The podcast

A weekly conversation among members and guests about the work of caring for complex and unusual patients in independent practice. It runs alongside the monthly journal club and is optional.

What it covers

• Outlier patients in primary care. Presentations that stop fitting the usual categories, and what to do next.
• Genetics in practice. Testing, results, and what a result changes for the patient in front of you.
• The cash-pay practice. Founding, pricing as method, and running the business.
• Referrals and the system. Getting a useful answer back from specialists, laboratories and centers.
• The physician. Peer support, staying with uncertainty, and well-being in a small practice.

Ground rules

• No patient information. Cases come up only as problems, without the patient.
• Guests disclose industry relationships at the start of the episode.
• Prices are discussed as method, never as agreement.
• Guests speak for themselves, not for the network.

Planned episodes

Twenty-five episodes in five themes. Each page has the plan: a description, a forty-minute run of show, the guest's prep questions, and show notes with sources.

Outlier patients in primary care

• 1. When a presentation stops fittingClinicians with complex patients

  How a clinician recognizes that a presentation has stopped fitting the usual categories, and what changes after that.

• 2. Hypermobility: hEDS, HSD or a genetic diagnosis?Clinicians with complex patients

  Telling the hypermobility disorders from the heritable connective tissue disorders that change management, using the 2017 international classification (Malfait 2017).

• 3. Dysautonomia after a normal workupClinicians with complex patients

  Fatigue, pain, orthostatic and cognitive symptoms after a standard workup has come back unrevealing.

• 4. One odd lab valueClinicians with complex patients

  One objective finding that points somewhere: a low alkaline phosphatase, a ferritin that won't settle, an unexplained cytopenia.

• 5. Treatable rare disease in adult primary careClinicians with complex patients; providers of specialized services

  The amyloidoses, lysosomal and metabolic diseases that present to adults, where a diagnosis changes treatment.

Genetics in practice

• 6. After a negative exomeClinicians with complex patients

  Pitsava 2025 found a molecular diagnosis in 54 of 353 undiagnosed families on genome sequencing, more than half in regions earlier testing had not assessed.

• 7. A VUS is not a diagnosisClinicians with complex patients

  Handling VUS results in primary care.

• 8. Family history as a diagnostic testClinicians with complex patients

  The theme of the first journal club session.

• 9. Healthy adults with a genome resultClinicians with complex patients

  What to do when a healthy patient arrives with an elective or consumer genome result.

• 10. Pharmacogenomics at the prescriptionClinicians with complex patients; providers of specialized services

  When a pharmacogenomic result is worth ordering, and how it reaches the prescribing decision.

The cash-pay practice

• 11. Leaving insurance-based practiceCash-pay founders

  Founding stories from members.

• 12. Setting a cash priceCash-pay founders

  Method, from what the practice costs to a visit price or a membership fee. Never what anyone should charge.

• 13. Good faith estimates for cash-pay practicesCash-pay founders

  What the federal requirement means for a cash-pay practice.

• 14. Panel size and timeCash-pay founders

  How many patients a relationship-based practice can carry well.

• 15. Superbills and out-of-network reimbursementCash-pay founders

  Helping cash-pay patients recover what their insurance will pay.

Referrals and the system

• 16. Referrals that come back answeredAll three groups

  The referral loop, and the network's one-question referral standard.

• 17. Working with cash-pay specialistsCash-pay founders; providers of specialized services

  Finding specialists who publish prices, see shared patients and write back.

• 18. Diagnostics at a published priceProviders of specialized services

  Imaging, laboratory and physiologic studies with cash prices quoted in advance.

• 19. Getting a hard case to an academic expertClinicians with complex patients; providers of specialized services

  Getting a hard case to the right expert, and getting an answer back.

• 20. How a care map is builtClinicians with complex patients

  How a three-year care map is built, cited and used.

The physician

• 21. Balint groups for complex careClinicians with complex patients

  What peer support looks like for long relationships and difficult cases.

• 22. Staying with a patient without a diagnosisClinicians with complex patients

  Staying with a patient through uncertainty.

• 23. Well-being in a small practiceCash-pay founders

  The fourth aim of the quadruple aim.

• 24. AI tools in a small practiceCash-pay founders

  Documentation, research and patient communication, with privacy in mind.

• 25. A patient organization's viewClinicians with complex patients

  What helps patients with rare and complex disease reach a diagnosis and care, from an independent patient organization. The guest speaks about patients in general, never about an individual.

Appear on the podcast

Members and guests are welcome. Email hello@coloradocarenetwork.com with a topic in two sentences: the question you want to talk through, and why it matters in your practice. Members can also post it in #podcast on Slack.