r/medicine

In 2025 there was a preliminary study presented at ASCO 2025 and subsequently published in Cancer Epidemiology that reported a relatively high prevalence of colorectal adenomas, including advanced adenomas, among a small cohort of extreme endurance runners. While the study is clearly hypothesis-generating and not sufficient to establish causality, I found the findings extremely intriguing. Funnily enough, I used to compete in road races on a national level for my country and generally thought I had a healthy diet and lifestyle, but ended up with a tuberous adenoma when I did my colonoscopy at 21 as well. There’s no family history of colorectal cancer on my end.

Anecdotally, have you observed a similar pattern among endurance athletes undergoing colorectal cancer screening? What are your thoughts on the proposed mechanisms such as repeated splanchnic hypoperfusion, alterations in the gut microbiome and chronic inflammation?

I’ve been practicing as an attending for 3 years now mostly outpatient clinic. Almost daily, I have 20 good patients (half great and appreciative, half meh), then there’s one that don’t trust you or is demanding / rude etc. It affects me and I take it personally. Even though deep down I know that 99% it’s a “them, not me issue”, it still makes me doubt my skills and personality like it never has when I was a trainee. and it makes me really dislike being a physician. The medicine itself I don’t have much issue with. And most people would actually describe as very personable as well. But any negative interactions honestly just stays with me for longer than it should. Edit to add that like a lot of hospitals, ours also has a ratings system, which leads to the increased people pleasing.

I think this is burn out? I already take a reduced hour. I see my own PCP for anxiety treatment. I just don’t really know what else to do to stop feeling this way other than leave clinical medicine.

Guys I'm really confused of which one should I buy as an emergency medicine doctor. Online reviews say both are best but ig can you guys help me? I mean you can understand the problems of emergency medicine docs right? So I need the best phone no budgets issues btw. I should use it for many years with no battery problems and heating issues. I'm considering iPhone 17 pro max or S26 ultra. Can you guys help me in suggesting?

I am a junior resident, and I have seen my share bit of ife and death situations, saw a lot of young people passing, a lot of mass trauma incidents, and thev always fueled my stubborness to be better and offer more help in the future. However when I see globa news and see a headline about a missile striking a building killing some dozen people instantly I feel a huge cognitive dissonance, I am studving all that busting my ass to work on a single case, feeling quilt about a single patient coding despite our best efforts, feeling pressure and high stakes all my life and realize some other human decided to wipe out an amount of humans worth a month of workina ai the hospital in just a second? I feel huge disappointment and lose the joy and purpose of the job sometimes. I know i am not supposed to let external news bleed into my life or that I can't contro the global conflicts but that doesn't make the ntrusive thoughts any less painful, any tips?

The complaint document is quite a read, https://www.courtlistener.com/docket/72167653/1/shaw-v-american-academy-of-pediatrics/

TLDR: (submitted Jan. 2026 but see update below)

• claims vaccines harmful
• claims AAP fraudulently makes money promoting harmful vaccines in so many ways, it's a RICO case
• claims AAP is in partnership with vaccine makers
• MDs Paul Thomas, Kenneth Stoller lost licenses over vaccine exemptions, claim reputations harmed by AAP's vaccine agendas
• claims 3 children died due to vaccination. One family stands out: brother and sister twins both presented to ED the day following 18 mo. vaccinations with blue lips and lethargy. Dagnosed with “vaccine reaction”. (Autopsy pending at filing,).

UPDATE: the mother of the twins has just been INDICTED for suffocation of the twins. https://www.eastidahonews.com/2026/07/defense-attorney-questions-murder-charges-in-payette-twins-deaths/

TLDR: Twins apparently D/C’ed to home some time after ED visit. Police called to home a week after vaccination, found both dead, considered suspect. Autopsy details not given but long investigation. Mother's attorney quoted is apparently another experienced vaccine litigator. 

My take:

1. Can't emphasize enough, the legal system does NOT prove medical issues like medical does. The ONLY thing that matters is which side wins the sympathy of the jury. Especially in pediatric cases, “that poor baby” is the mantra to the jury, over and over. As a member of our child abuse team, I’ve been astounded at non-standard crazy opinions that come out of the mouths of paid medical experts hired by defense teams, backed by crappy articles from no-impact journals, yet impressed juries. 
2. Children's Health Defense has a huge legal team with big financial backing that has been successful in past, albeit smaller, vaccine cases. AND
3. I suspect the legal team against AAP will withdraw then resubmit their complaint after removing the twin's mother as a plaintiff. BUT, if the mother is cleared legally, it may make the case against AAP MUCH stronger in the eyes of a jury. Which in turn will have great impact against the AAP, and in turn for those of use who recommend vaccines.

Thoughts? Discuss amongst yourselves!

I’m a dermatologist, been in practice about 3 years. My dad is undergoing a hemicolectomy for colon cancer, and he and my mom have been raving about his colorectal surgeon. What they loved the most is that at his initial consult, the surgeon said “I work for you” and gave them his personal cell number for if they have questions. I know my dad has just randomly texted him multiple times and almost immediately gotten a response. They then scolded me when I told them I never give patients my personal number. I’ve done that maybe once or twice, and it was super specific situations like coming up to a holiday weekend for an older patient I thought might have complications, etc. However this guy must give his out to everyone because my dad’s case is very routine and he’s not some VIP. Is this common?

I wanted to share some changes coming to corneal crosslinking, a sight-saving procedure that treats progressive corneal warpage known as keratoconus.

Keratoconus is a progressive condition that usually starts in the late teens/early 20s. The cornea gradually warps, causing irregular astigmatism, blurred vision, and other problems. Patients typically need expensive hard contact lenses. Those with extreme warpage often need corneal transplantation, which then entails a long recovery period and a host of risks.

Enter crosslinking (CXL). This sight-saving procedure was developed almost 30 years ago. It gained FDA approval in 2016. CXL is a simple procedure where riboflavin is then applied to the cornea under UV light, strengthening the cornea and halting its warpage. When performed early enough in the disease course, it can prevent further progression and even prevent long-term vision loss.

A single company, Avedro, gained FDA approval of both the drug and the UV light device in 2016. Glaukos then bought Avedro. Over time, the cost of the procedure rose from a few hundred to about $5,000 per eye, with surgeons required to purchase riboflavin from the manufacturer in order to obtain a card that would activate the device. This meant you could not obtain compounded riboflavin to save costs.

Insurance coverage has been inconsistent, especially those on Medicaid, which is what most affected patients have when they need CXL.

In the existing "epi-off" CXL, the corneal epithelium is removed at the start of the procedure. Recently, Glaukos has obtained FDA approval for another version of CXL known as "epi-on," meaning the corneal epithelium is not removed. They are raising the price to about $78,000 per eye.

Yes, you heard that right.

Glaukos is also sunsetting its epi-off procedure (while claiming it will allow select patients to continue to access it through an application process). This renders the epi-off devices surgeons purchased largely useless. However, the two procedures are not equivalent; the data suggests epi-off offers advantages in longevity and efficacy over epi-off. A lot of ophthalmologists feel surgeons should be able to determine what's best for their patients and want both procedures to be readily available.

CXL routinely costs around $1,000 per eye in other countries. Many countries have access to a variety of procedures.

Glaukos obtained a Rare Disease Exemption from the FDA, though many of us in the ophthalmology world recognize that the prevalence of keratoconus is much higher than indicated in the outdated studies Glaukos used to pursue RDE status.

Glaukos states that it will use Patient Assistance Programs to ensure patients can access the procedure. But it's not yet clear how this will work for those on Medicaid, nor whether the Patient Access Program has a sunset date. And Glaukos will charge insurance these high rates, meaning the price Glaukos demands will indirectly trickle down to the rest of us. It is scary to think that corporate profits and complex insurance processes may preclude access and lead to preventable blindness.

There is additional concern over how Glaukos may be using CXL to promote optometric scope expansion. Epi-on CXL is arguably an "easier" and less invasive procedure to perform, and unlike epi-off, does not require documentation of disease progression, so it can be theoretically be performed by a wider array of practitioners. But I would argue that accurate diagnosis is still critical. For a time, Glaukos was cross-promoting a corneal topographer (imaging device) with an ectasia display - making it easier to "suspect" keratoconus - but I am of the opinion that this was intended to water down the diagnostic process. Keratoconus can really only be diagnosed by the more-complex tomogrpahy, which requires more skill to interpret.

Ophthalmologists now fear a return to the pre-crosslinking times, where people would routinely go blind from keratoconus. We are concerned that patients will not have ready access to this sight-saving procedure due to the costs and the quirks of insurance, and we are concerned that people will go blind as a result. We are concerned about patients not having access to epi-off crosslinking even if their surgeon determines that they need it.

As a publicly-traded company that has spent money on the R&D to get epi-on CXL FDA-approved, Glaukos is entitled to turn a profit. That is not in question. They are not a non-profit organization. However, the heavy-handed methods they are employing (sunsetting epi-off; raising the price; controlling access to both drug and device) that risk preventing patients from accessing CXL are what is concerning.

Glaukos has been on a PR blitz about this, with numerous articles in ophthalmic journals and posts on physician forums written by their physician consultants supporting the benefits of CXL and praising their patient access efforts. But the devil is in the details, and I am extremely concerned about patient access to this sight-saving procedure now and in the long-term.

Is this now accepted practice? I don’t see any problem with it, but I’m curious 🤷‍♀️

CMS proposed reducing Medicare payments for 340B-acquired drugs from Average Sales Price (ASP) plus 6% to ASP minus 33.4%

https://www.healthcaredive.com/news/regulators-propose-slashing-340b-payments-broadening-site-neutral-policies-2027/824312/

We have gotten 10-12 in the last 24 hours. UHC has implemented an AI chat bot. The calls range from medical record requests to scheduling appts. I've instructed staff to ask to speak to a live agent once they determine its AI. The bot responds that they can do everything a live person can and asks why we do not want to help. My staff again asks for a live agent, and "Avery" gets snarky and says I will let the member know you won't help them. Had one for a patient who hadn't been seen in 5 years and is in collections. Staff let "Avery" know, patient would need to reestablish and pay the balance in order to be seen. "Avery" said "I'll let the member know you could not help today." Then, paused and said "When is the next available appointment for this patient." They've resorted to hanging up when they call. Sure, maybe the AI is more efficient for UHC since they don't have to pay humans to do their dirty work, but it takes about 10 times longer for MY Staff to interact with them. Not going to do it.

Also, who is calling their insurance to schedule an appt? We are a small private practice. Our staff have been here for years and know most of our patients on a first name basis. I instructed my staff to call the next patient personally after "Avery" calls on their behalf to find out if they are indeed calling on their behalf.

Hi All, 

Sharing findings from a new study, "Association of General Practice Continuity With Hospital Admissions and Costs: A Retrospective Study."

Researchers used data from 100,450 patients across 48 general practices in the Netherlands to examine two types of continuity and their associations with urgent hospital admissions and hospital costs. Continuity was measured two ways: by duration of the general practitioner-patient relationship (time registered with the practice) and by how concentrated a patient’s visits were with one physician (density). 

Patients registered with their practice for longer than 5 years had 9% to 21% lower odds of urgent hospital admission and 17% to 28% lower hospital costs compared with those registered for 0 to 5 years. Consistently seeing the same general practitioner was associated with 6% to 7% lower hospital costs, but not with fewer urgent admissions.

Started out in triage that day.

First patient, 20-something female with complaint of "generalized abdominal pain"

Joke to the nurse, "well, this could be just about anything. Let's bring her in and get clocked in for the day"

Patient strides in. Overall she looks well-enough. She's young. Healthy. Physically fit. She smiles at us.

She was two weeks postpartum and was convinced the pain and vomiting were just part of recovering from pregnancy. It had been a remarkable year. She had gotten married, moved here for work, and delivered her first child—a son.

Vitals are stable. Exam is reassuring. No focal tenderness, distension, or rigidity. Nothing appears apparently off.

Then I noticed her eyes

They’re big and impossibly bright.

The kind of eyes that smile at you before the rest of her face did. They were really quite striking.

But then... something isn't quite right about them... are they… just the faintest wash of yellow? Only slightly, one could've believed you were imagining it.

We start the workup. Labs look mostly good but sure enough the bili and LFTs are a little bumped. So we order the CT scan.

As the images become available I scroll through it.

Base of the lungs...hm well, that’s odd...

keep scrolling...

"oh no"

The words leave my mouth involuntarily. My stomach drops

I'm no radiologist. I didn’t need to be.

Read comes back, sure enough metastatic … liver, lungs, lymph nodes... and finding of singular focus, there's a mass in the gallbladder

Those big beautiful eyes stare right through me as I begin to talk. There's disbelief. Surely we're wrong. She's just sick from the pregnancy recovery, right? Her gaze slowly becomes hollow.

As we talk it sets in. We're progressing through stages of grief minute by minute.

There are conversations in medicine that no amount of training ever truly prepares you for. My responsibility was to tell her the truth. My hope was that I could do it without taking away every ounce of hope she still had.

I used every shred of tenderness, kindness, and strength I could muster while trying not to betray my duty to be honest with her. I talk to GI and our oncology diagnostic team to arrange the follow up and go over every detail

---
A few weeks go by and a young patient checks in for fever. Sure enough its her.

She comes in a wheel chair this time. Her obvious physical fitness has become more liken to a skeleton. This time, she does not appear "well-enough". Her eyes are a bit sunken in but still striking even now as she stares, trying to smile through them. HR 135, fever 102. Septic workup starts, she gets admitted.

I add her chart to my list of patients. I look back and she's had a bunch of office visits. She was diagnosed with metastatic cholangiocarcinoma. She's undergoing treatment.

I follow her chart, she ultimately gets discharged in about 8 days.

---
A few months later I'm getting ready to go to the hospital with my wife. We're expecting our son and it's time to go in for induction.

I'm not sure what inspired me while I'm sitting on the spouse's bench/bed in the delivery suite, but it jogs my memory.

So I check back on that patient’s chart. There were a stream of follow ups and treatments after her discharge. There were also a few additional ER visits and some admits.

Then... the office visits, treatments, ER visits and all other notes just... stop.

I'm holding my son now. He's just barely older than her's was when I met her. Sometimes it's hard to fathom how easy it is to take health for granted... and how cruelly that can change.

I’ve forgotten innumerable patients, labs, and CT scans. But I have never forgotten those eyes.

I recently got a letter in the mail about a denied loan application (which I never applied for), because luckily I had recently frozen my credit agencies accounts. I've been trying to defend myself from other attacks, and gemini tells me that there is a risk of someone misusing my NPI and that I should audit my billing. I wanted a reality check on this one from real people. Anyone been in this situation?

My primary job is patient care. I understand a small portion of my job is administrative tasks. I get no protected time to do admin tasks. This means I had to work 80+ hours a week, then fill out your forms. I’m literally just trying to keep my patients and myself alive here. I was elbows deep in someone’s chest when my phone started going crazy because someone desperately needed my attention to some paperwork right the fuck now. Idk what to tell you, I absolutely will not step away from my primary job to do paperwork. May you never appreciate that as much as the family of the guy whose insides I was in today.