diff --git a/Dockerfile b/Dockerfile
index a322c67..26246a5 100644
--- a/Dockerfile
+++ b/Dockerfile
@@ -1,6 +1,6 @@
 # syntax=docker/dockerfile:1
 
-FROM alpine/git as ms-tool-src
+FROM alpine/git AS ms-tool-src
 RUN git clone https://github.com/microsoft/Tools-for-Health-Data-Anonymization.git /app
 
 FROM mcr.microsoft.com/dotnet/sdk:6.0 AS ms-tool
@@ -25,7 +25,7 @@ RUN --mount=type=cache,target=/root/.cache \
   pip3 install /app/[tests]
 RUN rm -r /app
 
-ENV JAVA_HOME /opt/java/openjdk
+ENV JAVA_HOME=/opt/java/openjdk
 
 ENTRYPOINT ["cumulus-etl"]
 
@@ -42,6 +42,6 @@ RUN --mount=type=cache,target=/root/.cache \
   pip3 install /app
 RUN rm -r /app
 
-ENV JAVA_HOME /opt/java/openjdk
+ENV JAVA_HOME=/opt/java/openjdk
 
 ENTRYPOINT ["cumulus-etl"]
diff --git a/cumulus_etl/etl/tasks/basic_tasks.py b/cumulus_etl/etl/tasks/basic_tasks.py
index 2dacc97..8de799a 100644
--- a/cumulus_etl/etl/tasks/basic_tasks.py
+++ b/cumulus_etl/etl/tasks/basic_tasks.py
@@ -95,7 +95,8 @@ class MedicationRequestTask(tasks.EtlTask):
     tags: ClassVar = {"cpu"}
 
     # We may write to a second Medication table as we go.
-    # MedicationRequest can have inline medications via CodeableConcepts, or external Medication references.
+    # MedicationRequest can have inline medications via CodeableConcepts, or external Medication
+    # references.
     # If external, we'll download them and stuff them in this output table.
     # We do all this special business logic because Medication is a special, "reference" resource,
     # and many EHRs don't let you simply bulk export them.
@@ -110,20 +111,27 @@ def __init__(self, *args, **kwargs):
         super().__init__(*args, **kwargs)
 
         # Keep a cache of medication IDs that we've already downloaded.
-        # If this ends up growing too large in practice, we can wipe it during a call to table_batch_cleanup().
+        # If this ends up growing too large in practice, we can wipe it during a call to
+        # table_batch_cleanup().
         # But let's try initially with keeping it around for the whole task.
         self.medication_ids = set()
 
+        # Track whether we already warned about downloading Medications, to avoid spamming.
+        self.warned_connection_error = False
+
     def scrub_medication(self, medication: dict | None) -> bool:
         """Scrub incoming medication resources, returns False if it should be skipped"""
         if not medication or not self.scrubber.scrub_resource(medication):  # standard scrubbing
             return False
 
         # Normally the above is all we'd need to do.
-        # But this resource just came hot from the FHIR server, and we did not run the MS anonymizer on it.
+        # But this resource just came hot from the FHIR server, and we did not run the MS
+        # anonymizer on it.
         # Since Medications are not patient-specific, we don't need the full MS treatment.
-        # But still, we should probably drop some bits that might more easily identify the *institution*.
-        # This is a poor-man's MS config tool (and a blocklist rather than allow-list, but it's a very simple resource)
+        # But still, we should probably drop some bits that might more easily identify the
+        # *institution*.
+        # This is a poor-man's MS config tool (and a blocklist rather than allow-list, but it's a
+        # very simple resource)
 
         # *should* remove extensions at all layers, but this will catch 99% of them
         medication.pop("extension", None)
@@ -141,8 +149,9 @@ async def fetch_medication(self, resource: dict) -> dict | None:
 
         if not reference.startswith("#"):
             # Don't duplicate medications we've already seen this run.
-            # This will still duplicate medications from previous runs, but avoiding that feels like more work than it's
-            # worth - just download em again and push em through (there might be updates to the resources, too!)
+            # This will still duplicate medications from previous runs, but avoiding that feels
+            # like more work than it's worth - just download em again and push em through (there
+            # might be updates to the resources, too!)
             if reference in self.medication_ids:
                 return None
             self.medication_ids.add(reference)
@@ -150,7 +159,10 @@ async def fetch_medication(self, resource: dict) -> dict | None:
         try:
             medication = await fhir.download_reference(self.task_config.client, reference)
         except Exception as exc:
-            logging.warning("Could not download Medication reference: %s", exc)
+            if not self.warned_connection_error:
+                logging.warning("Could not download Medication reference: %s", exc)
+                self.warned_connection_error = True
+
             self.summaries[1].had_errors = True
 
             if self.task_config.dir_errors:
diff --git a/tests/etl/test_tasks.py b/tests/etl/test_tasks.py
index b417d49..7bc406b 100644
--- a/tests/etl/test_tasks.py
+++ b/tests/etl/test_tasks.py
@@ -441,7 +441,8 @@ async def test_external_medications_with_error(self, mock_download):
             ValueError("bad haircut"),
         ]
 
-        await basic_tasks.MedicationRequestTask(self.job_config, self.scrubber).run()
+        with self.assertLogs(level="WARNING") as logs:
+            await basic_tasks.MedicationRequestTask(self.job_config, self.scrubber).run()
 
         med_format = self.format
         med_req_format = self.format2
@@ -451,6 +452,11 @@ async def test_external_medications_with_error(self, mock_download):
         batch = med_req_format.write_records.call_args[0][0]
         self.assertEqual(3, len(batch.rows))
 
+        # Confirm we only logged about the first problem (to avoid spamming console)
+        self.assertEqual(
+            logs.output, ["WARNING:root:Could not download Medication reference: bad hostname"]
+        )
+
         # Confirm we still wrote out the medication for B
         self.assertEqual(1, med_format.write_records.call_count)
         batch = med_format.write_records.call_args[0][0]
@@ -520,6 +526,11 @@ async def test_external_medications_skips_unknown_modifiers(self, mock_download)
         self.make_json(
             "MedicationRequest", "B", medicationReference={"reference": "Medication/good"}
         )
+        self.make_json(
+            "MedicationRequest",
+            "Skipped",  # this will be ignored due to uknown modifier in the MedReq itself
+            modifierExtension=[{"url": "unrecognized"}],
+        )
         mock_download.side_effect = [
             {
                 "resourceType": "Medication",
@@ -534,7 +545,15 @@ async def test_external_medications_skips_unknown_modifiers(self, mock_download)
 
         await basic_tasks.MedicationRequestTask(self.job_config, self.scrubber).run()
 
-        med_format = self.format
+        med_format = self.format  # Medication
+        medreq_format = self.format2  # MedicationRequest
+
+        self.assertEqual(1, medreq_format.write_records.call_count)
+        batch = medreq_format.write_records.call_args[0][0]
+        self.assertEqual(  # no "Skipped"
+            {self.codebook.db.resource_hash("A"), self.codebook.db.resource_hash("B")},
+            {row["id"] for row in batch.rows},
+        )
 
         self.assertEqual(1, med_format.write_records.call_count)
         batch = med_format.write_records.call_args[0][0]