AFP: American Family Physician Podcast

Episode 243 — December 2025, Part 1
Release Date: December 15, 2025
Hosts: Dr. Steve Brown, Dr. Chiso, Dr. Austin
Produced by: University of Arizona College of Medicine–Phoenix, Family Medicine Residency

Episode Overview

This episode covers high-yield clinical updates and guidelines relevant to family medicine, including cancer screening in older adults, digital tools for sleep apnea detection, GI protection with NSAIDs, hemorrhoid management, late pregnancy bleeding emergencies, intensive glucose control in older adults, and a festive segment on ICD-10 codes for holiday mishaps. The hosts combine evidence-based insights with conversational humor in this holiday-themed wrap-up.

Segments & Key Discussion Points

1. Cancer Screening in Older Adults

(00:34–05:13)

• Main Message: Evaluate the appropriateness of continued cancer screening for older adults based on individualized life expectancy, comorbidities, and patient goals—not age alone.
• Key Insights:
  • Screening benefits like reduced mortality from breast and colorectal cancer take 8–10 years to accrue.
  • “If a patient's life expectancy is limited, like because of comorbidities or frailty, then the patient may endure the immediate harms of screening…long before they could have any benefit.” — Steve, (02:01)
  • Over-screening may cause more harm (false positives, unnecessary procedures) than benefit.
  • Assess each patient’s overall health, not just age (e.g., a healthy 78-year-old might benefit, while a younger but frail patient may not).
  • Guideline: The American Geriatric Society recommends cancer screening only for adults with ≥10-year life expectancy.
  • Check prior screening history; avoid redundant screening.
  • Lung and prostate cancer screening yield is low in older adults (e.g., NNS for lung cancer >320).
  • For prostate cancer, screening men over 70 is not recommended by the USPSTF or American Urological Association.
  • Emphasis on shared decision-making and respecting patient values.
• Memorable Quote:
  “Rather than operating on autopilot, have a clear conversation regarding whether it’s necessary to go forward with screening in the first place.” — Chiso (02:39)

2. Digital Diagnostic Tools: Samsung Health Monitor for Sleep Apnea

(05:13–07:29)

• Main Message: Wearables like the Samsung Health Monitor show promise in identifying obstructive sleep apnea (OSA) risk, but cannot replace gold-standard sleep studies.
• Key Insights:
  • Samsung Smart Watch app is FDA-authorized to market OSA detection features.
  • 2024 study: Shows an area under the curve >0.8 for detecting moderate/severe OSA.
  • Using with Questionnaires: Combining device data with STOP-BANG or Berlin questionnaires increased diagnostic value (positive likelihood ratios >20).
  • Limitations: Device variability, proprietary algorithms, and lack of airway assessment; not sufficient for therapy titration or definitive diagnosis.
  • Clinical Take: Best used to engage patients and triage for formal evaluation.
• Memorable Quote:
  “While this app is not a replacement for polysomnography, the watches may help engage patients and triage among the patients that might need a sleep study.” — Steve (06:41)

3. Cochrane Review: PPIs for NSAID-Induced GI Protection

(07:29–09:43)

• Main Message: Proton pump inhibitors (PPIs) are effective for preventing NSAID-related gastric and duodenal ulcers; evidence for superiority over H2 blockers or misoprostol is inconclusive.
• Key Insights:
  • Review: In >8,700 patients, PPIs modestly reduce dyspepsia and improve quality of life; NNT = 12 over 3–6 months for preventing an ulcer.
  • PPIs vs Other Agents: Low-quality evidence suggests possible higher ulcer risk with PPIs vs H2 blockers/misoprostol, but PPIs more tolerable.
  • Guideline: ACG recommends PPIs with NSAIDs, or consider selective COX2 inhibitors.
• Memorable Quote:
  “For most patients on long term NSAIDs, PPIs are a reasonable choice for GI protection. But we should individualize therapy, especially in high risk patients.” — Austin (09:11)

4. Practice Guideline: Management of Hemorrhoids

(09:43–11:29)

• Main Message: Evidence-based approach focuses on fiber, topical agents, and minimally invasive procedures for persistent symptoms.
• Key Insights:
  • Fiber Intake: Increases decrease persistent symptoms by 53%.
  • Topical Agents: OTC creams improve pan, itch, swelling.
  • First-Line Intervention: Rubber band ligation is better than surgical removal (less pain, fewer complications).
  • Alternatives: Sclerotherapy and excisional surgery for refractory cases.
  • Avoid: Stapled hemorrhoidopexy as first-line.
  • Guideline Quality: Perfect G Trust score due to transparency and lack of COI.
• Memorable Quote:
  “In patients with hemorrhoids, treat underlying constipation. Increasing fiber intake decreases persistent symptoms by 53%.” — Austin (10:40)

5. Late Pregnancy Bleeding: Emergencies & Management

(11:29–16:03)

• Main Message: Rapid diagnosis and management of late pregnancy bleeding (post-20wks) are essential to maternal and fetal safety.
• Key Insights:
  • Initial Workup: Assess vitals, fetal monitoring, STI/UA, avoid digital cervical exam without placental location.
  • Placental Abruption: Classic triad (bleeding, pain, hypertonia) only in 10%; remains a clinical diagnosis. Monitor all trauma cases.
  • Placenta Previa: Painless bleeding, diagnosed on ultrasound. Manage hospitalization as indicated; schedule cesarean if persists past 32 weeks.
  • Vasa Previa: Catastrophic if undiagnosed; use Doppler at 32 weeks for at-risk patients. Elective cesarean recommended if diagnosed prenatally.
  • Uterine Rupture: Presents with fetal distress, abdominal changes; immediate cesarean needed.
  • General measure: Have hemorrhage, type and cross, IV access ready; consider steroids if preterm—but do not delay delivery for steroids.
• Memorable Quote:
  “In the setting of non-reassuring fetal monitoring, abruption should always be on your differential.” — Steve (12:59)

6. Intensive Glucose Control in Older Patients with Diabetes

(16:03–19:21)

• Main Message: Less intensive A1C targets (~7.5-8.5%) improve outcomes for older adults; avoid hypoglycemia and overtreatment.
• Key Insights:
  • Case Example: Overmedication led to dizziness, confusion, and falls in an older patient.
  • Background: 75% Americans >65 have diabetes or prediabetes with current definitions.
  • Evidence: Intensive control does not reduce macrovascular events or increase longevity; increases mortality (ACCORD trial).
  • Risks of Hypoglycemia: Increased falls, cognitive/functional decline.
  • Continuous Glucose Monitors: Unclear benefit for non-insulin users; questionable ADA guidance due to conflict of interest.
  • Takeaway: “Treat the patient, not the numbers.” Favor moderate control and minimize meds in stable older patients.
• Memorable Quotes:
  • “Intensive glucose control does not increase longevity and does not improve macrovascular outcomes.” — Steve (17:24)
  • “Continuous glucose monitors in older patients not taking insulin has not been shown to be beneficial and may cause harm.” — Chiso (18:35)
  • “Less is more.” — Steve (19:21)

7. Holiday ICD-10 Codes (Festive Wrap-up)

(19:32–23:33)

• Main Message: Light-hearted, humorous segment listing amusing and oddly specific holiday-related ICD-10 codes.
• Notable Codes Mentioned:
  • Paper cut: W26.2XXA
  • Hoarseness from caroling: R49.0
  • Shopping mall injury: V92.59
  • Skier colliding with object: V00.322
  • Accidents on ski lifts: V98.3
  • Burn by candle: X08.8
  • Dizziness from dreidel: R42
  • Injury “run over by Santa’s sleigh”: V81
  • Air rifle eye injury (“You’ll shoot your eye out!”): S05.90XA
  • Poisoning from mistletoe: T63.79
  • Scrooge’s irritability: R45.4 and financial hardship: Z59.87
  • Visual disturbances after ghost visits: H53
  • Lack of relaxation & leisure: Z73.2
• Memorable Banter:
  “The Muppet Christmas Carol might be the best version.” — Austin (22:59)
  “Thanks to everyone working to take care of patients over the holidays.” — Chiso (23:33)

Notable Quotes

• "Rather than operating on autopilot, have a clear conversation regarding whether it’s necessary to go forward with screening in the first place." — Chiso (02:39)
• "For most patients on long term NSAIDs, PPIs are a reasonable choice for GI protection. But we should individualize therapy, especially in high risk patients." — Austin (09:11)
• “Less is more.” — Steve (19:21)

Timestamps for Key Segments

• Cancer Screening in Older Adults: 00:34–05:13
• OSA Detection App: 05:13–07:29
• PPIs with NSAIDs: 07:29–09:43
• Hemorrhoid Management: 09:43–11:29
• Late Pregnancy Bleeding: 11:29–16:03
• Diabetes Control in Older Patients: 16:03–19:21
• Holiday ICD-10 Codes: 19:32–23:33

Tone and Style

The discussion is friendly, collegial, and often playful, with evidence-based content presented in a highly accessible and conversational style. The episode balances serious clinical takeaways with light-hearted moments, particularly in the holiday wrap-up.

Summary Takeaways

• Personalize preventive medicine for older adults, especially regarding cancer screening and diabetes care.
• Digital health tools are helpful adjuncts, but clinical judgment and gold-standard diagnostics remain essential.
• Latest guidelines favor minimally invasive, patient-centered approaches—whether for hemorrhoids or intensive glucose monitoring.
• Always factor in risks of overtreatment—“less is more,” especially for elders.
• And for the holidays: even documentation can be festive (or at least, entertaining).

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