------------------------------Integrative Cancer Solutions was created to instill hope and empowerment. Other people have been where you are right now and have already done the research for you. Listen to their stories and journeys and apply what they learned to achieve similar outcomes as they have, cancer remission and an even more fullness of life than before the diagnosis. Guests will discuss what therapies, supplements, and practitioners they relied on to beat cancer. Once diagnosed, time is of the essence. This podcast will dramatically reduce your learning curve as you search for your own solution to cancer. To learn more about the cutting-edge integrative cancer therapies Dr. Karlfeldt offer at his center, please visit www.TheKarlfeldtCenter.com

If you want high-dollar procedures done more often in your practice, this is the episode for you. Kiera specifies what needs to be in place, including skillset, morale, and language. This kind of case acceptance goes beyond the everyday appointments, and Kiera explains the difference. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: Kiera Dent (00:00) Hello, Dental A Team listeners, this is Kiera. And today I feel like this is my bread and butter. I feel like this is what Kiera Dent was made to do. And I cannot wait to teach you guys the secret to getting patients to say yes to those high dollar, high ticket cases. We're talking the 20, the 30, the $40,000 cases. But the great news is these principles can be applied to your smaller cases too, because I just think that like how to do this and this is what Kiera's really good at. And I have a practice that ⁓ implementing incorporating these tactics.   has been able to grow every one of their locations, multi-millions every single year. And people look at these practices, they see their stats and they say, how did you get these numbers? And they said, it all started the day we brought Dental A Team into our company. And that's just a huge testament to me, to the work that we do, to what our consultants do. And for anything, it comes from a passion of being able to help more patients get the dentistry that they need and deserve. So I just feel like there's so much fun to case acceptance and ⁓   It's not about selling, it's about words are free. And so let's use our words to the best of our ability. Let's use our words to the best experience for our patient. And let's help all of them have the trust, the clarity and the confidence to be able to say yes to those. You guys, Dental A Team is obsessed with helping you and your teams have more profitable practices, happier practices, happier teams, happier patients. We are obsessed with that. And our mission is to positively impact the world of dentistry in the greatest way possible.   and doing it in a tactical, practical, let's do this. So I really want you guys to hopefully take this on, take the system, take the tactics and help more patients say yes. And to just be proud of the dentistry you're able to do. Now, step one is you've got to be really, really good at dentistry. I can sell any dentistry. Like I feel like I'm a miracle girl for practices. I feel like there's easy ways to do this. But step one is we've got to have great dentistry. Otherwise our treatment coordinators and   our team and our patients that makes it very, very hard actually for us to want to sell dentistry. So step one of this is going to be you've got to actually do great dentistry. Okay, that's step one. So if you're not good at something, please don't sell it, go get good at it. But also please don't make it worse than it is. You might actually be a great clinician, but you don't give yourself the credit for that. So I'm on a mission to help the best dentists thrive, the best dentists do great dentistry and to help more patients.   So that's step one is I got to make sure that you guys are doing really, really, really good. Step two is getting patients to say yes, especially for these higher dollar ticket ⁓ items. We've got to make sure that we've got dialed in systems. ⁓ I use the example from Disneyland that people can feel perfection. And so does our team feel well oiled? And this means that our hygiene team is teeing up treatment. We're all looking for it. If our associate doctors are not doing this treatment and they're referring to our general doc, our, our owner doctor,   We've got to make sure all the associates and the hygiene team are trained on what to look for, how to present this, how to tee it up. Do we bring them back for consult? Can we diagnose it? What's the process for that? And if you want these high dollar procedures to be done more often in your practice, training your hygienist and your associates is one of the best investments of your time. So everybody's looking for it. We basically become a referring practice to our doctors that do these procedures. ⁓ I really do believe that   everybody. So hygienist looking for it. Hygienist should be the first person and this goes for all treatment planning, but we're going to dive it into these higher dollar ones because there is a little bit different on how we actually present the treatment plan. But all these first steps should be all parts of high case acceptance. Now just also give a little credibility. ⁓ Implementing these processes usually take for just general dentistry, it usually gets you up to a 75-ish percent acceptance rate up to 90.   Now, if we're higher than that, I know we might not be diagnosing as much as we need to, but in general dentistry, we should be cracking pretty high case acceptance. Now for my like 20, 30, 40, $50,000 cases, right around a 35 to a 45 % acceptance rate is going to be the targets we're looking for. And that is dollar for dollar, not one for one acceptance rate. So if that helps you guys, that's what we're going for. ⁓ But step one is do great dentistry.   Step two is believe in the dentistry. And then step three is going to be where everybody is speaking the same language. hygienists should be the first person to tee up all dentistry. They should be the one showing the x-rays, showing the intraoral photos, showing all of that so the patient can absolutely 100 % see what we see. We want that patient to be bought in. We don't want to just try and help them like, okay, like you might have this. We actually speak in the same terms as the rest of our patients.   ⁓ In one practice what we did is we actually had the doctors tell us exactly how they diagnose treatment We as consultants recorded it on our phones and we had the whole team hear it and then we gave them all these recordings and the whole team has to listen to it and this was our fastest easiest way to get everybody up to par like driving into the office driving home from the office like listen to it in the office like you've got Christmas music playing but instead it's it's all the ways that we diagnose and describe this that way everybody says it the same way so the patients hearing it   multiple times in the exact same way. Now when the doctor comes in, there should be a handoff from hygienist to doctor. We call it the I creep. So introduce, compliment the patient, recap the treatment and say something personal. Hygienist, you want a fast exam? This is how you get it done. Doctors, you don't want to do that awkward dance of like, how do I get to know you without getting to know you, but I need to get to know you? This is how you do it. Introduce, compliment, that puts the patient more at ease, recap treatment already discussed, and then something personal about them.   Then doctors, we get them into a yes frame of mind. We're going to say, can I lean you back? Can I do a full exam on you? Yes, yes. You want to actually get them in the frame of mind of saying, yes. It's true psychology. Again, words are free. It's not manipulation. It is genuinely setting the stage to get a patient open-minded. They don't want to be at the dental office already. So how can I help them get into this higher frame of mind? Then after that, doctor's going to comprehensively diagnose. And then they're going to recap with what we call the NDTR handoff.   So next visit, date to return, time needed for appointment, re-care scheduled. This is going to be more for your general procedure. Then we take that, hygiene, then takes ordinal assistant, takes them up to the front office, say the exact handoff. Amalia's amazing up front. Dr. Smith wants to see Kiera back for that crown on the upper right. She wants to see her back for, you know. ⁓   an hour and a half and wants to see her in two weeks and she already has her cleaning scheduled. And then from there, the front office team picks it up. Let's get you scheduled in two weeks. I've got Monday or Wednesday, which works best for you. We need an hour and a half and then we go over financing. That patient has now heard this multiple times of the exact same thing. And that same process, just with a small fine tuning is going to be for these larger cases. Typically larger cases, yes, they are found in hygiene, but oftentimes it's going to be a little bit longer of a   consult if you will, ⁓ because we want to make sure that we have the before and after photos. We want to make sure we build trust with them. This is where having the hygiene team tee it up. This is where we have the perfect handoffs between doctor and hygienist. And then the doctor has to have confidence and clarity. So you've got to work this like pre-treatment build to make sure that the patient feels like they already know kind of what we're looking at. If it's all built up like this, it's very warm, it's very consistent.   everybody's on the same page. Your team feels like your patient feels like your team has their stuff together. And that's what we want. So I would look at this, like how are we doing on pre-treatment? Not even if just large cases, but how are we doing with those handoffs? How is the handoff from hygiene to doctor? How is hygiene teeing up treatment? How is everybody talking about treatment? Are we all on the same page or are we all on different pages? What does that look like? And then from that,   We wanna make sure that we're really, really, really good on visuals. So are we doing scans? Are we doing mockups? Do we have photos of before and afters of the cases? Do we have clear and simple explanations? Do we have ⁓ more like this is information. So if we're doing an all on X case, do we have information about what this happens and what are the steps? And do we have it broken down into really easy steps for them? I actually changed up treatment plans on these larger cases to step one is extraction in place.   Step two is impressions and step three is delivery. Those are very patient friendly. If our case is 45,000, I break it down to step one is, you know, 19 ish thousand and then step two is going to be like 11,000 and then step three is whatever the remainder of that is. This way it's very simple. They can pay in full for some practices or we pay per appointment. Now with these larger cases on AR and also on production and collections to make sure we're not having these huge spikes.   Sometimes it does make sense to have the patient pay as they go. Other practices want a pay in full. Both are totally fine. But what we've got to do and what we also have to realize is when we go into the finances. So typically when I'm presenting like a one to $7,000, I'm gonna schedule them first, I'm gonna present the dollars, I'm gonna talk the insurance as a coupon. ⁓ Here's total treatment, here's your insurance estimate, and then this is the total when I see you on Wednesday. Or if you would...   require a deposit, take the deposit then, and then ask what questions they have. Then we go into financing options, but it's just a very clear, very confident space that we're gonna walk into. Now, if I'm presenting a 20 or 30 or $40,000 case, it's psychology. It's a smooth flow from front to back. It is the confidence that we are gonna do the best for you. Here's what's going on. Let's talk about it. What questions do you have? I wanna make sure that you're very confident moving forward. Dr. Smith is the absolute best dentist.   to create this and to do this treatment for you, like you were in good hands. Notice in there, I edified my doctor. I made sure that I asked them what questions, not do you have questions? The last thing I ever wanna do is have my patient tell me no. I wanna keep them always in a yes frame of mind. Now, we're gonna look at this of cost. I'm not going to plant weeds in my flower garden on purpose. I don't wanna say like, is a big investment for you. Why am I saying that? It's not a big investment. This is an investment.   This is you taking care of yourself. This is you deserving this. Like how exciting is it to be able to eat food that you haven't been able to eat for the last however many years? How exciting is it to smile with confidence? I am going to radically focus on the positives for this. And then I'm going to go after and ask them what questions they have. I don't want to pre-assume question marks that they have. When people come in for these 20, 30, 40, $50,000, they're not going to be sticker shocked to see that it's that amount. Some of them might.   But the general population knows just like I use the example of when we were doing IVF, IVF is $50,000 per procedure. It's not ⁓ a cheap procedure. And the buyer is very educated when they walk into that. So it's not like what 50 grand? You didn't tell me that. It is more a great, this is what it is. What questions do you have? I want to be here as a support. Now for some offices, they do offer financial avenues that some people might not have thought about. For example, polling from a 401k.   For example, a home equity line of credit, going to a bank, you might work with a local bank and having some of those options just so people can see. And I will tell you an IVF, they did actually offer this with us and they put that in our sample, like our folder that we took home with us, just because they wanna make it to where it's easier for us not to have a barrier or a concern. I will say that a lot of times these larger cases are a two-part close, not a same day close. That does not mean that people don't just hand over their credit card and pay you.   80,000 or 150,000 right there on the spot. I've seen it done many times. So I'm not going to assume that people need that, but this will be a tool in my tool belt. Lending Club, Cherry, some of these are going to be better at financing higher amounts. ⁓ And so we're gonna look for that. Sometimes applying for financing in the office through Care Credit, or like I said, Cherry or Sunbit, or some of these others. Lending Club, look to see who you can use. It's going to really help. do know Cherry is a very big fan favorite. ⁓   that does help fund some of these higher ones. A local bank is a great thing and have a direct line to your person that's a loan processor there that can actually help these people get loans. It's a $50,000 procedure. That's like buying a car. There are loans for this and it's not uncommon to do that. And so helping the patient of whatever questions they have. They might have questions about the recovery time. They might have questions of the payment options. They might have questions all the way around. So,   Be really crystal clear in your practice of do we collect in full before we start initial records? If so, it might be a two part close where they've got to go find out their financial options, but you set the followup because again, you're a concierge of these, we're a high end, this is a high end surgery, we are completely changing their world. For my IVF, I had a financial coordinator who talked to me, I had a treatment coordinator who talked to me, I had a nurse who talked to me, there were steps through this whole process to make me feel confident.   Confidence is going to buy these and close these cases for you. Your treatment coordinator being exceptionally confident. They don't have to know all of the dentistry, but they do need to be confident talking dollars, looking for solutions and being confident in the dentistry you do. I will say all the time, people will hear me. No matter what size treatment plan, people are buying the doctor's confidence and they're buying the treatment coordinator's confidence. If you're confident that this is the best dentistry that people are ever going to get, you will close radically more cases.   Also your psychology, what am I thinking? Am I thinking like, that's a big number. If I am, people are going to feel that versus like it's a number, it's a treatment plan. This patient deserves great dentistry. So we really have to make sure and also with payment options, not being over the top on these financial avenues. You offer them 70 different options, they're going to be very confused. I prefer two to three that I'm very confident in. I know the ins and outs of them, things that most people use. I might have a few of these that are just a little bit more.   like unconventional, for example, the 401k or the home equity line. A lot of people don't even think about those as options, but they are viable options. ⁓ And then from there, we wanna just make sure that we are dialed in and we have a very, very solid followup on these if we don't close same day. But practice it, track your stats, look to see how you're doing on it, review your stats with your treatment coordinator and doctor every single week.   record yourself and listen to yourself back. And I know that sounds wild, but this office that we've added multi-millions to five locations, the treatment coordinators literally record themselves and send it to me and we listen to it. I role play with them for years. Every other week we are role playing. We are talking about it. What's going well, what's not going well. What's the psychology, what's the breakdown. I had a treatment coordinator the other day get on with me and she said, you know, Kiera, like 45 grand is like my large case for me.   But what I'm struggling with are these like perio ones where we're charging like 900 for gingivitis and I just don't know how to get through it. And so sometimes also presenting the other side of the coin. What happens if they do nothing? What happens if they start now? A lot of these things, but what I've learned is closing these cases is a finesse. There is clarity on schedule first. There is clarity on being direct in our treatment plans.   There is clarity on having a very simple process of step one, step two, step three. There's a very clear, like very strong correlation of higher acceptance when it's that clear, that direct, that confident. Because if I'm going in for surgery, the last thing I want is somebody who's like wishy washy or we can do it this way or what do you think or what do you want or you know, if you need it or if you want it. No, I need somebody who knows what they're doing. This is a $50,000 case. This is a $20,000 case.   We need to have our ducks in a row. We need to be very thorough. We need to be very confident in it. And we need to present this plan and help more patients. So when we look at all this, number one, we got to do great dentistry. And number two, everyone needs to be speaking the same language. And we need to have the psychology that everybody wants our dentistry. And we're great here. We need great handoffs, that warm handoff of teeing it up from hygienist to doctor. Everybody's speaking the same language. We need to be showing them.   testimonials, this is what it's gonna look like, transformations, this is how your life is going to change, this is how this one patient said. And then from there, we're going to make sure that we also are really, really strong on our how we schedule, how we do our handoffs, how we present the dollars and the financial clarity and the very, very clear next step for them. And then very, very strong follow-up. If a patient doesn't schedule in the office with me, it's two days, two weeks, two months of follow-up. I am going to be very rigid with my follow-up. I'm going to have a follow-up.   And then I'm going to review every single week my progress. I'm going to look at what I closed, what I didn't close, what was said. I'm going to listen to my calls. I'm going to listen to the doctor exams because usually, and I hope every one of you hears this, usually cases are won or lost by one or two words. It's not usually all the rest of it. We've got to have all the other pieces in place. But usually when I listen, I hear one or two words that tips a patient in one direction or the other, like,   It's very small, it's very much psychology, it's very much what you're hearing that's not being said is usually what's winning or losing this. I tell everybody sequence matters on how you present treatment plans. We can have a combination lock that the combinations one, two, three, and we can put three, two, one. I had all the right numbers, but in the wrong order and I don't open it. Same thing with presenting these larger cases. I can have all of the dots, but in the wrong order and I won't close. So this is something of.   realizing that when patients say yes, they trust you, they understand, they feel safe, they feel seen, they feel heard, they feel your confidence, and they feel very confident in their decision that this is the best absolute option for them. So I really hope that you realize that high value, high dollar dentistry is partnering with patients. It's transforming their life. It's giving them the confidence and they didn't have, it's giving them life experiences that they didn't have. And so this is a dialed in of how do we get more patients to say yes?   How do we get more patients to optimal health? How do we make sure that patients are getting the best dentistry with you? Now, if they come to you and they give the objections, time, money, spouse, la-di-la-di-la, those are just to me, top line levers that are telling me of an underlying root problem. And I need to listen for that. I need to answer that. And I need to listen to what's not being said and respond to what they actually need. So this is what I love to do. This is how we help a lot of offices.   ⁓ I'm obsessed, like we said, we role play with people, we help them, we transform them. And if we were able to boost your case acceptance one or 2%, what would that do for your practice, let alone 10, 15, 20 %? This is something we're obsessed with and I hope that you guys just heard some great tips, some great tools that you will go implement in your practice. Case acceptance to me is one of the greatest gifts you can give your patients. Doing great dentistry is what this is all about and helping patients see that and say yes to you is the greatest gift you can give them. So if we can help in any way, reach out.   Hello@TheDentalATeam.com. Go change lives, go change smiles, go be confident in yourselves and just know I'm rooting for you. I'm here in any way we can help you. And as always, thanks for listening. I'll catch you next time on the Dental A Team Podcast.  

How to Turn Patients into Raving Fans (and Referral Machines) In this episode of the PT Entrepreneur Podcast, Doc Danny breaks down why most clinics are stuck in "purgatory" with word of mouth and what separates average clinics from the ones patients can't stop talking about. Using a great chicken joint and a mediocre Italian restaurant as examples, he shows you how clients really think about your business and what has to change if you want more organic referrals in 2026. In This Episode, You'll Learn: Why saving clinician time with an AI scribe like Claire can quietly add $30,000 in revenue per staff PT per year The two levers that drive referrals in any service business: outcomes and experience How a chain "hot chicken" spot crushed a local restaurant on basic execution Why "pretty good" is the most dangerous place for your clinic to live What a 9–10 Net Promoter Score really looks like inside a cash practice How your space, punctuality, and communication shape patient trust Why referrals jumped when Danny moved from a subleased gym corner to a standalone space A simple way to mystery shop your own clinic and see what patients see Claire: Freeing Up Time and Unlocking Revenue Danny opens by talking about Claire, the AI scribe built for cash-based clinics. On average, Claire is saving staff clinicians six hours a week on documentation. Even if you only recapture half of that time for patient care, that is three extra one-hour visits per clinician per week. 3 extra visits per week at $200 per visit = $600 per week Roughly $30,000 in additional annual revenue per staff clinician And it all comes from taking notes off their plate and putting that time back into patient care. Try Claire free for 7 days: https://meetclaire.ai Two Restaurants, Two Very Different Referral Stories Danny shares a simple contrast to frame how referrals really work. On the same day, he took his son to Dave's Hot Chicken and later that night took his family to a new Italian restaurant near their house. Dave's Hot Chicken: Friendly staff, simple "honey hack" suggestion, clean space, food that exceeded expectations. He would happily tell people to go there. Local Italian restaurant: No clear host, missing reservation, clunky service, average food at a higher price point. He will not badmouth them, but he is not going to recommend them either. That is exactly how patients think about your clinic. They are either excited to send people, quietly neutral, or actively warning people away. Net Promoter Score and Your Clinic Danny ties this into Net Promoter Score (NPS), a simple question that predicts referrals. "On a scale of 0 to 10, how likely are you to refer a friend or family member to this clinic?" 9–10 = promoters who actively tell people about you 0–6 = detractors who may talk negatively 7–8 = passives who are neutral and mostly silent Most clinics live in the 6–8 range. Not good enough to be talked about. Not bad enough to be trashed. That is business purgatory. The Two Levers: Outcomes and Experience For a cash-based clinic, your referrals come from two places. Outcomes: Are you actually better than the average in-network option? Do people get results faster and more completely? Experience: What is it like to work with you? Space, punctuality, communication, how you follow up, how individualized things feel. If your space is a noisy gym corner or a rough sublease, you have to make up for that with flawless communication, punctuality, and outcomes. When you eventually level up into a standalone space, the experience finally matches the quality of your care. Danny saw that firsthand when his clinic moved from a subleased gym space to a standalone location. Referrals jumped. Patients openly said they were now more comfortable sending friends and family because the space matched the price and reputation. Are You "Just Okay"? Danny challenges clinic owners to be honest about where they sit. Are you truly a 9 or 10 out of 10 on outcomes and experience? Or are you a 6–8 where people say you are fine but do not talk about you proactively? He suggests a simple exercise. Have a friend or family member your staff does not recognize come through as a "mystery shopper" patient. Let them go through your entire process and give you brutally honest feedback about what felt confusing, clunky, or underwhelming. Getting Obsessive About Excellence Clinics that become referral machines look different on the inside. They: Obsess over outcomes and ongoing clinical improvement Obsess over small details in the patient journey, from first inquiry to discharge Answer quickly, follow up clearly, and stay ahead of patient questions Fix small frictions in their space and processes every month When you get this right, you build a stable referral base that cushions you from algorithm changes, ad costs, and platform shifts. You still might use marketing, but you are not desperate for it. Want a Clear Path to Go Full Time? If you are still in the early stages of leaving a job and going all in on your own cash-based practice, PT Biz runs a free Part Time to Full Time 5-Day Challenge that walks you through: Exactly how much income you need to replace How many patients you need to see and at what average visit rate Three different strategies to go from part time to full time The basic sales and marketing systems you need in place A simple one-page business plan so you can take action Join the free challenge: https://physicaltherapybiz.com/challenge

Trevor Maxwell lived the archetype of masculinity in rural Maine. Big, strong, splitting wood, raising kids, and carrying the load. Then cancer ripped that script apart. In 2018 he was bedridden, emasculated, ashamed, and convinced his family would be better off without him. His wife refused to let him disappear. That moment forced Trevor to face his depression, get help, and rebuild himself. Out of that came Man Up To Cancer, now the largest community for men with cancer, a place where men stop pretending they are bulletproof and start being honest with each other.Eric Charsky joins the conversation. A veteran with five cancers, forty-nine surgeries, and the scars to prove it, Eric lays out what happens when the military's invincible mindset collides with mortality. Together, we talk masculinity, vulnerability, sex, shame, and survival. This episode is blunt, raw, and overdue.RELATED LINKSMan Up To CancerTrevor Maxwell on LinkedInDempsey CenterEric Charsky on LinkedInStupid Cancer FEEDBACKLike this episode? Rate and review Walk It Off on your favorite podcast platform. For guest suggestions or sponsorship inquiries, email podcast@matthewzachary.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

 Fertility Docs Uncensored is hosted by Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Susan Hudson from Texas Fertility Center, and Dr. Abby Eblen from Nashville Fertility Center.  This episode answers key patient questions about polycystic ovary syndrome (PCOS) and fertility. We answer:· How is PCOS diagnosed? Using the Rotterdam criteria: irregular cycles, more than 12 microfollicles per ovary, or elevated male hormones. Two of three confirm the diagnosis.· Does stopping birth control pills help fertility? No. PCOS cycles return to baseline because the hormonal system does not reset.· Why don't patients with PCOS ovulate regularly? The brain does not release enough FSH to trigger ovulation.· What fertility treatments work? Oral ovulation-induction medications succeed in about 80% of patients.· Do patients with PCOS have ovarian cysts? No. Small follicles are normal; true cysts are a different condition.· Does weight affect PCOS? Yes. Weight gain or loss can influence hormone balance and ovulation.We also clarify why the name “polycystic ovary syndrome” is misleading. Patients with PCOS do not have true ovarian cysts. Instead, they have many small follicles, each containing an immature egg, which are a normal part of ovarian anatomy. True ovarian cysts, such as desmoids or endometriomas, represent entirely different medical conditions and are not part of PCOS. This episode provides clear, evidence-based guidance on PCOS diagnosis, myths, and effective fertility treatment.

Last year, actor, author, life coach and professional mad woman (she co-hosts the Women Are Mad podcast with psychotherapist Jennifer Cox) Salima Saxton got ill. Obviously she started a Substack about it and Bad Patient – in which she writes about being ill with raw honesty, humour, insight and on her own terms – was born. Salima chats to our Mick about illness: how we perceive it, how we talk about it, how we don't have to meet other people's expectations when dealing with it and how it can change our perspective on, well, everything. Also, bonus chat: tricky dads. Learn more about your ad choices. Visit megaphone.fm/adchoices

-A lot of people wanted Hoiberg fired after his third year, and it's hard not to see why----they were 7-25, 7-20 and 10-22 in his first 3years at Nebraska, and now it's started to flourish the last 3 years-Matt Rhule hasn't had THAT kind of rough start at Nebraska, but if he did he'd be surely gone…so has Hoiberg's success allowedpatience for Rhule or is it totally different?Our Sponsors:* Check out Aura.com: https://aura.com/remove* Check out BetterHelp: https://www.betterhelp.com* Check out Progressive: https://www.progressive.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

This episode is sponsored by Lightstone DIRECT. Lightstone DIRECT invites you to partner with a $12B AUM real estate institution as you grow your portfolio. Access the same single-asset multifamily and industrial deals Lightstone pursues with its own capital – Lightstone co-invests a minimum of 20% in each deal alongside individual investors like you. You're an institution. Time to invest like one.—-----------------------------Join us for Doctor PodFest in Florida! Go here to secure your ticket: Here------------------------------What if an angry patient's "eruption" isn't an attack on you, but a desperate attempt to protect something vital, like their health, time, or family?In this essential episode, Dr. Bradley Block sits down with Luke Wiesner, a seasoned conflict specialist who's trained hundreds of healthcare teams, to unpack de-escalation strategies for volatile patient interactions. Drawing from his decade of experience in mediation and coaching, Luke introduces the "volcano" model: eruptions stem from underlying pressures, not malice. He outlines a repeatable framework: regulate yourself, relate to their emotions e.g., frustration over wasted time, seek understanding, and collaboratively solve problems while offering choices. They discuss avoiding defensiveness, acknowledging experiences even if "wrong", empowering staff with boundaries, and knowing when to escalate for safety. Perfect for physicians and teams facing post-COVID edge in offices or hospitals.If tense encounters leave you or your staff drained, this blueprint empowers you to de-escalate safely, foster trust, and reduce burnout, making you the office hero.Three Actionable Takeaways:Regulate yourself first to avoid fueling the fire: When facing an eruption, pause for deep breaths or a quick mental reset, remind yourself they're protecting something vital (health, time, money). This prevents defensiveness, decoupling you from being seen as the "threat," and sets the stage for calm rapport-building.Relate and reflect to build connection: Acknowledge their emotion with muted words like "frustrated" or "concerned", avoid "angry" to prevent pushback. Reflect on their experience: "This probably isn't how you planned to spend your afternoon, I can see how frustrating that is." Genuinely show you care to shift from adversaries to allies, using nonverbal cues like tone for authenticity.Solve collaboratively and set boundaries: Offer options for control e.g., "We can slot you in two weeks or add you to the waitlist, which works?". If inappropriate (e.g., profanity, threats), give a choice: "I'd like to help, but I can't if you continue speaking that way—let's adjust, or I'll need to involve my manager." Know your office's escalation protocol (e.g., security) for safety.About the Show:Succeed In Medicine covers patient interactions, burnout, career growth, personal finance, and more. If you're tired of dull medical lectures, tune in for real-world lessons we should have learned in med school!About the Guest:Luke Wiesner has been a conflict specialist since 2014, offering mediation, coaching, training, and facilitation to workplaces, families, communities, and individuals. He's partnered with hundreds of organizations across industries, including healthcare, where he's helped physicians, surgeons, and teams de-escalate patient conflicts, improve communication, and resolve issues in clinical and office settings. LinkedIn: Luke Wiesner  Website: https://www.lukewiesner.comAbout the Host:Dr. Bradley Block – Dr. Bradley Block is a board-certified otolaryngologist at ENT and Allergy Associates in Garden City, NY. He specializes in adult and pediatric ENT, with interests in sinusitis and obstructive sleep apnea. Dr. Block also hosts Succeed In Medicine podcast, focusing on personal and professional development for physiciansWant to be a guest?Email Brad at brad@physiciansguidetodoctoring.com  or visit www.physiciansguidetodoctoring.com to learn more!Socials:@physiciansguidetodoctoring on Facebook@physicianguidetodoctoring on YouTube@physiciansguide on Instagram and Twitter This medical podcast is your physician mentor to fill the gaps in your medical education. We cover physician soft skills, charting, interpersonal skills, doctor finance, doctor mental health, medical decisions, physician parenting, physician executive skills, navigating your doctor career, and medical professional development. This is critical CME for physicians, but without the credits (yet). A proud founding member of the Doctor Podcast Network!Visit www.physiciansguidetodoctoring.com to connect, dive deeper, and keep the conversation going. Let's grow! Disclaimer:This podcast is for informational purposes only and is not a substitute for professional medical, financial, or legal advice. Always consult a qualified professional for personalized guidance. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

TSH: The Most Misunderstood Thyroid Lab — 25 Questions, Answered If you've been told your TSH is "normal" but you still feel exhausted, foggy, inflamed, or hypothyroid — this episode is for you. In this deep-dive Q&A episode, Dr. Eric Balcavage answers 25 of the most common and misunderstood questions about TSH, the lab marker most often used — and misused — in thyroid care. You'll learn: What TSH actually measures (and what it doesn't) Why TSH can go up in some stress states and down in others How inflammation, stress, sleep, dieting, and medication timing distort TSH Why "normal" TSH doesn't guarantee healthy thyroid function How to tell true hypothyroidism from adaptive physiology Why chasing TSH often keeps people stuck How thyroid medications affect TSH differently (T4 vs T3) Why tissue hypothyroidism can exist even when labs look "fine" This episode is designed for: Patients frustrated by "normal labs" Clinicians who want better thyroid interpretation Anyone trying to understand thyroid physiology beyond numbers

When should an antibiotic allergy actually be tested? In this episode of the BackTable ENT Podcast, guest host Dr. Basil Kahwash, an allergist and immunologist at Ohio ENT & Allergy, sits down with Dr. Cosby Stone, an allergist and immunologist at Vanderbilt University Medical Center, to discuss antibiotic allergies and how to distinguish true allergies from intolerances. --- SYNPOSIS Dr. Stone breaks down common misconceptions around antibiotic allergies, with a focus on penicillin and cephalosporins. The conversation explores how these allergies are evaluated, including when skin testing is appropriate, why inaccurate allergy labels matter, and how confirmed allergies should be managed long term. They also dive into more advanced topics such as drug desensitization, current research in the field, and where the future of drug allergy evaluation is headed. --- TIMESTAMPS 00:00 - Introduction 01:03 - Understanding Antibiotic Allergies07:28 - The Importance of Accurate Allergy Diagnosis10:55 - Key Questions for Diagnosing Allergies17:10 - Implementing Allergy Testing in Healthcare Settings19:06 - Identifying Severe Allergic Reactions26:31 - Interpreting Allergy Skin Testing Procedures33:17 - Penicillin and Cephalosporin Cross-Reactivity37:15 - Drug Desensitization: Indications and Process40:30 - Prognosis and Long-Term Outcomes of Drug Allergies47:22 - Conclusion and Final Thoughts --- RESOURCES Dr. Basil Kahwash https://www.ohioentandallergy.com/physicians/basil-kahwash-md/ Dr. Cosby Stonehttps://www.vanderbilthealth.com/doctors/stone-cosby

Join us for an enlightening discussion on the carnivore diet and its potential health benefits. In this episode, we dive into various aspects of meat-based eating, weight loss, and gut health, backed by research and personal experiences.⏱️ Episode Chapters[00:04] Grass-Fed vs. Grain-Fed Beef: Nutritional Differences[02:05] Weight Loss & Joint Pain Relief on Keto Diets[05:50] Nine Years on the Carnivore Diet: Personal Outcomes[07:43] How Meat Became Demonized in Nutrition Science[11:41] Obesity, Cancer Risk, and Dietary Correlations[13:37] Religious & Ideological Influences on Nutrition Guidelines[17:22] Diet Change vs. Medication: Where Real Healing Begins[18:57] Meat-Based Diets & Eating Disorder Recovery[22:15] Gut Adaptation During Dietary Transitions[23:45] Human Flexibility: Carnivore vs. Plant-Based Survival[27:17] Evolutionary Evidence for Meat-Centered Diets[29:00] Historical Emphasis on Meat in Human Nutrition[32:23] Vitamin C Needs on a Carnivore Diet[34:08] Nutrient Absorption & Bioavailability[37:43] Gut Health, Fiber, and Microbiome Myths[39:32] When Fiber Helps—and When It Doesn't[42:55] Lifestyle Foundations for Optimal Health[44:42] A Decade of Red-Meat-Focused Living[48:10] Flexibility Within the Carnivore Framework[49:45] Electrolytes, Training, and Performance[52:50] Cooking Meat: Health Implications[54:24] Gut Health Without a Colon[57:43] Encouraging Dietary Diversity When Appropriate[59:08] Diet, Brain Size, and Breastfeeding Evolution[1:02:23] Optimal Complementary Foods for Infant Growth[1:03:52] Defining Health: How You Feel vs. How You PerformTune in for insights that challenge traditional dietary beliefs and explore the science behind the carnivore lifestyle!

A life-changing diagnosis set Dr. Patrick Gee on a path that reshaped his purpose. In this episode, Patrick reflects on his kidney journey, the gaps in health literacy that fueled his advocacy, and how faith, perseverance, and lived experience transformed him from a patient into a powerful voice for health equity. His story is a reminder that advocacy begins when you choose to speak, not just for yourself, but for others who may not yet have the chance.

If growth is stalling, the problem is rarely the media plan. It is friction in the patient experience that marketing cannot fix after the fact. On this episode of Ignite, Cardinals VP of Brand Marketing Ashley Petrochenko sits down with Ben Whitaker, Director of Digital Strategies, Marketing, and Communications at UofL Health, to unpack why sustainable healthcare growth starts long before the appointment and often breaks at the digital front door. Drawing on 25 years of digital and SEO experience across industries, Ben shares how consumer behavior, not new tactics, should shape SEO, AI search, site experience, reviews, and scheduling. This conversation matters now as AI accelerates search behavior and raises the stakes for accuracy, trust, and usability across the entire patient journey. You'll learn: Why SEO still underpins patient acquisition in an AI-driven search world How small experience gaps quietly kill conversion and retention What healthcare marketers can fix without waiting on a full redesign How marketing can lead cross-functional alignment around patient access If improving patient access and driving real growth are priorities for 2026, this is the episode to listen to next. RELATED RESOURCES Connect with Ben - https://www.linkedin.com/in/bentwhitaker/ What is a Patient Journey? Examples to Grow Your Practice - https://www.cardinaldigitalmarketing.com/healthcare-resources/blog/what-is-a-patient-journey-grow-your-practice/ Optimizing for AI Search: A New Era in Healthcare Marketing - https://www.cardinaldigitalmarketing.com/healthcare-resources/blog/optimizing-for-ai-search-a-new-era-in-healthcare-marketing/ How to Build a Full-Funnel Healthcare Marketing Strategy - https://www.cardinaldigitalmarketing.com/healthcare-resources/blog/healthcare-full-funnel-marketing-strategy/ How a Primary Care Provider Futureproofed Their SEO in an AI-Driven Search World - https://www.cardinaldigitalmarketing.com/healthcare-resources/blog/search-content-strategy-ai-landscape/

Start your year with powerful insight into how God uses pressure to refine your faith! In this first message of our new series "Integrated," Pastor Stephen unpacks James 1:1-18 to reveal why trials aren't meant to break us—they're meant to complete us. Discover the difference between testing and temptation, learn why God allows difficulties in your life, and find out how endurance develops through patient faith. This message will challenge you to close the gap between what you believe and how you live. Key Takeaways: Pressure reveals your integrity—it doesn't break it God tests you to strengthen you; sin tempts you to destroy you A faith that can't be tested can't be trusted God uses trials to refine you, not punish you Patient endurance leads to wisdom, wholeness, and the crown of life The question isn't IF you'll face pressure, but WHAT it will reveal about you Scripture References: James 1:1-18 | Jeremiah 29:11-13 | 1 Corinthians 11:23-26 About This Series: Join us for "Integrated"—a 7-week journey through the book of James that will help close the gap between what we say we believe and how we actually live. It's time for an integrated life! ABOUT OPEN DOOR CHURCH: Open Door Church is located in Edenton, NC, where Pastor Stephen Mizell serves as lead pastor. We believe in the transformative power of God's Word and the life-changing message of Jesus Christ.

Health is splitting into two loud camps: “follow the science” or “burn it all down.” And if your symptoms don't fit the script, you get dismissed—and left to figure it out alone. We expose how social media can save you or sabotage you—and how to spot health misinformation without getting misled. We also unpack the collision between population-level messaging and individual care, especially when a real human is sitting in the exam room saying, “Something changed in my body—and I need you to take it seriously.” Then Erin tells the story that changes everything: a woman spends 10 years in pain, gets dismissed repeatedly, and Erin solves it in seconds with the right pattern recognition. If you've ever felt dismissed, stuck, or lost in the noise, this episode is wildly validating—and it gives you language, strategy, and something medicine forgets to prescribe Want more practical health tips? Join my newsletter! https://freechapter.lpages.co/newsletter-opt-in/ Check us out on social media: drefratlamandre.com/instagram drefratlamandre.com/facebook drefratlamandre.com/tiktok #functionalmedicine #drefratlamandre #medicaldisruptor #NPwithaPHD #nursepractitioner #medicalgaslighting Chapters [00:00:00] Social media divide [00:03:55] N-of-one reality [00:16:30] Glomus tumor story [00:24:25] Empathy training gap [00:49:55] Fixing the access gap Guest Links: FB: Doctorerinnance IG: @doctorerinnance Website: Feelbetr.health Learn more about your ad choices. Visit megaphone.fm/adchoices

“Many women don't have the information they need to understand what's going on with their hormones.” - Kate WellsWhile the conversation around menopause and hormone therapy has progressed significantly in recent years, many women remain unaware of their options and lack access to practitioners who can guide them through these transitions. When you add the fact that many of the symptoms associated with these hormone changes are still highly stigmatized, it's no wonder women are left feeling isolated and uncertain.The good news is that more practitioners and companies are changing the way they approach women's health. Expanding their focus beyond efficacy, they're building a more engaging and empowering experience for their customers.Today, I'm excited to introduce you to someone who's doing just that - menopause advocate and self-proclaimed biochem nerd, Kate Wells. Recognizing the need for more education on and access to hormone therapies, Kate and Kirsti Hegg founded Parlor Games. Being a clinician and a businesswoman can be hard, and Kate has been able to successfully meld the two and pursue a new purpose, starting in midlife.In this conversation, Kate and I discuss why so many women are finding themselves on a new path after 50, her journey in creating accessible hormone products, the challenges of educating women about hormonal health, the significance of community support, what to think about when choosing over-the-counter hormone therapies, why practitioner guidance is important, common misconceptions about estrogen, why Kate is passionate about the educational aspect of Parlor Games, and more.Enjoy the episode, and let's innovate and integrate together!---Learn more or watch the video version of this conversation at https://integrativewomenshealthinstitute.com/what-are-bioidentical-hormones-with-kate-wells/.Connect with me and access our entire platform at IntegrativeWomensHealthInstitute.com (https://integrativewomenshealthinstitute.com/).Find and follow us @integrativewomenshealth on YouTube (https://www.youtube.com/@integrativewomenshealth) and Instagram (

This episode of Little Teeth, BIG Smiles explores how co-locating pediatric dentistry and orthodontics under one roof advances dentistry's version of the Triple Aim: improving patient experience, enhancing population oral health, and reducing per-capita costs. Dr. Christina Carter joins our host Dr. Joel Berg for a discussion that reframes co-location not as a convenience model, but as a value-based, prevention-oriented system of care that is particularly impactful for children, families, and underserved communities. Guest Bio: Dr. Christina R. Carter is a graduate of Haverford College in Haverford, Penn. She earned her dental degree at UMDNJ-NJDS, now Rutgers School of Dental Medicine. She earned her Certificate in both Pediatric Dentistry and Orthodontics at New York University College of Dentistry. She completed a fellowship in Cleft, Craniofacial and Surgical Orthodontics at the Institute of Reconstructive Plastic Surgery- New York University Langone Medical Center. She earned her Certificate as a Holistic Health Coach from the Institute of Integrative Nutrition in New York. She is a Diplomate of the American Board of Pediatric Dentistry and American Board of Orthodontics. Dr. Carter is in private practice in Madison, NJ. She has been named multiple times as a “Top Doctor” by New Jersey Magazine and “Favorite Kid's Doc” by New Jersey Family Magazine. She has served on the AAO Council of Orthodontic Health Care and multiple AAO committees and is a past president of the Northeastern Society of Orthodontists (NESO) and served as their Delegate Chair to the ADA House of Delegates. She often appears on Sirius Radio “Doctor Radio”, AAPD Podcasts, and has been published in Scholastic and Kiwimagazines. In addition, she has appeared on “Inside Edition”, WPIX NYC News, and Today.com. She lectures nationally and internationally on pediatric dentistry, orthodontics, and treating patients with special needs. She is an Assistant Professor at New York University College of Dentistry in the Departments of Pediatric Dentistry and Orthodontics. Dr. Carter enjoys volunteering with Special Olympics and alongside her certified therapy dog, Callie, through Creature Comfort Pet Therapy in New Jersey. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Join host Dr. Nikolaos Papadantonakis as he welcomes Dr. Colin Vale from Winship Cancer Institute of Emory University and Dr. Nancy Luna Torres from Moffitt Cancer Center to discuss the fundamentals of allogeneic hematopoietic stem cell transplantation for MDS patients.  Our experts break down complex medical concepts into easy-to-understand language, helping patients make informed decisions about this important treatment option.

In this follow-up episode,  Dr. Nikolaos Papadantonakis continues the conversation with Dr. Colin Vale from Winship Cancer Institute of Emory University and Dr. Nancy Luna Torres from Moffitt Cancer Center, diving deeper into advanced transplant topics. This episode is ideal for patients and families who want to understand the nuances of transplant care and post-transplant management.

Cody Mansfield joins the show to unpack the real value of residency and fellowship training — and to share insights from his new Cardon Research Award–funded study examining outcomes in non-operative knee pain.Cody serves as Director of the Ohio State OMPT Fellowship, research associate, physical therapist, associate editor for JOSPT Cases, and instructor in the OSU DPT program. His mixed-methods research evaluates whether post-professional training changes outcomes related to quality, service, and cost — and what patients themselves value about receiving care from fellowship-trained clinicians.In this conversation: • Why this research matters for the future of OMPT • Early insights from comparing trained vs. non-trained clinicians • Patient perspectives on fellowship-trained PTs • Residency vs. fellowship — how they actually differ • Cody's educational sessions on LE referral patterns and spinal decision-making • His journey through a PhD while raising two young boysWhether you're a student, clinician, educator, or program director, this episode gives you a grounded look at what advanced training really does for patient care.

In this conversation, Jeff Sarris and Jill Harris discuss the importance of sodium intake in the kidney stone diet, emphasizing that while reducing sodium is crucial, it should not be excessively low. They highlight common misconceptions about dietary recommendations and the need for specific guidance from healthcare professionals. The discussion also touches on the balance of nutrients, portion control, and the implications of various dietary choices on health, particularly for those prone to kidney stones.TakeawaysLowering sodium too much can lead to health issues.Specific dietary guidelines are essential for kidney stone prevention.Patients often misinterpret dietary advice from healthcare providers.Sodium is necessary for bodily functions; too little can cause dizziness.Dietary recommendations should be tailored to individual health needs.Overeating healthy foods like almonds can still lead to problems.Consulting with a doctor about dietary needs is crucial.Portion control is key in maintaining a healthy diet.Added sugars can be minimized without negative effects on health.Balance in nutrient intake is vital for overall well-being.00:00 Understanding Sodium in the Kidney Stone Diet07:52 The Balance of Nutrients and Portion Control——HAVE A QUESTION? _Leave us a voicemail at (773) 789-8764.KIDNEY STONE DIET® APPROVED PRODUCTSProtein Powders, Snacks, and moreWORK WITH JILL _Start HereKidney Stone Diet® All-Access PassKidney Stone Diet® CourseKidney Stone Diet® Meal PlansKidney Stone Diet® BooksPrivate Consultation with JillOne-on-One Deep Dive24-Hour Urine AnalysisSUPPORT THE SHOW _Join the PatreonRate Kidney Stone Diet on Apple Podcasts or Spotify——WHO IS JILL HARRIS? _Since 1998, Jill Harris has been the #1 kidney stone prevention nurse helping patients reduce their kidney stone risk. Drawing from her work with world-renowned University of Chicago nephrologist, Dr. Fred Coe, and the thousands of patients she's worked with directly, she created the Kidney Stone Diet®. With a simple, self-guided online video course, meal plans, ebooks, group coaching, and private consultations, Kidney Stone Diet® is Jill's effort to help as many patients as possible prevent kidney stones for good.

Can adults really expand their maxilla? Is treating sleep apnea with a CPAP or mandibular advancement device only MASKING the problem? How does craniofacial anatomy influence airway health, and what should dentists look for? Dr. Dave Singh joins us to dive into CranioFacial Sleep Medicine. He breaks down how structural issues—like a narrow maxilla, high-arched palate, or limited tongue space—can be root causes of sleep-disordered breathing, rather than just treating symptoms.  The episode also touches on controversies in orthodontics and presents evidence supporting interventions once thought impossible in adults. https://youtu.be/WUyeOjKquJU Watch PDP253 on Youtube Protrusive Dental Pearl: Obstructive Sleep Apnea is NOT just a “fat old man disease.” If you're not screening every patient for sleep and airway issues, you're missing a huge piece of their overall health. Snoring, bruxism, and craniofacial anatomy are all connected, and understanding these links can transform the way you approach patient care. Key Takeaways: Mandibular advancement appliances are not a universal solution. While effective for some patients, they often fail to address the underlying causes of airway collapse. Craniofacial sleep medicine focuses on airway etiology, not just symptom control, by identifying why the mandible, tongue, and airway behave as they do during sleep. The cranial base plays a foundational role in facial growth, jaw position, and airway size, directly influencing sleep apnea risk. A retruded mandible is frequently due to developmental and epigenetic factors, rather than being an isolated mandibular issue. Sleep apnea has multiple endotypes—including craniofacial, neurologic, metabolic, and myopathic—requiring individualized treatment planning. Bruxism is not a reliable airway-opening mechanism and may be a primitive physiological response to hypoxia rather than a protective behavior. Tooth wear can be an early indicator of sleep-disordered breathing, and should prompt clinicians to screen beyond restorative concerns. Upper Airway Resistance Syndrome (UARS) can occur even when the apnea-hypopnea index (AHI) is low, particularly in non-obese patients with fatigue, pain, and poor sleep quality. Palatal expansion should be understood as a 3D craniofacial intervention, aimed at improving nasal airflow and airway function—not merely widening the dental arch. Effective care depends on an integrated, multidisciplinary approach, involving dentists, orthodontists, sleep physicians, ENTs, and myofunctional therapists. Youtube Highlights: 00:00 Teaser 01:01 Introduction 02:56 Pearl: Debunking Myths About Sleep Apnea 04:27 Interview with Professor Dave Singh: Journey and Insights 13:23 Craniofacial Development 18:53 Epigenetics and Orthodontic Controversies 25:52 Diagnosis and Treatment of Sleep Apnea 32:49 Understanding Upper Airway Resistance Syndrome 34:17 Midroll 37:38 Understanding Upper Airway Resistance Syndrome 39:45 Diagnosing Sleep Disorders and Treatment Modalities 43:58 Exploring Bruxism and Its Hypotheses 45:19 CPAP and Alternative Treatments for Sleep Apnea 48:12 Managing Upper Airway Resistance Syndrome 55:11 Integrative Approach to Sleep Disorder Management 57:17 Diagnostic Protocols and Imaging Techniques 01:02:25 The Importance of Proper Device Fit and Function 01:07:16 Upcoming Events and Further Learning Opportunities 01:09:56 Outro ✨ Don't Miss Out: Practical, anatomy-based approaches to sleep and airway management for dentists and specialists

Noninterventional studies in clinical research are underutilized in clinical research and inefficient. Dan Drozd, CMO of PicnicHealth, knows we can do better. With host Deborah Borfitz, Drozd discusses the issues and ramifications researchers face from the lack of noninterventional studies, offers tactics for raising the bar for evidence generation, and shares what he expects in the clinical research space in 2026 in this episode of the Scope of Things. Plus, Borfitz shares the latest news on an expanding good pharma score card, an entirely telehealth-based cancer trial, a novel online platform for bowel cancer research, improving patient-reported outcomes in cancer trials, a virtual clinical trial for psychedelics, and identifying Type 1 diabetes in the symptom-less window stage. Show Notes   News Roundup Good Pharma Scorecard Study in JAMA Internal Medicine News on the Yale Scool of Medicine website  Nationwide telehealth trial for cancer News on The Ohio State University website Online platform for bowel cancer research News on the Newcastle University website Patient-reported outcomes in cancer clinical trials Paper in The Lancet Oncology News on the European Organisation for Research and Treatment of Cancer website Virtual clinical trial of psychedelics Research article in Advanced Science Type 1 diabetes risk prediction testing Study in The Lancet News on the University of Exeter website Guest Dan Drozd, M.D., CMO of PicnicHealth The Scope of Things podcast explores clinical research and its possibilities, promise, and pitfalls. Clinical Research News senior writer, Deborah Borfitz, welcomes guests who are visionaries closest to the topics, but who can still see past their piece of the puzzle. Focusing on game-changing trends and out-of-the-box operational approaches in the clinical research field, the Scope of Things podcast is your no-nonsense, insider's look at clinical research today.

David Dodd, CEO of GeoVax,  highlights the need for next-generation vaccines, specifically multi-antigen and T cell-focused technologies, to provide better protection for immunocompromised populations. Their pipeline includes a COVID-19 vaccine candidate, an Mpox/Smallpox vaccine, and a gene therapy for solid tumors. A priority for GeoVax is to develop new manufacturing processes to significantly accelerate vaccine production, increase yield, and reduce costs. David explains, "Multi-antigen vaccines become critically important, especially for populations for whom the existing approach in vaccines, meaning single-antigen vaccines or antibody-focused or antibody-only vaccines, is inadequate. And to clarify that, there are approximately 40 million adults in the United States, about 10 times that number worldwide, who suffer from various medical conditions, such as blood cancers. They may have renal disease, diabetes, or be HIV positive. They may also have weakened immune systems, they could have multiple sclerosis or lupus. So there are a host of medical conditions that the result is they inhibit or they deplete an individual's immune system from mounting an adequate antibody response. And keep in mind, the antibody system is that first line of defense when an infectious threat occurs. And that's sort of like the frontline soldiers. They throw up a protective guard to respond to that." "That means for those individuals, what we need to do is also address this, as we develop vaccines, and some technologies allow you to do this. The majority of vaccine platforms do not, unfortunately. And that is to also induce a very strong cellular immunity or T cells. And this becomes critically important because T cells are what clear a virus from the body. It's also what drives what is known as memory, and also gives breadth or robustness of protection. So it becomes critically important that if one has the opportunity because of their technology or the platform they're utilizing to enlist and engage both the antibody as well as the cellular side, then one can generally develop a much more robust protective immune response that will reduce the risk of severe infection, hospitalization, and the risk of death against certain infections." #GeoVax #Biotech #Vaccines #PublicHealth #Healthcare #COVID19 #LifeSciences #Biotechnology #Mpox #GlobalHealth  geovax.com Listen to the podcast here

David Dodd, CEO of GeoVax,  highlights the need for next-generation vaccines, specifically multi-antigen and T cell-focused technologies, to provide better protection for immunocompromised populations. Their pipeline includes a COVID-19 vaccine candidate, an Mpox/Smallpox vaccine, and a gene therapy for solid tumors. A priority for GeoVax is to develop new manufacturing processes to significantly accelerate vaccine production, increase yield, and reduce costs. David explains, "Multi-antigen vaccines become critically important, especially for populations for whom the existing approach in vaccines, meaning single-antigen vaccines or antibody-focused or antibody-only vaccines, is inadequate. And to clarify that, there are approximately 40 million adults in the United States, about 10 times that number worldwide, who suffer from various medical conditions, such as blood cancers. They may have renal disease, diabetes, or be HIV positive. They may also have weakened immune systems, they could have multiple sclerosis or lupus. So there are a host of medical conditions that the result is they inhibit or they deplete an individual's immune system from mounting an adequate antibody response. And keep in mind, the antibody system is that first line of defense when an infectious threat occurs. And that's sort of like the frontline soldiers. They throw up a protective guard to respond to that." "That means for those individuals, what we need to do is also address this, as we develop vaccines, and some technologies allow you to do this. The majority of vaccine platforms do not, unfortunately. And that is to also induce a very strong cellular immunity or T cells. And this becomes critically important because T cells are what clear a virus from the body. It's also what drives what is known as memory, and also gives breadth or robustness of protection. So it becomes critically important that if one has the opportunity because of their technology or the platform they're utilizing to enlist and engage both the antibody as well as the cellular side, then one can generally develop a much more robust protective immune response that will reduce the risk of severe infection, hospitalization, and the risk of death against certain infections." #GeoVax #Biotech #Vaccines #PublicHealth #Healthcare #COVID19 #LifeSciences #Biotechnology #Mpox #GlobalHealth  geovax.com Download the transcript here

Never assume a hospital bill is correct. What's the first thing to ask for? Clark discusses how to handle these bills, and a new way to help get a hospital bill reduced. And speaking of reduced bills, how about a lower heating bill? Clark shares some new innovations to help you Spend Less on home energy.  Lower Hospital Bills: Segment 1 Ask Clark: Segment 2 Lower Energy Bills: Segment 3 Ask Clark: Segment 4 Mentioned on the show: Patient uses AI to reduce hospital bill by 83% - HumbleDollar AI is helping patients fight insurance company denials Can a Patient Advocate Help With Your Medical Bills? Are Extended Warranties Ever Worth It? This paint-like coating lets buildings collect water from the air I tried a sleek new window heat pump that can be installed in less than an hour 10 Ways To Lower Your Heating Bill What Is Service Line Insurance and Do I Need It? Scam Alert: How To Avoid Home Title Theft Home Title Lock: Is It the Same As Home Title Insurance? Clark.com resources: Episode transcripts Community.Clark.com  /  Ask Clark Clark.com daily money newsletter Consumer Action Center Free Helpline: 636-492-5275 Learn more about your ad choices: megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, Dr. Anthony Youn sits down with Beverly Hills plastic surgeon Dr. Kelly Killeen for a refreshingly honest conversation about what really works — and what doesn't — in modern cosmetic surgery. They dig into the truth about breast implants: what's changed over the years, what women should realistically expect, and how doctors are navigating the complex topic of breast implant illness. Dr. Killeen also breaks down the controversy around en bloc capsulectomy in a way that finally makes sense — including when it's necessary and when it may be more hype than help. From there, the conversation moves below the neckline. You'll hear the latest on body contouring procedures, non-surgical skin tightening, and whether those trending “miracle” treatments online actually deliver results. And if you've ever wondered how to find a plastic surgeon you can truly trust, both doctors share the exact questions they'd want their own family members to ask. This is a thoughtful, candid deep dive into cosmetic surgery — focused on safety, honesty, and helping patients make confident, informed decisions about their bodies.

The Breggin Hour with Dr. Peter & Ginger Breggin – Healthcare in the United States increasingly places power in the hands of institutions rather than patients. This piece examines long-standing policy failures, rising prescription costs, and emerging reforms aimed at restoring medical freedom. By reducing middlemen, expanding consumer choice, and strengthening patient control, meaningful healthcare reform begins to take shape...

If you're going to a gym today, be a friend.

Contributor: Aaron Lessen, MD Educational Pearls: The Case 24F brought in for anxiety. Patient is tearful, not talking, and potentially hyperventilating. History from boyfriend is that she suddenly stopped talking and started crying and it was hard to understand what she was saying. On exam, patient appears anxious and has a gaze preference for the right side and is still having difficulty speaking. Decision is made to stroke alert patient. CT shows early MCA stroke and M2 occlusion. Patient is treated by IR with mechanical thrombectomy. What are the risk factors for strokes in young people (

Your team thinks they’re selling braces. They’re wrong. What patients actually buy is certainty. Certainty about cost, timing, next steps, and whether they’re making the right call for their kid or themselves. When you don’t create that certainty fast, you get the same complaints every practice has: they ghosted us, bad lead, they said they needed to think about it, they price-shopped, they no-showed. Here’s what hurts: your leads aren’t bad. Your process leaks certainty. Fix that, and your team won’t need to push harder. They’ll just need to get clear, confident, and better at leading conversations. The kind of leadership that feels like service instead of sales. Get your copy of the Practice Paradox and the Personality Assessment: https://ion.agency/practice-paradox-book The Core Truth — People Don’t Buy Orthodontics. They Buy Certainty. Whether someone is choosing braces, clear aligners, or even deodorant, the psychology stays the same: people move when they feel safe taking the next step. That’s why calls fall apart even when your team says all the right things. If the prospect feels confused, guarded, uneasy, or overwhelmed, you can keep talking. You’ve already lost. Not because they hate you. Because their brain is protecting them from a decision that feels risky. So the question becomes: How do you manufacture certainty, fast, without sounding salesy? Let’s break it into five levers: mindset, voice, speed, follow-up, and simplification. Redefine “Sales” So Your Team Stops Sabotaging It A lot of practices hate the word “sales.” They picture a used-car lot: fake smile, pressure, manipulation, take the money and run. That’s exactly why they struggle. Here’s the reframe: sales isn’t taking. Sales is giving. If your team believes sales is something you do to people, they’ll avoid it, rush it, or apologize for it. If they believe sales is something you do for people (clarifying, guiding, simplifying), they show up differently. Two guardrails matter: integrity and a true desire to help paired with belief that the service will positively impact the patient’s life. Violate those, and you’re back in the version of sales everyone hates. Hold those two guardrails, and closing isn’t predatory. It’s service. Why this matters to certainty: Certainty doesn’t come from convincing. It comes from leadership. People relax when they feel guided by someone who knows what they’re doing and genuinely has their interests in mind. If your team doesn’t buy that idea, every tactic in this article turns into a script. Scripts don’t create certainty. Free Growth Session Certainty Starts With How You Sound — Tone and Tempo Beat Perfect Wording The fastest way to kill a call isn’t the wrong sentence. It’s the wrong cadence. Two things matter most: tonality and tempo. Tone and tempo communicate what words can’t: calm confidence, leadership, empathy, impatience, uncertainty, awkwardness. The Real Phone Skill Is Emotional Control When your scheduler or treatment coordinator sounds rushed, unsure, or overly chirpy, the prospect doesn’t feel guided. They feel processed. And if the prospect doesn’t feel guided, they don’t feel safe. Use Anchoring Questions to Uncover What Creates Certainty for This Person Three questions shift the call from “schedule this” to “understand why this matters.” “How long have you been thinking about straightening your teeth or bringing Johnny in?” This tells you whether they’re a “yesterday” person or a “two years” person. Very different energy, very different barriers. “Why did you feel like now was a good time to address this?” This reveals the trigger: pain, bullying, a dentist referral, a life event, a deadline, a job, a wedding. The trigger is often where certainty lives. “Why did you decide to come see us?” This exposes perceived differentiation or lack of it. It also surfaces competitive context without you sounding defensive. These questions aren’t cute. They build certainty because they make the prospect feel understood. And they give your team leverage to connect the consult to what the person actually cares about. If You Sense Uncertainty, Address It Immediately If someone sounds uneasy, uncertain, confused, or guarded, you can’t just continue your flow and hope it resolves itself. You need to pivot and handle that emotion right now. Or you won’t have their attention for the rest of the call, and you’ll often earn a no-show. Use something playful as a pattern interrupt (something they don’t expect) to regain attention. The point isn’t the exact line. The point is: certainty requires attention, and attention disappears when emotion turns skeptical. The Underrated Skill — Being Comfortable With Silence Most teams panic during silence and start filling space with nervous checking: “Hello?” “Did you get that?” “Can you hear me?” Don’t do that. Embrace the silence. The person just answered an unexpected call. You don’t know what they’re doing. If you can sit through a few seconds, you keep authority and flow. Why this matters to certainty: When you talk like a leader (steady, calm, unhurried), you lend your certainty to the other person. When you sound nervous, you amplify theirs. Speed Is Strategy: Desire Decays Faster Than You Think If you’re treating online leads like they’re 2012 leads, you’re getting cooked. Amazon has trained consumers. If something doesn’t have the two-day delivery vibe, what do people start thinking? “Do I really need this?” “Maybe I’ll find something similar I can get tomorrow.” That same consumer expectation bleeds into choosing an orthodontist. If you don’t respond fast, if it’s hard to schedule, if it takes forever to get clarity, people don’t wait patiently. They move on or talk themselves out of it. The Five-Minute Rule Isn’t Aggressive. It’s Reality. Studies show that if you don’t follow up within five minutes, there’s a 400 percent decrease in ever getting in touch. Calling back within 60 seconds can boost conversions by 391 percent. Whether you obsess over exact numbers or not, the operational takeaway is undeniable: your speed determines whether you’re still top of mind. Here’s what should sting a little: five minutes should be your worst day. Because in a digital world, five minutes can feel like an hour. Nobody submits a form and then sits there doing nothing, waiting for your office to call. They go right back to scrolling, eating dinner, getting pulled into life. And when you finally call, you’re no longer “the answer.” You’re “some unknown number.” Certainty Collapses When You’re Not Top of Mind When your callback is slow, you trigger confusion: “Who is this?” “Where are you calling from?” “Why are you calling me?” That confusion isn’t neutral. Confusion is uncertainty. Uncertainty is delay. Delay becomes ghosting. If you want more conversions, stop treating speed like an operational detail. Speed is part of your sales system. “Bad Leads” Are Often Just Cold Opportunities, and Your Follow-Up Must Match Human Behavior Most practices overuse the term “bad lead” as emotional protection. It feels better to say “they were a bad lead” than “we didn’t create enough certainty fast enough.” Here’s the reframe: a bad lead is someone you truly can’t serve. Someone without teeth, no pulse, extreme mismatch. Everything else? That’s not a bad lead. That’s an opportunity that either isn’t ready yet, lost excitement, didn’t feel safe, or didn’t get enough follow-up to stay warm. It’s not always that the leads are bad. It’s that the opportunities have gone cold. The Simplest Reason Follow-Up Fails — Nobody Answers Unknown Numbers (Including You) Most of us do not pick up calls from numbers we don’t know. So why is your team shocked when prospects don’t answer? This is why you need a specific cadence: call, voicemail, text, email, repeat. That multi-touch pattern creates recognition: “Oh right, I did request that.” It builds association. And it reduces the emotional friction of picking up. Micro-Impressions Before the Consult Decide Whether They Show Up This might be the most overlooked certainty killer in orthodontics: the little irritations that happen before the patient ever meets the doctor. Being put on hold for minutes (feels like forever). The office not answering. Getting disconnected and not being asked for a callback number. Having to call back and re-enter the queue. These micro-impressions create a subtle story in the patient’s mind: “This is going to be a pain.” That story produces uncertainty. Bottom line: If your front-end experience feels clunky, you can’t treatment-coordinate your way out of it in the consult. Free Growth Session Create Certainty in the Consult by Simplifying the Process and the Money Conversation If you want more same-day starts, stop turning the consult into a college lecture. Here’s a real-world example of a practice that aggressively simplified the consult process: 30 minutes total per new patient exam, records done fast (an eight-minute window), doctor in the room for one to two minutes, treatment coordinator does most of the explanation and fee conversation, they deliberately trained and timed the team to move faster, and fee presentation is simple and consistent. The insight isn’t “everyone must do 30-minute exams.” The insight is: complexity creates hesitation. When the doctor spends 20 minutes explaining the science of orthodontics, the patient walks out thinking, “Wow, this is a big deal. I need to go home and digest this.” In other words: you made it feel heavy, risky, and uncertain. Simplification doesn’t mean low quality. It means low friction. Fees — Answer the Real Question Without Overwhelming Them The patient’s number one question at the consult is: “How much is it?” When offices avoid this, they don’t create certainty. They create suspense. And suspense is not your friend in a high-consideration purchase. One practice’s approach: Lead with one simple plan ($300 down and a monthly that stays under $200). Don’t lead with four options. Options create overwhelm. If they ask about pay-in-full, then you introduce that. If $300 today is a barrier, step it down: $150 today and draft the other $150 in one to two weeks. This strategy isn’t about discounting. It’s about making the decision feel manageable. On the Phone — If You Won’t Quote Fees, You Still Must Remove Financing Fear When people hear “payment plans” and “financing,” they often assume interest, credit checks, banks, and paying more over time. So if your team says, “We have great payment plans,” that’s not certainty. That’s vague reassurance. And vague reassurance reads like sales fluff. Instead, proactively clarify: zero percent interest, no credit checks, in-house financing, no banks involved. That removes uncertainty. And when uncertainty drops, people move forward. Stop Trying to Differentiate With Tech Patients Don’t Understand Some practices try to win by talking about technology (CBCT, bonding techniques, fancy bracket systems) as the primary differentiator. The general public has low dental IQ. Most people don’t know what those things are, and they aren’t buying them up front. What are disruptors winning on? Speed, convenience, little resistance, affordability, and a cool brand. You can wow them clinically once they’re in and committed. But at the decision point, patients buy what reduces friction and uncertainty. Practical Takeaways — A Certainty-First Playbook You Can Implement Now You don’t need a new script. You need a new operating system. Here’s a practical checklist, organized by where certainty is won or lost. Phone: Create Certainty in the First 60 Seconds Train the two T’s: tonality and tempo. Start coaching cadence, not just words. Add the three anchoring questions: How long have you been thinking about it? Why now? Why us? The moment you hear uncertainty, pivot and address it. Don’t keep going like nothing happened. Get comfortable with silence. Nervous filler kills authority. Scheduling —Stop the Endless Loop With Wide Net Statements Replace open-ended scheduling chaos with two-option narrowing. “Specific date or day or first available?” “Morning or afternoon?” “1 p.m. or 3 p.m.?” This approach prevents the call from dragging and keeps you leading. Speed — Protect Momentum Like It’s Revenue (Because It Is) Treat five minutes as unacceptable in normal conditions. Aim to call back before they exit the browser whenever possible. Build operational systems that make fast response normal, not heroic. Follow-Up — Assume They Won’t Answer and Build Recognition Anyway Use the cadence: call, voicemail, text, email, repeat. Stop labeling unresponsive people as “bad.” Most are just cold. Clean up micro-impressions: reduce holds, avoid disconnects without callback capture, and tighten the front desk experience. Consult — Simplify Until Decisions Feel Easy Reduce information overload. Don’t make treatment feel like a complicated life event. Standardize a simple fee presentation. Lead with one clear path. Introduce alternatives only if asked. Remove financing uncertainty with clear language (zero percent interest, in-house, no banks, no credit checks). If You Fix Certainty, You Fix Conversion Your practice isn’t competing only on clinical outcomes anymore. You’re competing on how fast you respond, how easy it is to schedule, how confident your team sounds, how predictable your process feels, and whether the patient understands the money without anxiety. People don’t buy braces. They buy certainty. If you want more starts without feeling salesy, stop trying to close harder. Start building a system that makes the next step feel obvious, safe, and simple. That’s what your market is actually demanding now. Free Growth Session The post Patients Keep Saying No? Here’s What You’re Missing appeared first on HIP Creative.

This issue will review: 1.     Evolocumab in Patients without a Previous Myocardial Infarction or Stroke 2.     SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria 3.     Continuous SGLT-2, GLIP-1RA and Frailty Progression in Older Adults with Type 2 Diabetes   4.     Effects of Sodium Glucose Cotransporter 2 Inhibitors by Diabetes Status and Level of Albuminuria 5.     Tirzepatide in Adults With Type 1 Diabetes: A Phase 2 Randomized Placebo-Controlled Clinical Trial 6.     Listening to Hypoglycemia: Voice as a Biomarker for Detection of a Medical Emergency Using Machine Learning Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. For more information about each of ADA's science and medical journals, please visit Diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health

In hour 3, Mark is joined by Richard Porter, a Real Clear Politics Contributor and a Former National Committeeman to the RNC from Illinois. His latest piece in Real Clear Politics is headlined, "Ten Reasons to Cheer the Arrest of Maduro". He is later joined by Matt Kittle, a Senior Elections Correspondent for The Federalist. He discusses his latest piece which is titled, "The Left's Top 25 Lies of 2025". They wrap up the show with the Audio Cut of the Day.

Two dentists can say completely different things and still close the case, so what actually matters? In this episode, Jeff reveals the three factors that truly drive treatment acceptance, with one overlooked mindset shift that changes everything.  The MGE Communication & Sales Seminars - https://www.mgeonline.com/abc 

Interview with Adeeb Al-Quthami, MD

What really happens inside the healthcare system when patients aren't heard — even those with expertise? ⚠️ In this powerful and eye-opening episode, Dr. Eugene Manley Jr., PhD, biomedical scientist and founder of the STEM & Cancer Health Equity (SCHEQ) Foundation, joins Amb. Elisha to expose the realities of medical racism, healthcare disparities, and the urgent need for patient advocacy

Date: December 23, 2025 Reference: Todd et al. Antihypertensive prescription is associated with improved 30-day outcomes for discharged hypertensive emergency department patients. J Am Coll Emerg Physicians Open. 2024 Guest Skeptic: Dr. Mike Pallaci is a Professor of Emergency Medicine at Northeast Ohio Medical University and a Clinical Professor of Emergency Medicine at Ohio University […] The post SGEM#499: Under Pressure – To Start Antihypertensives in Hypertensive ED Patients at Discharge first appeared on The Skeptics Guide to Emergency Medicine.

Information overload crisis — Today's endless data flood overwhelms the mind, triggering instability and reliance on simplistic narratives — ancient meditation practices build the inner stability needed to navigate this chaos clearly Filters create reality — The mind adopts filters to simplify reality into something the conscious mind can process, inevitably removing many critical details while creating a biased and inaccurate perception of reality Rigid divisions — In politics, this filtering causes people on both sides to be rigidly convinced their truth is correct. Likewise, it makes doctors worship vaccines and be unable to recognize the harms of pharmaceuticals, even when their own patients are injured Patient-focused healing — In medicine, many diagnoses can only be made if a physician works to move beyond the filters they were trained in and instead directly see the complexity that each patient brings to the encounter Path to clear perception — Cultivate intuition for key data, recognize source biases, drill to core truths, and expand awareness through nervous system health — all of which are essential for discerning reality in our hyper-connected, impactful era

Pulmonary embolisms don't always announce themselves... sometimes they ambush. One minute your patient is walking with physical therapy, the next they're hypotensive, hypoxic, and coding. This re-released early episode dives deep into why PE patients can look deceptively stable… right up until they aren't.In this episode, I revisit one of my earliest case-based teachings on pulmonary embolism, updated with an added segment on vasopressin use in obstructive shock from PE. Through real bedside stories from my time as a rapid response and ER nurse, we break down the physiology behind PE-related collapse, why intubation isn't always the answer, and how to think through management when the right ventricle is failing in front of you. This is a sobering but essential refresher on one of the most dangerous diagnoses we encounter.Topics discussed in this episode:Why pulmonary embolism is a common cause of in-hospital cardiac arrest (even if it's not common overall)Classic and subtle PE presentations and why they're often missedA real-time rapid response case: stable to crashing in minutesRisk factors for PE and the anticoagulation double-edged swordObstructive shock explained: what's actually killing the patientRight ventricular failure, septal bowing, and the spiral of deathWhy intubation can worsen outcomes in massive PEVasopressors in PE: norepinephrine, epinephrine, and vasopressinThe unique benefits of vasopressin in obstructive shockThrombolysis vs. thrombectomy: when TPA helps — and when it's deadlyBedside echo findings that point to massive PEWhy PE patients can crash during transport (and what to always bring)Nursing vigilance, rapid escalation, and activating help earlyWhen perfect care still isn't enough and the heart of nursing in end-of-life momentsMentioned in this episode:CONNECT

Peripheral artery disease has been called the ‘silent circulatory crisis'—affecting millions, limiting mobility, and quietly raising the risk of heart attack, stroke, and limb loss. For decades, treatment focused on walking programs, aspirin, and sometimes a stent or bypass. But today, the landscape is changing. From PCSK9 inhibitors that drive cholesterol to record lows, to GLP-1 agonists like semaglutide improving walking distance, to novel antithrombotic strategies that balance bleeding and clotting—PAD care is entering a new era. In this episode, we'll explore the breakthroughs, the evidence behind them, and what they mean for patients who just want to keep moving forward." Hosted by the University of Michigan Department of Vascular Surgery: - Robert Beaulieu, Program Director - Frank Davis, Assistant Professor of Surgery - Luciano Delbono, PGY-5 House Officer - Andrew Huang, PGY-4 House Officer - Carolyn Judge, PGY-2 House Officer Learning objectives:  1.  Describe the current evidence-based recommendations for multifactorial medical management of peripheral artery disease (PAD), including lipid, glycemic, and antithrombotic strategies per 2024 SVS/AHA guidelines.  2. Interpret the clinical implications of the FOURIER trial regarding the role of PCSK9 inhibition in reducing cardiovascular events in patients with atherosclerotic disease, including PAD.  3.  Evaluate the emerging role of GLP-1 receptor agonists, such as semaglutide, in improving walking performance and quality of life among patients with diabetic PAD based on findings from the STRIDE trial. Sponsor URL: https://www.goremedical.com/ References:  H. L. Gornik et al., “2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease,” JACC, vol. 83, no. 24, pp. 2497–2604, June 2024, doi: 10.1016/j.jacc.2024.02.013. L. Mazzolai et al., “2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM),” Eur Heart J, vol. 45, no. 36, pp. 3538–3700, Sept. 2024, doi: 10.1093/eurheartj/ehae179. https://pubmed.ncbi.nlm.nih.gov/40169145/ M. S. Sabatine et al., “Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease,” N Engl J Med, vol. 376, no. 18, pp. 1713–1722, May 2017, doi: 10.1056/NEJMoa1615664. https://pubmed.ncbi.nlm.nih.gov/28304224/ M. P. Bonaca et al., “Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial,” Lancet, vol. 405, no. 10489, pp. 1580–1593, May 2025, doi: 10.1016/S0140-6736(25)00509-4. https://pubmed.ncbi.nlm.nih.gov/40169145/ N. E. Hubbard, D. Lim, and K. L. Erickson, “Beef tallow increases the potency of conjugated linoleic acid in the reduction of mouse mammary tumor metastasis,” J Nutr, vol. 136, no. 1, pp. 88–93, Jan. 2006, doi: 10.1093/jn/136.1.88. https://pubmed.ncbi.nlm.nih.gov/16365064/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US