This week, I’m diving into one of the weirdest modern medical questions: what actually makes a “top doctor” in the age of TikTok? After an Allure article exposed the rise, and sometimes fall, of social-media-famous plastic surgeons, I have thoughts. Many thoughts. Mostly about ethics, entertainment, and why the operating room should never be a live-streaming studio.

Then we shift into something much more fun: a full mystery case. A patient with double vision, oscillopsia, lower-extremity weakness, and a history of gastric bypass walks into my exam room… and everything looks normal except the motility. So what do you do when both eyes refuse to abduct and the MRI shows a thalamic signal? You follow the clues to a diagnosis most clinicians never see coming.

Takeaways:

Why plastic surgery thrives on social media and where ethical lines are getting dangerously blurry.

The subtle difference between educating the public… and turning patient care into spectacle.

How a patient with bilateral abduction deficits and upbeat nystagmus led to a surprising diagnosis.

Why thiamine deficiency after bariatric surgery can masquerade as a neurologic emergency.

The importance of physicians setting their own social media guidelines before someone else does it for them.

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Today’s episode is brought to you by Microsoft Dragon Copilot. Dragon Copilot is an AI clinical assistant that streamlines documentation, surfaces critical information, and automates routine tasks — empowering healthcare teams to focus more on patients and less on administrative work. Learn more at ⁠https://glau.cc/Dragon⁠

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