Knock Knock, Hi! with the Glaucomfleckens

I've got something serious to get off my chest this week. It's about how Kristin gets treated in the comments section of our own YouTube clips. A recent clip from our episode with Rana Awdish set me off; Kristin talked about the "God complex" in medicine and what happens when patients don't fit neatly into the box the system has for them. The response from some corners of the internet was exactly the kind of misogynistic, dismissive nonsense that proves her point.

So I'm laying out two things I will not tolerate: comments about her appearance or her right to be here, and anyone downplaying her experience as my wife, my business partner, and a co-survivor of my own medical trauma. Kristin has been by my side through two cancer diagnoses and a cardiac arrest. She did the compressions that kept me alive. She's lived the healthcare system from the outside in a way I never could from the inside, and that perspective matters. I explain in this episode why Glaucomflecken couldn't exist without her.

Takeaways:

I will not tolerate misogynistic comments or attacks on Kristin's appearance in our comments section.

Kristin is an equal part of Glaucomflecken, not someone riding my coattails.

Kristin's view of medicine's "God complex" comes directly from real experiences, including being barred from information and support during my hospitalizations.

Medical trauma affects family members and caregivers, not just patients, which is the core of the co-survivorship conversation.

I'd rather lose viewers who disrespect Kristin than keep an audience that won't respect her.

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

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

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If you want more information on models I use:

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

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

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We start with Kristin's ever-escalating sleep setup, my childhood bedtime prayer that explicitly included the possibility of dying in my sleep every night from ages zero to eighteen, and the fact that I then did actually die in my sleep, which, in retrospect, really should have been a tell. The midlife crisis hobby conversation covers mountain biking, beekeeping, Bob Ross-style painting, and acting class, which I have already signed up for and fully expect to enjoy. We also invent CampDash, a concierge service that sets up and takes down your campsite so that tent camping becomes something a normal family can do without spending an entire weekend in misery. Someone else needs to run it.

The second half is a real one about surgeon personalities, specifically, the thing a TikTok surgeon pointed out that I think actually matters: what gets missed in all the characterizations of surgeon ego and God complex is the constant, pervasive worry that surrounds every case. The operating room is the only time all of that goes away, which is why surgeons "just want to operate", it's not arrogance, it's peace. I'm an ophthalmologist doing 12 cases a day, so I operate on a different scale than a neurosurgeon doing one eight-hour case, but I still have particular things I need exactly right: bed height, head position, the scrub tech anticipating my next move. I talk through how surgical complications require the kind of mentorship that nobody trains you for, and how one of the most humanizing videos I ever made came directly from that experience.

Takeaways:

Surgeon personalities aren't just ego. They're largely driven by pre- and post-op worry

Surgical complications are inevitable and the mental recovery from them is something medicine barely addresses

Ophthalmology surgery occupies a different psychological space than high-stakes surgical specialties

Making adult friends in your 40s is legitimately hard

Bedtime prayers that include the possibility of dying in your sleep probably shouldn't be a nightly ritual for children

—

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

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

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

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

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

If you want more information on models I use:

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

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

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Dr. Oz's proposed 2027 CMS rules dropped, and I've been waiting all week to get into them. The push toward value-based care and Accountable Care Organizations continues, but the headline for anyone in private practice is the multiple procedure cut: if you bill an E&M code and a procedure on the same day, Medicare now pays 100% for the more expensive service and only 50% for the other, regardless of modifiers, regardless of whether they're for two totally separate problems. That is a direct assault on independent practices, and every commercial insurer will follow Medicare's lead. There's one small win. Mandating real-time electronic prior authorization across Medicare Advantage, Medicaid, and ACA marketplace plans One head-scratcher...Medicaid work requirements of 80 hours per month starting January 2027, which I suspect will land squarely on physicians' documentation burden. Also, everyone say it with me: physician compensation is 10% of U.S. healthcare expenditure.

After the break, medical malpractice for ophthalmologists. A colleague just came out of a settlement, and it got me looking at the top drivers of ophthalmology lawsuits: cataract surgery complications, missed or delayed retinal detachments, glaucoma management failures, and post-op infections. The uncomfortable truth: the only way to avoid surgical complications is to not operate, and sometimes even perfect communication and documentation don't stop a lawsuit. But they help.
Takeaways:

The proposed 2027 CMS rules would pay only 50% for a second same-day service when an E&M visit is billed alongside a procedure, regardless of modifier, effectively a major reimbursement cut that will hit independent private practices hardest and be adopted by commercial insurers

Physician compensation accounts for just 10% of total U.S. healthcare expenditure, yet Medicare physician reimbursement is cut nearly every year while hospital and insurer reimbursement continues to rise

The 2027 rules push physicians further toward Accountable Care Organizations and value-based care, favoring large health systems and insurers over independent physician-owned practices, with one bright spot: mandatory real-time electronic prior authorization across Medicare Advantage, Medicaid, and ACA plans

The top ophthalmology malpractice risks are cataract surgery complications (posterior capsule tears, retained lens fragments, unfulfilled patient expectations), missed or delayed retinal detachment diagnosis, glaucoma management failures (insufficient IOP monitoring), and post-op infections

Per OMIC, the three biggest drivers of ophthalmology claims are documentation deficiencies, communication gaps, and technical performance, about 60% of claims involve surgical execution errors, and diligent documentation, brutally honest informed consent, and strong physician-patient rapport are the biggest mitigators

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

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

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

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If you want more information on models I use:

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

--

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

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Dr. Rana Awdish is one of those rare humans who can speak from both sides of the hospital bed with complete authority, and somehow make you feel understood in the process. She's a critical care physician whose first book, In Shock, is a landmark medical memoir about becoming critically ill on the last day of her fellowship in her own ICU and it was one of the books that helped Kristin make sense of her own co-survivor experience after my cardiac arrest. Rana's new book is Aftershock: Learning to Reinhabit My Body After Illness, and it picks up where In Shock left off: not the dramatic part, but the harder part, the years of PTSD, the process of learning to trust her own body again, and the realization that medicine doesn't own healing. We talk about her experience of being repeatedly hospitalized in her own ICU, the embodiment work she had to do to unlearn what medical training takes from you, and the specific, extraordinary moment when she was sitting at her window watching snow that looked like dividing cells and understood, with total certainty, that she had cancer, before any test confirmed it. She then tried to schedule her own surgery before the pathology came back. The biopsy came back positive. Her body was right.

Kristin asks us both the question I've been avoiding: is humor a deflection? I can't fully say it isn't. There's a pretty direct line between making a wearable defibrillator comedy video the moment I got home from the hospital and not having fully processed what happened. Rana's concept of "externalizing", putting difficult things outside yourself so they live somewhere other than inside your body, maps uncomfortably well onto what I do. We also get into interoception (a new word for me, as Kristin noted with zero surprise), moral injury, and what Rana would tell healthcare professionals who reflexively dismiss patients who say they know something is wrong. She's a professor at two medical schools, and the line I keep thinking about is this: "There's so much in our training that causes us to believe we have to have the answer or we have no value." This is one you'll want to sit with for a bit. I'm still sitting with it.

Takeaways:

Medicine doesn't own healing.

Humor and creativity can be externalizations as much as they are healing

Interoception, the nervous system's awareness of internal body states, is real, measurable science, not woo

Living with a foreshortened sense of the future is a predictable and poorly-addressed consequence of surviving critical illness

Physicians are trained to function without physical or emotional needs, and the deprogramming required to reconnect with their own bodies is real and difficult

—

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

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

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

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

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

If you want more information on models I use:

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

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

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Two topics today. First, unionization, which is having a real moment in healthcare. Banner Health's hospitalists just formed the largest physician union in Arizona. The Brigham and Women's nurses recently held the largest one-day strike in Massachusetts history. I get into why physicians are so far behind on this, historically we've been independent, and you can't unionize as a practice owner or contractor, and why we're catching up now that companies like Apollo MD, Sound Physicians, SCP Health, and even Optum are employing us.

After the break, another eye drop recall. This one is a big one. 2.5 million bottles of prednisolone from Lupin Pharmaceuticals recalled after a foreign substance was found. Prednisolone is one of the most commonly prescribed drops in ophthalmology and standard after cataract surgery, so this one is going to be felt.

Takeaways:

Physician unionization is accelerating: Banner Health's hospitalists just formed Arizona's largest physician union, and the Brigham and Women's nurses recently held the largest one-day strike in Massachusetts history

Physicians have lagged nurses on unionization because they were historically independent, practice owners and contractors can't unionize, but as more doctors become W2 employees of health systems, private equity groups, and corporations like UnitedHealthcare (the country's largest employer of physicians), unions become both viable and appealing

SCP Health's move to hire displaced Valley Health emergency physicians as 1099 contractors has multiple downstream effects, no benefits obligations for the company, and no legal path to unionization for those doctors

Lupin Pharmaceuticals is recalling 2.5 million bottles of generic prednisolone eye drops after a foreign substance was found; prednisolone is one of the most commonly prescribed post-cataract drops in ophthalmology, so a shortage could disrupt post-op inflammation control

Instead of intra-healthcare-worker infighting, Will's ask is radical transparency from hospitals, actual prices, actual reimbursement rates, actual margins, actual payer contracts, so everyone can see where the money is really going before accepting the argument that one group's raise costs another its own

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

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

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

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If you want more information on models I use:

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