Overheard In The Emergency Room

A patient comes in for a laceration on her hand. Simple visit. Then the cuff cycles and the number thatcomes back is 182 over 112. She feels completely fine. No headache, no chest pain, nothing. And now there is a decision to make that is one of the more contested calls in emergency medicine.This is Overheard Journal Club, where I take a single paper I find genuinely interesting, break it down, and tell you how it changed the way I practice. Today it is a 2024 observational cohort study of more than 93,000 discharged emergency department visits carrying a hypertension diagnosis, asking whether an antihypertensive prescription at discharge is associated with better 30-day outcomes.We go through the full PICO, the results, and an honest critical appraisal, including why an adjusted odds ratio that looks dramatic still cannot prove cause and effect. I also explain where I sit relative to the ACEP clinical policy, which is deliberately cautious here, and what I actually do on shift instead of reflexively starting a drug.Key takeaways•  Asymptomatic hypertension is everywhere in theemergency department, and fewer than 1 in 20 of these patients leave with aprescription•  Prescribing at discharge was associated with lower30-day odds of severe adverse events and ED revisits, with no difference inmortality•  This is observational data, so it is a strong signal toengage rather than proof that a prescription is right for everyone•  The ACEP policy warns against rapid pressure reductionin the department, and it is right to do so•  The practical move is structured home monitoring,honest lifestyle counseling, and a values-based conversation about medicationDisclaimerEducational purposes only. This podcast does not provide medical advice and does not establish a physician and patient relationship. Cases are deidentified and altered. Always discuss management decisions with a qualified clinician.LinksCompanion blog and full reference list: https://drcois.com/blog

For most acute musculoskeletal injuries, the patient asks for something strong and we reach for the opioid almost by reflex. But is the opioid actually stronger? In this episode of Overheard Journal Club, I unpack a randomized trial of 600 emergency department patients that compared 5 common oral analgesic combinations, including two with no opioid at all, for acute pain in the arms and legs.The punchline is clean. Every combination dropped pain by about the same amount at 1 and 2 hours. The opioid arms delivered no additional relief and came with more nausea and vomiting, and that is before you count the dependence risk a short trial cannot measure. I walk through the PICO, the results, an honest critical appraisal, and the companion trial that speaks to the patient who is still hurting after first-line treatment. Then I lay out a practical, opioid-sparing default you can use on your next shift.Key Takeaways●   Five oral analgesic combinations produced essentially equal relief for acute musculoskeletal pain at 1 and 2 hours.●   The opioid arms added nausea and vomiting without adding analgesia.●   Ibuprofen plus acetaminophen works through two mechanisms, giving additive relief that competes with low-dose oxycodone.●   Default to the non-opioid combination for acute musculoskeletal pain, and reserve opioids for specific, deliberate indications.DisclaimerEducational purposes only. This podcast does not provide medical advice and does not establish a physician–patient relationship. Always discuss management decisions with a qualified clinician.

One red number at 11 p.m. cansend an otherwise healthy person into a full worst-case spiral before their doctor has even seen the result. In this Season 2 episode, Dr Cois walks through the framework physicians actually use to read a lab report: why a “normal range” isn’t the line between healthy and sick, why 1 in 20 healthy people flag on any given test, why how far out of range a value is matters more than the color of the flag, and the one question that defuses almost any result. This is the home base for the whole Lab Results Explained series, and the episode that makes all the test-specific ones make sense. Companion guide and references at DrCois.com.

Two patients came through the emergency department on the same shift. One waited 9 hours at home with chest pressure. One arrived at 3 am for a splinter. Both made the same mistake: neither had a way to answer the question, do I need to be seen right now, or not?In this episode, Dr. Cois shares the decision framework he uses to triage, simplified for home use. You will learn the one screening question that sorts almost every symptom into three lanes, the red-lane patterns that mean calling 911 immediately, when urgent care is the smarter choice, the tie-breaker rule for genuine uncertainty, and the modifiers that shift you between lanes, including blood thinners, age extremes, and your own gut instinct. It closes with the Tier 1 move that keeps more people out of the emergency department than any symptom list: a primary care doctor who actually knows you.Printable framework and companion guide at DrCois.com. Educational purposes only; this episode does not provide medical advice or establish a physician-patient relationship. If you think you may be having an emergency, call your local emergency number.Key takeaways• Ask one question first: could this seriously harm me inthe next few hours if I do nothing?•  Red lane means call 911, and calling beats drivingbecause the ambulance is the start of treatment•  Amber lane means seen today, usually at urgent care;green lane belongs with your own doctor•  When genuinely unsure, always treat it as the moreserious lane•  A primary care physician who knows you is the singlebest tool for staying out of the ER

For ten years I treated the bougie as a backup — the break-glass tool, Plan B. Then a 2024 systematic review and meta-analysis in Annals of Emergency Medicine made me reconsider whether it should be my first move on every airway.In this episode of Overheard Journal Club, I break down von Hellmann and colleagues’ pooled analysis of 18 studies and 9,151 patients: the headline 11% relative improvement in first-attempt success, the much larger benefit in difficult airways, and the honest caveats — high heterogeneity, low certainty, and a heavy dependence on operator skill. We also unpack the BEAM versus-BOUGIE plot twist that explains why the same tool can look transformative in one trial and useless in another, and I lay out a practical, four-step way to decide whether the bougie belongs in your hand on attempt number one.Key takeaways•  Across 18 studies and 9,151 patients, bougie use was associated with an 11% relative improvement in first-attempt success (RR 1.11).•  The benefit is much larger in difficult airways — Cormack-Lehane grade 3–4 — where the relative risk hit 1.60.•  Certainty is low and heterogeneity is high; the effectdepends heavily on who is holding the bougie.•  The bougie is a standard-geometry tool — keep direct laryngoscopy plus bougie fluent even if your department defaults to hyper-angulated video laryngoscopy.•  With a standard-geometry blade, consider moving the bougie from backup to first-line — then practice it.DisclaimerThis podcast is for educational purposes only. It is not medical advice and does not establish a physician–patient relationship. Always discuss management decisions with a qualified clinician.

A device can win a randomized trial and still be the wrong tool for your environment. In this episode of Overheard Journal Club, Dr Cois takes apart the 2024 JAMA cluster-randomized trial comparing video and direct laryngoscopy across 8,429 operating-room procedures. Video laryngoscopy cut multiple intubation attempts from 7.6 per cent to 1.7 per cent and reduced device-switch failures roughly fifteen-fold, with no increase in airway or dental injury — a large, biologically plausible result. But the trial was single-center, mostly performed by trainees, and used a hyperangulated blade. Dr Cois explains why he agrees with the result for the OR, why he reaches for a standard-geometry blade in the emergency department, and how he keeps his direct laryngoscopy skills sharp for the day the camera fails.•  Video laryngoscopy reduced multiple intubation attemptsversus direct in the OR (1.7% vs 7.6%), with no rise in injury.•  Device-switch failure dropped roughly fifteen-fold with video.•  The trial used a hyperangulated blade — which commits you to a device swap if the camera is contaminated.•  In emergency airways, a standard-geometry blade lets you convert to direct without swapping devices.•  Preserve direct laryngoscopy skills: look down first on low-risk airways, convert to the screen when needed.Disclaimer: This content is for educational purposes only. Itdoes not constitute medical advice and does not establish a physician–patient relationship. Clinicians should rely on their own training, judgment, and local protocols; patients should discuss any management decisions with a qualified clinician.

In January 2025, a New York Times headline announced that fluoride exposure is linked to lower IQ in children. Within days, parents were tossing fluoride toothpaste and buying water filters, and a national political fight reignited over community water fluoridation.The paper behind the headline — Taylor et al, JAMA Pediatrics — is the largest and most rigorous meta-analysis of fluoride and children’s IQ ever assembled. It includes 74 studies and roughly 21,000 children. So it deserves a careful read, not a panicked one. And that’s what this episode is.Dr Cois, an Emergency Physician, breaks the paper down Journal Club style. He walks through the PICO framework — Population, Intervention, Comparator, Outcome — then steps through the three separate analyses inside the paper and explains why they don’t all point in the same direction. You’ll learn where the IQ signal is genuinely concerning (at high exposures), where it gets shaky (at the WHO threshold), and where it essentially disappears (at the levels an American kid actually drinks). You’ll also learn to spot cherry-picking — the influence tactic that takes a true finding, strips away its context, and turns it into a panic headline. And you’ll meet the more US relevant evidence the headlines ignored: the Australian Do et al cohort. Whether you’re a clinician fielding the “should I stop using fluoride?” question, a trainee learning to appraise a meta analysis, or a parent who just wants the truth — this one’s for you.Key takeaways•  The pooled IQ signal is driven largely by high-exposure, high risk-of-bias studies, and is largely absent below 1.5 mg/L in drinking water•  The best-quality data shows roughly one IQ point per 1 mg/L of urinary fluoride — negligible for an individual, debated at population scale•  The authors state plainly that this paper was not designed to address US water fluoridation•  Screen the patients who genuinely face high exposure — private wells, high-fluoride regions, pregnancy, and infancy — and leave the toothpaste aloneDisclaimerThis episode is for educational purposes only. It does not provide medical advice and does not establish a physician patient relationship. Always discuss management decisions with a qualified clinician. Full references are at DrCois.com.

Quick Hits Episode 6. A listener wrote in asking for a framework to read a medical paper — and it could not be timelier. Misinformation has now been ranked the most severe short-term risk facing the world by the World Economic Forum, ahead of armed conflict and cyber attacks. One in four Gen Z respondents turns to TikTok for medical advice, and viral medical content is consistently more likely to be wrong than non-viral content.In this episode, Dr Cois walks through the three-question framework that every medical student is taught — and that he still uses today on every paper he reads. Then he pressure-tests it by walking you through three different studies that have tried to answer the same question: does saturated fat raise your cardiovascular risk? A human-and-overfeeding mechanism study, an umbrella review of cohort data, and a Cochrane meta-analysis of randomised controlled trials — same question, three different weights of evidence, one converging answer.If you have ever wanted to push back on the loudest voice in the room without needing a medical degree, this is your playbook.Key Takeaways•  Misinformation is the #1 short-term global risk; thefirehose is not slowing down•  Three-question framework: study type and journal,funding and authors, PICO•  PICO unpacks to Population, Intervention, Comparator,and Outcome•  The body of evidence is what matters — convergenceacross study designs is the signal•  Five red flags: single studies, surrogate outcomes, relative risk without absolute risk, cherry-picking, and conclusions that don’t match the data•  Your homework: track one social-media health claim back to the paper and run the PICODisclaimerThis podcast is for educational purposes only and does not provide medical advice or establish a physician patient relationship. Always consult a qualified clinician for personal health questions.

My pharmacy tried to charge me $90 for a generic nausea medication. Five minutes later, with a coupon I signed up for in the aisle, I paid $9. Same drug. Same store. Same five minutes.If that sounds impossible — or like a trick — this episode is for you.In Quick Hits Episode 5, I walk you through exactly how prescription drug pricing works in America, who is actually setting the price you pay (hint: not your insurance company, not the pharmacy), and the three-step habit you can use every single time you fill a script.This is one of those moments where a small amount of knowledge gives you real power.•  There is no single “real” price for your medication. Multiple negotiated prices exist, and which one you pay depends entirely on which contract you invoke at the counter.•  Pharmacy Benefit Managers (PBMs) — not your insurance company — do most of the actual price-setting. Three companies control 79% of all U.S. prescription drug claims.•  The “cash price” is almost never the real price. It’s a sticker price designed for patients who don’t know to ask for anything else • GoodRx isn’t cash. It’s a different PBM’s contract you can piggyback on.• Three habits, every prescription: Ask the cash price. Compare on GoodRx and Cost Plus Drugs. Choose the lowest legitimate option.•  The February 2026 PBM reforms are a real step forward — but none of it changes what you pay today.DisclaimerThis podcast is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Always consult your physician or pharmacist regarding your specific situation.

Welcome to Overheard Journal Club. In this new short-form series, ED physician Dr Adrian Cois takes a single paper that's changed how he practises and breaks it down conversationally — PICO, results, critical appraisal, and the practical "so what do I do with this on my next shift" synthesis.First up: SALT-ED. Self and colleagues, NEJM 2018. A pragmatic crossover trial in 13,347 noncritically ill adults asking whether balanced crystalloids beat normal saline as the default IV fluid in the emergency department. The answer reshaped Adrian's reflex — and gave him his favourite pharmacology joke.In this episode: why "normal" saline carries a supraphysiologic chloride load, how the pragmatic crossover design hit 88% adherence without blinding, what the MAKE30 composite outcome actually means, and the short list of hard indications for which saline still earns its place on the IV pole.Key takeaways•  In noncritically ill adults receiving IV fluids in theED, balanced crystalloids reduce major adverse kidney events at 30 dayscompared with saline (NNT 111).•  The mechanism is the supraphysiologic chloride load insaline, which causes hyperchloremic metabolic acidosis.•  Default to lactated Ringer's. Reserve saline for hyperkalemia, traumatic brain injury, hyponatremia, and drug compatibility issues — and even then, keep volumes modest.DisclaimerEducational content only. Not medical advice. Does not establish a physician-patient relationship. Always discuss management decisions with a qualified clinician.

Two vehicles. Same destination. One question: which one will you actually do?If you’ve spent any time on health and fitness social media in the last two years, you’d be forgiven for thinking the only acceptable way to train your VO2 max is to strap on a weighted vest and grind out an hour of Zone 2 cardio every day. That’s what the algorithm is selling. The data tells a very different — and far more forgiving — story.In this Quick Hit, Dr Cois walks through the two evidence backed vehicles for building cardiorespiratory fitness in the average adult: Zone 2 cardio and interval training. Both work. Each has a place. And the choice between them is far more practical than philosophical.You’ll get the conversation test for finding your Zone 2 without a heart rate monitor, a 4-week interval progression that reliably moves the VO2 max needle by 5–10 points, the under prescribed half of the exercise guideline almost nobody is doing, and the simplest predictor of whether you’ll still be exercising a year from now.Plus: a heads-up on what’s coming next — Overheard Journal Club.Key Takeaways•  VO2 max is one of the strongest predictors of long-term health we have• Roughly half of US adults don’t meet even the aerobic activity guideline• Zone 2 is a way, not the way — and it has one underrated strength• Intervals are extraordinarily time-efficient and free up space for strength training• Adherence beats optimisation — the vehicle you’ll actually do is the one that winsDisclaimerEducational content only. Not medical advice. If you are starting a new exercise program, have known cardiovascular disease, or have symptoms with exertion, consult a qualified clinician before beginning.

Welcome to the Season 1 finale of Overheard in the Emergency Room. There's no single ED case anchoring this episode. There are fourteen of them — every patien every story, every lesson we walked through across the season. And rather than introduce one more case and pretend it summarises a whole year of conversations, Dr Cois pulls everything into a single playbook.Five Tier 1 pillars - in the order that actually matters:1. A primary care physician who knows you and screens you (the single most evidence-backed longevity intervention in the literature).2. A whole-plant-predominant diet, with specific steps to build fibre and plant diversity.3. Exercise across three buckets — resistance training, cardiorespiratory fitness, and incidental movement.4. Sleep, treated like your Olympic sport, with four concrete steps.5. Stress management as a clinical skill, practised when calm.Plus a free 16-week Recapture Your Health roadmap PDF at DrCois.com — no email gate, no upsell.If you've been with us since Episode 1, thank you. If you're new, this is a great place to start.🩺 Educational content only. Not medical advice. Cronometer is referenced without anyfinancial relationship.Let's chase less bad days and more good decades together.• A primary care physician isthe single most evidence-backed longevity intervention — more powerful than anysupplement, peptide, or wearable.• Diet, exercise, sleep, and stress management are the four lifestyle pillars that compound across decades - work all four, not one.• Aim for 30–40 g of fiber daily, 30+ unique plant species weekly, and 80% of your plate as whole plant foods.• Exercise has three required buckets: resistance training, cardiorespiratory fitness (Zone 2 + intervals), and incidental movement.• Treat sleep like an Olympicsport. Anchor with wake time, not bedtime.• Stress management is a learnable clinical skill — practise it in calm moments so it is available in real ones.•  Pick one pillar this fortnight. Behaviour change fails when people try to overhaul everything at once.Educational content only. This podcast does not provide medical advice and does not establish a physician–patient relationship. If you have symptoms concerning for a medical condition, please seek care from a qualified clinician.

If you work night shifts, swing shifts, or any schedule that doesn't line up with the sun, this Quick Hit is your sleep playbook. Dr Cois — emergency physician and host of Overheard in the Emergency Room — walks through the evidence-based system he uses for himself and shares with his patients.You'll learn why shift work nudges your long-term risk of diabetes, cardiovascular disease, and other chronic conditions, and exactly what to do about it. The framework: four circadian behaviours (consistent wake time, daily nervous-system regulation, meal timing, pre-shift exercise) plus three environmental levers (cool room, true darkness, noise control). Honourable mentions cover sunglasses on the drive home, alcohol, strategic napping, screen light, sleep apnea screening, and how to use wearables without letting them stress you out.For the deep dive on sleep physiology, the hormone story, and the cohort evidence, listen to Episode 4 of the main season.Key Takeaways•  Shift work raises long-term cardiometabolic and chronic disease risk — but the levers to push back are well-defined.•  Cluster your shifts into blocks rather than scattering one-off nights.•  Stop eating four hours before sleep; cut caffeine in the second half of your shift.•  Exercise hard before your shift to manufacture the morning cortisol spike your body would normally produce on a day schedule.•  Build a daily nervous-system regulation practice — the car meditation is the easiest start.•  Protect your sleep environment: cool, dark, quiet, and household-aligned.Chapter MarkersChapter timestamps are maintained on YouTube as the master version — refer to the YouTube description for a full chapter breakdown.DisclaimerEducational purposes only. This podcast does not provide medical advice and does not establish a physician-patient relationship.

“Dr Cois, I’ve got abdominal pain. What will happen to me when I come to the ED?” It’s one of the most common questions in my inbox — and one of the top 3 reasons people present to my Emergency Department. In this Quick Hit, I walk you through what actually happens when you come in with stomach pain: the conversation we have, the 4 diagnoses we cannot miss, and the bigger story most patients never hear.Inside this episode:•  How emergency physicians use the SOCRATES framework to find the diagnosis before any test is ordered•  The 4 can’t-miss diagnoses — cholecystitis, appendicitis, diverticulitis, and small bowel obstruction — and how each one classically presents•  Non-GI causes of abdominal pain we always consider,including kidney stones, UTIs, aortic emergencies, and mesenteric ischaemia•  Why most recurrent abdominal pain comes back toconstipation, reflux, and non-alcoholic fatty liver disease•  A practical, week-by-week plan to safely increase yourfiber from 15 g to 40 g a day•  Why a CT scan isn’t always the right answer, and how to think about radiation risk in the ER•  The bold takeaway: if we don’t find a life threat, your next step isn’t another scan — it’s your Tier 1 habitsKey Takeaways•  Most abdominal pain in the ER goes home safely•  80% of your plate should be plant foods•  Increase fiber gradually — not 15 g to 40 g overnight•  PPIs are a 2–6 week tool, not a forever medication•  Establish care with a primary care provider for any recurrent abdominal symptomsChapter MarkersChapter timestamps available on the YouTube version of this episode — use that as the master reference.DisclaimerThis episode is for educational purposes only and does not constitute medical advice. If you have symptoms that concern you, please contact your physician or local emergency services.ClosingSend your next Quick Hit question via the contact form at DrCois.com or DM @dr_cois on socials. Fewer bad days. More good decades.

Welcome to the very first Quick Hit — a brand new bonus series from Overheard in the Emergency Room where Dr Cois tackles the questions you’ve been sending in. Short. Focused. Practical. Today: “What actually happens when I walk into the Emergency Department with chest pain?” Dr Cois walks you through the full chest pain workup — why we move so fast, what door-to balloon time means, the three body systems behind every differential (heart, lungs, GI), which tests get ordered and when, and the diagnoses your ED doctor is quietly thinking about even when they don’t mention them. Plus the most important takeaway: when to come in, and what to do after. This is a clinical overview, not a deep evidence dive — but if you’ve ever sat in an ED waiting room wondering what was actually happening, this is the inside view. For the companion blog post and free resources, visit DrCois.com. Key takeaways:●     Chest pain gets immediate attention becausecardiovascular disease is the #1 killer in high-income countries●     Door-to-balloon time is the metric that drives EDurgency around chest pain●     Three main body systems frame every workup: heart,lungs, GI tract●     ECG, troponin, chest X-ray, and bedside echo are theworkhorses; CT angiogram is risk-stratified●     “Musculoskeletal” and “gastritis” are essentiallydiagnoses of exclusion — follow up with your PCP●     If chest pain is new, severe, or doesn’t fit a patternyou recognise: come inEducational content only. Not medical advice. If you are experiencing chest pain, seek emergency care immediately.

The global wellness industry is a 6.8-trillion-dollar business — more than four times the size of global pharma — and it runs on supplements. But how much of it actually has evidence behind it?In Episode 14 of Overheard in the Emergency Room, Dr Adrian Cois — a board-certified Emergency Physician — walks through the published systematic reviews and meta-analyses for the nine most common supplements of 2026. Which ones have genuine evidence? Which ones are selling you a story? And how should you make decisions in a regulatory environment where, under DSHEA, supplements do not have to be proven safe or effective before they hit the shelf?The episode is anchored by two clinical stories: a coworker asking whether any supplement will stop her from getting sick, and an older man on Social Security spending his limited income on a herbal product while eating free meals at a senior centre. In between, Dr Cois breaks down creatine, vitamin D, omega-3, magnesium, and multivitamins — the five with reasonable evidence — and then takes apart NMN, berberine, collagen, and "detox" supplements — four with very thin evidence and very large marketing budgets.The episode also takes on the February 2026 FDA peptide reclassification, explains why BPC-157's evidence base is 35 rat studies and one uncontrolled case series, and closes with a blinded randomised-trial comparison between the Pfizer-BioNTech mRNA COVID vaccine trial and the retatrutide phase 2 obesity trial — revealing why influencers who dismissed the first while promoting the second are holding incoherent evidentiary standards.•  Supplements are Tier 2 by definition. They cannotsubstitute for diet, movement, sleep, stress management, and a primary carephysician.•  Five supplements with reasonable evidence in specificpopulations: creatine (resistance training), vitamin D (deficiency, older adults, prediabetes, pregnancy), omega-3 (specific cardiovascular contexts), magnesium (blood pressure, migraines), multivitamins (older adults with imperfect diets).•  Four with large marketing and small evidence: NMN, berberine (outside metabolic syndrome), collagen, and "detox" protocols.•  The BPC-157 evidence base is 35 preclinical animal studies and one uncontrolled case series in 12 humans. Reclassification by the FDA in 2026 restored access; it did not validate evidence.•  The three-question cabinet audit: Is there a medical reason? Can I name the evidence? What could this money do elsewhere?Note: Final timestamps to be filled in after recording. Use the YouTube chapter block above as the master, then synchronise to Spotify.Companion blog post with full references, evidence tables, and clinician-facing notes at drcois.com.Educational content only. Not medical advice. Always consult your own physician before starting, stopping, or modifying any supplement or medication regimen.

A 35-year-old patient walked into my Emergency Department with diverticulitis — and told me he was eating 2.2 grams of protein per kilogram of body weight per day because he heard it on a podcast. He had rearranged his entire diet around a number that was never meant for him, and in doing so, had displaced the exact foods that would have protected him from the diagnosis he was sitting in front of me with.This episode is the conversation that case deserved. We walk through where the 0.8 g/kg RDA actually came from, why it's a floor rather than a target, and what the real evidence says about protein intake across three distinct populations — healthy adults, athletes, and adults over 65. We cover the landmark Harvard cohort data on plant versus animal protein, the controlled trial showing habitual vegans and omnivores build identical muscle when protein is matched, and the 2025 meta analysis that delivers the single most important finding for your grandparents: protein without resistance training does nothing.Along the way, we break down three myths — the "war on protein," the "plant protein is inferior" claim, and the "more is always better" fallacy — and flag the manipulation tactics behind each one.By the end of this episode, you'll know exactly how much protein you need based on your goals, where it should come from, and why none of it matters without the weights.•      Healthy adults maintaining muscle: 1.0–1.2 g/kg/day•      Adults resistance training: 1.2–1.6 g/kg/day•      Adults over 65: 1.0–1.5 g/kg/day, always with resistance training•      Prioritise plant sources; animal protein as a complement, not the foundation•      Protein without resistance training does not prevent sarcopeniaFor the full reference list, companion blog post, and free resistance training programme templates, visit DrCois.com. If this episode was useful, please share it with someone who's rearranged their diet around a protein number they never needed.Next episode: supplements — what works, what doesn't, and how to tell the difference.

I was running through Forest Park in Portland when the thought hit me. No headphones. Wind in the trees. A creek below the trail. And then, out of nowhere: my two boys might never get to hear this if we let climate change go unchecked.I remember thinking: I’m just an Emergency Room doctor. What can I do about this? It turns out — quite a lot. And in this episode, Dr Cois — Emergency Physician and creator of drcois.com — walks you through the evidence, the framework, and the action. In this episode: --- The clinical disease burden of climate change: air pollution (9 million premature deaths annually), heatwaves (14,800 excess deaths in France in 2003 alone), wildfire smoke, zoonotic infectious disease, and natural disasters — with real emergency department data throughout --- The equity layer: why minority communities, low-income populations, the very old and the very young absorb the greatest burden — and why this belongs in our clinical frame --- The healthcare sector’s own footprint: 8.5% of US national greenhouse gas emissions, the virtual interview carbon savings study from OHSU, and why every procurement decision is a climate decision --- Educate, Mitigate, Advocate: a practical, evidence-based framework for clinicians at every career stage — from the 30-second bedside conversation to tabletop disaster drills, QI sustainability cycles, and vendor contract negotiations--- Diet and deforestation: the EAT-Lancet Commission, red meat, and the co-benefit of eating more plants — for your health and the planet --- Myth 1: EVs are more emissions-intensive than petrol cars — the cherry-picking technique explained, and what cradle-to-grave lifecycle data actually shows--- Myth 2: Regenerative or grass-fed beef is a net environmental benefit — why false balance makes this sound reasonable, and why the full accounting doesn’t support the claim--- Three things this month: for healthcare professionals and for the general public This is not a doomism episode. The physics of this problem is not on our side if we do nothing. But the evidence on what happens when communities and healthcare systems commit to action is genuinely hopeful. We just have to start. There are no healthy humans onan unhealthy planet. Let's chase fewer bad days and more gooddecades together.  Companion blog post + fullreferences at drcois.com

He walked into Bay Four holding eight pages of printed lab results. He was 43, fit, did CrossFit five times a week, and had spent real money on a direct-to-consumer “longevity subscription” panel. His LDL was 170 mg/dL — meaningfully high. When I raised it, he told me it didn’t matter. His LDL fractionation showed mostly large, fluffy particles. Those are the harmless kind. Right? Wrong. And in this episode, Dr Cois — Emergency Physician and creator of drcois.com — explains exactly why — and what the brand-new 2026 ACC/AHA Dyslipidemia Guideline actually says about it.In this episode: --- How the USPSTF develops prevention guidelines: the 5-step evidence review, letter-graded recommendations, and why this is nothing like a social media hot take --- The ADA’s 2026 Standards of Care: when to screen for prediabetes and diabetes, what HbA1c targets mean, and how lifestyle change cuts your risk of progression by 50%--- The 2026 AHA/ACC Dyslipidemia Guideline — five major changes: restored LDL targets (100, 70, and 55 mg/dL by risk tier), the new PREVENT risk equations, Lp(a) screening for all adults, ApoB’s expanded role, and the shift to earlier intervention--- Myth 1: Large fluffy LDL is harmless — what the prospective evidence actually shows, and why ApoB is the more important number--- Myth 2: The “get your labs,b uy our supplements” model — why unregulated supplement recommendations from lab companies represent a structural conflict of interest--- A plain-language guide to every blood test that matters in primary prevention: CBC, CMP, HbA1c, lipid panel, ApoB, Lp(a), TSH, vitamin D, B12, and iron — and how your Tier 1 habits move these numbers--- What to ask your GP at your next appointment Your primary care physician is the original longevity expert. The USPSTF, the ADA, and the AHA have spent years in methodological rigour so that your doctor knows exactly which tests to run, when, and what to do with the results. That system is imperfect. But it is evidence-based, publicly accountable, and not trying to sell you a supplement.Use it. Fewer bad days. More good decades.Companion blog post + full references at drcois.com

She came in on the bus. An 84-year-old woman, independent antwenty years, wa her health for d diligent abouts sitting in my waiting room for four and a half hours with a blood pressure of 222 over 104. Her insurer had dropped her long-standing doctor. The next available appointmentwith a covered provider was five months away. She was on $60 a day. She couldn't afford to pay out of pocket. So her blood pressure medication lapsed.This is preventable. It happens every week. And it is a direct consequence of how the US healthcare system is structured.In this episode, Dr Cois — Emergency Physician and creator of drcois.com — breaks down why the US spends more on healthcare than any other nation and still ranks last on outcomes, and walks through three serious proposals to fix it: Medicare for All, the Trump Great Healthcare Plan, and the EMBRACE plan from Annals of Internal Medicine.In this episode:— Why the US pays $13,500 per person annually — twicepeer nations — for worse outcomes— Five structural drivers of cost: fragmentation,high prices, fee-for-service, the uninsured, and monopolisation— Medicare for All: the Lancet evidence, thetrade-offs, and the political barrier— The Great Healthcare Plan: what the KFF analysissays about what it leaves unanswered— EMBRACE: a tiered universal coverage model with anindependent governance board — and why it may be the most realistic pathforward— Three healthcare reform myths busted with evidence:physician pay, VA quality, and the free market track record— What you should do this week — clinically andpoliticallyThis is a Tier 1 issue. Pillar 5 of our blueprint,s that accessible. For too many Americans, it doesn't.Fewer bad days. More good decades.Companion blog post + full references at drcois.com

The gut microbiome is one of the most talked-about — and most misunderstood — topics in modern health. In this episode, Dr. Cois cuts through the noise with a clear, evidence-based breakdown of what your gut microbiome actually does, how to support it, and why some popular dietary trends may be doing more harm than good.We start in the Emergency Department, where a 33-year-old woman with Crohn's disease arrived in crisis, after following carnivore diet advice she found on social media. It's a case that perfectly illustrates the gap between what the science shows and what goesv iral online.In this episode:• What the gut microbiome is and why microbial diversitymatters• The gut-brain axis — the science behind how your gutaffects your mood, cognition, and mental health• Short-chain fatty acids, butyrate, and why fibre is themost evidence-backed intervention for gut health• Gut microbiome testing — what commercial stool testscan (and can't) tell you• The evidence-based toolkit: fibre, fermented foods,exercise, sleep, and probiotics• Misinformation Watch: applying the prebunking toolkitto the carnivore diet and the 'gut reset' claimCompassionate, nuanced, and grounded in peer-reviewed science — this is the gut health episode you've been waiting for.Free resources at DrCois.com   |  Follow along: @drcoisOverheard in the Emergency Room — fewer bad days, more good decades.

In this episode of *Overheard in the Emergency Room*, Dr. Adrian Cois breaks down one of the most misunderstood medical conditions in modern healthcare: obesity.Starting with a real case from the Emergency Department, we explore why obesity is not a failure of willpower but a chronic, biologically regulated disease. Drawing from major clinical guidelines and landmark studies, this episode walksthrough the science of weight regulation, the role of hormones like leptin and ghrelin, and why the body actively resists weight loss.You’ll also learn about the two‑tier framework for obesity treatment:Tier 1 – Foundational lifestyle interventions including nutrition, exercise, sleep, stress management, and multidisciplinary care.Tier 2 – Evidence‑based medical treatments such as GLP‑1 medications like semaglutide and tirzepatide, as well as bariatric surgery.We examine the data from major randomized controlled trials including STEP‑1 and SURMOUNT‑1, discuss long‑term outcomes from bariatric surgery studies, and tackle an often overlooked issue: weight stigma in healthcare.Finally, we break down common myths promoted by wellness influencers and show how to spot misinformation when it comes to weight loss.If you want to understand the real science of obesity — and what evidence‑based treatment actually looks like — this episode is for you.For free health resources and training guides visit:DrCois.comIf you enjoyed this episode, please follow the show and share it with someone who wants fewer bad days and more good decades.

In this episode, Dr. Cois examines the science behind LDL cholesterol and heart disease. Through a real Emergency Room case, we explore how plaque forms, what ApoB means, why “lower for longer” matters, and how randomized trials have shaped modern prevention.We also tackle common myths about saturated fat and statins — and explain how to spot misinformation online.This is a data-driven, calm, evidence-based breakdown designed to help you makesmarter decisions about your health.Learn more and download free resources at DrCois.com.

In this episode of Overheard in the Emergency Room, we break down metabolic syndrome and type 2 diabetes using a clear, evidence-based two-tier framework.We cover:• What metabolic health actually means• Why diabetes is so common in Australia and the U.S.• The real pathophysiology of insulin resistance• What the best meta-analyses show about diet and lifestyle• Medications like metformin, SGLT2 inhibitors, and GLP‑1 receptor agonists• Prevention strategies that actually scaleNo hype. No diet camps. Just evidence and practical action.Visit www.drcois.com for free resources and episode notes.

A 75‑second guided box breathing reset you can use anytime your body feels stuck in fight‑or‑flight.Inhale 3 • Hold 3 • Exhale 3 • Hold 3 (repeat).Disclaimer:Educational content only; not medical advice. If you have severe symptoms (e.g., chest pain with exertion, fainting, severe shortness of breath, new neurologic symptoms, or thoughts of self-harm), seek urgent medical care or call your local emergency number.

In this episode, Dr Cois breaks down the biology of stress: how your eyes and amygdala can flip the body into fight-or-flight, why panic feels so physical, and what chronic ‘on-edge’ does to sleep, mood, blood pressure, and the gut. Through two ER cases—a first-time panic attack and an 8-year-old with stress-triggered abdominal pain—you’lllearn practical tools to tap the brakes: box breathing, downshift exhales, progressive muscle relaxation, and a 2-minute meditation that even non-meditators can do.Educational only; not medical advice. If symptoms are severe or persistent, seek medical care.Next episode: Metabolic red flags—insulin and glucose.

I flipped from night shifts to days for my kids’ soccer and school events and felt “fine”… until my wearable gave me a literal skull recovery score. That screenshot did what no lecture ever did: it made sleep feel urgent.In this episode, we cover Sleep Basics — what sleep is (NREM/REM cycles), how it’s regulated (sleep pressure + circadian rhythm), and how melatonin, cortisol, light exposure, meal timing, temperature, activity, social schedules, and alcohol shape sleep quality. Then we take a quick world tour of large cohort studies (UK Biobank, MESA, Whitehall II, China Kadoorie Biobank and more), break down a practical “Core Four” circadian habit framework, and finish with an 80/20 Tier 1 sleep plan you can start tonight.We’ll also tee up a later episode that goes deep on shift-work sleep — because nights are a different game with different rules.Educational only — not medical advice. If you have symptoms of a sleep disorder (e.g., loud snoring, witnessed apneas, severe daytime sleepiness), please seek care from a qualified clinician.

G’day team! Episode 3 is all about exercise: what to do, how much to do, and why it matters for living with "less bad days and more good decades".We build around the Two-Tiered Longevity Blueprint:• Tier 1 (foundations): weekly cardio targets, 2 days of strength, and everyday movement (NEAT/steps).• Tier 2 (upgrades): VO₂max work, smarter programming, power/balance as you age, and how athletes train - scaled to real life.We’ll cover the US + Australian physical activity guidelines, the evidence linking cardiorespiratory fitness to lower mortality, why resistance training protects independence (falls + bone density), and an 80/20 weekly plan you can actually stick to.Educational only - this is not personal medical advice. If you have health concerns, talk with your clinician before starting a new program.

In Episode 2 of Overheard in the Emergency Room, Dr. Cois breaks down diet as the first Tier 1 pillar in a two-tier blueprint for longevity. Using real ED cases—including incidental fatty liver and severe hypertension—he explains what major dietary guidelines consistently agree on, why nutrition science often gets misunderstood online, and what the biggest cohort studies reveal about long-term health.You’ll leave with an ED-ready “elevator pitch” for eating well (the 80/20 plate) and a 3-step plan you can start this week: build an anchor meal, do three protein swaps, and create a friction-proof backup plan for busy days.https://youtu.be/c2mJQT109-s

An emergency physician steps out of the resus bay to talk about what really keeps you out of it. Each episode breaks down food, movement, sleep, stress, and the systems around us into clear, practical steps for living longer and better. No shame, no biohacking gimmicks—just evidence, stories from the ER, and habits you can actually stick with.