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Rob helps emergency departments rethink outdated workflows and improve patient flow.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 framework
• Public transportation, walkability, and downstream population health
• Lifestyle medicine and transatlantic perspectives on healthcare costs
• A preview of Season 2 guests and episodes
• What Adam and Lara have been up to since last season

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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.