Overheard In The Emergency Room

About Overheard In The Emergency Room

I'm an emergency physician. I take what I see in the ED and turn it into what you actually need to know to stay out of one. Overheard in the Emergency Room is a show about the evidence behind the advice. Full episodes break a topic down from the ground up. Quick Hits answer your questions in about ten minutes. Overheard Journal Club takes a single paper apart for clinicians and trainees. Whether you're a patient trying to make a real decision about your own health, a student or resident learning to read a paper properly, or a colleague who has been looking after everyone except yourself, there's something here for you. Every case is deidentified. Every claim has a source. No affiliate links, anywhere, ever. New episodes every Friday. Companion blogs, references, and free resources: https://drcois.com Let's chase less bad days and more good decades together.

Publisher

Dr Adrian Cois MD

Category

education · health & fitness · science

Language

en

Explicit

No

First episode

1 Jan 2026

Latest episode

16 Oct 2026

Latest episodes

39 episodes in the feed.

1. 

   16 Oct 2026

   Why Your Vegan Doctor Says It's Okay to Eat Meat!

   Can a vegan doctor tell you it's okay to eat meat? In Episode 39, Dr Cois takes you from the boundary line of a premiership-winning Aussie Rules club, to a rural Australian birth suite at 3 a.m., to an American Emergency Department, and explains how each room shaped the Two-Tier Blueprint. Then he gets to your plate. The 2025 EAT-Lancet Commission's Planetary Health Diet, built on health evidence alone, suggests about 1 serving of red meat a week and could prevent about 15 million premature deaths a year. Health care is itself a significant polluter, and prevention is climate action. You'll hear what the diet looks like, three common objections prebunked, including the protein question, and one practical swap to make this week. Key takeaways You don't need to go vegan: the Planetary Health Diet allows about 1 serving of red meat a week. Fundamentals beat gadgets, on the sports field and in your health. A primary care physician is the closest thing most people have to a performance team. Health care has a large carbon footprint, and prevention shrinks it. Your one thing: swap one red meat meal for a legume meal this week. Disclaimer Educational purposes only. This podcast does not provide medical advice and does not establish a physician-patient relationship. Talk to your own clinician before changing your diet or medications.

2. 

   2 Oct 2026

   The Chest X-Ray Misses 1 in 4 Pneumonias [Journal Club]

   You think your patient has pneumonia, so you order a chest X-ray. Checked against CT, that film misses about 1 in 4 pneumonias. The ultrasound probe beside the bed, in trained hands, catches roughly 9 in 10. In this Overheard Journal Club, Dr Adrian Cois, an Emergency Physician, appraises Chavez and colleagues' 2014 meta-analysis in Respiratory Research: 10 studies, 1,172 adults, 94% sensitivity and 96% specificity. Then he looks under the hood at one study of 32 patients that became 384 data points, a rule-in that wobbles while the rule-out holds, the patients who were excluded, and a 2025 head-to-head update that used CT for everyone. Key takeaways: • A negative scan is lung ultrasound's most trustworthy result:a 30% pretest drops to about 3 to 5% • The 2014 numbers are a ceiling. In the 2025 CT-referencedupdate, ultrasound was 90% sensitive and 91% specific, against 73% and 82% forthe X-ray • B-lines alone are not pneumonia. Look for consolidation, theshred sign, and the dynamic air bronchogram • It all depends on training, and nobody yet knows how much isenough Companion blog, visual walkthrough of every finding, and fullreferences at DrCois.com. Educational purposes only. Not medical advice. No financialrelationships with any ultrasound manufacturer. Let's chase less bad days and more good decades together.

3. 

   25 Sept 2026

   Why Your Doctor Will Not Order a Fasting Insulin Test

   A man in his 40s came to my emergency department on a Sunday morning with an abscess. We drained it, checked his blood sugar because of where the abscess was, and it came back at 440. He went home with antibiotics, metformin, and a diagnosis of type 2 diabetes he had no idea he had. A number like that takes years to arrive. For most of those years, a routine blood test would have looked normal. This episode is about why that happens, and about the one test on your panel that does not care what you had for breakfast. This is episode 2 of Lab Results Explained, the reference series in Overheard in the Emergency Room. I walk through the physiology of insulin and the two very different ways it fails, the 3 tests used to diagnose diabetes and what each one physically measures, the exact diagnostic thresholds, and where the US Preventive Services Task Force and the American Diabetes Association agree and differ on who should be screened. I also take on the loudest claim in online metabolic health, which is that your doctor is deliberately withholding a fasting insulin test that would have caught this years earlier. The biology behind that claim is correct. The conclusion is not, and I explain exactly why using the assay standardization data. And then the part I actually made this episode for: the personal fat threshold, the DiRECT trial, and what remission really means for a condition most people are told is permanent. KEY TAKEAWAYS • An A1c reflects roughly 3 months of blood sugar,because red blood cells live about 120 days. It does not require fasting. • Diabetes thresholds: fasting glucose 126 mg/dL orhigher, A1c 6.5 percent or higher, or a 2-hour glucose of 200 or higher. Prediabetes: 100 to 125, 5.7 to 6.4 percent, or 140 to 199. • Unless the hyperglycemia is unequivocal, a diagnosis needs a confirmatory test. One abnormal number is a reason to test again, not to panic. • The USPSTF recommends screening adults 35 to 70 withoverweight or obesity. The ADA screens everyone from 45, and earlier with risk factors. • Anemia, kidney failure, pregnancy, recent transfusion, and hemoglobin variants can all make an A1c unreliable. Use glucose criteria instead. • Fasting insulin is a real physiological quantity and a legitimate research tool, but assay variation between labs ran from 12 to 66 percent, no society has ratified a diagnostic cutoff, and HOMA-IR is not recommended outside research. • In DiRECT, 46 percent of the intervention group were in remission at 12 months versus 4 percent of controls, and 86 percent of those who lost 15 kg or more went into remission. • The highest-yield action for most listeners is not atest at all. It is having a primary care physician who is looking. DISCLAIMER This episode is for educational purposes only. It does not provide medical advice or establish a physician-patient relationship. The case discussed has been deidentified. If you have symptoms concerning for a medical condition, please seek care from a qualified clinician. All sources are available at DrCois.com, with no affiliate links.

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