This week in medical subreddits: Social media coverage of the Lindsay Clancy trial, a step-therapy denial that routed a prescriber to an alternative carrying its own prior authorization (PA), and two threads on what lands in a physician’s lap without warning — a scathing patient review and a faxed liver mass. 

A Liver Mass Arrives by Fax

r/FamilyMedicine · u/jcereno1 · August 21, 2026

A family physician received an outside calcium score via fax from a cardiology nurse practitioner (NP) with the note, “Liver mass — notify PCP [primary care provider].” The physician did not receive a phone call or a nurse message. They asked the community, “Am I insane for this really upsetting me? In my opinion, this is lazy, dangerous medicine. No provider is above picking up the phone and calling me over something like this.”

Commenter u/Dogsinthewind let the poster know they were not overreacting and wrote “the power to order testing comes with the responsibility of having to address everything that test has found.” They added that a request for help belongs in a text, a call, or a formal letter. In a follow-up comment, the original poster separated the safety problem from the etiquette one: They call specialists routinely and take no issue with another physician titrating a medication or adding an antihypertensive, but “Just writing ‘See PCP’ and faxing something over is a huge risk,” and remarked that this type of message “also conveys a ‘My time is too important’ or ‘this isn’t worth my thought process’ vibe.”

The anecdote reflects a closed-loop notification failure. A faxed annotation carries no acknowledgment, no tracking, and no fallback if it lands in the wrong queue. The practice-level question is not whether the NP should have called but whether inbound outside imaging has a tracked route into the chart and a named owner for follow-up.

Join the Conversation ▸ “Incidental finding - Notify PCP” 

Is the Lindsay Clancy Trial Amplifying Anti-Physician Sentiment?

r/medicine · u/Several_Act_2358 · August 18, 2026

The Lindsay Clancy murder trial has captured national attention, but one physician has become disheartened by the social media commentary surrounding it. Lindsay Clancy’s psychiatric care has been a central dispute in the trial, but the poster was disappointed to see the negativity extended to the profession as a whole. They wrote, “something really rubs me the wrong way about the recent celebration of lawyers on social media ‘exposing doctors.’”

Replies focused on how this anti-physician sentiment costs patients. u/seekingallpho argued that an increasingly adversarial view of physicians degrades care by degrees, whatever its source. “More defensive medicine is bad for patients. Less transparent documentation is bad for patients.” u/EXPLODEDman counted off the forces converging on the moment: “On the one hand, there is a massive degradation of public trust in any and all experts, or people considered officials,” alongside an anti-science current in public life, a financial system that rewards litigation over work, institutions whose power dwarfs that of the individual patient who was genuinely harmed, and insurers making the actual clinical decisions.

The thread discusses how the cost of an adversarial climate is paid in defensive testing and in documentation written for a future reader rather than the next clinician.

Join the Conversation ▸ The “Gotcha” Mentality with Lawyers “Exposing” Doctors is Unsettling… as it they’re altruistic

When the Alternative Needs Its Own PA

r/medicine · u/SocraticDoc · August 20, 2026

A clinician prescribed a newer, nongeneric medication for a patient, and the medication was flagged for PA. After doing what the insurance company asked, the medication was still denied, and the clinician was told to try one of two or three alternatives first. But the alternative they sent to the pharmacy came back with a PA of its own. “It’s turtles all the way down. I rage quit.”

The poster asked the community what physicians can reasonably do to push back. The replies were less interested in a workaround than in the design. u/SillyRabbit2013 said they now tell patients outright that insurance companies are creating barriers to treatment, and “the more they drown us in paperwork, the less they have to provide for patients. The time it takes for the PA to be done, reviewed, rejected/approved are all days, weeks, months patients go without treatment.” u/FAx32 thinks the only way there will be a change is if there is “a massive patient-initiated class action lawsuit for insurance policies that require medicines as alternatives without evidence that they are equivalent.”

The issue here is sequential authorization: A step-therapy denial pointing to a drug that is itself on the PA list turns one review cycle into two, and the second arrives after the patient has been told to expect a fill.

Join the Conversation ▸ Prior Authorizations on Prior Authorizations

The Review From the Patient You Could Not Help

r/medicine · u/Allisnotwellin · August 19, 2026

After a recent encounter with a patient, an attending 2 years out of training was called a poor listener who lacked care or empathy in a patient review. The visit was for long-standing back pain in which the MRI showed minimal findings and the working diagnosis was fibromyalgia. The patient had already tried medications, declined them again, and declined physical therapy; at that point, the poster wrote, there was nothing left to offer. They asked the community, “Any tips or recommendations for how to navigate these encounters?”

Two clinicians answered by moving the intervention out of the treatment plan and into the framing of the visit. u/FlexorCarpiUlnaris recommends acknowledging the patient’s frustration, waiting for their response, and then apologizing if they can’t help them further. “I am always surprised at how much this diffuses the tension and puts us both on the same team again,” they wrote. u/Wohowudothat commented, “I like to ask them what their expectations are, and if they have unrealistic expectations, I tell them at the outset that I will not be able to achieve those goals. I do tell them what I can accomplish and what I think realistic goals are. That helps set expectations.”

Both replies treat the expectation gap, not the diagnosis, as the thing being managed.

Join the Conversation ▸ Dealing with reviews, looking to improve

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.