💡 This article is written from the perspective of an emergency medicine physician with direct experience in South Korea’s emergency medical system. Every country’s healthcare system is different — but some problems have a way of looking familiar no matter where you are.

If you follow Korean news, you’ve probably come across the term ambulance diversion — when emergency crews are turned away from one hospital after another, unable to find a bed. It’s a phenomenon where a 119 crew (Korea’s equivalent of 911) spends precious time calling hospital after hospital, unable to find one willing to accept their patient.

The phrase conjures an image of an ambulance frantically circling the city. The reality is less dramatic but no less troubling: in most cases, the crew stays put — parked at the scene or somewhere nearby — while the phones keep ringing and the clock keeps ticking.

As an emergency physician, and as someone whose own family has been through this, I want to explain why this keeps happening. Not with statistics or policy jargon, but honestly.

Why Does This Happen?

There are two root causes — and they compound each other.

Not Every Hospital Has Specialists on Call Around the Clock

When a 119 crew brings a patient to the ER, some cases can be handled entirely by the emergency physician on duty. But many patients need a specialist from another department — a neurosurgeon, a cardiologist, a vascular surgeon. And here’s the problem: in most Korean hospitals, that specialist simply isn’t there at night or on weekends.

Only hospitals of a certain size — large general hospitals or university-affiliated medical centers — can even attempt to staff after-hours specialists. And even then, putting together a schedule with one doctor per department per shift is genuinely difficult. If the specialist on duty is already with another patient, the next emergency case either waits or gets redirected elsewhere.

This naturally leads to a question: Does Korea just not have enough doctors?

Not exactly. Walk through any busy commercial district in Korea and you’ll see clinics packed between the coffee shops — there is no shortage of physicians. The shortage is far more specific: there aren’t enough doctors willing to cover nights, weekends, and true emergencies.

Two systemic forces are driving this.

The first is reimbursement. Korea’s national health insurance fee schedule pays so poorly for emergency and after-hours care that hospitals genuinely cannot afford to staff these shifts. We’re not just talking about physician salaries — even covering support staff for overnight shifts is a financial stretch under the current structure.

The second is legal exposure. Treating an emergency patient means taking on someone who is already in serious condition, doing your best, and accepting that outcomes aren’t guaranteed. But in Korea’s current legal climate, even when there’s no criminal wrongdoing, civil liability has been found — and it has become a powerful deterrent. When a physician can be held responsible for a bad outcome that began before they ever met the patient, the rational response is to avoid those situations altogether. And many do.

Medical Resources Are Finite

The first problem was about people. This one is about infrastructure.

The number of ambulances, paramedics, emergency beds, and critical care equipment in any given region is fixed. And fixed resources — no matter how well distributed on average — will always have moments of scarcity.

I know this firsthand. My father-in-law fell down a flight of stairs and hit his head hard. He had a laceration over 10 centimeters long with arterial bleeding, and he couldn’t get up on his own afterward. With clear neurological signs, I had to rule out intracranial hemorrhage. I called 119 immediately.

The response? “All units are currently deployed. Please wait for one to return.”

Twenty minutes passed. A unit finally became available. Fortunately, it was the middle of the day, and a nearby university hospital agreed to accept him. We were lucky on two counts. At night, or if another emergency had come in ahead of us, the story could have been different.

Dispatch centers do their best to allocate resources based on regional data and historical demand. But emergencies don’t follow schedules. Temporary gaps are inevitable in any system — what matters is how small and infrequent you can make them.

The bed shortage tells a similar story. Patients and families naturally gravitate toward large university hospitals because they trust them to have the specialists needed for complex cases. This is a rational choice. But it creates chronic overcrowding in the places best equipped to handle serious illness. During my residency, even at a large institution, we regularly ran out of beds — patients waiting in family seating areas, sometimes in the hallway.

So What’s the Fix?

Honestly? A complete solution doesn’t exist. What we can do is make the problem smaller, less frequent, and less deadly.

The Definition of a “True Emergency” Needs to Shrink

Korea’s Emergency Medical Services Act defines eligible emergency conditions so broadly that the system is overloaded before a single ambulance moves. Conditions that rarely lead to true emergencies are listed alongside ones that kill in minutes.

In my view, a genuine emergency — the kind where the system must drop everything — falls into three categories:

• Neurological: altered consciousness, paralysis, seizure, sudden severe headache
• Cardiopulmonary: chest pain, difficulty breathing
• Hemorrhage: significant internal or external bleeding

What these have in common is that their underlying causes often involve a golden hour — the critical window where early intervention makes all the difference. The symptom itself doesn’t have a timer, but the diseases behind these symptoms often do. Stroke, myocardial infarction, aortic dissection, intracranial hemorrhage — these are conditions where every minute of delay accelerates irreversible damage.

Could the same symptom turn out to be something less serious? Absolutely. But no bystander, no family member, no one standing in that moment can reliably make that call. That’s exactly why the default should always be: assume the worst and move.

The other conditions currently listed in the law? Many of them warrant a hospital visit — but not necessarily an emergency system pushed to its limit to deliver them there.

On-Call Specialties Need to Be Distributed Across Hospitals by Region

Korea already has a system called the rotating on-call system for critical emergency conditions, where hospitals take turns covering specific critical illnesses. The concept is right. The execution falls short.

Participation is voluntary. The scope is narrow. And perhaps most importantly, having a specialist on call doesn’t always mean having the right specialist. A cardiothoracic surgeon who specializes in lung surgery can’t necessarily perform aortic repair. A neurosurgeon whose focus is the spine isn’t always the right person for a brain bleed.

In the Seoul metropolitan area, there are hospitals with dedicated aortic surgery teams available around the clock. Outside of that region, maintaining that level of specialized staffing and surgical infrastructure every single day is simply not realistic.

The solution, then, is to stop trying to make every hospital capable of everything — and instead guarantee that certain hospitals can handle specific critical emergencies reliably. That means funding, staffing, and protecting those centers from the administrative and legal pressures that currently push physicians away from the hardest cases.

Legal protection for good-faith emergency care. Reimbursement structures that don’t penalize hospitals for taking the sickest patients. These aren’t radical ideas — they’re prerequisites.

Final Thoughts

None of this gets fixed overnight. Building a functional emergency medical system requires movement across government, legislature, judiciary, and public culture simultaneously. That’s a slow process, and I have no illusions about how slow.

But as someone who works in emergency medicine — and as someone who will, one day, be on the other end of a 119 call — I believe it’s worth pushing for.

It’s not just Korea. Wherever you are in the world — I sincerely hope the day comes when emergency care works just a little better than it does today. As one emergency physician, that is my deepest wish.

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Dr. Edge keeps writing — as a doctor, and as a human being navigating life one story at a time.

My father-in-law was recently admitted to a university hospital with aspiration pneumonia.

He had been living in a nursing home — unable to move on his own, classified as Grade 1 disability, his days shaped by the twin burdens of a prior stroke and Parkinson’s disease. Then came the fever, the labored breathing, and a trip to the nearest university hospital emergency room. I was on my way home from a shift when my wife called. No one else could get there in time. Could I go ahead as his guardian?

Should I Tell Them I’m a Doctor?

This question follows me every time I walk into a hospital as a family member rather than a physician. The moment medical staff find out the person sitting across from them holds the same credentials they do, something shifts — a subtle pressure that’s hard to put into words but impossible to miss. I know, because I feel it myself. When I learn mid-consultation that a patient or their guardian works in medicine, I catch myself recalibrating: how much jargon is too much? How much do they actually want to know? So this time, I made a quiet decision: say nothing, and blend in.

As the attending explained the treatment plan, I nodded along like any worried family member would — while discreetly scanning the vitals on the monitor and stealing glances at the chest X-ray on the screen, running my own silent assessment in the background. When the doctor kept the language simple and accessible, I took it as a good sign. Mission proceeding as planned. I thanked them warmly, deferred completely, and played the role of the model guardian.

What Hospital Admission Actually Looks Like

At the administrative desk, I ran into something unexpected. This hospital required the ER bill to be settled on the spot before admission paperwork could move forward — a different system from my own hospital, where everything rolls into a single discharge payment. That alone was a small adjustment. But what caught me more off guard was a line in the admission consent form requiring a guardian co-signature as a financial guarantor. Picking up the pen felt heavier than I anticipated.

The Reality of Integrated Nursing Care — What I Never Knew as a Doctor

More surprises waited on the ward. After collecting detailed family contacts and emergency information, staff made clear that a guardian was expected to be present at all times. At my hospital, the integrated nursing care unit keeps patients reasonably well looked after — even those with limited mobility. Here, the division of labor was drawn differently. Nurses handled clinical tasks, and the rest — diaper changes, helping with oral medications, cleaning up after nebulizer treatments — fell squarely to whoever was sitting in the guardian’s chair.

Even the air mattress for pressure ulcer prevention had to be sourced by us. We rented it from a nearby medical supply shop and set it up ourselves with the help of a nursing aide. Routine repositioning to prevent bedsores? Nobody took ownership of that either. Things I had simply assumed were being handled — quietly, behind the scenes, as a matter of course — turned out to be gaps that only become visible once you’re sitting on the other side of the bed.

Mission Failed — An ER Specialist in the Guardian’s Seat

Because my father-in-law’s pneumonia stemmed from aspiration due to dysphagia, the team decided to place a nasogastric tube for feeding. A couple of interns arrived to perform the procedure — just two months into their careers — and watching their careful, slightly uncertain movements, I caught myself wondering: did I look like that once?

Then came the moment that ended my cover. During the attending professor’s rounds, it became clear he already knew exactly who I was. My wife, it turned out, had stopped by briefly earlier and casually mentioned that her husband was an emergency medicine specialist. All this time, I had been carefully avoiding medical terminology around the nurses, phrasing my requests in plain language, doing my best impression of an ordinary family member — while the entire ward staff apparently already knew and had been watching me keep up the act. Even now, thinking about it makes my face go warm.

What Makes a Good Doctor — A Lesson from the Attending’s Rounds

To his credit, the professor didn’t make a thing of it. He explained everything at exactly the right level — precise enough to be genuinely useful, considerate enough not to feel like a performance. It was a small thing, but it landed. Standing there as a family member rather than a colleague, I felt it differently than I might have otherwise. And I found myself asking a question I don’t ask often enough: when I’m the one doing the explaining, do I leave people feeling that way?

Medically, the picture was more or less what I had expected. Where I’d underestimated things was the timeline — my mental estimate had been optimistic, and the professor laid out a more cautious, realistic projection.

Nursing Home vs. Long-Term Care Hospital — A Family’s Dilemma

The diagnosis wasn’t the family’s biggest worry. The bigger fear was logistical. Getting my father-in-law into a public nursing home had taken considerable time and effort. If this hospitalization ran long enough to trigger a formal discharge from that facility, the only realistic fallback was a long-term care hospital — and none of us felt good about that.

I’ll be honest: my impression of long-term care hospitals, shaped by time I spent working in one, is not a favorable one. Too often, the environment felt less like care and more like management — patients processed rather than seen. As someone who loves this man, the thought of him ending up somewhere like that was difficult to sit with. That wasn’t a clinical assessment. It was just family.

What I Learned from the Other Side

Two days in, it’s too early to say much. The antibiotics need time, and we wait. But something shifted in me through this experience — something that won’t shift back. Sitting in the guardian’s chair, I saw things I had simply never registered from where I usually stand. The particular helplessness of watching someone you love confined to a hospital bed. The slow, grinding fatigue of families keeping vigil over elderly patients who can no longer care for themselves. I had known these things intellectually. Now I know them differently.

I hope my father-in-law recovers soon and gets to go back to the nursing home where he belongs. And I hope I carry a little more of what I felt in that chair into every room I walk into from here on.

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Dr. Edge keeps writing — as a doctor, and as a human being navigating life one story at a time.

Working in an emergency room, you quickly learn that self-harm cases are far more common than most people would ever guess.

Many patients have a prior psychiatric history, but it’s equally common to see people with none at all — individuals who acted in a single moment of unbearable emotion. And every time, I’m reminded of the same thing: self-harm is never just one thing. It comes in many forms — overdose, lacerations, hanging, falls — and the outcomes are just as varied.

Overdose — More Common Than You’d Think, and More Dangerous

Overdose cases come in nearly as often as lacerations. The most common scenario is psychiatric medication overdose. Because many of these drugs carry sedative properties, patients typically arrive barely conscious.

The more dangerous cases, however, are the ones that don’t involve psychiatric medications at all. Overdosing on antihypertensives or diabetic medications may not raise immediate alarm, but these cases frequently escalate into something far more critical. The same goes for chemical ingestion — pesticides, bleach, corrosives. The scale and speed of organ damage operate on an entirely different level.

Treatment depends heavily on antidotes, but the reality is that clear, targeted antidotes exist for only a small fraction of substances. Most cases default to symptomatic management — treating each complication as it surfaces. When vital signs deteriorate or organ damage becomes a serious concern, hemodialysis may enter the picture.

Lacerations — What You See Isn’t the Whole Story

Self-inflicted lacerations most commonly involve cuts to the wrist or upper arm, though injuries from punching through glass aren’t uncommon either.

Wounds that stay superficial can be sutured and closed on the spot. But the arm’s anatomy tells a different story. Tendons, vessels, and nerves run much closer to the surface than most people realize — close enough that a wound appearing routine on presentation can turn out to require surgery. What looks clean on the outside can be significantly more complicated beneath it.

Hanging — Whether the Feet Touched the Ground Changes Everything

When assessing a hanging patient, one of the first things I confirm is whether their feet were fully suspended or whether they maintained some ground contact, allowing partial weight-bearing. That single variable can dramatically shift the prognosis.

More decisive, though, is time. The brain starts dying within minutes of oxygen loss. Patients found quickly have a fighting chance. But those who weren’t — or who arrive in cardiac arrest — face a far grimmer reality. Even when CPR works and the numbers stabilize, the best realistic outcome can still be permanent disability: a life measured in assisted breaths and caregiver hours.

That burden then lands entirely on the family. Anyone who has witnessed it up close understands the weight of that without needing it explained.

Falls — When Confirming Death Comes Before Resuscitation

Falls in this context are rarely from low places. Patients who arrive in cardiac arrest are frequently assessed as non-survivable from the outset. In cases where resuscitation is attempted — sometimes because external injuries appear deceptively minor — imaging later reveals the truth: intracranial hemorrhage, pelvic fractures, catastrophic internal blood loss. The body doesn’t always show what it’s been through.

Among fall cases, those involving water — rivers, open water — carry marginally better odds, largely because the impact is partially absorbed on entry.

Even when resuscitation succeeds, significant long-term disability is common, placing the same prolonged weight on families that we see following hanging survivors.

Doctors Are Human Too

When a self-harm patient arrives, the emotional toll on the team is real — and the workload is rarely light. There are shifts where it honestly feels like too much.

I struggled with it early on. Every case used to land differently. These days I can manage — though I’m still not entirely sure whether that reflects experience gained or something quietly numbed over time.

What I do know is that something has shifted. Early in my career, I focused on the injury: treat it, stabilize, refer to psychiatry. Now, when the patient is ready to talk, I ask why. I try to understand what brought them to that moment, and I offer what little I can — a few words, sometimes just a question about what comes next. It might seem like a small thing. But I’ve come to believe that being asked why can mean something to a person who felt entirely unseen.

So Why Do People Hurt Themselves?

When I’ve been able to have those conversations, the most common answer is something like: “I just couldn’t take it anymore.” An emotion that overwhelmed everything in a single instant. The second most common is quieter: “Things aren’t going to get better. They never do.”

The first group tends to fare better. As the body heals and the acute intensity fades, psychiatric care can build a bridge back to ordinary life.

The second group is harder. The body recovers, but nothing about their circumstances has changed. Medicine can treat the wound. It can’t fix a broken home, a predatory environment, or years of compounded hopelessness. That requires social support, welfare infrastructure, genuine follow-through — and whether those systems actually deliver is an entirely separate problem. In those gaps, even experienced clinicians feel the limits of what they can do.

A Final Thought — Deaths That Don’t Have to Happen

In South Korea, suicide is the leading cause of death among people in their teens and twenties — ahead of traffic accidents. Globally, suicide ranks among the top three causes of death in the same age group.

If medicine’s ultimate goal is to reduce mortality, then self-harm and suicide represent deaths that are, to a meaningful degree, preventable — not primarily through clinical intervention, but through sustained attention at the social and family level.

There’s intense national focus on birth rates and demographic decline. But if young people are dying by suicide at this rate, the loss runs far deeper than any statistic can capture. These aren’t just numbers — they are the people who were supposed to carry the next generation forward.

Every time a self-harm patient comes through those doors, I carry that thought with me. If even one person who reads this pauses to check on someone they’ve been meaning to reach out to — that’s enough.

📚 References
– WHO, “Suicide Fact Sheet”, March 2025.

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Dr. Edge keeps writing — as a doctor, and as a human being navigating life one story at a time.

When it comes to reproductive medicine, I’ve been around the block more than most.

I became a father to twin girls through IVF. Then, after years of chaotic parenting and marriage, I made the deliberate choice to get a vasectomy. Done. Finished. Or so I thought — until my wife casually floated the idea that a baby boy would be awfully cute. One thing led to another, and I ended up undergoing testicular sperm extraction, a second round of IVF, and somehow walked away with a son.

IVF — Checking My Pride at the Door

People are getting married later. That’s just the reality now — most couples want financial stability before starting a family, which means they’re also starting that family older. It’s no surprise, then, that fertility clinics are busier than ever.

For us, a year passed after our wedding with no luck. I wasn’t prepared to keep waiting, so we decided to get help. And honestly? My pride took a hit. As a man, there’s something quietly humbling about accepting that nature isn’t going to cooperate on its own timeline. But when you want a child badly enough, your ego becomes a pretty small thing.

The process starts with a full evaluation of both partners. Blood panels for hormone levels, imaging and structural assessment for the woman, semen analysis for the man. The semen collection, I’ll admit, is exactly as awkward as it sounds — a small dimly lit room, a plush single-seat sofa, a screen playing adult content, and a cup. You figure out the rest. You tell yourself it’s for the baby. You get through it.

The harder road belongs to the woman, without question. My wife had to self-administer daily hormone injections to induce hyperovulation — essentially forcing her ovaries to produce as many eggs as possible — before having them retrieved at the clinic using a needle that is, by no one’s definition, small. Some women develop Ovarian Hyperstimulation Syndrome (OHSS) during this process, which can make it genuinely miserable. Every time I watched her go through it, I felt a mix of guilt and gratitude I still don’t have the right words for.

Once both samples are collected, the embryology team does their work — pairing the best-quality eggs and sperm, cultivating the resulting embryos, and vitrifying (flash-freezing) the strongest candidates for transfer. And this is where it’s worth saying: the embryologists and lab technicians deserve far more recognition than they usually get. Their precision determines outcomes just as much as the physicians do.

We tried once at a local fertility clinic without success. The second attempt, at CHA Fertility Center, Seoul Station, worked on the first try.

Vasectomy — Shopping Around for a Surgeon I Could Actually Trust

The moment I decided to get a vasectomy, my brain immediately served up an unwelcome memory: getting circumcised as a kid. Same general vicinity, same dread. Not rational, I know. But there it was.

The procedure itself is genuinely straightforward. Local anesthetic to the scrotal area, a small midline incision, electrocautery to cut and seal both vas deferens, one suture to close. That’s it. I’ve never performed one myself — it’s outside my specialty — but I understand the anatomy well enough to know that the procedure isn’t technically complex. What kept nagging at me was a specific, very reasonable fear: what if the surgeon nicks a vessel?

Being a patient has a way of reminding you why patients ask for experienced hands. So I did something I’d never done before in a medical context — I went clinic-hopping. I visited several urology practices near my home, explicitly introduced myself as an emergency physician upfront to avoid any awkward misreading of my questions, and asked each surgeon directly about their experience and their approach to the risks I was concerned about.

The responses were revealing. One doctor appreciated the candor and admitted, refreshingly honestly, that he hadn’t done enough of these to feel fully confident about vascular complications. Another took my questions as some kind of challenge and told me to leave. The third walked me through everything calmly, addressed my concerns without defensiveness, and made me feel like I was in good hands. I booked with him immediately. The procedure went perfectly.

What I didn’t expect from the whole experience was what it showed me about primary care in private practice. There are physicians out there operating well outside their comfort zone without ever acknowledging it to patients. That’s a problem worth knowing about — whether you’re a doctor or not.

Testicular Sperm Extraction — Caving to My Wife (Again)

Here’s the thing about vasectomies: they’re effective. And here’s the thing about my wife: she’s persuasive.

“A little boy would be so cute, though.”

And that’s how I ended up back at CHA Fertility Center, Seoul Station, this time to discuss how to extract sperm from a body that had been surgically prevented from releasing it. The first thing I noticed was how much the waiting room had changed — a noticeably higher proportion of international couples than I’d remembered. Korea’s fertility medicine has developed a quiet global reputation: the outcomes are comparable to anywhere in the world, and the costs are a fraction of what you’d pay in the US, UK, or Australia. Word gets around.

My two options were vasectomy reversal or surgical sperm retrieval. Reversal makes sense if it’s been under five years since the vasectomy and you want the option of future pregnancies without intervention. But for a one-time attempt with no desire to restore natural fertility, retrieval is cleaner. I chose retrieval.

The procedure mirrored the vasectomy in approach — local anesthetic, small incision, tissue sample taken from whichever testicle showed better ultrasound characteristics. Having gone through something similar before meant the psychological weight was considerably lighter than it was the first time. My wife, meanwhile, went through the entire ovarian stimulation and egg retrieval process again. Same injections, same side effects, same needle. She didn’t complain once.

One constraint worth noting for anyone considering this in Korea: sex selection is not legally permitted. We started this whole thing hoping for a boy, but the honest answer was that we wouldn’t know until implantation. We got lucky. A boy was confirmed, and our family quietly completed itself — two daughters, one son.

Final Thoughts — Living Between the Beginning and the End of Life

Emergency medicine means I spend most of my professional hours at the other end of the life spectrum. People arriving in crisis. Families in the waiting room, watching the clock. That’s the work.

But as a patient, I’ve somehow accumulated most of my experiences near the very beginning of life. The hushed corridors of fertility clinics, the careful movements of an embryologist at a lab bench, the particular silence that falls when you hear the words “we have a positive.” I experienced all of it not as a physician, but as a husband and a father-in-waiting.

Doctors make the worst patients. We know too much and trust too little. But there’s something genuinely valuable in crossing to the other side of the examination table — you stop abstractly understanding why patients need clear communication and start feeling it. When I sat across from that urologist who calmly answered every question I had, I understood in a different way why that kind of interaction matters. Not as a principle, but as a relief.

I live between the beginning and the end of life. Most days, that’s just a description of a job. Sometimes, it feels like something more.

📚 References

– Jang YJ, et al. “Clinical Predictors of Successful Pregnancy After In Vitro Fertilization: A Systematic Review.” PMC / NIH. 2026.

– Vollweiter D, et al. “Vasectomy reversal or assisted reproductive technology?” Urologe. 2024.

– Shen Y, et al. “Microdissection testicular sperm extraction outcomes in post-orchidopexy azoospermia: systematic review and meta-analysis.” PMC / NIH. 2024.

📌 More medical stories by Dr. Edge → Browse all articles

Dr. Edge keeps writing — as a doctor, and as a human being navigating life one story at a time.

The short version

If you’re looking for a real Mounjaro review — not a sponsored post, not a before-and-after ad — you’re in the right place. I’m an ER physician who injected myself every week for six months and kept notes.

– 238 lbs → 212 lbs (108kg → 96kg): 26 lbs (12kg) lost over 6 months
– Burping, nausea, unpredictable appetite — side effects, unfiltered
– Who should use it. Who probably shouldn’t.

Why I decided to try it myself

Working as an emergency physician on rotating shifts means irregular meals are the norm. Night shifts in particular wore me down — the stress eating, the vending machine runs at 3 a.m., the complete collapse of any routine I tried to build. Back in school I played soccer, swam, cycled. I was fit. Residency took all of that away.

I knew exactly what excess weight was doing to my body. I’m a doctor — I’ve counseled patients on this a hundred times. And yet I kept failing at it myself. Every time my shift pattern changed, whatever diet or exercise routine I had going would fall apart within a week.

Eventually my BMI crossed 30. My old lumbar disc herniation flared back up, and the lower back pain and leg numbness became daily background noise. Around that time, Mounjaro launched in Korea. I’d tried Saxenda before with essentially zero results. So I made a decision: before I ever recommend this to a patient, I need to know what it actually feels like.

What is Mounjaro? — The science behind it

Mounjaro (generic name: tirzepatide) is not just another GLP-1 drug. Unlike semaglutide-based medications like Ozempic or Wegovy, tirzepatide is a dual GIP/GLP-1 receptor agonist — meaning it activates two separate hormonal pathways simultaneously.

GLP-1 (glucagon-like peptide-1) is released from the small intestine after eating. It stimulates insulin secretion, slows gastric emptying, and signals the brain’s satiety center to suppress appetite.

GIP (glucose-dependent insulinotropic polypeptide) also supports insulin release, but crucially, it acts on the brain’s reward circuitry — reducing the drive to eat, not just the ability to keep eating.

Because both receptors are targeted at once, tirzepatide consistently outperforms GLP-1 monotherapy in clinical trials. In the SURMOUNT-1 trial, participants lost an average of over 20% of their body weight over 72 weeks. Your results, as always, may vary.

6-month weight timeline

Starting weight: 238 lbs (108kg).

Month 1 (2.5mg) — -4 lbs (-2kg) → 234 lbs (106kg)

The 2.5mg starting dose isn’t about results — it’s about letting your body adjust. I noticed my appetite was slightly muted, but nothing dramatic happened. I treated it as an adaptation phase and kept my expectations low.

Months 2–3 (5mg) — -18 lbs (-8kg) → 216 lbs (98kg)

Stepping up to 5mg is where things got real. I was dropping roughly 2 lbs (about 1kg) per week. This was the sweet spot — the period where Mounjaro’s effects were most noticeable. My portion sizes shrank naturally, and the late-night snacking habit I’d had for years just… stopped. The pull toward food felt genuinely weaker.

Months 4–6 (5mg) — -4 lbs (-2kg) → 212 lbs (96kg)

The plateau hit. Weight loss slowed to roughly 1–2 lbs (0.5–1kg) per month. Frustrating at first — but entirely predictable. As body weight decreases, basal metabolic rate drops in parallel, and the body works to defend its new set point. A plateau isn’t failure. It’s adaptation.

Side effects, honestly

Positive-only reviews don’t help anyone. Here’s what I actually experienced.

① Frequent burping.

Mounjaro slows gastric emptying, which causes gas to build up in the GI tract. It came out as burping — a lot of it. Not painful, just embarrassing. (Nothing like mid-consultation burping to test your professional composure.) It improved significantly after the first few weeks.

② Nausea after overeating.

Pre-Mounjaro, I could push through fullness without much consequence. Post-Mounjaro, crossing the line into “too much” triggered immediate nausea. Annoying at first — but it turned out to be a remarkably effective built-in brake. I started actually listening to my stomach for the first time in years.

③ Appetite suppression is real, but not total.

A lot of reviews claim hunger disappears completely. Mine didn’t. Overall it was reduced, but on high-stress days and post-night-shift mornings, cravings came back hard. GIP’s effect on the brain’s reward circuitry seems to weaken under conditions of sleep deprivation and acute stress. Mounjaro is a powerful tool. It’s not a switch.

My medical assessment — Who should use it?

I’d recommend it for:

• BMI ≥ 30, or BMI ≥ 27 with obesity-related comorbidities (hypertension, type 2 diabetes, dyslipidemia)
• People who have genuinely tried diet and exercise and aren’t seeing results
• Patients whose quality of life is being impacted — joint pain, sleep apnea, mobility issues

I’d recommend caution for:

• Anyone who is pregnant or planning to become pregnant
• Personal or family history of medullary thyroid carcinoma or MEN2 syndrome
• History of pancreatitis
• People at a healthy weight seeking purely cosmetic results

And yes — get a prescription from an actual physician. That sounds obvious, but the rise of online weight-loss clinics and unmonitored telehealth prescriptions makes it worth saying plainly. Having a doctor who knows your full picture isn’t just a formality.

Why starting matters — and why I’m stopping

Twenty-six pounds in six months. The number looks clean, but the process wasn’t. I didn’t follow a perfect diet. I had bad weeks. I hit plateaus that felt permanent.

What I can say with confidence is this: obesity is a chronic disease, not a character flaw. Mounjaro is a treatment tool — a good one. But it doesn’t work in isolation. Lean on it completely while abandoning diet and exercise, and you’re leaving most of the benefit on the table.

Six months in, with results plateauing, I’m now tapering off. My plan is to step back down to 2.5mg for approximately four weeks before stopping.

From a pharmacology standpoint, tirzepatide has a half-life of roughly five days (120 hours), meaning it takes about 30 days to fully clear the system. Some argue that stopping cold turkey from 5mg is effectively an auto-taper — and they’re not wrong.

But I chose a stepdown for reasons that are less about pharmacokinetics and more about psychology and habit formation. The same way a sudden shift change can throw off your entire daily rhythm, an abrupt stop risks destabilizing the eating patterns I’ve been quietly building for months. I want a slow goodbye — enough time for both body and mind to prepare.

I’d be lying if I said I wasn’t worried about rebound. The SURMOUNT-4 trial showed that participants who discontinued tirzepatide regained roughly two-thirds of their lost weight within a year. That data is real, and it’s why what you build in terms of habits has to outlast the drug.

On that note — the habits I’ve been working on alongside the medication.

Time and mental bandwidth are both still in short supply as an ER doc on rotating shifts. An hour at the gym simply isn’t realistic on most days. So I chose something different: air bike Tabata intervals.

The protocol is simple. 20 seconds all-out → 10 seconds rest, repeated for 8 rounds. Four minutes of actual work. Fifteen minutes including warm-up and cool-down. This format was developed by Japanese researcher Dr. Izumi Tabata in the 1990s and has been shown to deliver simultaneous aerobic and anaerobic adaptations in a fraction of the time of conventional cardio. It also produces a significant EPOC (excess post-exercise oxygen consumption) effect — meaning your metabolism stays elevated for hours after you stop. Three times a week. That’s the plan.

Four minutes doesn’t sound like much — until you’ve actually maxed out on an air bike. Then it sounds exactly right.

I’ll post a follow-up when I’m off the medication completely. The honest version, as always.

📚 References

– Jastreboff AM, et al. “Tirzepatide Once Weekly for the Treatment of Obesity.” N Engl J Med. 2022.

– Aronne LJ, et al. “Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity.” JAMA. 2024. (SURMOUNT-4)

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Dr. Edge keeps writing — as a doctor, and as a human being navigating life one story at a time.

**Key Takeaways**

Medication adherence challenges affect even ER doctors like me. Poor adherence leads to ER emergencies — but small habits prevent ER visits.

– Even doctors forget medication sometimes
– Skipped meds → stroke, DKA, infections
– Don’t aim for perfect, just don’t quit

My Father’s “Just Because”

My father cut his finger. It wasn’t serious — a small laceration, a few sutures, and he’d be on his way. But what happened next in that ER room stuck with me more than any critical case I’ve seen.

After the procedure, he was prescribed antibiotics and anti-inflammatory pain relievers. Then he turned to me — his son, a doctor — and asked if he really had to take them.

I told him yes, absolutely. Infection prevention is not optional after a skin laceration. But he just kept pushing back. When I finally asked why, he shrugged and said: “Just because.”

Because he’s my father, I took a slow breath and said calmly, “You need these so your wound heals properly. Please take them — even if you don’t feel like it.” That’s the only reason he agreed.

If a patient had said the same thing to me in a clinical setting, I’d have tried to persuade them once or twice — and if nothing worked, I’d have said “That’s your call” and moved on.

Even ER Doctors Struggle with Medication Adherence

Here’s something I don’t usually admit out loud: I also have medications I’m supposed to take every day — and keeping up with them consistently is harder than it sounds.

As an emergency physician working rotating shifts, my days and nights are constantly flipped. Chronic sleep deprivation takes a real toll on short-term memory, and small details just slip away. There have been times I couldn’t remember whether I’d already taken my morning dose — and I’d end up digging the empty pill packet out of the trash just to check. Once, I took an extra vitamin because I genuinely had no idea if I’d already had one.

If even a doctor struggles with this, imagine what it’s like for patients.

Medication Adherence ER Realities

The ER sees all kinds of patients — but a significant number come in because of poor medication adherence: skipped doses, missed follow-ups, or neglected lifestyle changes.

Patients with chronic conditions like hypertension or diabetes need consistent medication management. But I regularly see patients who stopped their medications because they believed “long-term use must be harmful,” assumed “my numbers looked fine, so I figured I could stop,” or simply missed one clinic visit and never went back.

Many of them arrive with systolic blood pressure over 200 mmHg — nearly double the normal range — or blood glucose over 500 mg/dL. The consequences are severe:

Even with something as minor as a laceration or burn, patients who skip antibiotics or miss wound care follow-ups can develop infections that escalate from a quick outpatient visit to full hospitalization.

Unmanaged hypertension can lead to intracerebral hemorrhage (bleeding in the brain) or aortic dissection — both life-threatening emergencies.

Poorly controlled diabetes can result in diabetic ketoacidosis (DKA), silent heart attack, or acute kidney injury — conditions that bring people straight to the ER.

Why Patients Skip Medication (ER View)

Based on what I hear directly in the ER, it comes down to three things.

1. “I feel fine, so I must be fine.”

When there are no symptoms, it’s easy to feel like there’s no disease. This is exactly why hypertension is called the silent killer — the damage is happening, you just can’t feel it. One of the most common things I hear in the ER is“My blood pressure has been fine lately.” That same patient’s reading is often over 200 mmHg.

2. “Taking medication long-term must be bad for you.”

This is one of the most persistent misconceptions I encounter. Yes, every medication has potential side effects. But in most cases, the consequences of abruptly stopping blood pressure or diabetes medication are far more dangerous than any side effect. Intracerebral hemorrhage. Aortic dissection. DKA. These are among the most critical emergencies we manage.

3. Life just gets in the way.

Honestly? This is the most relatable reason of all — for my father, for me, for everyone. Taking pills is inconvenient. Booking a clinic appointment feels like a hassle. Miss one visit, and it’s easy to just stop altogether. It’s hard to call this laziness. It’s just being human.

Please Don’t Give Up.

With all of that said, here’s what I really want you to hear.

I completely understand not wanting to take your medication. I understand dreading another clinic visit. I struggle with the same things — and I’m a doctor.

But working in the ER, I’ve seen too many people put it off and end up in a far worse situation because of it.

The patient who had a stroke and lost movement on one side of their body.
The patient who ended up in the ICU with DKA.
The patient whose finger infection spread to their entire hand and required surgery and hospitalization.

Every one of them started with one small thing left undone.

You don’t have to be perfect. You’re allowed to forget sometimes. Just don’t give up entirely.

I’m going to take my medication today, too.

📚 References
– Vrijens B, et al. “A new taxonomy for describing and defining adherence to medications.” Br J Clin Pharmacol. 2012.
– AHA Journals. “What Is New and Different in the 2024 European Society of Cardiology Guidelines for the Management of Elevated Blood Pressure and Hypertension?” Hypertension. 2025.

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Dr. Edge keeps writing — as a doctor, and as a human being navigating life one story at a time.