Unstable Vitals

You put on a lead apron and assume it's keeping you safe. But what if it's carrying MRSA, ringworm, and nearly 10 times the bacteria of a gas station pump handle? Even worse, what if nobody's required to clean it?Justin McKay, founder of RadCare Services, joins Dr. Adam Brown and Dr. Lara Zibners to share how a ringworm infection, a torn-up apron on his first day in the OR, and a year of quietly studying hospitals across the country led him to build something the healthcare industry didn't even know it needed: a full-service lead apron cleaning, repair, and compliance program.In this episode, we dig into the disgusting (and dangerous) reality of radiation protection garments in U.S. hospitals from blood and fecal-stained aprons going right back on the rack, to a culture study that found MRSA on the majority of aprons tested. Justin shares the moment a skeptical surgical director called his pitch "snake oil," so he tested her busiest surgeon's apron on the spot. The results were jaw-dropping.We also talk about the uphill battle of building a business around a problem no one is required to fix, why financial incentives in healthcare make or break innovation, and what gives Justin hope for the future of medicine.In this episode:Why hospital lead aprons are virtually unregulated for cleanliness in the U.S.The ATP test that proved aprons are nearly 10x dirtier than gas pump handlesHow a 2017 lawsuit tied defective PPE to cancer deaths among OR staffThe founder's journey: quitting a VP of sales job, two years without a paycheck, and bootstrapping a new businessFollow Unstable Vitals:LinkedInInstagramYoutube

In this episode of Unstable Vitals, Dr. Adam Brown and Dr. Lara Zibners are joined by a very special guest, Lara's husband, Robert Pinate, a nurse consultant with over 30 years in UK emergency medicine.Rob helps emergency departments rethink outdated workflows and improve patient flow. The conversation dives into how the NHS actually works from its funding model and workforce of to the freedom clinicians feel when billing isn't part of the equation. Rob breaks down the rapid assessment and treatment model he champions, the culture shock of implementing America's Epic EHR in a system that doesn't bill, and what it's like walking into struggling hospitals that feel like they've regressed.The trio explores the sobering parallels between the NHS's decline after years of austerity and the growing cracks in the U.S. system, from Medicare cuts to frontline burnout. But it's not all doom. Rob shares where he's seeing improvement and makes the case that sometimes all it takes is pulling the right people off the floor, handing them a blank sheet of paper, and asking: how can we do this better?

What happens when a Canadian finance guy with zero healthcare experience decides to take on one of the most broken systems in the world? You get Alex Barrett, co-founder and CEO of Meroka, and a genuinely different perspective on why independent medicine is dying and what can actually be done about it.In this episode, Drs. Lara Zibners and Adam Brown sit down with Alex to unpack the real force behind healthcare consolidation, and it's not the "silver tsunami" you keep hearing about. CMS reimbursement rates have been essentially flat since 2002 while costs have surged, making the business model of running an independent practice quietly unsustainable for thousands of physicians across the country.Alex shares how Meroka is building a third exit path for retiring physicians, one that keeps practices out of private equity hands and transfers ownership to the staff who actually do the work. But the conversation goes deeper: Why does the only OB delivering babies in a 100-mile radius in rural West Virginia still have no negotiating power? Why are non-compete clauses one of the biggest hidden barriers to independent medicine? And is the system so broken it simply can't be fixed?Spoiler: Alex doesn't think so.Listen now.

Dr. Adam Brown and Dr. Lara Zibners are back for Season 2 of Unstable Vitals, and they're wasting no time. After catching up on life, including Laura's Arctic Circle dog sledding adventure, Adam's new London life, Calla Lily's first Big Pharma partnership, and a spirited rant about Yorkshire pudding, the duo lays out their ambitious plan for the season ahead.This episode introduces the "Five P's" framework that will guide Season 2: Politicians/Policymakers, People (patients), Providers, Payers, and Producers. They argue that fixing America's broken healthcare system requires engaging all five groups, and they plan to do exactly that through conversations with health tech founders, clinical innovators, device executives, regulators, and investors.From the cost of estrogen gel in Europe vs. the U.S. to why walking to the grocery store might be better healthcare policy than anything coming out of Washington, this season promises to be equal parts hilarious and eye-opening.Topics covered:The "Five P's" of healthcare: the season's guiding frameworkPublic transportation, walkability, and downstream population healthLifestyle medicine and transatlantic perspectives on healthcare costsA preview of Season 2 guests and episodesWhat Adam and Lara have been up to since last seasonFollow Unstable Vitals on LinkedIn to stay connected.

In this special year-end episode of Unstable Vitals, Dr. Lara Zibners and Dr. Adam Brown reunite for their funniest, most unfiltered conversation yet. From GLP-1 mania to AI hype, from the workforce crisis to the seismic impacts of the 2025 election, Lara and Adam break down the five biggest healthcare stories of the year, with the honesty and occasional oversharing you’ve come to expect.Along the way, they revisit their favorite moments from Season 1, reflect on personal wins, and look ahead to what excites and terrifies them most about 2026. They also talk negotiations, vaccine misinformation, reproductive rights, and why you should always travel with spare underwear.Lara and Adam close out 2025 exactly the way they started it: unstable, opinionated, and determined to make healthcare a little less chaotic, one candid conversation at a time.

In this episode of Unstable Vitals, we sit down with Mac Deford, former local government attorney, community advocate, and congressional candidate from South Carolina. From his time in the Coast Guard to his work in behavioral health and affordable housing, Mac has seen firsthand how policy decisions ripple through people’s lives.We talk about what inspired him to run for Congress, the realities of healthcare and housing access in South Carolina, and why public service still matters, even when the system feels a little… unstable.

In this episode of Unstable Vitals, Dr. Lara Zibners and Dr. Adam Brown welcome Alison Fragale, organizational psychologist, professor, and author of Likeable Badass, to talk about the science of respect, influence, and why women in leadership still face steep uphill battles.From trading nail files for shoes to unpacking why “likeable” and “badass” aren’t opposites, this conversation dives into how gender bias shapes pay, leadership, and culture, and what can be done to change it.Alison breaks down the psychology behind earning respect and why bias isn’t just a “men vs. women” problem. Lara and Adam bring it home with real-world reflections on mentorship and what it means to balance warmth and authority in a system that often rewards the opposite.Smart psychology, unfiltered honesty, and a little bit of chaos the Unstable Vitals way.

In this episode of Unstable Vitals, hosts Dr. Adam Brown and Dr. Lara Zibners sit down with orthopedic surgeon, researcher, and author Dr. Jocelyn Wittstein. Together, they dig into an often-overlooked area of medicine: bone and joint health as the foundation for long-term wellness.Dr. Wittstein shares insights from her new book, The Complete Bone and Joint Health Plan, exploring why osteoporosis and arthritis are more than “aging problems” — they’re critical, preventable drivers of disability that ripple into cardiovascular health, cognitive decline, and overall quality of life. The conversation covers:Why mobility is medicine and how preventing fractures protects independence.The evidence (and myths) behind supplements like glucosamine, collagen, and more.How proactive, cross-specialty care (from hormone therapy to strength training) can reduce complications and extend healthy years.Dr. Wittstein’s journey as one of the 6% of women in orthopedics, and how her perspective shapes both her practice and her advocacy for women’s health.Blending humor, real-life stories, and evidence-based strategies, this episode shines a light on the connection between musculoskeletal health and the stability of our entire healthcare system.

In this episode of Unstable Vitals, Dr. Adam Brown and Dr. Lara Zibners welcome Dr. Steven Farmer, former senior leader at the Center for Medicare and Medicaid Innovation (and Adam’s husband).Between playful banter and sharp commentary, the trio dives into the serious business of healthcare regulation: why the U.S. system remains unaffordable, how payment models shape medical practice, and what it really takes to shift toward value-based care. From international adventures to bundled payments, Dr. Farmer shares his unique journey through medicine, policy, and innovation—sprinkled with equal parts humor and frustration.If you’ve ever wondered how regulation, incentives, and a little bit of “gaming the system” affect the care you receive, this is the episode for you.

Trigger warning: This episode contains discussion of physician mental health  and suicide. If this topic is distressing, please consider listening with support nearby or using local mental health resources.In this episode of Unstable Vitals, hosts Dr. Adam Brown and Dr. Lara Zibners sit down with Dr. Stefanie Simmons, Chief Medical Officer of the Dr. Lorna Breen Heroes' Foundation, for an urgent, unfiltered conversation about the mental health crisis in medicine. Timed for National Physician Suicide Awareness Day (September 17), the episode explores why clinicians—especially emergency and critical care providers—face elevated rates of burnout, depression, and suicide; the systemic barriers that keep clinicians from seeking help; and concrete policy and operational changes that can begin to “heal the healers.”Dr. Simmons explains the Foundation’s work that’s shifting culture and protections for clinicians. The hosts bring personal stories from residency and frontline care to highlight how stigma, intrusive application questions, and unsafe workplace systems drive clinicians away from care. This episode is essential listening for physicians, nurses, hospital leaders, policy makers, and anyone who cares about the future of the healthcare workforce.Subscribe to Unstable Vitals, share this episode to raise awareness, and consider supporting clinician wellbeing efforts in your organization.

In this episode of Unstable Vitals, Dr. Adam Brown and Dr. Lara Zibners dive into one of the biggest challenges in healthcare today: misaligned incentives. Should our system prioritize profit or patients? How do payment models, public policy, and personal responsibility collide to shape health outcomes?From fee-for-service vs. value-based care to the impact of public transportation, food policy, and behavioral nudges, Adam and Lara unpack the hidden forces driving both innovation and inequity in modern medicine. Along the way, they share personal stories, debate policy trade-offs, and explore how we can make healthy choices easier, care more accessible, and incentives better aligned, without sacrificing innovation.If you’ve ever wondered why our healthcare system feels broken (and what it would take to fix it) this episode is for you.🎧 Listen now to hear:Why profit-driven incentives often work against patient healthHow public health policies intersect with economic growthThe promise and pitfalls of value-based careBehavioral nudges  and making healthy choices easierWhy doctors need to understand the business of healthcareListen to Part 1 before diving into Part 2.

Why is the U.S. healthcare system so expensive, yet so ineffective? In this episode of Unstable Vitals, Dr. Adam Brown and Dr. Lara Zibners dive deep into the tangled web of patients, profits, and misaligned incentives driving instability in American healthcare.From skyrocketing medical school debt and low primary care reimbursements to insurance company profits and hospital billing practices, Adam and Lara expose the financial forces shaping how (and if) patients receive care. They compare the U.S. system to models in the U.K. and Europe, exploring why Americans pay more but live shorter, less healthy lives.This episode tackles big questions, like:Why do we prioritize treating illness over preventing it?How do insurance companies profit while patients struggle with medical bills?What does “health” actually mean and who gets to decide?Can we fix a system where profit often outweighs patient care?If you’ve ever wondered why navigating healthcare feels so complicated, or why the U.S. spends more per person on healthcare than any other developed nation but ranks lower in life expectancy, this conversation is a must-listen.

Residency: the rite of passage every doctor must survive before practicing on their own. But is the system built to train (or to break) young physicians?In this episode of Unstable Vitals, Dr. Laura Zibners and Dr. Adam Brown sit down with Dr. Jared Dashevsky, a resident physician at Mount Sinai and founder of Healthcare Huddle, to unpack the realities of residency and what it reveals about the larger instability in U.S. healthcare.From 80-hour work weeks and six-figure medical school debt to the high-stakes “Match” process and the infamous July 1st turnover, we dive into the pressures that shape doctors before they even become attendings. Jared shares his perspective as a third-year resident, new father, and healthcare communicator, offering an unfiltered look at the sacrifices, frustrations, and occasional absurdities of residency life.Along the way, we ask:Is the residency system outdated?How do pay disparities and debt burden destabilize medicine?What changes could make training more sustainable for doctors and the patients they serve?Whether you’re in medicine, thinking about it, or just want to understand what’s behind the curtain, this conversation exposes the cracks in the system and why they matter for all of us.

In this episode of Unstable Vitals, we dive into a staggering truth: women make 80% of healthcare decisions, yet only 4% of R&D dollars focus on women’s health. Dr. Marina Gerner, award-winning journalist, author of The Vagina Business, and professional myth-buster, joins Dr. Lara Zibners and Dr. Adam Brown to unpack why the system is built on male-centric research, why funding for women’s health innovations still lags behind, and how centuries of normalized female pain have kept progress stalled.From the under-research of PMS compared to erectile dysfunction to the under-researched effects of blockbuster drugs like Ozempic, we pull back the curtain on the biases, blind spots, and investment taboos that keep women’s health unstable. 

Can we really Make America Healthy Again?In this dynamic and slightly unconventional episode, our hosts Dr. Adam Brown and Dr. Lara Zibners combine a spin class with a candid conversation on the fragility of the American public health system. As they pedal through pop hits and resistance levels, they dig into the recent political shifts shaking up healthcare leadership, namely the appointment of RFK Jr. and others with controversial public health views. They challenge the legitimacy of decisions like dismantling vaccine review boards and appointing science skeptics to positions of power, all while reinforcing the importance of evidence-based healthcare policy.Beyond politics, the conversation expands into the broader social determinants of health, including how infrastructure, socioeconomic status, and nutrition access influence America's wellbeing. They contrast Europe’s walkable cities and food transparency with the U.S.’s car dependency and ultra-processed diets. Whether you're on a bike or a walk, this episode will get your heart rate up.

In this episode of Unstable Vitals, ER docs-turned-entrepreneurs Dr. Adam Brown and Dr. Lara Zibners sit down with Dr. Owais Durrani — emergency physician, media personality, STEM advocate, and Coldplay superfan — for an unfiltered conversation that flies from fighter jets to frontline care. A first-generation college student, Dr. Durrani shares how his lived experiences shaped his passion for equitable healthcare, science education, and public policy.They unpack the harsh realities of an unstable U.S. healthcare system, the impact of funding cuts on STEM initiatives, and why inspiring the next generation of scientists matters more than ever. Oh, and yes, Coldplay and sh*t golfer names all make an appearance.

In this episode of Unstable Vitals, hosts Dr. Adam Brown and Dr. Lara Zibners sit down with Dr. Melissa Parsons, a former top pediatrician turned life coach, to unpack the emotional cost of surviving in the healthcare system. Melissa shares her deeply personal journey from burnout and perfectionism to finding healing through coaching, vulnerability, and letting go of the unrealistic expectations placed on physicians. Melissa walks us through the moment she realized she needed help—and how that decision transformed her life.Together, the trio explores the culture of silence and shame in medicine, especially around mental health, and the dangerous separation of emotional and physical well-being. They confront the damaging myths doctors are taught: that resilience means suppression, that rest is weakness, and that showing emotion is unprofessional. The episode tackles physician burnout, systemic failures, and the urgent need to create a healthcare system that supports its healers.

In this special episode of Unstable Vitals, your hosts Dr. Adam Brown and Dr. Lara Zibners dive into their experience at the HLTH Europe conference in Amsterdam — a dynamic, innovation-driven gathering for health tech startups, investors, and industry leaders. They share what made the event stand out, from the high-energy networking and startup pitches to the unconventional amenities like on-site massages, ginger shots, and even a roaming unicorn mascot named Petunia. As founders and participants, they reflect on how the event compared to traditional medical conferences and discuss the importance of early strategy, branding, and planning for startup success.Beyond the booths and business cards, the episode captures the human side of attending a global health innovation conference. This includes bonding dinners, the emotions of pitching on stage, and surprise bird poop attacks (yes, you read that right). Whether you're a founder, clinician, or just curious about what really happens behind the scenes at one of Europe's most impactful healthcare events, this episode delivers a mix of insight, inspiration, and chaos.The full video version can be watched here: https://www.youtube.com/watch?v=C2XcPo_3Pnc

Episode 2 of Unstable Vitals features hosts Dr. Lara Zibners and Dr. Adam Brown, as they offer an unfiltered and often humorous look into the realities of emergency medicine. They delve into why people are so fascinated by ER stories, particularly the more bizarre and gruesome ones, a common question they face at social gatherings. The hosts share personal anecdotes, from gross medical incidents like "code browns" involving bodily fluids, to lighthearted pranks played among hospital staff.The discussion also highlights the critical role of nurses in the ER, with both hosts sharing heartfelt stories of how nurses have been instrumental in patient care and their own professional development. They explore the unique team dynamic that often exists in the emergency department, emphasizing the need for mutual respect and collaboration when facing extreme situations. The episode also includes amusing tales and the odd challenges of working in such a high-pressure, unpredictable environment.

In our debut episode, meet your hosts—two ER doctors turned health policy nerds—who are fed up with pretending everything’s fine in healthcare when it’s clearly… not. From government chaos to moral injury in medicine, we kick off with a candid (and sometimes hilarious) look at why the system feels broken and what inspired us to start this podcast.We dive into:Why DC’s silence is anything but quietHow we met (shout out, UNC!)Why instability isn’t the end—it’s the start of something realWhat we’ve seen across U.S. and U.K. healthcare systemsThe absurdity of public service layoffs, burnout, and corporate creepAnd yes, the origin of our name—including a very real code brown momentIf you’ve ever felt disoriented navigating the healthcare system—from inside or out—you’re not alone. We're here to pull back the curtain, talk about what’s actually happening, and invite the brilliant, bold, and brave to help us make sense of the madness.