Stimulus.: Recent Episodes
Rob Orman, MD
A podcast that deconstructs strategies to live and practice medicine with intent. Focusing on mindset, burnout, leadership, and your wellbeing. Hosted by emergency physician and executive coach Rob Orman, MD. Don't just suck it up, think differently.
No one enters medicine expecting to land on a performance improvement plan, yet for many physicians, it becomes a disorienting reality. A PIP can feel like both a warning and a test, raising existential fears about career, reputation, and future. Behind the formal language is often a complex mix of organizational risk management and legitimate behavioral concerns. In this episode, we explore what it really means to be placed on a PIP, how to navigate the process effectively, and why resistance is rarely a successful strategy. Finally, we share a structured approach to coaching through a PIP that can turn even the most fraught situation into meaningful professional growth.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
We Discuss:
- Understanding the Purpose and Structure of a Performance Improvement Plan (PIP)
- Variability and Pitfalls in PIPs
- Why Coaching Matters During a PIP
- Common Reactions and Emotional Toll
- Structural Flaws That Undermine PIPs
- Negotiating and Responding to a PIP
- The Myth of Performance Immunity
- A Coaching Framework for Navigating PIPs
- Collaborating With Leadership
- Success and Long-Term Impact
Mentioned in this episode:
UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course
As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.This course will teach you the hidden anti-burnout curriculum.
The UnBurnable Course
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
What if addiction isnât about drugs, but about pain? Beneath compulsive behaviors often lie histories of trauma, anxiety, and unmet emotional needs, hidden behind layers of stigma and misunderstanding. In medicine, addiction is still often mischaracterized as a moral failing rather than a treatable illness with deep psychological roots. In this episode, we explore the personal and professional evolution of Dr. Casey Grover, an addiction medicine physician who reframed both his own struggles and the way he cares for patients. Finally, we uncover how shifting mindset and language can transform both clinical outcomes and clinician well-being.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest bio: Dr. Casey Grover is a board-certified physician in Addiction Medicine and Emergency Medicine at Montage Health, where he also serves as Chief of Staff. He is the Physician Champion for the Monterey County Prescribe Safe Initiative, a program focused on reducing opioid misuse through education, safe prescribing, and improved treatment access. In addition to his clinical and leadership roles, Dr. Grover hosts the podcast Addiction Medicine Made Easy, where he breaks down complex topics to make addiction care more approachable for both providers and the public.
We Discuss:
- What is Addiction?
- When Food Becomes a Coping Mechanism
- The Stigma of Addiction
- The Neurology of Addiction
- Divided Views on Sobriety
- Why Some People Recover and Others Relapse
- The Reason Some Brains Get Hooked
- Addiction vs. Dependence â and Why Stigma Makes It Worse
- Building Trust with Patients
- From Frustration to Compassion: Reframing Patient Encounters
- Trauma, PTSD, and Personal Reckoning
- The Practice of Addiction Medicine
Mentioned in this episode:
UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course
As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.This course will teach you the hidden anti-burnout curriculum.
The UnBurnable Course
Never Lame. Never Spammy. Always Fresh.
If youâd like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our Newsletter
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
What is it about your work that still lights you up inside? At the center of every profession is a core - the reason we chose it in the first place, the part that feels meaningful no matter the chaos around it. When we reconnect with that core, even amid challenge, fulfillment often follows. Sometimes, though, that spark fades. Sometimes the core of what we love evolves, shifts direction, or gets buried under layers of stress and routine. In this episode, we explore how to evaluate your relationship with the essence of your work and how small (or big) recalibrations can realign your day-to-day with what matters most. Finally, we share strategies to clear out the noise, fuel the flame, and shape a career that energizes rather than drains.
đ§ UnBurnable | Our Cohort-Based Burnout Prevention and Cure Course
As physician coaches, my partner, Scott Weingart, and I have noticed a clear pattern: some doctors are thoroughly burned out, and many others are on the path toward it. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.
This course will teach you the hidden anti-burnout curriculum.
Learn more at unburnablecourse.com đ
We Discuss: Starting with the central question: How do you feel about the core of your work?* * Using the stories you tell about your job as diagnostic tools. What tone are you bringing to those tales? * What is a micro recalibration, and how can it reshape your workday from within your current job? * How do you recognize when overwhelm is a sign of a broken approach, not a broken you? * Exploring macro recalibrations. What if you love the work, but the environment is eating you alive? * Running the âlook-around testâ to evaluate other institutions. * Identifying âgravity problems.â Which issues can't be solved within your current system? * Considering a mega recalibration. What does it mean to step away from the work entirely? * How identity and sunk costs keep us rooted in roles we may have outgrown. * Visualizing the flame and smoke of your career. Whatâs burning bright, and whatâs clouding the view? * Defining what a fulfilling day looks like. Is that kind of day even possible where you are now? * Use a five-year future vision to clarify whether your current job fits into your ideal life. * Why walking away doesnât have to mean burning it down. What might rediscovery look like instead? * You donât have to burn it all down to rediscover what lights you up.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Burnout isnât just emotional, itâs financial. Many doctors put off financial planning until theyâre deep in debt, stuck in lifestyle inflation, and too burned out to pivot. In this episode, The White Coat Investor Jim Dahle lays out how to build a burnout-resistant career by making smart, intentional money decisions, whether youâre a student or a seasoned physician.
We delve into frugality (the useful and the absurd), how burnout can quietly become your biggest financial threat, what makes a solid investment plan, the waterfall method of managing your money, and why many doctors end up wealthy on paper but broke in practice. Plus: when hiring a financial advisor is the smartest move you can makeâand when itâs the worst.
Guest bio: Jim Dahle, MD, FACEP is a practicing emergency physician and the founder of The White Coat Investor. After early experiences with predatory financial advisors, he taught himself personal finance and saw firsthand how financial literacy transformed his life. Motivated to help colleagues avoid similar pitfalls, he launched The White Coat Investorâthen the only unbiased financial education resource for physicians. More than a decade later, Dr. Dahle continues to lead the organization as CEO, columnist, and podcast host, staying true to its mission: âhelp those who wear the white coat get a fair shake on Wall Street.â
We Discuss:* Financial goals as the âgame,â not competition with others * Embracing frugality (and where it can go too far) * Burnout as a major financial risk * Strategies to reduce burnout, including working less and managing spending * Understanding your financial âbasementâ (minimum monthly needs) * Lifestyle creep and how to monitor it * The âlive like a residentâ strategy post-training * Net worth versus income, and why physicians sometimes retire broke * The financial âwaterfallâ (how to prioritize where your money goes) * Why trying to beat the market usually backfires * Whole life insurance: the hype versus reality * Creating an Investment Policy Statement (IPS) * Real estate investing: REITs versus hands-on ownership * Designing your life and shifts as a financially independent physician * The "night shift marketplace" model * When to work with, or fire, a financial advisor * Case study: mid-career physician financial planning
Making a major career shift is never easy, especially when you've dedicated decades to a profession that has become part of your identity. The decision to leave clinical medicine can be fraught with self-doubt, financial considerations, and the lingering question - what comes next? But at some point, the balance shifts, and the cost of staying outweighs the fear of leaving. In this episode, we explore what it takes to walk away from a stable medical career, redefine success, and craft a life that aligns with evolving priorities. Finally, we dig into strategies for managing stress, investing in personal growth, and finding fulfillment beyond the bedside.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest bio:Dr. Patrick OâMalley is an emergency physician with nearly two decades of experience in community emergency departments and high-acuity urgent care. Based in Columbia, South Carolina, he has recently expanded into entrepreneurial ventures, including The Laceration Course, in partnership with EB Medicine. He helps moderate the EM Docs Side Hustle Facebook group, a community of over 3,000 emergency physicians exploring side gigs and alternative careers. Dr. OâMalley is dedicated to helping physicians explore new opportunities beyond the walls of the emergency department.
We discuss:
- The Decision to Resign
- Financial Readiness and the Role of Family Support
- Looking Back on a Career in Emergency Medicine
- Redefining Work-Life Balance
- Transitioning to a New Identity
- Investing in Yourself
- Burnout, Coaching, and the Road to Change
- Finding Joy in Medicine: Small Moments, Big Impact
- Living Another Yesterday
- Crafting Your Own Path: Empowering Clinicians
- Newman and John Marks: Managing Stress and Calm
Mentioned in this episode:
đ„ New Free Resource! đ„
Just dropped: a brand-new video + PDF on how to recalibrate your career based on our sold-out webinar, now re-recorded with the best audience questions and tactical takeaways.Youâll get strategies for micro, macro, and mega career shifts, rules for adding anything to your plate, and real stories of how others made it work.Plus: explore our full collection of free resources for getting unstuck, unburnt, and back in the driverâs seat.
Free Resources Link
Recalibrate Your Career
I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. Itâs free, low-pressure, and will give you clarity on your next steps.
Learn more about 1-on-1 coaching
UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course
As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.This course will teach you the hidden anti-burnout curriculum.
The UnBurnable Course
Delivering the news of death is one of the hardest yet most overlooked skills in emergency medicine. Many learn by watching others or through trial and error rather than structured training (or just make it up as they go). This lack of preparation can lead to discomfort, stress, avoidance, and even systemic failures in how death notifications are handled. In this episode, we explore the critical components of death communication, how to navigate these difficult conversations with clarity and compassion, and why avoiding or mishandling these moments can have lasting consequences for both providers and families. Finally, we discuss the emotional toll of secondhand grief and the importance of proactive mental health care for those on the front lines of healthcare.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest bio: Alexandra Jabr, PhD, EMT-P, is the founder of Emergency Resilience and a leading voice in the overlooked aspects of first responder training. With nearly 15 years of experience as an EMT, paramedic, cardiac tech, EMS coordinator, and educator, she saw firsthand the emotional toll of the jobâespecially when it came to death communication. She went on to earn a Masterâs in Death, Grief, and Bereavement, followed by a Ph.D. in Depth Psychology, focusing on how first responders can maintain their mental health while supporting grieving families and colleagues. Through her work, sheâs redefining continuing education, ensuring first responders get the training they truly needânot just another CPR recert.
We discuss:
- Why On-Scene Death Notifications Are So Difficult
- Challenges in Death Communication Training
- Practical Steps for Delivering the News of Death
- A Structured and Compassionate Framework
- Handling Determination of Death
- Common Mistakes
- Secondhand Grief and Provider Well-being
- Proactive Mental Health for Providers
Mentioned in this episode:
Never Lame. Never Spammy. Always Fresh.
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Awake + Aware | May 5â7, 2025
Bend, Oregon | A 3-day, in-person workshop with world-class faculty to challenge your mindset, recharge your purpose, and connect with people who get it. 18 Hours Category 1 CME
Awake + Aware Bend 2025
Leadership impacts everyoneâwhether you're steering an entire organization or simply navigating team dynamics. Itâs an essential skill, yet it often feels elusive, even for experienced professionals. While every leadership challenge is unique, the core principles remain universal.
In this episode, we break down eight critical leadership principles drawn from years of experience, hard lessons, conversations with seasoned experts, research, and coaching leaders at all levels. Plus, we share actionable strategies to help you refine your leadership, whether you're guiding thousands or leading a small team.
Want more? Subscribe to our free newsletter, Doctoring Done Well. Every other Saturday, straight to your inboxâstrategies to work smarter, lead better, and build a career that lasts.
We Discuss:* Donât Worry About Leading, Worry About Listening * This is Not Your Dumpster Fire * Slow Your Roll * You Will Have to Be a Judge, Even When You Donât Want to Be * Model the Values * With Behavioral Issues, Build the Pathway, Not Just the Expectation * You Donât Know What Youâre DoingâAnd Thatâs OK * People Do Things for Their Reasons, Not Yours
Mentioned in this episode:
UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course
As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.This course will teach you the hidden anti-burnout curriculum.
The UnBurnable Course
Violence has a cadence, a rhythm that disrupts the normal flow of life. When an act of violence erupts, the first sign is often a sudden, unexplainable shift in the environmentâan eerie silence, a heightened energy, or a gut feeling that something is wrong. But when does that uneasy feeling cross the threshold into immediate danger? In this episode, we explore the critical decision points in an active violence situation in the healthcare/hospital setting, the moral and ethical dilemmas of medical providers staying versus escaping, and tactical strategies for survival. Finally, we break down the "run, hide, fight" approach and how to act decisively when every second counts.
Guest bio: Mike Shertz, MD is an emergency physician who spent 13 years as a Green Beret and a Special Forces medic. He is the founder and purveyor of Crisis Medicine, which teaches tactical casualty care to medical professionals. Check out this video that we did together in 2019 on how to place and remove a tourniquet and this one on how to pack a gunshot wound with combat gauze.
Want more? Subscribe to our free newsletter, Doctoring Done Well. Every other Saturday, straight to your inboxâstrategies to work smarter, lead better, and build a career that lasts.
We Discuss:
- Recognizing an Active Violence Situation
- Moral Dilemmas: Stay or Escape?
- Perspectives on Risk and Response
- Tactical Survival: Run, Hide, Fight
- Post-Shooting Medical Response
Dealing with an angry, upset patient can feel like walking into an emotional storm. The frustration in the room is palpable, and even the most experienced clinicians can feel thrown off balance. While medical training equips us to handle complex diagnoses and emergencies, it often falls short when it comes to managing interpersonal conflict. Thatâs where the Universal Upset Patient Protocol comes inâa straightforward, highly effective framework designed to de-escalate tense situations, restore trust, and protect your own emotional bandwidth. In this episode, we explore Dr. Dike Drummondâs original protocol, breaking down each step with specific language to use in the heat of the moment. Finally, weâll add a few practical tweaks to help make these conversations even more natural and effective in real-world practice.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bio: Dike Drummond, MD, is a physician coach, burnout prevention expert, and creator of the Universal Upset Patient Protocolâa step-by-step framework for managing challenging interactions with upset patients. A former family physician, he transitioned to coaching to address the emotional toll of healthcare on providers. As founder of TheHappyMD.com, heâs helped thousands of physicians improve communication, manage stress, and build healthier professional relationships.
We Discuss:* The Universal Upset Patient Protocol: A Framework for Diffusing Conflict * Key Principle: Acknowledgment Over Fixing * Step 1: Acknowledge the Vibe and Name the Emotion * Step 2: Open the Door for Them to Speak * Step 3: Apologize and Show Compassion * Step 4: Identify Their Need * Step 5: Clarifying Reflection (Rob O Addition) * Step 6: Set Boundaries and Expectations * Step 7: Express Gratitude * Beyond the Protocol: The Magic of Conflict Framework
Mentioned in this episode:
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course
As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.This course will teach you the hidden anti-burnout curriculum.
The UnBurnable Course
Doctoring Done Well | Bite-Sized Wins
Every other week, a few minutes of career-elevating insight delivered straight to your inbox.The Doctoring Done Well Newsletter is never lame, never spammy, and always fresh.
Sign up for our Newsletter
What defines the unique mindset of an emergency clinician? Itâs not just the fast pace or the chaotic environmentâitâs the deliberate, top-down thinking that prioritizes patient safety over diagnostic certainty. This approach, though deceptively simple, often flies in the face of traditional medical training, which emphasizes comprehensive differentials and exhaustive workups. In emergency medicine, knowing what the patient needs often matters more than knowing exactly what they have. In this episode, we explore the emergency medicine mindset, the pitfalls of the bottom-up approach, and why experienced clinicians focus on acute interventions and dangerous conditions. Finally, we discuss how humility and strategic communication with patients can make all the difference in mitigating risk and building trust.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest bio: Reuben Strayer is an emergency physician based in Brooklyn, at Maimonides Medical Center. He tweets @emupdates and blogs at EMupdates.com on a variety of emergency medicine topics. His clinical areas of interest include airway management, analgesia, opioid misuse, procedural sedation, agitation, decision-making, and error. His extra-clinical areas of interest include sweeping generalizations and jalapeño peppers.
We Discuss:
- A Critique of Medical School Training and the Bottom-Up Approach
- Top-Down Approach and Ophthalmology Insights
- The 8 Responsibilities of Emergency Physicians
- The Wheel of Dangerous Conditions
- Top-Down Thinking in Practice
- Humility and Communication in Emergency Medicine
Mentioned in this episode:
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course
As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.This course will teach you the hidden anti-burnout curriculum.
The UnBurnable Course
Doctoring Done Well | Bite-Sized Wins
Every other week, a few minutes of career-elevating insight delivered straight to your inbox.The Doctoring Done Well Newsletter is never lame, never spammy, and always fresh.
Sign up for our Newsletter
Mastering nonverbal communication can be an elusive task, but the fact remains: whatâs unsaid leaves a significant footprint in any interaction. Nowhere is this more palpable than in the medical exam room, where trust and connection between physicians and patients often hinge on subtle, nonverbal cues.
So, how can one build trust through facial expressions and tone of voice alone?
In this episode, we break down how to silently establish rapport, effective use of pauses, the curious role of your eyebrows, impact of end-of-sentence inflection, how to convey uncertainty with confidence, and why learning a patientâs eye color can pay dividends.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest bio: Bradley Block, MD, is a private practice otolaryngologist on Long Island, New York, where he lives with his wife and three young sons. He is a partner at ENT and Allergy Associates and creator of the Physicianâs Guide to Doctoring Podcast. He realized that rapport was the key to gaining trust, seeing patients efficiently, enjoying his practice, and building his reputation. He tried to find a podcast that would help him improve at doctor-patient communication, but there was none, so he created Physicianâs Guide to Doctoring! The topics quickly expanded to âeverything we should have been learning while we were memorizing Krebâs Cycle.â
We Discuss:
- The "Interest and Authority" Framework for Nonverbal Communication
- Facial Expressions: Conveying Interest
- Humor and Likability in Patient Interaction
- Making Eye Contact and Noticing Eye Color
- Attitude and Authority in Patient Care
- Effective Communication Techniques
- Addressing Patient Concerns and Fears
Mentioned in this episode:
UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course
As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.This course will teach you the hidden anti-burnout curriculum.
The UnBurnable Course
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
Doctoring Done Well | Bite-Sized Wins
Every other week, a few minutes of career-elevating insight delivered straight to your inbox.The Doctoring Done Well Newsletter is never lame, never spammy, and always fresh.
Sign up for our Newsletter
Whatâs the biggest mistake people make about meditation? Thinking theyâre bad at it. Why do they think this? Because theyâve tried meditating, and their mind just wonât shut up!
Itâs a common misconception that meditation means clearing your mind of all thoughts. But in reality, meditation has littleâor nothingâto do with that. If your mind wanders or feels like a crowded room full of shouting voices when you close your eyes, youâre not alone. Thatâs exactly whatâs supposed to happen!
A wandering mind isnât failureâitâs expected, even for seasoned meditators.
In this episode, we break down the exact steps of how to meditate, what to do with a wandering mind, and why a flurry of thoughtsâpopping up like popcornâdoesnât mean youâre bad at meditation. In fact, it means your mind is working exactly as it should. Ultimately, meditation isnât about thinking less; itâs about changing how you engage with your thoughts, making it a skill you simply canât fail.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Mentioned in this episode:
Doctoring Done Well | Bite-Sized Wins
Every other week, a few minutes of career-elevating insight delivered straight to your inbox.The Doctoring Done Well Newsletter is never lame, never spammy, and always fresh.
Sign up for our Newsletter
It started in medical school, when I witnessed the stark reality of the hidden curriculum: a transgender patient referred to as "it" by an attending physician. Over the years, I saw more subtle but no less harmful behaviorsâsnickers, misused pronouns, quiet biases. I often felt lost in how to respond.
Today, transgender identity feels more politically charged than ever. But beyond the politics, whatâs it like simply to be transgender? What challenges do transgender patients faceâphysically, medically, socially, and emotionally? And how do you navigate a world that sees you differently after transitioning?
In this episode, Dr. Jailyn Avila shares her story. We cover the deeply personal aspects of transition, from conversations with her wife and kids to navigating professional dynamics as an internationally recognized expert. Dr. Avila offers candid insights into her experience as a physician presenting as both male and female, practical advice for providing better care for transgender patients, and strategies for addressing pronouns and mistakes with grace.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest bio: Jailyn Avila is a board-certified emergency medicine physician, transgender woman, wife, and mother of three. She has been heavily involved in medical education with an emphasis on bedside ultrasound and runs Core Ultrasound, delivering online educational content. In 2021, Jailyn began her gender transition and âcompletedâ said transition in 2023. Jailyn is currently Core Faculty for the UHS SoCal MEC Emergency Medicine Residency in Temecula, California where she also functions as the Associate Ultrasound Director and the Director of Faculty Development.
- Coming Out to Her Wife
- Navigating External Frictions and Gender Identity
- Balancing Personal and Professional Identity
- The Gradual Process of Transition
- Work and Social Dynamics
- Experiences as Both a Male and Female Physician
- Managing Emotions: The RAIN Method
- Caring for Transgender Patients in the Emergency Department
- Impact of Jailyn's Transition on Her Family and Children
- Understanding Gender and Biological Variations
Mentioned in this episode:
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressureâs on and lock in the mindset you need to flourish. Space is limited.đ P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
Never Lame. Never Spammy. Always Fresh.
If youâd like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our Newsletter
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
Why do our minds seek explanations for everyday patterns, even attributing a cause where none may exist? "Regression to the mean" offers a statistical lens on why extreme experiences naturally revert to the norm. In medicine, this concept reveals why critical observations and repeated assessments are essential to avoid overreactions to abnormal results.
In this episode, we explore the nuances of regression to the mean, breaking down its impact on medical decision-making, patient assessments, and even how we view high-stakes scenarios in healthcare. Finally, we delve into how understanding this principle can enhance clinical judgment and reduce unnecessary interventions.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest bio: Josh Russel, MD, is the editor-in-chief of the Journal of Urgent Care Medicine and is double board-certified in Palliative Care and Emergency Medicine. Apart from his clinical practice, he is a writer, educator, entrepreneur, and trivia enthusiast.
We Discuss:* Superstitions in the Emergency Department * Understanding Regression to the Mean * Is It a Good Idea to Chastise Fighter Pilots? * Blood Pressure Lives on a Bell Curve * The Importance of Control Groups * Pediatric Visits For Fever * Natural History of Disease Processes: Some Are Outliers * The Test of Time * Balancing Urgency with Thoughtful Testing Thresholds
Mentioned in this episode:
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
Never Lame. Never Spammy. Always Fresh.
If youâd like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our Newsletter
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressureâs on and lock in the mindset you need to flourish. Space is limited.đ P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
Being a patient can feel like a lonely experience, especially when you sense your doctor is disconnected. A rushed or disengaged interaction can leave patients feeling unheard and uncared for, no matter how clinically skilled the physician is. At the same time, doctors struggle with overwhelming workloads, which can lead to unintentional detachment from those they treat.
In this episode, we explore five ways to build connection in the exam room quickly, why small gestures matter, and how intentional preparation can change the entire dynamic. Finally, we dive into the emotional complexities of patient care and the essential role of listening and presence in preventing burnout. Our conversation centers around the âPresence 5 Practicesâ from this article.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bio: Clay Smith, MD, is an Associate Professor of Emergency Medicine at Vanderbilt University. He is triple board-certified in Internal Medicine, Emergency Medicine, and Pediatrics and the founder of JournalFeed, which provides concise, daily summaries of top medical journal articles.
We Discuss:* The Disconnect Between Patients and Physicians * Why Genuine Doctor-Patient Connections Matter More Than You Think * Easing Patient Anxiety and Shame * The Impact of Preparation and Focus on Patient Care * Listening Intently and Completely * Aligning Care with Patient Priorities * Building Trust by Connecting with the Patient's Story * Understanding Emotional Cues * The Delicate Balance of Antibiotic Stewardship * Understanding Fear Behind Patient Anger
Mentioned in this episode:
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressureâs on and lock in the mindset you need to flourish. Space is limited.đ P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
Never Lame. Never Spammy. Always Fresh.
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Holding onto a grudge can feel strangely delicious, but that sense of righteousness often comes at a steep cost. In this episode, EMRAP founder Mel Herbert joins Rob to unpack a rift thatâs lingered for over half a decadeâand explore the way forward to healing.
We also break down why achievement does not demand extraordinary genius or talent but a shift in how we view our perceived mediocrity. Why the idea that we need to be exceptional to succeed fuels imposter syndrome and keeps us from valuing the potential in our "average" qualities. We examine the pressing challenges of modern medicine, where corporate pressures often clash with the need for human connection, and how clinicians can reclaim compassion and autonomy. Finally, we address the role of forgiveness and communication in personal and professional growth, revealing how setting boundaries and letting go of resentments can transform relationships and renew purpose.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bio: Dr. Mel Herbert is an acclaimed emergency medicine educator, entrepreneur, and speaker renowned for his innovative approach to accessible medical education. An Australian-born, U.S.-trained physician, Mel founded EM:RAP, a leading platform providing engaging, high-quality education for emergency care providers globally. His dedication to equitable access led to EM:RAP GO, a nonprofit extending emergency medical training to underserved communities worldwide. Melâs philosophy, captured in his debut book The Extraordinary Power of Being Average, champions the idea that anyone can achieve remarkable things through dedication and resilience. Currently a Professor of Emergency Medicine at UCLA, Mel also serves as a consultant on the upcoming TV series The Pitt on MAX.
We Discuss:
- The Power of Embracing Mediocrity
- The Myth of Extraordinary and Why Determination Outshines Talent
- Turning Weaknesses into Strengths
- The Evolution of Medical Education
- The Squeeze of Modern Medicine
- Emotional Intelligence in Medical Practice
- Forgiveness and Personal Growth
- A Dust-Up and Its Aftermath
- The Weight of Sadness and Forgiveness
- The Power of Communication
- Boundaries and Forgiveness â Healing Without Compromising Safety
- Entrepreneurial Challenges and Lessons: Balancing Vision and Collaboration
Mentioned in this episode:
Never Lame. Never Spammy. Always Fresh.
If youâd like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our bi-weekly newsletter
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressureâs on and lock in the mindset you need to flourish. Space is limited.đ P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
It's often not the big power moves that change our lives; it's the small, intentional actions. By focusing on micro-skills, even the most ambitious goals become achievable.
In this episode, we talk with Drs. Adaira Landry and Resa E. Lewiss about their new book, MicroSkills: Small Actions, Big Impact. We explore how financial literacy, self-presentation, concise communication, and allyship can be developed as essential micro-skills for a successful career. We also navigate workplace dynamics, including recognizing and addressing issues like mansplaining and bropropriating. Finally, we discuss the nuances of learning when to say âyesâ or âno,â and the art of timely, respectful communication.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bios: ADAIRA LANDRY, MD, MEd, is an assistant professor at Harvard Medical School who studied and trained at University of California, Berkeley; University of California, Los Angeles; New York University; and Harvard with almost a decade of experience mentoring students and early-career professionals. She is an entrepreneur, keynote speaker, and award winning mentor. She co-founded Writing in Color, a nonprofit that teaches the craft of writing.
RESA E LEWISS MD is a professor of emergency medicine, TEDMED speaker, TimesUp Healthcare founder, designer, entrepreneur, and award winning educator, mentor, and point-of-care ultrasound specialist. She studied at Brown University, the University of Pennsylvania School of Medicine, the NIH Howard Hughes Research Scholars Program, Harvard Emergency Medicine, and Mount Sinai St. Lukeâs Roosevelt. She hosts the Visible Voices Podcast, amplifying content in the healthcare, equity, and current trends spaces.
They have written for CNBC, Fast Company, Forbes, Harvard Business Review, Nature, the Philadelphia Inquirer, Science, Slate, STAT News, Teen Vogue, VOGUE, and USA Today.
We Discuss:
- The Concept of Micro-Skills
- Financial Literacy and Debt Management
- Performing a Debt Inventory to Understand the Landscape of Your Debt
- Appearance Matters and Personal Hygiene is a Skill That Doesn't Always Come Naturally
- Timing and Context are Critical When Checking In or Providing Feedback
- Weâre Trained to be Cumbersome in Communication When What We Need is to be Succinct
- Don't Bury The Lead
- Role-Playing to Improve Communication
- Learning from Experience and Modeling. Do we Leave Too Much Up to Chance?
- Micro-Skills for Self-Care and Burnout Prevention: The Art of Saying No
- Responding to Emails Promptly and Respecting Deadlines are Force Multipliers
- Addressing Mansplaining and Bropropriating
- The Power of Allyship
- Recommended Books
Mentioned in this episode:
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressureâs on and lock in the mindset you need to flourish. Space is limited.đ P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
Never Lame. Never Spammy. Always Fresh.
If youâd like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our bi-weekly newsletter
Ready to reset, recharge, and level up?
Join us at our live event - Awake + Aware, a game-changing 3-day workshop from May 5-7 in Bend, Oregon.
Learn how to stay cool when the pressureâs on and lock in the mindset you need to flourish. Space is limited.
đ±ïž Website: Awakeandawarebend.com
đ P.S. Yes, this is a CME event!
How do you handle your authority being challenged under stress? Even minor communication missteps in high-pressure environments like medicine can create lasting rifts and missed details. While the instinct to push back is strong, it's rarely the best response.
We share a story of miscommunication between a resident and a nurse, highlighting the importance of humility and inquiry in clinical settings. We examine why leading with curiosity instead of ego can save time, build trust, and improve patient care.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
We Discuss:
- Because I Said So
- Cherubic Buddha vs Grumpy Gravel
- You May Feel Frustrated, That's OK
- Pushing vs Pulling
- Tell Me What You're Thinking
- The Three Reasons Why a Nurse Might Question a Doctor's Order
- Why Inquiry Saves Time and Improves Care
- The Other Person's Special Knowledge
Itâs hard to be a good boss and even harder to work under a bad one. This episode breaks down how to begin as a new leader with little to no experience, the critical errors leaders often make, and what to do when your boss is suboptimal. We explore how quick fixes, lack of empathy, and poor communication can alienate teams and stifle growth. Leaders who ignore the importance of relationships, skip proper onboarding, or impose their own agendas without collaboration set themselves up for failure. We also discuss how future writing can help leaders clarify their vision and avoid these pitfalls. Finally, we offer strategies to recognize and correct these missteps, creating a more effective and cohesive leadership style.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bio: Karl Pister is president and founder of The Coaching Group, with over 34 years of experience in executive coaching, conflict management, and leadership development. Heâs also the host of the Healthcare Leadership Podcast, which focuses on leadership, conflict resolution, and emotional intelligence.
We Discuss:
- The Practice of Future Writing
- The Logic Behind Future Writing
- Daily Writing Routine and Its Impact
- Premeditation Malorum | Best vs. Worst Case Scenario Visualization
- Maladaptive vs. Adaptive Perfectionism
- What Daily Future Writing Looks LikeâDoesnât It Get Repetitive?
- Write for the Future in the Present Tense
- How to Be a Successful New Leader With an Underperforming Team
- Tom Peters' Top 5 of Excellent Leadership
- Your Team Knows What Action Needs To Happen
- How Do You Know When You Have Enough Information To Start Taking Action?
- Identify Your Influencers
- Handling Someone Elseâs Emergencies as a New Leader
- Day One as a New Physician Leader, Youâre Prodded From Multiple Sides About a Pressing Issue. What Do You Do?
- Dealing with Difficult Bosses
- Building Positive Relationships With a Bad Leader
- A Bad Leader Is Often Insecure. Becoming an Asset to Them Rather Than an Opponent Can Make Your Job a Lot Better
Books mentioned in this episode:
- The Inner Game of Tennis by Tim Galloway
- Atomic Habits by James Clear
- The Leadership Challenge by James Kouzes and Barry Posner
- What Got You Here Wonât Get You There by Marshall Goldsmith
- Getting to Yes by Roger Fisher and William Ury
- Possible by William Ury
- Negotiating the Non-Negotiable by Daniel Shapiro
- The First 90 Days: Proven Strategies for Getting Up to Speed Faster and Smarter, Updated and Expanded by Michael D. Watkins
Mentioned in this episode:
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressureâs on and lock in the mindset you need to flourish. Space is limited.đ P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
Navigating the complexities of taxes can be daunting, especially for medical professionals with unique financial situations. From maximizing retirement contributions to understanding the benefits of Health Savings Accounts (HSAs), strategic tax planning is essential. In this episode, we explore various tax strategies that physicians can leverage to optimize their financial outcomes. Finally, we delve into practical tips for managing multiple income streams and setting up your business on the right side of the IRS.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bio: Alexis E. Gallati is the founder and Lead Tax Strategist at Cerebral Tax Advisors, Cerebral Wealth Academy, and the author of the book Advanced Tax Planning for Medical Professionals. She has over 20 years of experience in high-level strategic tax planning and multi-state tax preparation and has trained at the highest level, holding two masterâs degrees. Alexis grew up in a family of physicians and is married to a private practice physician. Thatâs why she understands how hard medical professionals work to get where they are and why she provides simple and accessible tax solutions tailored to busy physicians.
We Discuss:
- Maximizing Retirement Contributions
- Understanding 403b and 457b Plans
- Why Health Savings Accounts (HSAs) are Tax Advantageous Compared with Flexible Spending Accounts (FSAs)
- Immediate vs. Deferred Medical Expense Payments
- How to Make Smart HSA Choices
- TurboTax: When to DIY and When to Go Pro
- A Primer on LLCs and S-Corps for Physicians
- Balancing Multiple Income Streams
- The Benefits of 1099 Income
- Retirement Plans for 1099 Income
- SEP IRA vs. Backdoor Roth
- Renting Your House to Your Business
- Can I Write Off My Vacation?
- Starting a Business on the Right Side of the IRS
Mentioned in this episode:
Physician Coaching
I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. Itâs free, low-pressure, and will give you clarity on your next steps.
Physician Coaching FAQ
Never Lame. Never Spammy. Always Fresh.
If youâd like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our bi-weekly newsletter
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling consults.
Free Resources Link
A cautionary tale about how I mismanaged my own physician burnout for many years, doing the easy thing instead of the right thing.
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Psychological safety is a crucial factor in creating a healthy and effective workplace. It involves a shared belief that the team is safe for interpersonal risk-taking. This episode delves into the intricacies of psychological safety, particularly in high-stakes environments like medicine. We explore how rigid hierarchies, cultural biases, incivility, and unrealistic expectations can hinder psychological safety and how fostering a culture of openness and vulnerability can lead to better team performance and resilience. We explore various strategies to enhance psychological safety, including setting clear expectations, modeling vulnerability, and showing gratitude. Finally, we provide actionable tools for leaders to create a psychologically safe team environment.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bio: Kim Bambach, MD is an Assistant Professor of Emergency Medicine at The Ohio State University and Assistant Director of the Kiehl Resident Wellness Endowment
We Discuss:
- What is âpsychological safetyâ?
- Google's Project Aristotle
- Why psychological safety is important, even on a SWAT team
- Threats to psychological safety
- The Korean Air Crash of 1997
- Contributors to trainees feeling psychologically unsafe
- Collegiality between specialties and its impact on psychological safety
- The Psychological Safety Scale
- Six key leadership behaviors to create a culture of psychological safety
Mentioned in this episode:
Physician Coaching
I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. Itâs free, low-pressure, and will give you clarity on your next steps.
Physician Coaching FAQ
Never Lame. Never Spammy. Always Fresh.
If youâd like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our bi-weekly newsletter
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling consults.
Free Resources Link
What would you do if your job ended tomorrow? Even though you might want to say, âTake this job and shove it,â that wonât help build stepping stones to your next job.
In this episode, we discuss: what itâs like for physician coaches who regularly work with docs in this situation, getting fired, dealing with unexpected events that shake up professional stability, planning for career disruption, the importance of networking, and finding your clinical practice N plus one.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bio: Health Joliff, DO, is dual-boarded in Emergency Medicine and Medical Toxicology. He is a certified executive coach and can be found at Physician Coaching Solutions.
We Discuss:
- We plan for what happens at the bedside. Why don't we plan for what might happen to our careers?
- What happens to the majority of docs who come to coaching wanting to get out of medicine
- The importance of clinical medicine + 1
- Networking doesn't have to be a massive labor. Small steps can make a big difference.
- Great doctors getting fired
- First steps after losing employment: be humble and don't burn bridges
- Strategies for bringing up having been fired in an interview
- The therapeutic power of venting (versus dumping)
- Should you accept your group's director position?
- The distinction between imposter syndrome and inexperience
- Your contract has not been renewed
- You are a new resident, and your health system suddenly closes
- An older physician plans to retire in a year and is uncertain what to do next
- Your first job out of training will likely not be your last
Mentioned in this episode:
The Flameproof Course. Sept 10, 2024
Real-time instruction with Rob Orman, MD, and Scott Weingart, MD. Specific tools and strategies for anti-burnout, career longevity, and self-mastery.From a recent Flameproof graduate, "I went from constantly dreading work and thinking of quitting to being able to enjoy shifts on a regular basis."
Flameproof Course
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling consults.
Free Resources Link
1 on 1 Physician Coaching
Love medicine, but the job itself leaves a lot to be desired? I work with many doctors in your shoes and help them rediscover the joy of being a physician.
Learn more about 1-on-1 coaching
Many of us have ideas that could make a great business. Most of the ideas, however, never see the light of day. It can feel like a big leap from physician to entrepreneur. So how do you do it? We speak with Dr. Jason Hine, the founder of SimKit, and see how he went from community emergency medicine doctor to successful business owner.
In this episode, we cover how Jason started his business, accounting for the knowledge gap between clinician and entrepreneur, setting boundaries, why saying hell yes has a critical proviso, the inevitable oscillation between passion and money, and a marketing exercise thatâs critical to walk through before you even consider jumping in on a new product or business.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bio: Jason Hine, MD, is an emergency physician in southern Maine, where he is the Director of Education for his community hospital. He is a graduate of Tufts University School of Medicine and completed his residency at Temple University Hospital, where he served as chief resident. His interests include procedural skillset decay and the role of academics in improving the recruitment, retention, and satisfaction of community physicians. He is the founder of SimKit, a medical education company focusing on delivering convenient and effective hands on procedural skills practice.
We Discuss:
- Sharks and boulders
- Build a business plan early
- Effective resources and dead-end rabbit holes
- The first thing to consider before starting a business: the pain point and value proposition
- Getting out of the Lone Wolf mindset and forming an advisory committee
- What challenge surprised Jason as he got the business rolling
- How do you pay your advisory committee before your business makes money?
- What it means money-wise to give someone equity in your company
- Negotiating equity stake and why contracts are by nature adversarial
- The tipping point from dreamer to doer
- A self-reflective prompt that puts endeavors in proper perspective
- It might be a hell yes for you but a no for your family
- Protecting immutable boulders
- Logistics of setting and keeping boundaries
- Nothing super cool happened because someone just wanted to make a bunch of money
- Finding your ideal customer before the product even exists
- A marketing exercise to do when a product is still an idea
Mentioned in this episode:
The Flameproof Course. Sept 10, 2024
Real-time instruction with Rob Orman, MD, and Scott Weingart, MD. Specific tools and strategies for anti-burnout, career longevity, and self-mastery.From a recent Flameproof graduate, "I went from constantly dreading work and thinking of quitting to being able to enjoy shifts on a regular basis."
Flameproof Course
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling consults.
Free Resources Link
1 on 1 Physician Coaching
Love medicine, but the job itself leaves a lot to be desired? I work with many doctors in your shoes and help them rediscover the joy of being a physician.
Learn more about 1-on-1 coaching
Success and happiness are often determined by where we place our focus: within ourselves or on external factors. Mastery lies in asking the right questions, and understanding the locus of control is a key part of this. Those who focus on what they can influence are generally happier and more successful. In this episode, we explore the philosophy behind the locus of control, its impact on burnout, the importance of small bets in making significant changes, and state vs. trait gratitude. Finally, we delve into practical strategies to cultivate a more resilient mindset
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bio: Dan Mccollum, MD is an emergency physician and Director of Teaching and Learning at the Medical College of Georgia. Hear more of Dan on Stimulus episodes #1 Verbal Judo #14 Stoic With A Capital S, #25 Digital Minimalism, and #59 Aim to Be A Zero.
We Discuss:
- Waiting room medicine has become the norm. It's not ideal. So what do you do about it?
- The power of placing small bets
- Stoicism and the philosophy behind locus of control
- Some things in the world are up to us; others are not
- Sextus, "The crowd is irrelevant."
- What is the locus of control?
- Shades of gray in the locus of control
- The Stoic approach to patient complaints
- Taming the blame ogre
- Domains of control and the paradox of varied strength
- The Stoic approach to patient complaints
- How a mishandled aspirin overdose led to a major recalibration of control locus
- A tactical approach to developing an internal locus of control
- The 'Good' reframe
- The five slices of gift exercise
- The jar of awesome
- Power of an end-of-day debrief
- Trait vs. state of gratitude
- Not every approach is for everybody
- Book recommendations for operationalizing an internal locus of control
Mentioned in this episode:
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling consults.
Free Resources Link
The Flameproof Course. Sept 10, 2024
Real-time instruction with Rob Orman, MD, and Scott Weingart, MD. Specific tools and strategies for anti-burnout, career longevity, and self-mastery.From a recent Flameproof graduate, "I went from constantly dreading work and thinking of quitting to being able to enjoy shifts on a regular basis."
Flameproof Course
1 on 1 Physician Coaching
Love medicine, but the job itself leaves a lot to be desired? I work with many doctors in your shoes and help them rediscover the joy of being a physician.
Learn more about 1-on-1 coaching
Medical debt has a strange and storied history in America. Stretching back to colonial times, physicians and patients alike have grappled with its harsh realities. In recent years, hospitals have resorted to selling medical debt to third parties, who then aggressively pursue patients. In todayâs episode, medical historian Luke Messac, MD, PhD, guides us through the past and present landscape of medical debt, examining perspectives from patients, providers, hospitals, and governments. We delve into a form of indentured servitude in the name of debt clearance, the birth of nonprofit hospitals, a pivotal shift in the 1980s, feasibility of operating healthcare under free market principles, medical economics in the 1600s, hospitals suing patients, and the emergence of medical debt as its own thriving industry.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bio: Luke Messac MD, PHD emergency physician and medical historian whose research focuses on health care's history and political economy. Luke is an attending physician at Brigham and Womenâs Hospital, an Instructor in Emergency Medicine at Harvard Medical School, and the author of two books, No More to Spend: Neglect and the Construction of Scarcity in Malawi's History of Health Care and most recently, Your Money or Your Life: Debt Collection in American Medicine.
We Discuss:
- Hospitals suing patients over debt
- The Service Credit Program | Indentured servitude in the name of debt clearance
- Nonprofit hospitals were born out of the almshouse tradition, where charity care was part of the mission
- The 1980s were a turning point for medical debt in the United States
- With cuts in government medical spending, hospitals cut costs by limiting charity care and aggressively pursuing unpaid debts
- Why healthcare cannot operate in a pure free market
- Hospitals used to refuse care to patients and the courts supported it
- Patient dumping and the rise of EMTALA
- Collecting money from patients has been an issue for hundreds of years
- In the 1600s, doctors could be arrested for charging too much
- Debtor's prison
- Does suing patients to recover medical debt improve a hospital's bottom line?
- In the early 2000s, Yale New Haven Hospital put liens and foreclosing on patients' homes as part of a debt collection strategy
- Medical debt collection has now become a thriving industry
- How third-party medical debt collectors operate
- RIP Medical Debt buys and forgives medical debt
- Is buying and forgiving medical debt better or just forgiving it upfront?
- Dollar For is a nonprofit focused on helping patients navigate financial assistance programs
- Some hospitals are making financial assistance easier to access
- State legislation is starting to address medical debt collection
- National approaches to medical debt
- Medical debt is prevalent around the world, but the US stands apart among wealthy countries
- The consequence of copays
- Paul Farmer and caring for the destitute sick.
- The jungle hospital that's carrying out Paul Farmer's vision in Guatemala
- Rudolf Virchow - Physicians are the natural attorneys for the poor
Mentioned in this episode:
The Flameproof Course. Begins Sept 10, 2024
Real-time instruction with Rob Orman, MD, and Scott Weingart, MD. Specific tools and strategies for anti-burnout, career longevity, and self-mastery.From a recent Flameproof graduate, "I went from constantly dreading work and thinking of quitting to being able to enjoy shifts on a regular basis."
Flameproof Course
1 on 1 Physician Coaching
Love medicine, but the job itself leaves a lot to be desired? I work with many doctors in your shoes and help them rediscover the joy of being a physician.
Learn more about 1-on-1 coaching
Do Stimulus a solid and leave us a review on your podcast app
Our show grows in two ways: word of mouth and reviews. If youâve enjoyed our episodes, consider leaving us a 5-star review and a few kind words. Think of it as spreading good vibes. Thanks in advanceâyou rock!
It's natural to feel guilt or shame when living in abundance while much of the world faces hardship. In this episode, Dr. Barry Kerzin, the Dalai Lama's personal physician and a Buddhist monk, shares his approach to managing these emotions with a simple yet powerful tool. He also discusses his journey to becoming a monk, life within the Dalai Lama's compound, as well as anger management, self-compassion, and impatience strategies.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bio: Barry Kerzin, MD is a US born and trained family physician who for the past several decades has resided as a monk in Dharamshala, India â home of the Tibetan community in exile. In addition to serving as H.H. the Dalai Lamaâs personal physician, Dr. Kerzin is the founder of the Altruism in Medicine Institute, whose mission is to increase compassion and resilience among healthcare professionals and extended professional groups, such as police officers, first responders, teachers and leaders.
Self described as ââŠa doctor, a monk, a teacher, a lazy man. All of these things, yet none of these things,â you can follow Dr. Kerzin on Facebook, Youtube, Instagram or learn more about his story here.
He's also got a new app that you might be interested in -- AIMIcare. This app is crafted to counteract the distressing prevalence of burnout, depression, and frustration among those facing the brunt of human suffering by instilling the virtues of compassion, mindfulness, and self-care
Download AIMIcare: here
AIMIcare Mobile App Website: https://aimicare.altruismmedicine.org/
We Discuss:
- How Dr. Kerzin made the trade from US-based family doctor to Buddhist monk and the Dalai Lama's personal physician
- Studying Tibetan medicine for the treatment of high blood pressure
- A day in the life of the Dalai Lamaâs doctor
- What the food is like in the Dalai Lama's compound
- How Barry feels about being referred to as 'The Dalai Lama's Doctor'
- Two experiences in younger life that sparked Barry's spiritual quest
- The guilt of living in abundance
- The importance of generosity
- Self-compassion
- An approach to imposter syndrome
- Anger management
- Healthy self-confidence
- Using purpose as an antidote for impatience
- Having patience in the time-compressed reality of medical practice
Mentioned in this episode:
1 on 1 Physician Coaching
Love medicine, but the job itself leaves a lot to be desired? I work with many doctors in your shoes and help them rediscover the joy of being a physician.
Learn more about 1-on-1 coaching
Why Burnout Happens and How to Prevent It: The Flameproof Way
Free Webinar July 10, 2024With Rob Orman, MD, and Scott Weingart, MD
Register for the webinar here
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations | The Driveway Debrief | My 4 favorite documentation templates | The quick and dirty guide to calling consults
Free Resources Link
Non-compete clauses have plagued contracts for decades. Itâs been analogous to asymmetric warfare, with employers holding the upper hand.
All of that may soon be a thing of the past.
In this episode, we explore the Federal Trade Commission's recent ruling to ban these clauses and its implications for doctors and the healthcare industry. We'll also discuss the unexpected ways non-competes can protect smaller groups, the rise of independent contractor models, and the critical staffing issues in emergency medicine. A highlight of our discussion includes the lure and the trap of signing bonusesâwhat seems like a generous offer can sometimes come with subtle strings attached. Finally, we'll touch on the U.S. Senate's investigation into major staffing companies and the innovative emergence of empath units for mental health patients.
đĄ Check out our Free Resources specifically designed to address pain points in medical practiceđĄ
Guest Bio: Leon Adelman, MD, MBA, FACEP, FAAEM is an emergency physician and co-founder of Ivy Clinicians, a software company that simplifies the emergency medicine job search through transparency. Dr. Adelman is the author and publisher of the Emergency Medicine Workforce Newsletter, which explores the business of emergency medicine.
We Discuss:
- What is a non-compete clause?
- The Federal Trade Commission's ruling making non-complete clauses null and void
- Why employers and private equity are unhappy with the non-compete ruling
- The emergency medicine-specific burn point of the non-compete ruling: contract retention
- The unexpected way that individual non-compete contract clauses can protect a group from being replaced
- Why small groups like to use non-compete clauses
- How larger groups have moved away from non-competes and favored a 1099 independent contractor model
- Why the non-compete ruling is a massive win for independent physician practices
- The lure and the trap of physician signing bonuses
- A signing bonus is a loan, not a check. It's a loan you are paying back with time.
- What is the chance of someone not paying back the time attached to a signing bonus?
- There's a reason that some jobs offer a signing bonus and others don't.
- The US Senate Committee on Homeland Security and Governmental Affairs is investigating the staffing models of USACS, Team Health, Envision, and Life Point
- When private equity owns a hospital, it tries to lower expenses by decreasing staffing
- 48 states and the federal government don't require a physician in the emergency department
- Indiana and Virginia are the only two states that require a physician to be on duty in emergency departments
- Are Empath Units the solution to helping emergency department mental health patients?
Mentioned in this episode:
The Flameproof Course. Sept 10, 2024
Real-time instruction with Rob Orman, MD, and Scott Weingart, MD. Specific tools and strategies for anti-burnout, career longevity, and self-mastery.From a recent Flameproof graduate, "I went from constantly dreading work and thinking of quitting to being able to enjoy shifts on a regular basis."
Flameproof Course
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations | The Driveway Debrief | My 4 favorite documentation templates | The quick and dirty guide to calling consults
Free Resources Link
1 on 1 Physician Coaching
Love medicine, but the job itself leaves a lot to be desired? I work with many doctors in your shoes and help them rediscover the joy of being a physician.
Learn more about 1-on-1 coaching
Understanding cultural context in healthcare can seem overwhelming, especially when time and resources are limited. Why should clinicians invest energy in learning about different cultures? In this pod, we break down the differences between cultural competence and cultural safety, explaining why the latter is essential for patient care. We share practical examples of how understanding cultural context can improve interactions, strategies for making patients feel seen and heard, and the pitfalls of the term ânon-compliantâ. We also touch on how these practices can make your job more rewarding and prevent burnout.
Guest Bio: Raj Sundar, MD, is a family physician and community organizer in Washington state. His podcast, Healthcare for Humans, âis dedicated to educating you on how to care for culturally diverse communities so we can be better healers.â
For full show notes of this episode and all sorts of other goodies, visit our podcast website
The Flameproof CourseThis is the hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets
We Discuss
- What does it mean to care for diverse communities effectively?
- An argument for why itâs not the patientâs job to teach clinicians about their culture
- Understanding the cultural context of frustrating behaviors
- Shifting from 'why me' to 'of course'
- How to create a framework for cultural knowledge
- What happened to Raj's practice when he started interviewing local Pacific Islander community leaders
- How to have patients feel seen, heard, and known in the point of care
- Cultural competence vs cultural safety
- What does cultural safety look like?
- Why should I spend my energy on learning another's culture? If they've moved here, shouldn't they be the ones to assimilate into this culture?
- The language of noncompliance vs nonadherence vs nonjudgmental
- Why social determinants of health in documentation might be a good thing
- Rumi's The Great Wagon
Mentioned in this episode:
Out On Time Course
Finishing shifts with a stack of charts to complete gets old fast. It also contributes to burnout.Join us for 'Out on Time,' a comprehensive 10-week six-session course where you'll learn how to walk out the door unencumbered.This is the only Out On Time that will be fully live, so don't miss out!The course begins on August 15, 2024.
Out On Time Course
1 on 1 Physician Coaching
Love medicine, but the job itself leaves a lot to be desired? I work with many doctors in your shoes and help them rediscover the joy of being a physician.
Learn more about 1-on-1 coaching
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations | The Driveway Debrief | My 4 favorite documentation templates | The quick and dirty guide to calling consults
Free Resources Link
"Kicking the can down the road" is a common behavior that manifests in various ways, from delaying difficult patient decisions to avoiding complex tasks. We explore the reasons behind on-shift procrastination and strategies for overcoming it. Our discussion includes practical steps to recognize and address decision deferral, techniques for managing aversion to some decisions, and pre-loading accountability. We also highlight the importance of building decision-making resilience and creating systematic pathways to streamline the decisional process.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We Discuss:
- What does it mean to kick the can down the road?
- How procrastination shows up on a clinical shift
- Why does procrastination happen?
- It doesn't take much dread for can-kicking to occur
- Avoidance Awareness
- Decisional Interrogation
- Kicking the can because deciding will set off a cascade of more work
- Avoiding the infinite test of time
- Identify how, when, and where youâll make high-level decisions
- Long term guests | How is it that decisions can finally be made when the shift is over?
- Chunking
- Zero in on your critical decision points
- Kicking the can at work: pick one thing and identify YOUR decision points
- Preloading accountability
- Perfectionists get caught in a tree when they're actually in a tunnel
Mentioned in this episode:
Out On Time Course
Finishing shifts with a stack of charts to complete gets old fast. It also contributes to burnout.Join us for 'Out on Time,' a comprehensive 10-week six-session course where you'll learn how to walk out the door unencumbered.This is the only Out On Time that will be fully live, so don't miss out!The course begins on August 15, 2024.
Out On Time Course
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations | The Driveway Debrief | My 4 favorite documentation templates | The quick and dirty guide to calling consults
Free Resources Link
1 on 1 Physician Coaching
Love medicine, but the job itself leaves a lot to be desired? I work with many doctors in your shoes and help them rediscover the joy of being a physician.
Learn more about 1-on-1 coaching
How do you build a team in the critical first moments of a crisis? The balance between rapid response and thoughtful planning is delicate, especially when understanding what defines a crisis and acknowledging when you're in the midst of one. This conversation delves into the complexity of emergency team dynamics, emphasizing that the composition and organization of these teams are deeply influenced by their members' specific skills and contexts, with lasting implications long after the crisis has passed.
We introduce 'Name, Claim, Aim'âa straightforward, three-step framework designed to streamline team organization under pressure. It's about rapid situational assessment, clear role delegation, and setting concise objectives. The discussion extends to effective leadership in high-stakes situations, including establishing command, ensuring effective communication from the start, and striking the right balance to encourage team input without compromising decisiveness.
Exploring the subtleties of crisis leadership, we'll discuss the strategic balance needed for effective oversight and the practicality of 'Name, Claim, Aim' as a distilled version of more complex crisis management theories tailored for the immediacy of emergency care. The conversation will also cover the practical implementation of this framework, from team huddles to understanding the profound impact of the first few seconds on the trajectory of team success.
This episode builds on episode 115 - Zero Warning | Frameworks for no notice critical patients
Guest Bio:
Lon Setnik, MD, is an emergency physician practicing in New Hampshire and the associate director of clinical programs at the Center for Medical Simulation. Lon is a Stimulus fan favorite. Here are some of his most popular episodes:
- Listening to Understand versus Listening to Win
- Feedback can be hard to give and harder to receive. Here are techniques to do both better
- Take the Suck out of Documentation | Making the most of scribes, documenting in the room (and in front of the patient), efficient workflows
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We discuss:
- The tension between planning and action
- What defines a crisis?
- How do you know when you're in a crisis?
- Teams are contextual in their skill sets
- How you organize a team in a crisis has ripples after the event has ended
- The three steps to organizing teams in a crisis: Name, Claim, Aim
- How to declare yourself as a team leader
- Modeling closed-loop communication from the first moments of team formation
- The balance between being a tyrant vs an effective leader and how to avoid suppressing speaking-up behaviors
- The two pillars of Aiming what we want to achieve and who is going to do what to get us there
- Name, Claim, Aim needs to be fast and efficient; otherwise, people will just start getting to work without organizing
- Balancing the balcony and the dance floor | The impulse in crisis is to do. The leader does not have to be the primary operator, but it's hard to hold back!
- As a team leader, it's ideal to keep your hands off the patient during the beginning of a resuscitation
- Distributing decision-making across time and space, explicitly transferring authority when you need to put your cognitive load elsewhere
- Resetting Name, Claim, Aim at the first lull in action
- Crisis resource management transformed how teams function, but it has a lot of steps and can be hard to deploy in a flash. Name, Claim, Aim is a simple distillation of CRM that can be used in the point of care
- A graded introduction of Naming, Claiming, and Aiming
- Practicing Name, Claim, Aim in team huddles
- Taking 10 seconds for the next 10 minutes | Time is not linear and every second is not worth the same amount
- The consequences of not getting the first 10 seconds right
- Team success is an emergent property
Mentioned in this episode:
Awake and Aware is right around the corner!
Earn 16.25 hours of CMEMay 1-3, 2024. Bend, OR. An in-person live workshop to help you put into practice the tools you hear on this show. Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work.
Awake and Aware
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversationsThe Driveway DebriefMy 4 favorite documentation templatesThe quick and dirty guide to calling consults
Free Resources Link
Will you have enough money to retire? What does that even mean? In this pod, our guest physician financial coach, Elisa Chiang, M.D. Ph.D. breaks down
- Trading time for money and money for time
- Working harder vs creating value
- The FIRE (Financial Independence Retire Early) movement and why it doesn't always mean living by austerity rules
- The risk of relying solely on retirement accounts to fund your post-career life
- Her biggest financial mistake
- How identity influences spending habits
- Incorporating real estate into an investment portfolio
Guest Bio: Elizabeth âElisaâ Chiang, M.D. Ph.D. is a board-certified ophthalmologist and fellowship-trained oculoplastic surgeon who found her way into personal finance and real estate investing during her MSTP program, aspiring for FIRE long before it became mainstream. Battling burnout from her work in a hospital system, she turned to real estate as her avenue to financial independence, complemented by her newfound passion for life coaching. With active involvement in rental properties and passive investments in syndications and real estate funds, Elisa now helps others achieve financial independence while embracing life's journey. Learn more at https://www.growyourwealthymindset.com/
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We discuss:
- Why a high income does not equate to wealth
- Working harder vs creating value
- Once debt is gone, attention to money can dwindle
- Finding a place to start investing can be overwhelming and lead to inertia
- How to navigate a scarcity mindset
- How identity influences spending habits
- Money can buy time, but there's a catch
- Elisa's biggest financial mistakes
- How to decide if a real estate investment is a good (or bad) deal
- Elisaâs big-picture financial strategy
- Real estate investing for positive cash flow
- If you only think about maxing out your retirement account, you probably won't retain the same lifestyle when you stop working
- Beyond real estate investing, what are other areas for investment to produce cash flow?
- F.I.R.E Financial Independence Retire Early | Survival, Regular, and Fat FIRE
- How to figure out how much FIRE money you'll need to stop working
- Will my retirement funds actually last? Rate of withdrawal and sequence of returns risk
- Fat FIRE | Spending more in retirement than you did while working
Mentioned in this episode:
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversationsThe Driveway DebriefMy 4 favorite documentation templatesThe quick and dirty guide to calling consults
Free Resources Link
The Flameproof Course. Sept 10, 2024
Real-time instruction with Rob Orman, MD, and Scott Weingart, MD. Specific tools and strategies for anti-burnout, career longevity, and self-mastery.From a recent Flameproof graduate, "I went from constantly dreading work and thinking of quitting to being able to enjoy shifts on a regular basis."
Flameproof Course
Phantasia Kataleptike, a lesser-known gem from Stoic philosophy, offers a transformative approach to life's challenges. This practice of 'objective representation' strips away the layers of subjective judgment that often cloud our perceptions. Imagine the power of viewing a setback not as a disaster but simply as a fact of life, a moment ripe with potential for growth. How does this shift affect our inner turmoil? The Stoics had insights that might surprise you, blending ancient wisdom with actionable strategies for modern living.
In this pod, we break down the essence of Phantasia Kataleptike and multiple methods for employingit as a tool for equanimity and de-catastrophization.
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets
Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time!
We Discuss:
- Defining Phantasia Kataptike
- Acceptance of what is
- A dog and a cart | Epictetusâ classic simile
- Why the words we use impact us as much as (or more than) they impact others
- The lost ship
- The A-hole in a Jaguar
- Operationalziing Phantasia Kataleptike
- Valence | Awareness of emotion and narrative
- The Dichotomy of Control
- How to Think Like a Roman Emperor
- Actively de-catastrophizing
- Shifting from âwhat ifâ to âwhy didâ to âso what?â to âwhatâs nextâ
- The threat-challenge seesaw
- What to do when the emperor banishes you
- The counterarguments to Phantasia Kataleptike
Mentioned in this episode:
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversationsThe Driveway DebriefMy 4 favorite documentation templatesThe quick and dirty guide to calling consults
Free Resources Link
Our Live Event. May 1-3, 2024 | Bend, OR
Awake and AwareAn in-person live workshop to help you put into practice the tools you hear on this show.Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work. CME? Yes! This is a CME event.Unplug, slow down, and dig in.
Awake and Aware
Have you ever found yourself deep in âThe Pitâ where the mere thought of going back to work triggers an existential crisis? You wonder if your current job is the right choice. Sometimes, all it takes are a few adjustments to the current job and you'll feel fully refreshed and stoked to tackle that next shift. It may also, however, be time for The Trade.
In this episode, we delve into the critical juncture many professionals, particularly physicians, find themselves in when their once-aspired career paths no longer bring fulfillment. We tackle:
- Whether to deepen commitments to your current role or brave the uncertainty of switching careers
- What it means to tolerate another yesterday
- The silent tax paid by grinding it out
- The emotional and practical implications of making significant life changes
- How a well-cultivated professional identity can become an albatross
- A step-by-step guide on how to transition towards a more satisfying career
So, whether you're a physician on the brink, a professional in a pickle, or just someone who enjoys a good existential quandary with their morning coffee, tune in. Let's laugh in the face of the status quo and ponder if the grass is greener, or if it's just astroturf.
Guest bio: Lon Stroschein is the purveyor of the Normal 40 podcast and author of The Trade. In past career interactions, he was an aide to a US senator and brokered billion-dollar deals in the aerospace industry. He now guides professionals in finding their second-half stories.
The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets
Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time!
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We Discuss:
- Do I double down on what I'm doing right now or consider making a career change?
- Tolerating another yesterday
- The Pit: A Signal for Change
- Recognizing and Overcoming the Tax of Discontent
- Working yourself into The Box | We strive for years to get into it, but then it can feel like a trap.
- The two things that keep high-level professionals stuck in a career or position
- Work identity takes a long time to build. It gives amazing opportunities but also takes some away
- The Trade: Step by Step
- The mindset to thwart inertia #JFDS
- Has this job given me all it has to give and have I gotten all I have to get?
- A lifetime is a long time, but it doesn't take long to live it
Mentioned in this episode:
Awake and Aware
Our Live Event. May 1-3, 2024 | Bend, ORAwake and Aware An in-person live workshop to help you put into practice the tools you hear on this show. Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work. CME? Yes! 16.25 hours 16.25 AMA PRA Category 1 Credits.
Awake and Aware
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversationsThe Driveway DebriefMy 4 favorite documentation templatesThe quick and dirty guide to calling consults
Free Resources Link
The interplay between the Default Mode Network (DMN) and the Task Positive Network (TPN) is crucial for our cognitive and emotional health. The DMN, active during restful states and wandering mind, facilitates introspection, memory recall, and creativity, serving as a foundational element in our mental processes. On the other hand, the TPN takes charge during focused, goal-oriented tasks, enabling attention, decision-making, and problem-solving. They operate in balance - when one is active, the other quiescent and this dynamic is essential for optimal mental functioning.
However, imbalances in these networks can lead to mental health challenges. For instance, excessive DMN activity is linked to conditions like depression and anxiety, where rumination and negative self-referential thoughts prevail. In contrast, overreliance on the TPN without adequate rest can lead to burnout and stress.
Mindfulness meditation offers a practical approach to equilibrating the DMN and TPN, promoting mental well-being by fostering a state of alert relaxation and enhancing self-awareness. Moreover, incorporating regular breaks into the workday, particularly those that allow for mental disengagement from task-focused activities, is vital for sustaining cognitive performance and preventing decision fatigue. Engaging in activities that stimulate the DMN, such as spending time in nature or practicing mindfulness, during these breaks can further enhance cognitive restoration and emotional balance.
ï»żAwake and Aware | Our 2024 Live Event
Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.
Website: Awakeandawarebend.com
16.25 Hours Category 1 AMA CME
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We Discuss* What is the Default Mode Network? * What is the Task Positive Network? * Interplay of the TPN and DMN * Default Mode Network out of Balance | Mental Illness * The Neurophysiology Behind How Taking a Small Step of Action Can Decrease Rumination and Anxiety * The Default Mode Network and Insomnia * What Happens with the DMN in Meditation? * The Task Positive Network's Role in Meditation * Why Your Task Positive Network is Begging You to Take a Break in the Workday * How to Take a Break That Effectively Recharges Your Task Positive Network
Mentioned in this episode:
Our Live Event. May 1-3, 2024 | Bend, OR
Awake and AwareAn in-person live workshop to help you put into practice the tools you hear on this show.Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work. CME? Yes! This is a CME event.Unplug, slow down, and dig in.
Awake and Aware
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversationsThe Driveway DebriefMy 4 favorite documentation templatesThe quick and dirty guide to calling consults
Free Resources Link
Moral injury, a term initially used in the military context during the Vietnam War to describe the psychological trauma soldiers experienced, has become increasingly relevant in medicine. In this episode, we discuss how moral injury manifests as psychological distress when healthcare professionals' actions, or inactions, contradict their moral or ethical codes, leading to feelings of guilt, inadequacy, and a sense of betrayal.
Our conversation will navigate through the history of this term, its definition, relationship with burnout, PTSD, and moral distress. We'll examine real-life scenarios where healthcare workers face moral dilemmas, feeling trapped in a system that often works contrary to their values.
Moreover, weâll explore individual and systemic actions that may help mitigate the impact of moral injury.
Guest Bio: Kim Baumbach, MD is an Assistant Professor of Emergency Medicine at The Ohio State University and Assistant Director of the Kiehl Resident Wellness Endowment
ï»żAwake and Aware | Our 2024 Live Event
Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.
Website: Awakeandawarebend.com
16.25 Hours Category 1 AMA CME
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
Mentioned in this episode:
Our Live Event. May 1-3, 2024 | Bend, OR
Awake and AwareAn in-person live workshop to help you put into practice the tools you hear on this show.Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work. CME? Yes! This is a CME event.Unplug, slow down, and dig in.
Awake and Aware
The Driveway Debrief
A free resource to help you transition from work to home life. Developed from extensive experience with one-on-one physician clients, The Driveway Debrief is a structured exercise for decompression and processing the day's events. Release work tensionEstablish a boundary between professional and personal life*Be more present with your loved ones after a day's work
The Driveway Debrief
Thereâs no getting around the surges and potential chaos of an emergency department. The good news is that these events are predictable, you know theyâre going to happen, just not when. So how do you prepare and then navigate the storm once youâre in the thick of it?In todayâs episode, we start with a discussion with Thom Mayer, MD exploring strategies to steel yourself for the inevitable chaos, underscoring the importance of maintaining a positive, agentic, proactive mindset. Drawing parallels to General Theodore Roosevelt Jr.'s decisive leadership on D-Day, the discussion highlights the critical need for quick, confident decision-making. A key focus is on the concept of "energy packets," a methodical approach to managing the cognitive overload in the ED by strategically allocating mental resources to specific tasks. We also delve into understanding individual stress thresholds and how to manage stress without succumbing to a sense of helplessness. In the second half of the episode, Chris Hicks, MD gives his approach to managing high patient volumes, communication while managing critical patients, and how to address a direct challenge in the resus bay. Guest Bios:Chris Hicks, MD
Chris is an emergency physician and trauma team leader at St. Michael's Hospital in Toronto. He has innovated in several areas of resuscitation and psychological skills, including mental practice, stress inoculation training. These days he enjoys a quieter life, free from the problematic corporate jib-jab of academic deliverables. In 2018, as a partial rebuke of the status quo, Chris co-created and chaired resusTO, an inter-professional simulation-based resuscitation conference in Toronto with international acclaim. In 2020, he co-founded Advanced Performance Healthcare Design, consulting with hospitals and industry using simulation to inform the design of systems, spaces and teams. Chris is an avid speaker and lecturer, staunch #FOAMed supporter, occasional runner and cyclist, fledgling boxer, semi-retired pianist, and proud father of three lunatic boys.
Thom Mayer, MD
Dr. Mayer is the Medical Director for the NFL Players Association, Clinical Professor of Emergency Medicine at George Washington University and a Senior Lecturing Fellow at Duke University.
Dr. Mayer was named the ACEP Outstanding Speaker of the Year in the second year the award was given and has twice been named ACEPâs âOver-the-Topâ award winner.
On September 11, 2001 Dr. Mayer served as one of the Command Physicians at the Pentagon Rescue Operation, coordinating medical assets at the site. Dr. Mayer has served on the Department of Defense on Defense Science Board Task Forces on Bioterrorism, Homeland Security and Consequences of Weapons of Mass Destruction. Dr. Mayer also serves as a Medical Director for the Studer Group.
ï»żAwake and Aware | Our 2024 Live Event
Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.
Website: Awakeandawarebend.com
16.25 Hours Category 1 AMA CME
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We Discuss: Setting Yourself Up for Success at the Beginning of a Busy Shift * Counting Down the Hours Til the Shift is Over * Energy Packets - Closing the Loop on Open-Ended Attention Vampires * Identifying Your Stress Tolerance Level * When You Feel Like You're a Victim and Losing Control * Multitasking Makes You Stupid * Systems and Scribes to Mitigate Repeated Interruptions and Breaks in Task * Donât Be Boring, Get to the Point, and Stay on a Level Playing Field * What Stresses Out the Teacher's Teacher of Emergency Department Systems Excellence * How to Keep Things from Falling Apart When You're Slammed with Patients * Putting Patients into Orbit * Taking a Pre-defined Pause to Review and Decide on Action * Reframing the End of Shift When You're Way Behind * Starting a Shift with a Ritual * The Mental Checklist When Walking into the Room of an Unknown Trauma Patient * The Three Things to Learn (or Teach) for Equanimity in a Crisis * How to Effectively Answer a Challenge from a Team Member During Trauma Resuscitation * Making Sure Decisions are Focused on Patient Care and Not Ego*
Mentioned in this episode:
Our Live Event. May 1-3, 2024 | Bend, OR
Awake and AwareAn in-person live workshop to help you put into practice the tools you hear on this show.Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work. CME? Yes! This is a CME event.Unplug, slow down, and dig in.
Awake and Aware
The Driveway Debrief
A free resource to help you transition from work to home life. Developed from extensive experience with one-on-one physician clients, The Driveway Debrief is a structured exercise for decompression and processing the day's events. Release work tensionEstablish a boundary between professional and personal life*Be more present with your loved ones after a day's work
The Driveway Debrief
We all have an internal drive that propels us forward, inspiring us to achieve and create. Yet, there's also an innate anti-drive, a subtle yet powerful force that holds us back. This episode delves deeply into the nature of this anti-drive. We explore the foundations of resistance, drawing insights from Stephen Pressfield's 'The War of Art' and linking it to entropy and the Second Law of Thermodynamics. We'll examine why resistance occurs, how it manifests in both our personal and professional lives, and the various ways it can be hidden, even under the guise of positivity. We'll discuss practical strategies to overcome this resistance, ranging from the psychological tools developed by Phil Stutz to Stephen Pressfieldâs adopting a professional mindset.
ï»żAwake and Aware | Our 2024 Live Event
Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.
Website: Awakeandawarebend.com
16.25 Hours Category 1 AMA CME
The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets
Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time!
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We Discuss:
- What is Resistance?
- The link between resistance and entropy
- Resistance is always on patrol and ready to thwart creativity
- Where does resistance come from, and how does it work? The pain of leaving the comfort zone
- Resistance can be hidden in positive action
- How to overcome resistance. Strategy 1 â Phil Stutzâs The Tools
- Even the best feel fear, it can rarely be overcome
- How to overcome resistance. Strategy 2 â Going Pro
- Why being process vs goal-oriented is a key to overcoming resistance but nearly impossible to execute fully
- How criticism can be a manifestation of resistance
- Overcoming resistance in documentation habits
- Making your bed and small acts that squeeze resistance out of the picture
Mentioned in this episode:
Our Live Event. May 1-3, 2024 | Bend, OR
Awake and AwareAn in-person live workshop to help you put into practice the tools you hear on this show.Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work. CME? Yes! This is a CME event.Unplug, slow down, and dig in.
Awake and Aware
When a critical patient lands on your department's doorstep without prior notice, even the most seasoned professionals can find themselves momentarily at a loss â wondering what steps to take first and how to prioritize actions in those crucial initial seconds. What do I do first, what do I do next? Whatâs REALLY important in the first few seconds? In this episode, emergency intensivist and physician coach Scott Weingart breaks down how to get your mind unstuck and move into action.
Guest Bio: Scott Weingart, MD is a physician coach and emergency department intensivist from New York. He did fellowships in Trauma, Surgical Critical Care, and ECMO. He is best known for talking about Resuscitation and Critical Care on the EMCRIT podcast , which has been downloaded > 40 million times.
ï»żAwake and Aware | Our 2024 Live Event
Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.
Website: Awakeandawarebend.com
16.25 Hours Category 1 AMA CME
The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets
Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time!
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We Discuss:
- Temporizing vs. Stabilizing: Why Seconds Count but Don't Really Count
- The Emergency Action Drill
- Get Off the Spot: Taking Action to Get Out of the White Noise
- Beat The Stress Fool: Breathe, Self Talk, See (Mental Rehearsal), Focus with a Trigger Word
- Using Operant Conditioning to Train a De-escalating Trigger Word
- You Don't Need to Be Everything, Everywhere, All at Once: The Critical Steps to Start Unfreezing
- The transition from temporizing to definitive care in a trauma arrest
- Why ACLS Fails as an Emergency Action Drill: Strategy vs Logistics
- The Reason Why Cognitive Freeze Happens in a Zero Warning Critical Situation
- How to Craft Your Own Emergency Action Drills: The Difference Between Thinky Time and Pure Action
- Building an Emergency Action Drill from the Ground Up for a New Disease
- A Hospital's Resuscitation Readiness Contributes to an Individual Clinician Freezing in a Zero Warning Situation
- Making an Emergency Department Resuscitation Ready on an Individual Level
- Emergency Department Resuscitation Readiness on a Systems Level: The Four Steps to Become a Resus World Champion
- Potential Objections to Becoming Resuscitation Ready
- How to Communicate Uncertainty in a Critical Situation
Mentioned in this episode:
The Driveway Debrief
A free resource to help you transition from work to home life. Developed from extensive experience with one-on-one physician clients, The Driveway Debrief is a structured exercise for decompression and processing the day's events. Release work tensionEstablish a boundary between professional and personal life*Be more present with your loved ones after a day's work
The Driveway Debrief
Our Live Event. May 1-3, 2024 | Bend, OR
Awake and AwareAn in-person live workshop to help you put into practice the tools you hear on this show.Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work. CME? Yes! This is a CME event.Unplug, slow down, and dig in.
Awake and Aware
The specter of medical malpractice lawsuits looms large for many clinicians, but according to Mark Brown, MD, JD, this anxiety may be disproportionate to the actual risk. In this discussion, we explore the contrasting nature of law and medicine, the unpredictable and capricious nature of legal proceedings, the systemic elements that fuel the high number of medical malpractice lawsuits in the United States, and several practices to reduce the risk of lawsuits.
Guest Bio:
Mark W. Brown, M.D., J.D., holds a JD from Harvard Law School (1970), and an MD from Dartmouth Medical School (1982). His career includes roles in the Los Angeles District Attorney's Office, criminal defense practice, and teaching law at Southwestern School of Law. In medicine, he completed his internship and residency in Emergency Medicine at Presbyterian Hospital, San Francisco, and UCLA and is currently an emergency physician at Antelope Valley Medical Center and clinical faculty member at UCLA School of Medicine.
ï»żAwake and Aware | Our 2024 Live Event
Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.
Website: Awakeandawarebend.com
16.25 Hours Category 1 AMA CME
The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets
Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time!
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We Discuss:
- The Fundamental Difference Between Law and Medicine
- Should you be worried about the National Practitioner Data Bank?
- Can Getting Sued Lead to Getting Sanctioned by the Medical Board?
- The Odds of Getting Sued
- Three Reasons Why The US Has So Many Malpractice Suits
- Should You Push For Settling a Lawsuit?
- The Plaintiff's Attorney Is Not Your Friend, Even If They Act Like It
- When the Doctor's Med Mal Fear Supersedes the Patient's Risk Tolerance
- What's Really Happening in a Deposition
- High Yield and Low-Cost Ways to Reduce Med Mal Risk and Anxiety
- There's a Big Ticket Item That Your Documentation Doesn't Capture
- What to do About Hindsight Bias
None of us are born with the skills to build and sustain healthy relationships. These things are learned. In this episode, our guest is Ryan Cheney, an experienced psychotherapist and behavioral leadership coach, guiding us through the intricacies of healthy and unhealthy relationship dynamics. Our conversation will explore the importance of interdependence, the negative impacts of codependency, and the nuanced practice of attunement, including how to rectify misattunements. Further, we will delve into the role of healthy boundaries in building resilience and trust, how resistance and perfectionism can hinder growth, acceptance and self-awareness, and the difference between appeasement and compromise
Guest Bio:
Ryan Cheney MS, LPC, is a licensed professional counselor, wellness specialist, certified behavioral leadership coach, breath work specialist, and certified XPT (extreme performance training) coach.
He received his Master of Science in clinical mental health from Oregon State University and has dedicated himself to learning how to help others through continued research, education, and practice for over 15 years. He has worked in many settings, including community mental health crisis work, clinical outpatient work within medical settings, and as a clinical supervisor for Deschutes County Behavioral Health. He works in his private practice as a clinical mental health therapist specializing in trauma work and as a performance coach, helping others gain self-mastery and thrive.
Connect with Ryan Here
ï»żAwake and Aware | Our 2024 Live Event
Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.
Website: Awakeandawarebend.com
16.25 Hours Category 1 AMA CME
The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets
Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time!
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We Discuss:
- The Campfire Metaphor for Relationships
- Interacting with Others' Campfires
- The Difference Between Healthy Interdependence and Codependency
- The Dynamics of Healthy Relationships
- Identifying Healthy vs. Unhealthy Relationships
- Blaming Never Helps, But It Sure Happens A Lot
- Understanding Resistance in Personal Growth and Relationships
- Resistance is a Struggle Against Acceptance
- Confronting and Recovering from Perfectionism
- The Impact of Attunement on Personal and Professional Interactions
- The Importance of Boundaries in Healthy Relationships
- The Distinction Between Appeasement and Compromise
What: Awake and Aware. Our 3-day live event
When: May 1-3 2024
Where: Bend, Oregon. USA
Website: Awakeandawarebend.com
Early bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024
CME: Yes! Category 1 AMA continuing medical education credit
Burnout is not a foregone conclusion. While individual efforts play a pivotal role, continually battling systemic challenges can be exhausting. In this episode, we delve into a simple and cost-effective systemic intervention that not only mitigates burnout but also enhances job satisfaction. We then discuss how you can recognize when your colleagues might be in distress, what to do about it, what to say, what not to say, and how to break through the stigma of seeking help.
Guest Bio:
Dr. Tricia James is an internist and the Director of Wellness at Providence Portland Medical Center. A champion of local and regional clinician wellness, she is the first author of the groundbreaking HOSP-CPR study
ï»żAwake and Aware | Our 2024 Live Event
Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.
Website: Awakeandawarebend.com
16.25 Hours Category 1 AMA CME
The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets
Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time!
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We Discuss
- A study of two hospitalist groups. One struggled. One thrived.
- The intervention groupâs mandate was threefold: Listen, identify the pain points, find agency
- The Role of regular debriefing, sharing experiences, and addressing uncertainty
- Engagement levels were high
- The Intervention Group continued meeting after the study, and it helped. A lot
- Itâs not just talking about medicine and logistics. Thereâs a sense of cohesion and mutual support:
- Outcome of the Non-Intervention Group
- Challenges in wellness funding
- The value of funding and compensation for wellness initiatives
- Approach to securing grants
- Data and stories are great for persuasion. But it's empathy and curiosity that will win the day.
- Most start by approaching administration for grants
- The first step when creating an in-house clinician-run program to build agency and thwart hopelessness
- Staffing is a significant stress for many and can seem insurmountable. What can you as an individual do about it?
- Emotional suppression in healthcare professionals
- Our tendency to conceal weakness
- How to identify when one of your colleagues is in distress
- Approaching a distressed colleague
- What to do if you ask a distressed colleague how they're doing and they repeatedly say, "I'm fine," but it's clear they are not
- It's not our job to fix our colleagues that we're worried about. But we can step in and offer an invitation.
- The hardest part about reaching out to offer support is trying not to fix it
- Importance of asking hard questions
- The internal and external barriers to seeking help when we're struggling | Tricia paid for counseling out of pocket, so no one would know about it
- Dr. Jamesâ vision for medicine
Whatâs the impact of private equityâs increasingly large footprint in medicine? The results so far have not been promising.
We dissect: what is private equity, the recent bankruptcy of the largest emergency medicine staffer in the US and how that impacts clinicians, can corporations practice medicine, the American Academy of Emergency Medicine has jumped into the fray, does profit-driven medicine ever serve patient care, HCA has been accused of naughty deeds, performance metrics versus the one metric that really matters, the No Surprises Act, and physician unions.
Guest Bio: Leon Adelman, MD, MBA, FACEP, FAAEM is an emergency physician and co-founder of Ivy Clinicians, a software company that simplifies the emergency medicine job search through transparency. Dr. Adelman is the author and publisher of the Emergency Medicine Workforce Newsletter, which explores the business of emergency medicine. As medical director at Tennova Healthcare Clarksville and Johnston Health UNC (large rural EDs in Tennessee and North Carolina), Leon led emergency department teams to exceptional patient-centered outcomes. Leon is a graduate of Brown University, the University of North Carolina School of Medicine, the Harvard-Affiliated Emergency Medicine Residency at Beth Israel Deaconess Medical Center, and the University of Tennessee Haslam College of Business. Leon is married to an emergency nurse and has two adorable dogs.
ï»żAwake and Aware | Our 2024 Live Event
Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.
Website: Awakeandawarebend.com
16.25 Hours Category 1 AMA CME
The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets
Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time!
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We Discuss:
- What does 'venture capital/private equity' in medicine really mean?
- The largest emergency medicine staffer in the US, Envision, recently went bankrupt.
- What happens with all of those clinicians and hospitals when the staffing company implodes?
- A corporation cannot practice medicine in most states in the US (but can in some!).
- The American Academy of Emergency Medicine is suing Envision and their corporate entity for the illegal corporate practice of medicine
- Is there a functional difference between the old-school CMG (contract management groups) and modern-day private equity-owning medical groups?
- Does profit-driven medicine ever serve patient care?
- HCA has been accused of funneling patients into end-of-life care to improve hospital mortality metrics.
- Has private equity made universal healthcare impossible in the US?
- The group you want to work for sees physicians as the business rather than an expense to minimize
- Quality of shift is a metric you rarely see on your monthly performance stats, but it should be at the top of the list
- Would you ever wash your rental car? The downstream of not having ownership in a group
- The No Surprises Act was set up to protect patients. Itâs kind of a mess.
- Physician unions. Can doctors go on strike?
- Leonâs guess outlook for the emergency medicine job market in the coming years
In this real-life coaching session, we walk Dr. Brit Long through building a framework to help navigate being overwhelmed during the middle part of an emergency department shift. Since this session, he has become more efficient, gotten home earlier on a consistent basis, lowered his stress level, felt less burnout, and experienced more joy in his career.
Guest Bio
Brit Long is an assistant professor of emergency medicine in San Antonio, Texa, and Editor-in-Chief of Clinical Content at emcdocs.net. He is one of the most published authors in the field of emergency medicine. In addition to that, he is a father of two and works in both academic and community settings.
ï»żAwake and Aware | Our 2024 Live Event
Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.
Website: Awakeandawarebend.com
16.25 Hours Category 1 AMA CME
The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets
Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time!
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We Discuss:
- The fundamental differences between the beginning, midpoint, and end of the shift
- Why mid-shift is so fraught
- What we usually do when feeling overwhelmed
- Why willpower will almost always fail as a sole strategy for keeping up with documentation
- The specific steps for navigating mid-shift overwhelm
- Early detection of overwhelm
- A mid-shift action plan
- How to keep up with documentation
- The real reason timely documentation is important
- Breaking through your comfort zone
- Britâs plan for triaging tasks
- Why deferring charts is so seductive and a slippery slope
We wear many hats in life, and one of them can become disproportionately large: our professional identity. Donât get me wrong, being a physician is amazing and the associated identity is imbued with meaning and purpose. The challenge comes when identity becomes calcified and too narrowly defined. When that happens, it can limit us.
In this episode, we delve into the diverse and often unforeseen roles of a physician, the constraints placed on one's identity due to deeply entrenched beliefs about our own capacities, strategies to overcome limiting beliefs, how the term "just" can undermine one's potential, the significance of embracing alternate identities, and the common thread between Ted Lasso and Deion Sanders.
Guest Bio:
Pranay Parikh is a principal of Ascent Equity Group, a real estate, private equity company, predominantly for physicians with over 310 million in assets. Pranay is also the purveyor of the Passive Real Estate Income Academy course, which teaches doctors to be able to find vet and invest in real estate syndications; part of the Passive Income MD podcast, and most recently The Effective Living Formula Course - doing more of what matters. (here's his free webinar) On the side, he is a hospitalist, nocturnist, husband, and father of two young sons.
ï»żAwake and Aware | Our 2024 Live Event
Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.
Website: Awakeandawarebend.com
16.25 Hours Category 1 AMA CME
The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets
Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time!
Love medicine, but the job itself leaves a lot to be desired?
I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We Discuss:
- You are more than âjustâ a doctor
- Pranayâs system for how he approaches life
- An over-the-top identity exercise
- What assumptions do you make about yourself?
- Unpacking the word 'Just'
- Exercises to Overcome âJustâ
- The Power of Alter Egos
- Belief impacts outcome
Itâs tempting to think of accepting the reality of the moment as acquiescence or giving up, but the opposite is true. Awareness and acceptance of whatâs going on inside of you and around you is a recipe for equanimity. With this equanimity, you are able to operate at a higher level as well as be an effective agent for change in the system. Sounds like a paradox!
In this episode, we look at mindfulness as a tool for addressing and mitigating burnout, fostering self-compassion, promoting a sense of well-being, squashing imposter syndrome, restoring autonomy, working through our âspecialnessâ, getting out of a scarcity mindset, doubting self-doubt, and getting charts done so you can get home on time (yes, itâs true!)
For complete show notes, click here.
Stay Connected * Sign up for our newsletter here * Read our last newsletter âThe Kids Who Hated Math Have Something to Teach Usâ here
Elevate Your Career * To learn more about 1 on 1 coaching, start here
Guest Bio Gail Gazelle, MD, MCC is an assistant professor at Harvard Medical School and Master Certified Coach for physicians. She is the author of Everyday Resilience. A Practical Guide to Build Inner Strength and Weather Lifeâs Challenges, and most recently Mindful MD. 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout. To hear more of Gail, sheâs the featured guest on Stimulus Episode 27.
We Discuss * What the heck is mindfulness anyway? * The thinking mind can be overwhelming. * Mindfulness training helps us gain autonomy. * Apps and other methods to assist with meditation and mindfulness. * Mindfulness helps in gaining awareness and insight into one's inner dialogue. * Recognizing that we are not our thoughts helps restore autonomy and cure burnout. * Imposter beliefs contribute to burnout and prevent recognition of our own accomplishments. * Steps that can be taken to challenge and overcome imposter beliefs. * Combatting the "special syndrome" experienced by many physicians? * The role self-compassion plays in reducing burnout and improving motivation. * Shifting from inner criticism to inner ally. * How does the focus on comparison affect healthcare professionals' well-being? * Practicing gratitude and abundance mindset shifts physiology and wellbeing * Emotional reactivity and resistance to accepting reality impact healthcare providers. * Mindfulness helps healthcare providers appreciate the present and avoid a "milestone mindset" * There's often confusion between acceptance of the moment and acquiescence to an external issue that you want to change
Investigative journalist Scott Carney is our guest as we dive into: Why you might want to consider getting in cold water, the technique for staying in cold water for more than a few seconds, how to take your first step into the freeze, brown fat, the power of lightly held beliefs, how people are dying with the Wim Hof method, and the law of speedy gains.
Shield yourself from bullsh*t Want to re-spark the joy in your practice, get home on time, unstick whatâs feeling stuck, or even just build a shied for all the BS you face in a workday? Start here to learn more about 1 on 1 coaching. Youâll be glad you did.
Guest Bio: Scott Carney is an anthropologist, investigative journalist, author, and a seeker of both the fringes of human experience and the core of what makes us human. Scott has written four books to date, including The Vortex, The Enlightenment Trap, The Red Market, What Doesnât Kill Us, and The Wedge, and produced the recent film The Rise and Fall of the Wim Hof Empire.
Scottâs work has been featured in many magazines â Wired, Mother Jones, Playboy, Foreign Policy, Menâs Journal, and National Public Radio. He has won the Payne Award for Ethics in Journalism and is a multi-finalist for the Livingston Award for International Journalism. You can find all his goodies on his website.
Check out our new (free!) Mini Book Scripting Your Least Favorite Conversations
We Discuss:
- The mindset method for staying in cold water
- Detailed steps for entering cold water
- The benefit of breaking through walls and physiologic control using ice water exposure
- The power of lightly held beliefs
- Cold exposure as a lightly-held belief
- People are dying using the Wim Hof method
- The Bitcoin Enema
- Does Brown Fat matter?
- The law of speedy gains
The Drama Triangle identifies our roles in dysfunctional interpersonal dynamics. It can be a potent tool for understanding conflict and miscommunication within personal and professional relationships. In this episode, we break down the core components of the Drama Triangle, strategies to disentangle ourselves from âdramaâ, and explore practical tools to identify and navigate the dynamics of our own interactions.
Check out our new (free!) Mini Book on Scripting Your Least Favorite Conversations Kickassery Want to re-spark the joy in your practice, get home on time, or just unstick whatâs feeling stuck? Start here to learn more about 1 on 1 coaching. Youâll be glad you did.
In this podcast, we discuss: * What is the Drama Triangle? * The Empowerment Dynamic * Recalibrating from drama to neutrality
How do you make important decisions? Do you go by your gut, some sort of defined process, or perhaps a combination of the two? When we're offered an opportunity to participate in something that seems amazing, itâs almost always associated with a cost. That cost is time. Every âyesâ is accompanied by even more ânoâsâ.
In todayâs episode, we take a look inside a real coaching session that addresses just this scenario. Our client is a physician who wants to develop a decision-making process so that he can derive meaning from his professional life and not take on projects or jobs that on the surface sound intriguing but may end up draining rather than fueling him.
Client Bio: Josh Russell MD is the editor-in-chief of the Journal of Urgent Care Medicine and is double board certified in Palliative Care and Emergency Medicine. Apart from his clinical practice, he is a writer, educator, entrepreneur, and trivia enthusiast.
For full show notes visit our podcast page
Interested in one-on-one coaching? Learn more at roborman.com
Subscribe to our kickass newsletter here
Are you often quick to give advice? You're not alone, but sometimes our advice may not be as helpful as we think. In this podcast episode, we explore the concepts of the advice trap and humble inquiry, which shift communication from telling to asking and encourage us to stay curious a little longer.
For complete show notes with way more detail than you see on this podcatcher summary, click here. If youâre not into that kind of detail, have an aversion to websites, donât really care about show notes, or are contrarian in nature, by all means, do not click here.
Guest Bio: The late Edgar Schein, PhD. was a renowned figure in the field of organizational psychology, with significant contributions to the understanding of organizational culture and leadership. As a Professor Emeritus at the Massachusetts Institute of Technology's Sloan School of Management, his academic work spanned several decades, educating countless leaders and thinkers. Holding a Ph.D. in Social Psychology from Harvard University, Dr. Schein was widely recognized for his groundbreaking theories on corporate culture and process consultation. His seminal works, including âHumble Inquiryâ, "Organizational Culture and Leadership" and "The Corporate Culture Survival Guide", continue to be pillars of study in the field. Dr. Scheinâs dedication and influence earned him prestigious accolades, including the Lifetime Achievement Award in Workplace Learning and Performance from the American Society for Training and Development. His insights continue to shape modern approaches to organizational development and leadership.
Kickassery: Want to re-spark the joy in your practice, get home on time, or just unstick whatâs feeling stuck? Start here to learn more about 1 on 1 coaching.
Mentioned in this episode:
Our recent newsletter on communicating with patients
Newsletter Signup Here
Freebies with documentation phrases and tips on calling consults Here
The Advice Trap Link
Humble Inquiry Link
Registration is open for the FlameProof Course This is a small cohort six-month course specifically for emergency and acute care clinicians that will build and strengthen tools for career longevity, strategies for well-being, life balance, and so much more. Learn more here.
In this pod, we discussâŠ
- We love to solve problems, and that can be a problem
- The Advice Trap
- Why even good advice can be bad
- The paradoxical pitfall of how we see our value
- The demotivator
- Where this comes up in coaching
- You are in the coffee shop with your best friend
- Hearing yourself think
- Humble inquiry
- Itâs not just to fill the awkward silence
- Asking questions is not straightforward
- Critical skills for implementing humble inquiry
- The take-home challenge
- Ed Schein quotes from this episode
How often do you walk into work hoping it will be a good day or at least not a bad one? What if it didnât matter what happened and the good/bad was entirely in your control? In todayâs episode, Christina Shenvi MD, MBA, PhD gives insight and specific strategies for a nearly perfect shift.
For complete and detailed show notes, visit our website
If youâre interested in 1 on 1 coaching, start here
Guest Bio: Christina Shenvi MD, MBA, PhD is an emergency physician at the University of North Carolina, Chapel Hill. She is president of the Association of Professional Women and Medical Sciences, director of the UNC Office of Academic Excellence, and a world-class time management coach www.timeforyourlife.org. A selection of her previous Stimulus episodes includes Procrastination, Habits, and âToo Much on My Plate.â
Registration is now open for the Flameproof Course. Scott Weingart and I are launching the FlameProof Course starting September 2023. This is a small cohort six-month course specifically for emergency and acute care clinicians that will build and strengthen tools for career longevity, strategies for well-being, life balance, and so much more. Learn more on the brand-spanking new website.
Mentioned in this episode:
The Quick and Dirty Guide to Calling Consults and My 4 Favorite Documentation Templates
Zen Driving
Be Water documentary
We Discuss:
- How do you define a nearly perfect shift?
- What to do when you canât get something done or things donât go your way?
- Why do we experience frustration?
- The irony of power and powerlessness
- Point of care frustration reversal
- Even out your standard deviation and raise your mean
- Mental contrasting with implementation intentions
- What Bruce Lee can teach you about adaptability
- Identify the opposite outcome
- Change your own mind
- Minimaize vs maximize
In this episode, we explore the 10% rule - the idea that in disagreement, the other person is at least 10% right. This is a tool for conflict abatement as well as resolution.
Registration is now open for the Flameproof Course The big kahuna! After a year in the making, Scott Weingart and I are launching the FlameProof Course starting September 2023. This is a small cohort six-month course specifically for emergency and acute care clinicians that will build and strengthen tools for career longevity, strategies for well-being, life balance, and so much more. Learn more on the brand-spanking new website.
Half day in person. Flameproof: Shift KickAssery workshop on May 29, 2023, at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here.
Interested in one-on-one coaching? Learn more at roborman.com
For full show notes visit our podcast page
We discuss
- The sublime feeling of basking in our own rightness
- How to operationalize the 10% rule
- Don't lie and try to appease
- Yes vs No. And vs But.
- All the buts in your day
- The 10% Rule in real-time
Transitions, by their nature, involve ambiguity and disorientation. It's important to recognize that this zone is a natural part of the process of growth and change. In this episode we break down the nature of the being in a transitional/liminal space, embracing it as an identity, and navigating it through small and tectonic changes.
Registration is now open for the Flameproof Course The big kahuna! After a year in the making, Scott Weingart and I are launching the FlameProof Course starting September 2023. This is a small cohort six-month course specifically for emergency and acute care clinicians that will build and strengthen tools for career longevity, strategies for well-being, life balance, and so much more. Learn more at the Flameproof website.
Half day in person. Flameproof: Shift KickAssery workshop on May 29, 2023, at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here.
Mentioned in this episode:
The Quick and Dirty Guide to Calling Consults
https://roborman.com/free-resources/
Interested in one-on-one coaching? Learn more at roborman.com
For full show notes visit our podcast page
In this episode, we discuss:
- What is a liminal space?
- Situational awareness and the big picture
- Embracing a transitional identity
- Essential tools and strategies for navigating uncertainty
Hidden in plain sight is the most important procedure we do. Listening. And not just listening, but listening to understand. Measurable, improvable, and, when done well, can have an incredibly positive impact. Intention is key with listening: are we doing it to understand or to win? In this episode, we break down specific strategies for quality listening, potential pitfalls, and how to know when you've got it right.
Guest bio: Lon Setnik MD is an Emergency Physician and Associate Director of Clinical Programs at the Center for Medical Simulation with expertise in communication
Registration is now open for the FlameProof Course
The big kahuna! A year in the making, Scott Weingart and I are launching the FlameProof Course starting in September 2023. This is a small cohort six-month course specifically for emergency and acute care physicians that will build and strengthen tools for career longevity, strategies for well-being, life balance, and so much more. Learn more on the brand-spanking new website.
Half day in person. Flameproof: Shift KickAssery workshop on May 29, 2023, at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here.
Our first-ever listener survey Your feedback helps us improve the quality of our podcast. We'd really appreciate it if you could spare a few minutes to answer this survey.
In this episode, we discuss: * The concept of listening as a procedure * Two modes of listening: listening to understand and listening to win * Specific tools for listening to understand * Separating the problem from the person * The external marker of quality listening * Finding the optimized solution in patient interactions * Negotiation strategies for success * Active vs empathic listening * How to stay present during conversation
Interested in one-on-one coaching? Learn more at roborman.com
For full shownotes visit our podcast page
Have you ever wondered what it takes to reach the highest level of mastery?Are you a medical student looking for ways to achieve excellence in medical school or a physician wanting to become an expert in your field? If so, youâre in luck! Join us as we explore a fascinating conversation with Dr. Jeff Riddell, a leading expert in medical education as he talks about strategies to develop any skill, how medical school curriculum is adapting, the importance of context and relationships for comprehension, and so much more.
Mentioned in this episode: Scott Weingart and I are putting on the Flameproof: Shift KickAssery workshop on May 29, 2023, at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here.
Guest bio: Dr. Jeff Riddell is an Assistant Professor of Clinical Emergency Medicine at the Keck School of Medicine of the University of Southern California. His research on digital technology in medical education has made him a sought-after teacher, speaker, and researcher. He has won numerous accolades and awards for his work in both teaching and research, including the 2019 CORD/EMF Emergency Medicine Education Research Grant and the 2019 Academy Scholar Award in the category of Education Research from the CORD Academy for Scholarship in Education in Emergency Medicine.
For full show notes visit our podcast page
We Discuss:
- Mastering Learning
- Mental Models of Expertise
- Evolving Medical Education
- Learning Retention from Podcasts
- Threaded Cognition - A Theory of Concurrent Multitasking
- Is There Gender Bias in Medical Education?
- Resident Burnout
Have you ever had a day at work that was so difficult and draining, it felt like it took a toll on your entire being? You're not alone. Meet Dr. Sara Gray, an expert in wellness, resilience, and resuscitation team performance. In this episode, Dr. Gray dives deep into her special framework for coping with difficult days and how to recover and even come out of them a little stronger. She has outlined a process to help you identify and acknowledge the struggles, practice self-care, and ultimately, learn from the experience. This framework will provide you with a roadmap for navigating the complex emotions that come with these difficult moments.
The Flameproof Course on Shift KickAssery: Scott Weingart and I are putting on the Flameproof: Shift KickAssery workshop on May 29, 2023, at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here.
Guest Bio: Dr. Sara Gray is an Emergency Medicine & Critical Care Physician, Associate Professor at the University of Toronto, and Chief Medical Director with Advisory Services by Cleveland Clinic Canada. Dr. Gray was once named Torontoâs best ER doctor by Toronto Life Magazine. She is also a professional coach and a public speaker.
Interested in one-on-one coaching? Learn more at roborman.com
For full show notes visit our podcast page
We discuss: * Why it's important for medical professionals to prepare for a bad shift or traumatic event. * The framework steps in coping with bad shifts and difficult cases. * What is a failure friend and what are their characteristics?
Quote of the pod
"We train to manage all sorts of disasters, to manage the worst cases, but nobody teaches you how to recover when it goes badly...If you have a plan, you can make your recovery so much easier." - Dr. Sara Gray
Part of practicing medicine is telling patients NO. Itâs never fun to do so and it can be a draining daily task. It doesnât have to be that way! In this episode, we break down pitfalls and pearls in these situations as well as specific scripting to help the medicine go down.
Mentioned in this episode: Scott Weingart and I are putting on the Flameproof: Shift KickAssery workshop on May 29, 2023, at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here. (The Flameproof reg is halfway down the page)
Interested in one-on-one coaching? Learn more at roborman.com
For full show notes visit our podcast page
We Discuss:
- What is the Spock Retreat?
- The scenario: a patient pushes for something that they think will help but will actually harm.
- A common response when we get pushback on our logic.
- You canât please all the people all of the time.
- When embracing our inner Spock is the right move.
- When embracing our inner Spock could be the wrong move.
- Introducing Bones McCoy.
- Why scripting is important.
- How to approach a situation that is frustrating and illogical.
- What do you want to avoid?
- How to say ânoâ in a positive way: The Yes, No, Yes framework, compliments of the Harvard Program on Negotiation.
- What does Yes, No, Yes sound like in real-time?
- A script for pushback.
For full show notes visit our podcast page
When you have a patient who requests a Z-pack for what is almost certainly an acute viral respiratory infection, you probably respond internally or externally (possibly both) that antibiotics do not treat viruses. But could there be some effect on their symptoms, or the viral infection itself, that is not part of the common discussion when it comes to such things? We know that azithromycin is an antibiotic, but it turns out that azithromycin actually has some activity in the viral arena. This absolutely shocked me. The question is, does it matter?
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - visit our Patreon site and help keep the wind in the sails.
For our full catalog of shows with complete show notes, visit our podcast page
To witâŠ
- In vitro studies show azithromycin reduces rhinovirus replication and release.
- Another in vitro study on respiratory cells from lung transplant patients found azithromycin reduces rhinovirus-associated cellular inflammation.
- Kids with coronavirus (the pre-COVID, old-school coronavirus) had reduced viral load with azithromycin.
- In enterovirus-infected mice, azithromycin improved survival.
- Patients infected with influenza a who were given azithromycin had reduced interleukins 6, 8, 17, tumor necrosis factor, and CRP, indicating anti-inflammatory properties in flu patients.
-
- This study, however, did not show improved clinical outcomes with azithromycin.
- Another study using a similar methodology did not see any change in inflammatory markers but had a slight improvement in sore throat and fever resolution in the azithromycin group.
- A 2009 paper found that azithromycin did not improve disease course in hospitalized infants with a respiratory synovial virus. There has been signal of clarithromycin decreasing hospitalization in patients with severe RSV, but the preponderance of data are fairly consistent that there is no benefit in hospital stay, length of illness, or oxygen utilization.
Selective poison
Every medication is a selective poison and azithromycin poisons a lot of stuff: interleukin beta production, PGE2 synthesis, tumor necrosis factor, cytokine expression, it slows membrane trafficking towards lysosomes, and inhibits the fluid phase of endocytosis of macromolecules. Suffice it to say, there's a lot going on here.
When we see these changes in inflammatory markers or in vitro decreased viral loads, it isnât far-fetched. By extension, it frankly wouldnât be far-fetched if this drug improved resolution and severity of illness in viral upper respiratory infections. When it comes to the flu, an illness with cytokine dysregulation, a medication such as azithromycin, with its immunomodulatory and anti-inflammatory effects, looks very tasty.
Bottom line: It's pretty clear that something happens when a patients take this drug. It's even possible that they may even have a sense of feeling better. I can't refute that. My assumption is that their cold or acute sinusitis improves despite their taking an antibiotic, but maybe there is something subtle afoot that is as yet unmeasured. Unfortunately, the data to date do not show observable clinical outcome benefits with azithromycin and viral infections.
Most of us are motivated to have compassion for those in need, but sometimes it can feel like the tank is running on empty. In this episode, wellness expert Kim Baumbach, MD gives insight into compassion fatigue and strategies to thwart it.Â
Guest Bio: Kim Baumbach, MDÂ is an Assistant Professor of Emergency Medicine at The Ohio State University and Assistant Director of the Kiehl Resident Wellness Endowment.
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - visit our Patreon site and help keep the wind in the sails.Â
We discuss:
- What is compassion fatigue?
- The signs and symptoms of compassion fatigue;
- How compassion fatigue is different from burnout;
- The âdark sideâ of empathy;
- How to combat compassion fatigue.
For full shownotes visit our podcast page
Our guest today is Dr. Stephanie Pearson, founder and CEO of Pearson Ravitz, an insurance advisory firm that specializes in disability and life insurance for healthcare professionals. In this episode we break down disability insurance start to finish: what to look for in a policy, pitfalls and traps, the deal with disability coverage through work, the steps you need to take in order to collect disability, why insurance companies so often put up a fight in paying, and much more.
To see our most recent newsletter, click here.
Interested in one-on-one coaching? Learn more at roborman.com
A full transcript of this episode is available on our podcast page
Guest bio: Before beginning her career in insurance, Dr. Pearson was in the prime of her career as an OB/GYN when she suffered a shoulder injury at work that soon prevented her from practicing medicine. Her struggle navigating the disability claims process and the challenges of losing her identity as a physician drove her to become a passionate advocate and advisor to her peers on the importance of disability insurance.
Stephanie dedicated herself to educating others on the vital need to have the appropriate policy (something she had lacked) and decided to become an insurance broker; specifically, the rare type of broker who follows her clients throughout their careers, advising them continuously as their life circumstances change.
We discuss:
- Getting paid a disability benefit from a group vs private policy
- The history behind insurance companies heavily scrutinizing physician disability claims
- The fundamental differences between a disability policy you get through work vs. one you buy on your own
- The important fine print in a private policy: specialty specific and own occupation
- Can you still have a job that makes money and collect disability payments?
- The essential questions to ask an insurance agent when shopping for a disability policy
- What in insurance expert looks for in a policy to see if itâs solid
- Disability policy discounts
- The elimination period/waiting period of long term disability policies
- Is it worth it to buy short term disability coverage?
- The steps to take if you think you might need to file for disability
- Black and white vs. gray cases- why some claims are challenged and others sail through
- Is there a penalty if you start the process of filing a claim but donât file it?
- Why some specialties pay more for disability than others
- The importance of getting private disability insurance when youâre a trainee/resident
- The disability insurance trainee package
- The big question - why should you get disability insurance in the first place?
Financial expert and raconteur Vitaliy Katsenelson gives his approach to the scarcity mindset, personal finance advice that changed his life, key strategies for making a budget, why people argue about money, geofencing as a diet tool, and a Stoic take on social media.
Guest Bio: Vitaliy Katsenelson was born in Murmansk, USSR, and immigrated to the United States with his family in 1991. After joining Denver-based value investment firm IMA in 1997, Vitaliy became Chief Investment Officer in 2007, and CEO in 2012. Vitaliy has written two books on investing and is an award-winning writer. Known for his uncommon common sense, Forbes Magazine called him âThe New Benjamin Graham.â
Heâs written for publications including Financial Times, Barronâs, Institutional Investor and Foreign Policy. His articles are also published on his website, ContrarianEdge, and in audio format on his Intellectual Investor Podcast. Vitaliy lives in Denver with his wife and three kids, where he loves to read, listen to classical music, play chess, and write about life, investing, and music. Soul in the Game is his third book, and first noninvesting book.
Awake and Aware Jan 13-15 2023: The Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (thatâs 15% off the whole package â lodging, meals, the course).
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - visit our Patreon site and help keep the wind in the sails.
For full show notes visit our podcast page
We Discuss
- The value of a scarcity mindset;
- Personal finance advice that changed a financial expertâs life;
- Loose vs strict budgeting;
- Finishing books vs stopping early;
- Why people argue about money;
- Geofencing as a diet strategy;
- Habit vs. identity vs. willpower;
- How a Stoic philosopher might view social media.
In a follow up to our episode on sleep, we break down five sleep tools weâve tested, like, and are still using.Â
For many of you, sleep can be a fraught landscape. This is doubly true if you are doing shift work, working nights, or even just getting home with your mind spinning. When you have built-in disrupted sleep, it is extra important to pay attention to how you go about getting as much quality sleep as possible. Whatâs discussed in this episode is 100% opinion and anecdote but hopefully there is something in here that youâll find useful.Â
For show notes and links to whatâs discussed on this pod, visit our podcast pageÂ
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - visit our Patreon site and help keep the wind in the sails.Â
Awake and Aware Jan 13-15 2023: The Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (thatâs 15% off the whole package â lodging, meals, the course).
Feedback comes in many forms and oftentimes we arenât even aware that itâs happening. In this episode, communication expert Lon Setnik, MD breaks down the basics of feedback, why cloaked or hidden feedback can be so dangerous, and critical skills for both delivering and receiving feedback.
Guest Bio: Lon Setnik, MD is a community emergency faculty at the Center for Medical Simulation.
Mentioned in this episode: The Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (thatâs 15% off the whole package â lodging, meals, the course)
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - visit our Patreon site and help keep the wind in the sails.
For full show notes visit our podcast page
We discuss:
- What is feedback?
- We need evaluation know where we stand;
- Feedback can be cloaked;
- The ground rules for feedback;
- Rob gets some feedback and we see see itâs dark underbelly;
- Why feedback is not mandatory;
- The three forms of feedback;
- The Advocacy Inquiry Molecule;
- Pendleton model for feedback;
- Self-feedback isnât easy and usually poorly executed;
- Effective receiving of feedback is about the âwhatâ and not the âwhoâ;
- Embracing your hypocrisy;
- Barriers to feedback.
Itâs a tough time to practice medicine right now, which makes paying attention to self care even more important. In this episode we break down three specific strategies for: improving mental and physical performance, sustaining shift endurance, and building a scaffolding for joy at work.
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - visit our Patreon site and help keep the wind in the sails.
For full show notes visit our podcast page
Episode Sponsor: Ivy Clinicians. Curious if thereâs a better clinical opportunity out there? Ivy is the simplest way for physicians, PAs, and nurse practitioners to match with jobs they love. With Ivy, you can find all 5,549 emergency departments, filter by your preferences, and connect securely with the right employers. All for free.
Mentioned in this episode: The Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (thatâs 15% off the whole package â lodging, meals, the course)
We Discuss
- A perennial nocturnist shares his approach to career longevity;
- An unexpected thread in the origin story of medical training in the US;
- Three strategies to focus on self care and improve endurance during shifts;
- Fuel like an Ironman triathlete;
- Does the patient always come first?
- Using the dynamic between tension and relaxation to conserve energy;
- Using intention as a tool for self care.
28 years ago, the die was cast for how emergency department encounters were documented. Since then, we've had note bloat, click fatigue, and too much attention placed on things that really didnât matter. All of that is slated to change in 2023 with dramatic new documentation guidelines (that todayâs guest calls ârefreshingâ) are implemented. When was the last time you heard the word ârefreshingâ used when it came to charting? And a massive thank you and hat tip to my friend Matt DeLaney who now runs ERcast - he was the first to alert us to these guidelines and interviewed Jason when they were first announced.
Episode Sponsor: Ivy Clinicians. Curious if thereâs a better clinical opportunity out there? Ivy is the simplest way for physicians, PAs, and nurse practitioners to match with jobs they love. With Ivy, you can find all 5,549 emergency departments, filter by your preferences, and connect securely with the right employers. All for free.
Guest bio: Jason Adler, MD is a clinical assistant professor of emergency medicine at the University of Maryland where he is also the director of compliance and reimbursement. He is also the vice president of acute care solutions at LogixHealth.
Mentioned in this episode: The Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (thatâs 15% off the whole package â lodging, meals, the course)
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - visit our Patreon site and help keep the wind in the sails.
For full show notes visit our podcast page
We Discuss:
- History and physical documentation are now at your discretion;
- Heavy value is placed on cognitive work and medical decision making;
- History from a non-patient source is valued in these guidelines;
- Ordering a test is equally valued as not ordering a test;
- Consideration of escalation or deescalation of care;
- In addition to documenting your shared-decision making conversations, your MDM should include;
- Population health - Stable means something different when it comes to documentation;
- Social determinants of health;
- There is a heightened emphasis of independent interpretations of separately billable procedures (EKGs, X-ray, CT, U/S);
- Jasonâs take home points;
- And More.
Barry Kerzin, MD, the Dalai Lamaâs personal physician, is back to dive deeper into: the difference between empathy and compassion, why compassion (versus empathy) is a critical aspect of medical care, generating self compassion, and answers to listener email.
Episode Sponsor: Ivy Clinicians. Curious if thereâs a better clinical opportunity out there? Ivy is the simplest way for physicians, PAs, and nurse practitioners to match with jobs they love. With Ivy, you can find all 5,549 emergency departments, filter by your preferences, and connect securely with the right employers. All for free.
Guest Bio: Barry Kerzin, MD is a US born and trained family physician who for the past several decades has resided as a monk in Dharamshala, India â home of the Tibetan community in exile. In addition to serving as H.H. the Dalai Lamaâs personal physician, Dr. Kerzin is the founder of the Altruism in Medicine Institute, whose mission is to increase compassion and resilience among healthcare professionals and extended professional groups, such as police officers, first responders, teachers and leaders.
Self described as ââŠa doctor, a monk, a teacher, a lazy man. All of these things, yet none of these things,â you can follow Dr. Kerzin on Facebook, Youtube, Instagram or learn more about his story here.
Mentioned in this episode: The Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (thatâs 15% off the whole package â lodging, meals, the course)
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - visit our Patreon site and help keep the wind in the sails.
For full show notes visit our podcast page
We Discuss:
- The difference between empathy and compassion;
- Can compassion be taught?
- Listener email about having a hard time switching between empathy and compassion;
- Barryâs response to the listener email;
- Self compassion after a bad patient outcome;
- Exercises to help build compassion;
- The decision point between accepting people how they are and trying to change them;
- And More.
Verbal de-escalation is a tool that can be learned by almost anyone. In this episode, we learn from two masters in the art of de-escalating those who are agitated and upset: Jose Pacheco, RN, known affectionately to his co-workers as âThe Drunk Whispererâ, and Dan McCollum, MD, emergency physician at Augusta University. The core of this conversation hinges around an approach to conflict resolution that evolved from the martial arts principle of using your opponentâs energy to resolve conflict, rather than simply butting heads. The name for this method? Verbal Judo.
A proviso to all of this is that if the room/scene needs to be safe. Your top priority is to keep yourself and your team safe. Do not put yourself at risk. That doesnât always mean physical escalation (though sometimes it does), it can simply mean removing yourself from the physical space of the escalating situation.
Mentioned in this episode: Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (thatâs 15% off the whole package - lodging, meals, the course)
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - visit our Patreon site and help keep the wind in the sails.
For full show notes visit our podcast page
We discuss:
- Jose Pacheco's tactics to de-escalate and defuse agitated patients in the emergency department [03:13];
- Dan McCollumâs de-escalation sequence based on needs of the situation [09:30];
- The unifying principle of verbal judo: Empathy absorbs tension [15:50];
- Present the professional image [22:50];
- The Universal Upset Patient Protocol [24:20];
- âWe treat people as ladies and gentlemen not because they are, but because we are.â [35:50];
- You canât control how an upset person is going to respond to conflict, you can only control how you respond. [36:40];
- Seeing a situation from the other personâs eyes. [37:50];
- Sword of Insertion technique aka How to politely interrupt [38:20];
- Active listening [40:50];
- Jose Pachecoâs tips for interacting with difficult patients in the ED. [42:30];
- Non-verbal cues [53:30].
What happens at the end of an event can disproportionately impact our perception and memory of it. In this episode, we investigate the research behind the peak end pattern and how you can use this phenomenon to improve your own experience at work (and life).
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - visit our Patreon site and help keep the wind in the sails.
For full show notes visit our podcast page
We discuss:
- Research identifying a peculiar aspect of how memories and impressions are formed;
- The peak end phenomenon is often portrayed as a bug in our operating system, but it can also be used as a feature;
- Michael Jordan was a master of finishing time;
- Focusing on a peak end can not only lead to a better memory of events, but possibly better patient care;
- Is there evidence that focusing on the peak end will improve job satisfaction and lessen burnout?
- Two types of peak endings.
Weâre all guilty of it, basing decisions on the most recent event. Itâs surely part of our wiring. The question is - what do we do about it? In this episode, Justin Morgenstern breaks down availability bias: what it is, how it shows up in life and medical practice, the difference between learning and bias, research showing availability bias happening in real time, and ways to turn availability bias from a bug into a feature.
Guest Bio: Justin Morgenstern is a community emergency physician with a passion for education, resuscitation, and evidence based medicine, Purveyor of the amazing First10EM blog, Justin works in the Greater Toronto Area.
On a personal note, Justin and I met years ago at a conference in the Bahamas. He was in the audience and was such an incredible contributor to a group conversation that I had him come up on stage and be a panel member. Since then, Iâve found that he is a rare mix of humility, genius, and kindness.
For full show notes visit our podcast page
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - our Patreon site is https://www.patreon.com/stimuluspod
We discuss:
- Availability Bias and how it relates to everyday decision making.
- What is availability bias;
- Where this shows up in clinical practice;
- Learning is not availability bias;
- Whether more testing is the right path for subtle presentations of life threatening diseases;
- Testing thresholds;
- Tips for avoiding availability bias in our practices;
- Real world example of availability bias;
- Justinâs tools for addressing bias;
- Ways to hack the bias.
Specific strategies to improve workflow and manage overwhelm during an emergency department shift.
Guest Bio: Landon Mueller, MD is an emergency physician and fellowship trained sports medicine specialist who gave the best talk Iâve ever seen on managing workflow in the emergency department. Now he's our guest on the show.
For full show notes visit our podcast page
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - our Patreon site https://www.patreon.com/stimuluspod
We discuss:
- 3 phases of the ED visit
- Why disposition is king, until it isnât
- Hierarchy of tasks
- Blocking time
- Linear vs parallel processing
- Swarming
- Batching
- The quick hit charting nidus
- Task switching
- Running the board
- Managing interruptions
For full show notes visit our podcast page
What does it mean to act like a true professional? Iâm not sure itâs been fully fleshed out in medicine but Iâve met those who are exemplars of it. This pod is a conversation with my partner in hundreds of critical resuscitations, Ben Peery, MD. We talk about wins, losses, lessons learned and, even more than that, I get to introduce you to someone who, for me, was a role model in how to carry yourself as a physician.
Guest Bio: Ben Peery, MD is a 20 year veteran of the emergency department, spending the bulk of that time working in a rural hospital. A former SWAT team member and tactical medicine expert, he is now host of The Grit Podcast with Ben Peery that you can find on Spotify, iTunes, and all the rest. Benâs show is conversations âwith colleagues in medicine, law enforcement, EMS and anyone else who has been in the sh*t. By sharing stories and insights we hope to offload mental trauma.â
Interested in one-on-one coaching? Learn more at roborman.com
Support our work on Patreon
For full show notes visit our podcast page
An inside look at what it takes to launch a ketamine clinic including: first steps, navigating hurdles, potential pitfalls, which patients benefit from ketamine, and an exhortation about why you should (and shouldnât) go into this type of business.
For full show notes visit our podcast page
Guest Bio: Dr. Samuel Ko is a Board Certified Emergency Physician and medical director of Reset Ketamine in Palm Springs, California. In addition to his medical practice, Dr. Ko is Co-Creator of an online course - Ketamine StartUp - which teaches other physicians how to start their own ketamine clinic. During his free time, he practices yoga, meditation, reads voraciously, and relaxes with his amazing wife, daughter, and four-legged son. Find Sam on the Insta and Facebook.
Here is the link mentioned in this episode with some ketamine clinic startup SWAG (the ultimate checklist and business plan template) from Sam Ko for Stimulus listeners.
Interested in one-on-one coaching? Learn more at roborman.com
Support our work on Patreon
When you are at the lowest of lows after a devastating case, how do you recover in real time? Itâs certainly not easy and it takes a clear plan of action to do it well.
In this episode, pediatric hospitalist Sarangan Uthayalingam walks us through a difficult case where nothing was working. He felt frozen in inaction and the patient, a newborn, did not survive. Immediately afterward, he was in a deep emotional hole, profoundly self critical, and still had his entire shift in front of him with other patients to care for. What happened next was quite extraordinary - a reset, recalibration, and reframing of intent and mental state so that when the next critical infant came in (which they did in short order) he was not only up to the task, but a better clinician. Sarangan breaks down exactly how he did this in granular detail.
Much of the discussion springboards off of Stimulus episode 65
Interested in one-on-one coaching? Learn more at roborman.com
To support the show, visit our Patreon site https://www.patreon.com/stimuluspod
For full show notes visit our podcast page
Have you ever had a situation where afterward you repeatedly questioned the choice you made at the time? You chewed on it, perseverated on it, kept coming back to it? If you are a clinician, there is an amplifier to this because someone elseâs life is also involved - the patientâs. You worry about their health, you worry about whether they or their family may sue you - you worry worry worry. I think most of us have been there to varying degrees. In this episode, we will discuss one strategy to manage these fears:Â the letter to your future self.
Interested in one-on-one coaching? Learn more at roborman.com
Support our work on Patreon
For full shownotes visit our podcast page
At work, you are often activated, hyper focused, and fully absorbed. There can also be stress points and challenges that don't get processed because, frankly, you've got to move on to the next thing.
These factors, amongst others, can make it difficult to just jump right into 'home brain'. In addition, there's a lot to untangle in your 'work brain' at the end of the day.
What many of us do is kind of push that tangle it to the side and get on with the rest of day or, taking that up a level, numb it or drown it out so that it doesn't make too much noise.
If any of this sounds or feels familiar to you, I encourage you to check out this guided exercise to help with the transition between work and home.
Click here to go to the blog post with the exercise(s)
What's in there..
- A brief focused breathing cycle down-regulate, shift from that sympathetic - go go go -to parasympathetic/decompressed
- A guided review of the day .
- What went well, what was interesting?
- What was challenging?
- Why was it challenging, what happened, and how could you approach it differently the next time?
- Release. Release whatever you're holding on to from work.
Medical Ethicist Abbott, MD walks us through her perspectives on myriad ethical quandaries including: How to approach discordance between a patient's written wishes and a family member who says do the opposite, the ethics of operating on demented patients who have an acute life threatening critical illness, a case of a young man with an unsurvivable brain bleed and whether or not to extubate him before the family enters the resus room, strategies to skillfully guide families through withdrawal of life support, and the real consequences of restrictive hospital visitation policies.
Interested in one-on-one coaching? Learn more at roborman.com
Support our work on Patreon
For full shownotes visit our podcast page
Guest Bio: Dr. Jean Abbott is a medical ethicist and faculty at the Center for Bioethics and Humanities and Core Faculty, Master of Science in Palliative Care, University of Colorado Health Sciences Center. She is also Professor Emerita University of Colorado School of Medicine, and 30 year veteran of the emergency department. Not part of her CV but germane to this show...she was my attending when I was a resident in the 1990s and had a profound impact on who I became as a physician. Irreverent, quick witted, and a tireless patient advocate, she is one of the finest physicians I have ever known.
We discuss:
- Visitor policyâ one of the enduring tragedies of the COVID-19 pandemic;
- A case of a 45 year old with an unsurvivable brain bleed â Do you remove the endotracheal tube before the family enters the room to say goodbye or do you await their permission to extubate?;
- The struggle that society has with brain death;
- Withdrawing and withholding care in the emergency department;
- One way to approach death disclosure;
- Accommodating requests to delay death so family members can arrive to say their goodbyes;
- The case of a minimally communicative, demented (but happy) patient with a subdural hemorrhage who was unable to provide consent to surgery and has no POLST;
- Reasons why we tend to over treat in the ED;
- The scenario where the patientâs POLST form (eg. comfort measures only) and the desires of the power of attorney (do everything) do not align;
- Priming families in the ED;
- The ethical thing to do when you canât get informed consent from a patient;
- Navigating the âDaughter from Californiaâ;
- When does the medical Power of Attorney kick in?;
Thereâs no denying that mistakes happen in medicine. When they do, whatâs the next step? Business as usual is to deny and defend. Not only is this an adversarial and destructive process, it is also a lost opportunity to learn (and for the patient/family to fully understand what happened). In this episode, we explore a novel approach that shifts thinking from ârisk managementâ to âpatient managementâ, which some argue is profoundly better for all parties involved in a medical error- clinicians, patients, and systems.
Guest Bio: Peter Smulowitz MD is an expert in health policy and author of Disclosure, apology, and offer programs: stakeholders' views of barriers to and strategies for broad implementation. He currently serves as Chief Medical Officer, Milford Regional Medical Center and is an Associate Professor of emergency medicine, University of Massachusetts Medical School.
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - our Patreon site https://www.patreon.com/stimuluspod
For full shownotes visit our podcast page
We Discuss:
- The status quo for the way we handle mistakes creates multiple victims, but no winners. [03:30]
- It was the aftermath of an unfortunate case that sparked Smulowitzâ interest in this subject. It motivated him to try to make systems better so that others did not have to go through the same trauma. [06:30]
- We are taught not to apologize after an adverse event. But is this good advice? [13:50]
- Communication, Apology, and Resolution (CARe) programs have been developed to bring providers out of the shadows, encouraging them to talk about adverse events and encouraging a transparent process with the patients and families. [15:55]
- How would you apply the CARe process to this hypothetical scenario: a young woman with a viable pregnancy is mistakenly given methotrexate (which was ordered for the patient with an ectopic in the room next to her)?
- What is the best way to deliver bad news and apologize effectively? [24:10]
- The University of Michigan made the CARe program an institutional process. What happened after they started using it? [22:05]
- What are the barriers and strategies for implementation of CARe programs? [28:45]
Sleep expert Mike Stone, MD joins us for a conversation about how to sleep well (and strategies to do it poorly!) We cover: how sleep cleans your brain, alcohol, caffeine, a pragmatic approach to wearables, light exposure, the villainy of devices before bed, cannabinoids, heat, room temp, and night shifts.
Guest Bio: Dr. Mike Stone has been in medical practice for almost 20 years, and currently serves as the Chief Education Officer at Wild Health. Dr. Stone has held academic appointments at Harvard Medical School and UCSF, and has received multiple national awards for education, innovation, and leadership in medicine. He has spent the bulk of his career focusing on educating students, trainees, and colleagues. Mike is obsessed with optimal health and peak performance, with a deep interest in the effects of lifestyle interventions to improve longevity and cognitive function. He is currently focused on knowledge translation for healthcare practitioners, striving to empower practitioners with practical techniques to competently construct strategies and tactics for their patients' health optimization.
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - our Patreon site https://www.patreon.com/stimuluspod
For full shownotes visit our podcast page
We discuss:
- What is sleep and why it is important [04:00];
- The benefits of exposure to morning sun early in the day and limiting light exposure later in the day [08:00];
- A primer on sleep stages [09:30];
- How to use wearable sleep trackers smartly [13:45];
- Alcohol and sleep [16:40];
- Light, blue light and screen time before bed [24:00];
- The physiology of caffeine [26:15];
- Cannabinoids as a sleep aid [29:30];
- Heat â what is the ideal room temperature for optimal sleep? [34:00];
- Other sleep hygiene ideas [38:20];
- Natural predilection: the early bird vs. the night owl [40:10];l.
- Damage control for night shift associated sleep disturbance [43:45];
- Melatonin questions [58:00];
None of us are immune from the Fundamental Attribution Error - chalking up the behavior of others to their character rather than the situation in which they find themselves. In this episode, we tease out the details of this common bias, its negative effects, and several strategies to address and work through it.
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - our Patreon site https://www.patreon.com/stimuluspod
For full shownotes visit our podcast page
Episode Highlights:
- The core tenant of fundamental attribution error;
- The fact that nobody sees themselves as the villain of their own story;
- Marcus Aureliusâ approach;
- Ways to address and manage fundamental attribution error;
- Stephen Coveyâs simple yet powerful technique: first seek to understand, then be understood;
- Empathic listening;
- An exercise to understand the other personâs perspective and sort out if you were truly wronged;
- âCould malice be misunderstanding?â;
- Navigating fundamental attribution error during conflict;
- The Most Respectful Interpretation, JFK, and the Cuban Missile Crisis;
- How to get 90% of the way with one step;
This podcast streams free on iTunes, Spotify, and Stitcher.
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Habit change doesnât have to be grand, spectacular, or a massive shift all at once. In fact, it may be better to start small, tiny, you might say. In this episode, Scott Weingart and I break down the methodology from BJ Foggâs Tiny Habits and give real world examples as to how it works (and might not work).
Tiny Habits was the selection for our most recent book club. We host these every few months and (free) tickets are available only to those on the mailing list. As youâll hear us talk about in this pod episode, the discussion amongst the community is by far the best part of the book clubs. Our next book will be The Art of Learning by Josh Watizkin.
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - our Patreon site https://www.patreon.com/stimuluspod
For full shownotes visit our podcast page
We Discuss:
- A Tiny Habits success story [04:55];
- Why it may be better for habits to start tiny [07:10];
- The three step process of Tiny Habits begins with an ANCHOR MOMENT [08:05];
- The second step is the NEW TINY BEHAVIOR [10:25];
- The third step and most often neglected: INSTANT CELEBRATION [12:45];
- Celebrations that are intrinsically rewarding resonate better from some people than those that are extrinsic [14:50];
- Behavior swarm refers to using multiple specific behaviors that can help you achieve a big aspiration [18:50];
- Why temptation linking can be remarkably effective [23:10];
- The two things that make an action more likely to happen: motivation and the ease of doing it [26:00];
- Scaling tiny habits to larger habits [30:00];
- Atomic Habits by James Clear may be even more applicable to large behavioral change [32:35];
- Willpower and behavioral change [35:20];
- The psychological concept of streak perception [38:30];
- Using a negative emotion as a prompt for behavioral change [40:00];
- And more.
This podcast streams free on iTunes, Spotify, and Stitcher.
Follow Rob: Twitter, Facebook, and Youtube.
Chances are that you have a robust inner critic. You might even believe that self criticism and castigation are the only ways to excel. As a high level performer, you are not alone. In this episode, we break down the nature of inner criticism and several ways to silence it (or nearly so).
Interested in one-on-one coaching? Learn more at roborman.com
To support the show - our Patreon site https://www.patreon.com/stimuluspod
For full shownotes visit our podcast page
We Discuss:
- 3 objectives in the training of ski jumpers which can be applied to any moment or high stakes situation [02:30];
- The importance of self talk [03:45];
- What IS your inner critic? [05:40];
- The first step to thwarting the inner critic is to be aware that it exists [08:00];
- Judgment vs. discernment [09:10];
- Dialogue of âthe Judgeâ compared with âthe Sageâ in a complex resuscitation scenario [11:00];
- Switching from âWhat ifâ to âWhatâs nextâ [13:15];
- The second step to quieting the inner critic: coming back to center [15:15];
- Activating the voice of the Sage, that motivates through curiosity, empathy, and purpose [17:22];
- One way to shift out of self judgment and into discernment is to speak (think) about yourself in the third person [21:20];
This podcast streams free on iTunes, Spotify, and Stitcher.
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Finding time to debrief challenging or difficult cases can feel nearly impossible amidst the tumult and task saturation of medical practice. The reality, however, is that itâs a necessity, not a nicety. In this episode, emergency physician Stuart Rose and rescue specialist Ashley Liebig discuss two different approaches to immediate debriefs: INFO and the hot offload.
Guest Bios:
Stuart Rose is an emergency physician practicing in Calgary, Canada and lead author of the seminal debriefing paper, Charge nurse facilitated clinical debriefing in the emergency department.
Ashley Liebig is a HEMS Flight Nurse and Helicopter Rescue Specialist with Austin Travis County STAR Flight. Prior to her flight and rescue career, Ashley served in the US Army as a combat medic with the 101st Airborne Division. She is known around the world as a teacher of managing the stress response
We Discuss
- A particularly stressful resuscitation that was taxing, emotionally and physically, and an approach to the âhot offloadâ [03:30];
- Debriefing core concept #1: The ED charge nurse is optimally suited to organize the debriefing and to lead the conversation [07:25];
- A structured approach to debriefing using the mnemonic INFO [12:40];
- Sample debrief scripting [13:30];
- Handling conflict or criticism that may arise during a debrief [18:35];
- The importance of establishing psychological safety [21:00];
- Principles of a hot offload [28:15];
- Hot offload steps [32:25];
- Ashleyâs Credo: work hard, be respectful, be kind [36:40];
- and more.
Support the show (https://www.patreon.com/stimuluspod)
For previous episodes, detailed show notes, or to sign up for our newsletter: https://roborman.com/category/stimulus/
This podcast streams free on iTunes, Spotify, and Stitcher.
Interested in one-on-one coaching? https://roborman.com/
Follow Rob: Twitter, Facebook, and Youtube.
It doesnât look like performance metrics are going away any time soon. So why not make them a feature instead of a bug?
Guest Bio: Shawn Dowling MD is the medical director of The Physician Learning Program at the University of Calgary and Clinical Content Lead at the Calgary Zone Emergency Department.
We discuss:
-
Why metrics are important and how reframing the process can make them feel less punitive
-
How providing metrics can be an impactful tool to get physicians to identify improvement opportunities and implement changes in their practice
-
The goal: to improve the quality of care provided by making individual-level as well as system-level changes
-
Audits are meant to be self-reflective, not punitive.
-
The fact that current metrics cannot identify the secret sauce for making the best ED provider. They are interrelated and need to be âbalancedâ.
Support the show (https://www.patreon.com/stimuluspod)
For previous episodes, detailed show notes, or to sign up for our newsletter: https://roborman.com/category/stimulus/
This podcast streams free on iTunes, Spotify, and Stitcher.
Interested in one-on-one coaching? https://roborman.com/
Follow Rob: Twitter, Facebook, and Youtube.
There is no doubt that handing over care of a patient to another clinician is potentially fraught with peril. After all, itâs in the transitional moments when error is most likely to occur. But thereâs a balance to strike here because there are also myriad upsides to signouts for both the patient and clinician. In this episode, Mike Weinstock, MD breaks down the arguments in favor of signouts, how to do them well, the big fat hairy signout pitfall, and why signouts might just be a key ingredient to career longevity and patient safety.
Guest Bio: Mike Weinstock, MD is Professor of Emergency Medicine, adjunct in the Department of Emergency Medicine of The Ohio State Universityâs College of Medicine, and director of research and CME at the Adena Hospital.
He has lectured nationally and internationally on medical topics and patient safety issues and is the executive editor for UC RAP, contributed to ERcast and Risk Management Monthly, and has published original research in JAMA IM and Annals of Emergency Medicine. He is the author of the Bouncebacks! series of books,and Howâd it Go?. Mike has practiced medicine nationally and internationally including volunteer work in Papua New Guinea, Nepal, and the West Indies.
We discuss: * How the key to protecting yourself medico-legally is having your primary concern be about patient safety and then documenting such that the chart reflects good medical care [01:50]; * Principles of medically defensible charting [05:00]; * Robâs chest pain template medical decision-making (MDM) [08:30]; * The importance of remembering that one-directional rules (like PERC for PE) do not obligate you to do a workup if a patient fails the rule [12:00]; * Why handing off a patient to the incoming doctor when your shift is over may contribute to a successful career as an emergency physician [13:00]; * Whether your level of busy-ness during an ED shift is seen as an extenuating circumstance by a defense or plaintiffâs attorney [18:45]; * An argument for always reviewing nursing/paramedic notes (and documenting that you did it) and trying to greet EMS when they arrive with a new patient [24:45]; * Mikeâs opinion of the ideal sign-out culture [32:00]; * Some doctors are not comfortable signing out patients, but they take a risk in their career longevity by not doing so [35:30]; * Why sign-outs need to have constraints [39:25]; * More.
Support the show (https://www.patreon.com/stimuluspod)
For previous episodes, detailed show notes, or to sign up for our newsletter: https://roborman.com/category/stimulus/
This podcast streams free on iTunes, Spotify, and Stitcher.
Interested in one-on-one coaching? https://roborman.com/
Follow Rob: Twitter, Facebook, and Youtube.
It can be hard enough managing critical tasks in the best of times, but when things start to go awry, you need to focus even more to keep moving in a positive direction. Back by popular demand, Dan Dworkis (our guest on episode 57) walks us through: navigating uncertainty when under situational pressure, powering down at the end of the day, managing the physiologic response to stress, the most thoughtful procedural time out weâve ever heard, and transparent team communication.
Guest Bio: Dan Dworkis MD, PhD is an emergency physician who is a clinical professor of emergency medicine at USC Keck School of Medicine. Heâs also host of the Emergency Mind podcast that focuses on helping individuals and teams perform better under pressure and the author of The Emergency Mind: Wiring Your Brain for Performance Under Pressure.
This episode brought to you by Wild Health! Wild Health provides personalized medicine that takes into account DNA, biometrics, microbiome, and lifestyle factors to come up with your ideal diet, supplements, and lifestyle to optimize health and maximize healthspan. I have been through the Wild Health program and found it a game changer as far as optimizing diet and exercise. Use the code GET30 for 30% off the monthly subscription. Learn more at wildhealth.com.
We discuss:
- How Danâs approach to resuscitation or stressful situations has changed since he started The Emergency Mind project [02:30];
- Applying the core principles of prepare, perform, recover, and evolve to the scenario of a difficult intubation [05:20];
- Breathing techniques to manage the physiologic response to stress [07:40];
- Being cognizant of the other people in the systems around you and communicating what you think you might need next [09:00];
- How to build a high-functioning culture [10:55];
- Leave no trace emergency medicine and tale of the squeaky door [15:30];
- The drama triangle: victim, villain, and hero [17:15];
- Altering the principles of behavioral economics when doing a timeout in the ED [19:15];
- David Marquetâs fist to five [24:15];
- Cognitive load theory and how it helps us guide trainees who struggle when it comes to knowledge under pressure [27:40];
- Managing task saturation with systems and structure [31:30];
- Powering down after a shift [32:45];
- The fact that some days a win is simply not âthrowing gas on the fireâ [40:12];
- Algorithmic vs creative thinking and the shape of uncertainty [42:20];
- Danâs recommendations for new listeners of his show [50:47]
For previous episodes, detailed show notes, or to sign up for our newsletter: https://roborman.com/category/stimulus/
This podcast streams free on iTunes, Spotify, and Stitcher.
Interested in one-on-one coaching? https://roborman.com/
Follow Rob: Twitter, Facebook, and Youtube.
A book I recommend to many coaching clients is âDesigning Your Lifeâ by Bill Burnett and Dave Evans. Iâve even had a client use a several month coaching engagement specifically to focus on the exercises in the book. What makes it such a potent tool? Design thinking. What happens if we take the same principles that are used to create the fastest road bike or most efficient electric vehicle and apply them to help us live our best life? The concept was not only intriguing, it blew me away. In todayâs episode we break down one tool from Designing Your Life: gauging how full/empty we are in 4 buckets of life (health, love, work, play), determining if these buckets are in balance, and introducing the process for rebalancing.
We Discuss
- âDesigning Your Lifeâ thinking is about approaching life from the perspective of engineering and design, building prototypes to see what does/doesnât work and using that information to create your next iteration.
- When thinking about the quality of your life, Bill Burnett and Dave Evans suggest that you assess your life in terms of these 4 distinct yet overlapping areas: health, work, love, and play.
- Start with health, since it is the foundation of all of the other gauges or buckets (pick your metaphor).
- While it is often imbalance the work gauge/bucket that brings people to seek the help of a physician coach, work is just another bucket in the totality of what goes into making your life.
- The love bucket takes into consideration both the love you give and the love you receive.
- The final gauge is play. Play is vital because it allows you to massively recharge.
- Once you have determined where your gauges fall or the fullness of your 4 buckets, the next step is to determine whether there is an imbalance and how to correct it. Only you can answer that.
For previous episodes, detailed show notes, or to sign up for our newsletter: https://roborman.com/category/stimulus/
This podcast streams free on iTunes, Spotify, and Stitcher.
Interested in one-on-one coaching? https://roborman.com/
Follow Rob: Twitter, Facebook, and Youtube.
After a short sabbatical, Stimulus Podcast returns next week.Â
In this 6 minute pod: what we've been up to and what we'll be up to in the coming months.
Our new website https://roborman.com/
Case studies using Nonviolent Communication in real world situations including: how to give a proper compliment, perils of bringing up past issues, emergency empathy when speaking to a consultant, receiving gratitude, point of care compassion, and the limitations of NVC in the resus bay.
Guest bio: Scott Weingart is an emergency physician who went on to complete fellowships in Trauma, Surgical Critical Care, and ECMO at the Shock Trauma Center in Baltimore. He is best known for his EMCrit Podcast which focuses on resuscitation and ED critical care, and most recently, On Deeper Reflection, an exploration of academic productivity, philosophy, and wellness. He is the author of two books: Emergency Medicine Decision Making and the Resuscitation Crisis Manual.
We discuss:
- The violence in communication that NVC is seeking to remedy [ 03:40];
- Why you should avoid discussing the past in heated conversations [06:00];
- How to give a compliment NVC-style [11:00];
- Receiving gratitude [17:25];
- Emergency empathy [18:45];
- 4 levels of response evolution [22:30];
- Limitations of using NVC in the emergency department [24:45];
- Point of care compassion [27:00];
- The last 3 words mirroring technique [28:50];
- Using NVC when the person youâre talking with has a personality disorder [30:40];
- What happens when you use NVC to âmanipulateâ someone who is astute and quickly realizes theyâre being managed [35:00];
- The fallacy of attribution [38:30];
- And more.
For complete shownotes: https://roborman.com/category/stimulus/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
Follow Rob: Twitter, Facebook, and Youtube.
Nonviolent Communication is one of the most powerful ways of speaking with people that I have ever come across. It eliminates useless strategies like judgment and proving yourself right and instead gives you absolutely tactical techniques to get the things you need for happiness for yourself and your interlocutor.
NVC is not a new, gimmicky set of dictum. It boils down the philosophies of Stoicism, the psychological approaches of cognitive behavioral therapy (CBT), and cognitive psychology.
For complete shownotes: https://roborman.com/stimulus/stimulus-podcast-69-a-primer-on-nonviolent-communication/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
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Nobody goes into medicine hoping they can have a long career in data entry, but thatâs how many feel when looking at computer screens more than patients during a work day. Documentation and the electronic medical record (EMR) are nearly ubiquitous sources of frustration in medical practice. In this episode we cover two solutions to make medical documentation, charting, and the EMR less onerous: a very specific way to interact with scribes and using technology thatâs already in your pocket to chart at the bedside. These might seem like âtech hacksâ but they are really tools to get away from the computer and back to patient care.
Guest bios: Alan Sielaff is an emergency physician in Ann Arbor, Michigan. Lon Setnik is a community emergency physician in New Hampshire.
We discuss:
- Challenges that scribes have when documenting critical parts of the medical record [08:25];
- Setting ground rules with your scribe [09:30];
- The provider-scribe workflow [11:20];
- Lon Setnikâs tips for successful utilization of scribes [19:45];
- The importance of doing as much of your documentation as possible in the room with the patient [24:35];
- The strategy of dictating the chart in the patientâs room requires several enabling technologies [26:00];
- The primary advantages of documenting in front of the patient [33:05];
- Habits for good workflow discipline and documentation [37:15];
- A primary goal in caregiving: building trust with the patient [42:00];
- And more.
For complete shownotes: https://roborman.com/category/stimulus/https://roborman.com/stimulus/68-taking-th/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
Follow Rob: Twitter, Facebook, and Youtube.
We share two conversations about navigating the waters of interacting with unvaccinated COVID patients. Brit Long, MD and Jose Pacheco, RN are thoughtful healthcare providers with somewhat different approaches. The common thread is that both are intentional and compassionate.
Guest bios:
Brit Long is an assistant professor of emergency medicine in San Antonio, Texas and Editor-in-Chief of Clinical Content at emcdocs.net. He is one of the most published authors in the field of emergency medicine. Brit is working in a unique environment where he's running what is in effect a COVID emergency department in an underserved area with an incredibly high unvaccinated rate.
Jose Pacheco is an emergency department nurse who is a local legend for his kind personality and fully engaged approach to caring for patients. He is not just a legend among healthcare providers, but frankly, among the community.
We discuss:
- Britâs mental processes when he enters the room of a patient with COVID pneumonia who is unapologetically unvaccinated [05:15];
- How Brit discusses the importance of vaccination with unvaccinated patients [05:43];
- The impact of oneâs belief system on vaccine decision-making [07:15];
- The fact that personal stories (and not scientific evidence) are what many who aren't able to critically appraise literature rely upon to make decisions [15:25];
- Framing the COVID vaccine as an anti-death vaccine [16:45];
- Handling post-shift frustration [19:30];
- The importance of celebrating the success when a vaccine hesitant person agrees to vaccination after you discuss its merits [22:45];
- Joseâs plea to fellow healthcare providers [25:00];
- What makes the COVID situation more difficult than others we encounter in the ED [27:40];
- Why Jose is referred to not only as the Drunk Whisperer (see Stimulus episode 1), but also the COVID whisperer [28:30];
- Many unvaccinated patients think theyâve done their due diligence [40:20];
- The root and seat of compassion -- wishing that all patients are well, vaccinated or not [46:15];
- And more.
For complete shownotes: https://roborman.com/stimulus/67-caring-for-the-unapologetically-unvaccinated/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
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How do you decide whether to say yes or no to something? In this 5 minute episode, we break down a simple yet incredibly effective heuristic taken from the book Hell Yeah or No by Derek Sivers.
For complete shownotes: https://roborman.com/category/stimulus/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
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The nature of medical practice dictates that we will have tough cases. Patients will die, we will have to deliver bad news, and we will, at some point, make mistakes. We have high expectations of ourselves so when we get figuratively knocked down, how do we get back up? In this episode, performance coach Jason Brooks guides us through strategies for dealing with the emotional and intellectual fallout of a bad case as well as how to re-engage during a shift when the last thing we feel like doing is seeing the next patient.
Guest bio: Jason Brooks Ph.D. is a performance coach helping healthcare providers, athletes, and other high-level performers live better, work better, and be better. Check him out at Phenomenal Docs and connect with Jason: Facebook, Twitter, email doctorjbro@Gmail.com
We discuss:
- The fact that no matter how good you are in your medical practice, you are not immune to a bad outcome [02:20];
- How to manage the sense of failure and the anxiety that naturally occurs when youâre faced with the same situation again [04:00];The importance of getting prepared ahead of time and expecting bad things to happen [06:00];
- Channeling the experience into something positive [08:25];
- Learning to live with and honor these experiences, rather than dread them [10:00];
- Drawing a lesson from a bad event and making a commitment to apply that lesson [16:30];
- The value of talking to someone who is able to receive your emotional turmoil in the immediate aftermath of a bad outcome [18:40];
- Why we shouldnât think of it as âbouncing backâ from a terrible outcome [23:00];
- What do you do when youâve had a bad outcome, but you donât have the time to process whatâs happened before your next shift [29:00];
- The importance of having a process that you can trust to be effective in helping you shift your attention back to where it needs to be [32:25];
- And more.
For complete shownotes: https://roborman.com/stimulus/65-bouncing-back-after-a-tough-case/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
Follow Rob: Twitter, Facebook, and Youtube.
Justin Bright MD, CPXP is an attending physician and the Assistant Medical Director for Patient Experience in the Department of Emergency Medicine at Henry Ford Hospital in Detroit. He is fascinated by the intersection of patient experience, interpersonal communication, customer service, and employee engagement. Check out his ideas at www.ptexpmd.com or on The Patient Experience podcast on Spotify, Apple Music, or any other listening platform you enjoy. In this episode, we learn that patient satisfaction and the patient experience are different things. We can improve the patient experience by asking open-ended questions, recognizing nonverbal cues, validating emotion, and pausing to listen.
We discuss:
- A patient satisfaction survey rant [02:45];
- The âpatient experienceâ and how it is influenced by every conceivable touchpoint, perception, and logistical thing that may happen to a patient [11:10];
- How making a purposeful choice to care helps ensure that our patients have a positive experience [16:15];
- The power of the pause [19:35];
- Avoiding the âdoorknob complaintâ by asking open-ended rather than direct questions [22:00];
- Efficiently handling the situation when a patient has extra questions after you thought you had already completed the encounter [24:50];
- The best way to acknowledge a patientâs long wait [26:40];
- How to respond to the disgruntled patient who voices complaints about other people involved in their care or their prolonged wait [29:30]
- Deescalating the unhappy patient whose expectations of care were not met [33:10];
- Salvaging the situation when a patient threatens to call the nurse administrator or an attorney [39:10];
- And more.
For complete shownotes: https://roborman.com/stimulus/63-the-patient-experience-with-justin-bright/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
Follow Rob: Twitter, Facebook, and Youtube.
Job satisfaction increases when the work we do aligns with our purpose. One way of looking at it is by creating pillars that support your career and being intentional about using those pillars to help guide your decisions. In this episode we learn that Jaime Hopeâs four roles as an emergency physician are to excel as a public safety officer, a resuscitationist, a diagnostician, and a patient advocate. Robâs pillars are to spark joy in the lives of others, to be present as much as possible, to be of service, and to facilitate awesomeness. This short segment is a preface to a deeper future conversation about the importance of purpose.
For complete shownotes: https://roborman.com/category/stimulus/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
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In this episode we hear from eight leading physician educators about a core principle of patient care: primum non nocere. We learn that limiting harm can translate into doing whatâs medically right, putting the patientâs welfare first, judicious use of IV fluids, reducing opioid prescribing, making a habit of pausing when depleted, acknowledging the end of life, and allowing a natural death.
For complete shownotes: https://roborman.com/stimulus/62-primum-non-nocere-first-do-no-harm/
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This podcast streams free on iTunes, Spotify, and Stitcher.
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The treatment of non-hospitalized patients suffering from COVID-19 is a hot topic and constantly changing. Today we have a conversation with Salim Rezaie, MD whose dive into this literature couldnât be much deeper. We discuss which subgroup of patients might benefit from monoclonal antibodies, why the jury is still out on the benefit of ivermectin, the role of inhaled budesonide, and outpatient anticoagulation which hasnât been studied, but hopefully will be someday.
Guest Bio: Salim Rezaie completed his medical school training at Texas A&M Health Science Center and continued his medical education with a combined Emergency Medicine/Internal Medicine residency at East Carolina University. He currently works as a community emergency physician at Greater San Antonio Emergency Physicians (GSEP) where he is the director of clinical education. Salim is the creator and founder of REBEL EM and REBEL Cast, a free, critical appraisal blog and podcast that tries to cut down knowledge translation gaps of research to bedside clinical practice. Hear more from Salim on Stimulus #16 Accumulation of Marginal Gains.
We Discuss:
- The fact that the best treatment of COVID is prevention through vaccination [2:30];
- The value and purported benefit of monoclonal antibodies [03:21];
- Whether a rapid antibody test would help predict seronegativity [06:30];
- Specifically which monoclonal antibodies are being used in Salimâs shop [07:40];
- The irony of people demanding monoclonal antibodies, but refusing vaccination because they donât know what's in it [08:50];
- Why you canât trust everything you read about COVID therapy in a news headline [12:40];
- One of the largest ivermectin studies which was based on falsified data, yet continues to influence the results of meta-analyses [15:30];
- Inhaled budesonide for COVID-19 symptom control [22:00];
- The slippery slope of outpatient anticoagulation [23:39];
- The things Salim might do if he had symptomatic COVID-19 and was well enough to be managed as an outpatient [27:25];
- And more.
For complete shownotes: https://roborman.com/stimulus/61-outpatient-covid-19-therapy-with-salim-rezaie-md/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
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This podcast streams free on iTunes, Spotify, and Stitcher.
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Scott Weingart and I will be hosting a book club.
When: Nov 14th 20:00 EST
Where: Via Zoom
Who: Anyone who will actually read the book and wants to participate. We are limiting this first one, so please don't sign up unless you are genuinely interested. We will be releasing a recording for those folks that want a passive experience.
Nonviolent Communication: A Language of Life: Life-Changing Tools for Healthy Relationships
How: Sign-Up Here. If we are full, put your name on the waiting list
Thinking about a career as an expert witness but now quite sure how to get started? Or perhaps you already have a side gig in this line of work but you want to up your game. In this episode we chat with Amal Mattu, MD who is an expert at being an expert witness. He shares pearls of wisdom including what inspires him to do this, how he does it, and why you should remain nice even when itâs getting heated in the courtroom. Our second conversation is with Rich Orman, JD who has years of experience working with expert witnesses as a trial attorney. He gives his perspective on the mistakes expert physicians make and teaches us that preparation is the key to success.
Guest Bios:
Amal Mattu, MD is a professor of emergency medicine at the University of Maryland. He's known worldwide for his expertise in educating on emergency cardiology issues as well as his medical legal expertise and experience.
Rich Orman, JD spent nearly three decades as a trial lawyer, working across the spectrum of practice types - public defender, private practice, and most recently as Senior Chief Deputy District Attorney in Colorado's 18th judicial district.
We Discuss:
- What inspires Amal to be an expert witness and why he usually works for the defense [1:59];
- How to review a chart [6:20];
- Reimbursement strategies and keeping track of hours [08:37];
- How being involved in court cases influences what you say in a podcast or teach publicly [10:00];
- The fact that medicine is not as clear cut as attorneys make it out to be [10:00];
- Why you should be even-keeled and nice when youâre on the stand and things get heated [13:55];
- The steps to getting started with med-mal work [18:30];
- The importance of knowing clinical policies and guidelines for your specialty (because theyâll be brought up in court) [20:30];
- An attorneyâs perspective on the mistakes expert physicians make [29:50];
- Alleviating the fear of physicians who are terrified of being on the witness stand [34:15];
- Advice Rich would give to an expert physician witness who is being cross-examined in an antagonistic way and is clearly unsettled [37:35];
- Richâs advice for responding to âyes/noâ questions when there isnât a âyes/noâ answer [41:55];
- What do the best expert witnesses do that the worst ones never do: prepare [43:15];
- The difference between direct testimony and cross-examination [50:15];
- And more.
For complete shownotes: https://roborman.com/category/stimulus/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
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What does your life have in common with that of an astronaut? A lot, it turns out. Dan Mccollum returns to Stimulus to break down the skills learned by International Space Station commander Chris Hadfield as explained in his autobiography An Astronaut's Guide to Life on Earth.
Guest Bio: Dan Mccollum, MD is an emergency physician, associate professor, and associate residency director at the Medical College of Georgia. Hear more of Dan on Stimulus episodes #1 Verbal Judo #14 Stoic With A Capital S and #25 Digital Minimalism.
We Discuss:
- The pitfalls of thinking too highly of yourself [1:46];
- The importance of being a âplus oneâ and the wisdom of not proclaiming your plus-oneness. âIf youâre really a plus one, people will noticeâ [2:23];
- Aim to be a zero -- having neutral impact [5:08];
- What Mccollum looks for in EM residency applicants: people who treat the receptionist or program administrator well [8:00];
- Why we should focus on the simple core things which are most likely to save lives, as opposed to shooting for the stars with cutting edge treatment [8:48];
- How the weight and power of ego impairs our ability to learn and harms patients [11:04];
- Sweat the small stuff [13:01];
- The quintessential nature of EM and how theyâre similar to flight rules: solving complex problems rapidly with incomplete information [13:49];
- The fact that perfectionism and zero likelihood of failure is not part of the flight rules for anything [15:49];
- Why early success is a terrible teacher. If youâve always been the star and never experienced failure, this can be a barrier to learning [18:27]
- The Jocko Willink video, Good. When bad things happen and you get knocked down, âget up, dust off, reload, recalibrate, re-engage, and go out on the attackâ [20:13];
- How to behave when you're in a position of leadership [22:00];
- Expeditionary behavior, which is the willingness to endure hardships for the sake of the mission, and why whining poisons the pool [24:13];
- And more.
For complete shownotes: https://roborman.com/category/stimulus/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
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Mass casualty events are rare and thus the mistakes made and lessons learned are often repeated, over and over. In this episode, emergency physician and former Special Forces medic Mike Shertz, MD walks us through the steps on how to be an effective first receiver of mass casualty victims and shares the lessons written in blood from previous events.
Guest Bio: Mike Shertz MD is an emergency physician who spent 13 years as a Green Beret and a Special Forces medic. He is the founder and purveyor of Crisis Medicine which teaches and trains first responders in tactical casualty care. Check out this video that we did together in 2019 on how to place and remove a tourniquet and this one on how to pack a gunshot wound with combat gauze.
We discuss:
- The First Receiver who is in a singularly unique position as it applies to a mass casualty [03:55];
- The difference between a hospitalâs surge capacity and mass casualty preparedness [05:30];
- The mindset of the medical provider after receiving a patient from EMS [10:32];
- The value of a field triage score which is a simple way to stratify casualties [12:50];
- How the success of a mass casualty event for the first receiver has to do with organization, throughput, and saving lives [16:15];
- Lessons learned from the Christchurch, New Zealand mass shooter incident [29:45];
- How your response to a mass casualty differs if youâre unsure about the safety of your facility (as was the case in the 2020 Beirut explosion) [41:15];
- One of the sayings of the Special Forces: âAll lessons are written in bloodâ [43:27];
- The question Shertz thinks people should ask of their hospital disaster planners [45:45];
- And more.
For complete shownotes: https://roborman.com/category/stimulus/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
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The emergency mind is cool under pressure. But how do you get there? For most us, itâs not an innate skill. Dan Dworkis MD, PhD lays out the path: graduated pressure, deliberate training, tired moves, and acknowledging the suboptimal.
Guest Bio: Dan Dworkis MD, PhD is an emergency physician who is a clinical professor of emergency medicine at USC Keck School of Medicine. He's also host of the Emergency Mind podcast that focuses on helping individuals and teams perform better under pressure and the author of The Emergency Mind: Wiring Your Brain for Performance Under Pressure.
We discuss:
- Deploying psychological countermeasures when youâre under stress and dealing with uncertainty [05:40];
- Whether the approach to managing pressure is universal for all stressful situations [11:15];
- Different modes of thought: system 1, system 2, and the recognition-primed decision-making model [15:50];
- The deliberate path to becoming an expert (beyond just repetition) [20:00];
- The value of training with an idea of graduated pressure [21:45];
- What it means to borrow pressure from other events to succeed in something that's unrelated [25:50];
- The YerkesâDodson law [28:45];
- Why sangfroid is a good thing and how you do it [35:20];
- The path to excellence which goes far beyond mastery of a specific skill [38:30];
- How acknowledging the suboptimal nature of a situation when something goes wrong can help you âregroup, recover, and evolve out of any crisisâ [41:50];
- What does it mean to train your âtired movesâ [42:55];
- Danâs challenge for the Stimulus audience [52:44];
- And more.
For complete shownotes: https://roborman.com/category/stimulus/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
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A hike in the jungle takes an unexpected turn.
In this episode: medical emergencies in austere environments, managing acute pain without medication, and using breath work vs distraction in high stress situations.
For complete shownotes and video of how it played out: https://roborman.com/stimulus/stimulus-podcast-56-rescue-in-the-jungle/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
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The phrase âtoo much on my plateâ and word âbusyâ are pervasive in modern discourse. But does it have to be so? We certainly didnât start out that way as children! In this episode, Dr. Christina Shenvi walks us through the path to clear our âschedule platesâ and open space in our lives, get un-busy, and conquer the email inbox.
Guest Bio: Christina Shenvi MD, PhD is an emergency physician at the University of North Carolina, Chapel Hill where she is the director of the UNC Office of Academic Excellence and the newly appointed president of the Association of Professional Women and Medical Sciences. A frequent guest on Stimulus, Dr. Shenvi is a world class time managment coach www.timeforyourlife.org where her goal is to help busy professionals find more peace with their schedules, feel less stressed, and use their time more effectively.. Her most recent Stimulus episodes were on Procrastination and Habits.
We discuss:
- The insidious path of getting to the point of having too much on your plate [02:00];
- A framework for deciding whether to say âyesâ or ânoâ to things [05:45];
- The 4 pillars Rob uses to help guide âyesâ or ânoâ decisions [08:30];
- Why itâs problematic to think of life as a zero sum game makes [10:20];
- The Japanese concept of Ikigai [13:30];
- Becoming more efficient by shrinking the amount of time you spend on things that are on your plate [15:45];
- The 5 Whys technique for understanding the fundamental bedrock of your motivation [19:30];
- Self worth theory, which helps explain both why we overwork/overcommit as well as why we sometimes procrastinate [25:00];
- The concept of Stoic meditation and the Ozymandias exercise [30:10];
- The constant struggle of determining if your work is aligning with your values and using Stoic indifference to suspend self-judgement [32:00];
- Choosing to do things vs. âI shouldâ [33:40];
- Reframing the notion of being too busy [40:44];
- Deep work [43:30];
- The importance of creating a system for shallow work [46:15];
- The freedom gained from managing your email inbox [51:50];
- And more.
For complete shownotes: https://roborman.com/stimulus/stimulus-podcast-55-too-much-on-my-plate-with-christina-shenvi-md-phd/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
Follow Rob: Twitter, Facebook, and Youtube.
What gives you fulfillment in your job? If you know it, do you make purposeful choices to keep pointed in that direction?
With special guests:
- Amal Mattu
- Scott Weingart
- Greg Henry
- Mizuho Morrison
- Haney Mallemat
- Reuben Strayer
- Mike Weinstock
- Victoria Brazil
- Ilene Claudius
For complete shownotes: https://roborman.com/category/stimulus/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
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Scott Weingart is arguably one of the most influential and polarizing physicians on the planet. He is not one to mince words and often comes across as definitive in how he describes his practice of medicine. What people don't realize, he says, is that his clinical care is often guided by fear, not bravado, ego, or machismo. In this episode, Scott breaks down his five fears when it comes to medical practice and thinks that those who seek to follow his advice should take these fears into account before acting.
Guest Bio: Scott Weingart is an emergency physician who went on to complete fellowships in Trauma, Surgical Critical Care, and ECMO at the Shock Trauma Center in Baltimore. He is currently chief of the Division of Emergency Critical Care at Stony Brook Hospital and a tenured professor of emergency medicine at Stony Brook Medicine. He is best known for his podcast on Resuscitation and ED Critical Care called the EMCrit Podcast; it currently is downloaded > 400,000 times per month. Scott is the author of multiple books including Emergency Medicine Decision Making and the Resuscitation Crisis Manual.
We discuss:
- The distinction between carrying fear and being afraid [06:50];
- Delayed sequence intubation (DSI) as an example for how healthy fear can keep things safe in the emergency department [09:30];
- The importance of embracing the idea that sick patients donât take a joke [13:40];
- Scottâs fear number one: lawyers [15:15];
- A common fear that Scott does not personally experience: being an imposter [21:00];
- Fear of Monday morning quarterbacking [28:10];
- Fear of procedural complications [33:15];
- How Scott Weingart is not a jerk. Heâs an acquired taste. [41:35];
- Scottâs final fear: a patient dying on his watch [46:55];
And more.
For complete shownotes: https://roborman.com/stimulus/53-the-five-fears-of-scott-weingart/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
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Most of us donât give a lot of thought to how and when we listen to podcasts. But like most of life, an intentional approach can reap benefits. In this episode, Josh Russell walks us through: strategies for maximizing retention, listening based on brain state, new data on listening while driving, the value of silence.
Guest Bio: Joshua Russell, MD is clinician, writer, and educator. Since completing residency training in Emergency Medicine, Dr. Russell has had a varied career including supervising PAs and NPs as a medical director for a regional Urgent Care network, contributing to various Hippo Education podcasts, and serving as the Editor-in-Chief of the Journal of Urgent Care Medicine (JUCM). Most recently, he has completed fellowship training in Hospice and Palliative Medicine at the University of Chicago Medical Center.
This episode is in support of the I AM ALS. I AM ALS was founded by Brian Wallach and his wife Sandra shortly after his diagnosis at the age of 37. He was given 6 months to live, and now 4 years later he is leading a revolution to find a cure. People often refer to ALS as rare, which is not really so. The lifetime risk is around 1 in 300. Since Lou Gehrig was diagnosed 80 years ago, available treatments have been shown to extend life a mere 3 months. I AM ALS supports research, legislation to fast track therapies, and provides critical resources to patients and caregivers. ALS is relentless, and so are they. The question is no longer if we'll find a cure for ALS, but when. This is an underfunded disease and every little bit makes a difference. We will match donations to I AM ALS up to $5000 -- get started here on our Stimulus Donation Page. And for your daily dose of positivity, follow Brian on Twitter.
We discuss: Strategies for maximizing retention of podcast content [04:20]; * Listen to educational podcasts when your mind is fresh, such as when on your way to work rather than commuting home after a long day. * Our limited amount of attention is relatively fixed, but it does depreciate as the day goes on and our energy wanes. * Many choose to listen to podcasts during âinterstitial timeâ, like when driving, exercising, or grocery shopping. Youâre more likely to retain information if youâre doing a task that doesnât require your full attention.
How your working memory is like the RAM of your brain [08:40]; * Just like a computer will become bogged down and slow when itâs overloaded, so too does your brain processing speed diminish when cognitively overloaded. * If your working memory is doing something fairly simple, like driving down the highway, then you have a fair amount of residual attention that you can spend on something like listening to a podcast. While driving through a busy city, however, the residual attention is going to be much less.
Why Josh prefers to listen to podcasts in the morning as this is when he is best able to focus [10:20]; * Josh is often trying to cram podcasts into the interstitial spaces of life, but he finds that his mental ability to focus and vigilance are highest in the morning. This is the time that it makes the most sense to devote attention to something that involves integrating new information. As his ability to focus wanes, it becomes less and less productive to listen to informational podcasts. * Similarly, it is common for people to do their âdeep workâ (that which requires the most attention) during the morning hours and âshallow workâ later in the day.
The importance of using your brain for tasks that are appropriate for the state that itâs in [12:45]; * When we first wake up, the vigilance that we have is very helpful for detail oriented tasks where we have to focus and pay attention. Conversely, weâre not so great at coming up with creative and innovative solutions to problems at that time. * As the day goes on and attention wanes, napping or taking a deliberate break can help restore vigilance. * Towards the end of the day, we do better at solving creative problems and âthinking outside the boxâ.
The fact that not every interstitial moment needs to be occupied by something educational or entertaining [15:55]; * Lost among our culture is the value of a quiet moment while youâre sitting alone. âGo for a walk and leave your phone at home. Enjoy the silence. Enjoy the solitude.â
âA lot of the insights that we have come from quiet moments when we're actually not focused.â
How Rob consumes podcasts [17:10]; * On road trips or long drives with his wife, they will pause and discuss points that come up. There is a spaced repetition element to this, but it also enhances the listening experience. * For educational podcasts (of which this is one) he reads the show notes and occasionally reads the linked references. * When deciding which podcast to listen to, first looks at the podcatcher summary and time stamped topics to see if itâs interesting. The title doesnât always reveal whatâs inside. * Educational podcasts only when fresh, such as on the way to work. If had time, would teach pearls from that show to the ED staff. * Usually, itâs not so high brow, itâs listening while cleaning the garage or folding laundry.
A recent study which evaluated the knowledge gained from listening to podcasts while driving compared to that gained from undistracted listening [20:40]; * The authors presented 2 competing theories for this type of knowledge acquisition and tried to determine which applied to driving and listening. * Limited capacity theory: âHumans have a limited capacity for the cognitive processing of information, because humans have finite resources available for learning. Each simultaneous task theoretically reduces available cognitive resources and may decrease their potential capacity for learning.â * Theory of threaded cognition: âTasks that do not require the same form of cognitive processing (e.g. walking and talking) may not compete for the same resources, thereby allowing for the performance of two distinct tasks without inhibiting the success of either component.â * This was a randomized, crossover trial of 100 emergency medicine residents who listened to an educational podcast either while driving or when sitting undistracted in a room. After each podcast they took a test on the content. * The findings: There was no significant difference between the driving and undistracted cohorts on the initial recall (74.2% vs. 73.3%) or delayed recall (52.2% vs. 52.0%). * Bottom line: Getting your education or trying to learn while driving seems to be an effective strategy, at least as far as retention goes.
The value of silence [24:10]; * Leave some of the interstitial cracks of time in your life open or free. Donât fill all of them with things like podcasts. âSitting in silence can have a rejuvenating, calming or stilling effect.â * One of the most famous studies on the effect of silence was published in 2006. Study subjects were exposed to 5 different types of music of varying tempo and type, from slow sitar to fast Vivaldi. * They found that passive listening to music accelerates respiratory rate, increases blood pressure and raises heart rate. The sympathetic activation of music was proportional to the tempo of the rhythm. The authors theorized that it was the level of concentration and attention that led to the arousal and sympathetic activation. * The most striking part of the study was that a randomly inserted short pause of 2 minutes decreased blood pressure, minute ventilation, and heart rate. This relaxation effect was even greater than that seen at the end of 5 minutes of quiet relaxation at baseline. * Bottom line: Inserting a few minutes of silence had a significant effect on relaxation, even more than listening to what is ostensibly relaxing music. Further, the effect of interspersed silence had an even greater relaxation impact than just baseline levels, giving importance to the contrast between listening and silence.
A functional MRI study which shows that listening to a story-based podcast lights up huge areas of the brain [28:35]; A study in mice which found that 2 hours of silence per day led to neurogenesis whereas background or white noise didn't [29:00]; * In this study, the nerve growth was in the hippocampus which is associated with memory, learning, emotion, and memory. The results infer the benefit of silence.
And more. References: Gottlieb M, et al. Maximizing the Morning Commute: A Randomized Trial Assessing the Effect of Driving on Podcast Knowledge Acquisition and Retention. Ann Emerg Med. 2021 Apr 27:S0196-0644(21)00162-1. Epub ahead of print. PMID: 33931254.
Bernardi L, et al. Cardiovascular, cerebrovascular, and respiratory changes induced by different types of music in musicians and non-musicians: the importance of silence. Heart. 2006 Apr;92(4):445-52. PMID: 16199412. Huth AG, et al. Natural speech reveals the semantic maps that tile human cerebral cortex. Nature. 2016 Apr 28;532(7600):453-8. doi: 10.1038/nature17637. PMID: 27121839. Kirste I, et al. Is silence golden? Effects of auditory stimuli and their absence on adult hippocampal neurogenesis. Brain Struct Funct. 2015 Mar;220(2):1221-8. PMID: 24292324. This podcast streams free on iTunes, Spotify, and Stitcher.
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
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Shownotes by Melissa Orman, MD
Pediatric surgeon Ross Fisher, the mind behind p cubed presentations, breaks down how to finish a talk (teaser, itâs not a random vacation slide or you saying, âThank you,â and walking off stage). As a bonus, he also discusses structuring a lecture with spaced repetition so your audience truly understands your message, fielding questions, staying on message, and how to (and how not to) use a script in lecture preparation.
Guest Bio: Dr. Ross Fisher is a UK based pediatric surgeon and the creator of p cubed presentations. The p cubed philosophy, based on three core principles of message, supporting media, and delivery, has fundamentally changed the delivery and quality of medical lectures.
We Discuss:
- Presentation feedback can be hard to take and hard to give. What is the best way to do it? [03:00];
Whatâs the best strategy for ending a talk? [08:59]; - Tactics for handling listener questions [13:15];
Scripts are helpful when structuring and rehearsing a talk. But what is the best way to use them and avoid making the delivery sound robotic? [17:33]; - What is the best way to present data? [23:44];
Spaced repetition of the message helps people remember the important points. [26:36]; - What is meant by, âMessage, not story, is the basis of a good presentationâ? [28:20];
- And More.
For complete shownotes: https://roborman.com/stimulus/stimulus-podcast-51-five-specific-techniques-for-excellent-presentations-with-ross-fisher/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
This podcast streams free on iTunes, Spotify, and Stitcher.
Follow Rob: Twitter, Facebook, and Youtube.
Investigative journalist and bestselling author Scott Carney is our guest as we discuss: what it means to be human, going deep in the Wim Hof method, benefits of cold exposure, climbing Kilimanjaro without a shirt, using The Wedge to change conversations with your limbic system, kettlebell throwing, and why you might want to embrace failure.
Guest Bio: Scott Carney is an anthropologist, investigative journalist, author, and a seeker of both the fringes of human experience and the core of what makes us human. Scott has written four books to date, including The Enlightenment Trap, The Red Market, and What Doesn't Kill Us. Most recently, he authored The Wedge, which dives deeply into understanding the space between stimulus and response. Scott's work has been featured in many different magazines -- Wired, Mother Jones, Playboy, Foreign Policy, Men's Journal, National Public Radio. He has won the Payne Award for Ethics in Journalism and is a multi-finalist for the Livingston Award for International Journalism.
This episode is in support of the Altruism in Medicine Institute, an organization founded by Barry Kerzin, a physician, teacher, author, and Tibetan Buddhist monk. The mission is to increase compassion and resilience among health care professionals and their patients. Compassion fatigue is a very real thing, especially in health care. Building your compassion muscle is one of the most potent tools not only for avoiding burnout, but for finding joy in what you do.
We discuss: The common theme of Scottâs books -- what does it mean to be human? [05:00]; * In The Enlightenment Trap, The Red Market, and What Doesn't Kill Us, Scott writes about organ trafficking, cults, and ice/cold exposure. * His most recent book, The Wedge, is about how to change the way one reacts to different stimuli and how changing that reaction changes your physiology.
Who is âThe Icemanâ Wim Hof and and why might cold water immersion lead to general resilience [09:10]; * Wim Hof is a Dutch athlete who developed a method of ice water immersion and breathwork protocols that give him what appears to be superhuman powers. Wim claims that his techniques can boost the immune system and cure autoimmune disease. * Scott was initially dubious of Wimâs assertions and was eager to meet him. He quickly learned that Wimâs program works. * Extreme cold exposure combined with breathwork creates a stressful internal state and triggers a fight-or-flight response. With Wim Hof training, you tell yourself, âI can do this, the stress isnât so badâ, and the amount of cortisol, adrenaline, and other stress hormones that are secreted is reduced. * By being able to handle that stress, your physiology adapts and contributes to overall resilience. * Link to the science behind the Wim Hof method.
âWe live in relatively static environments, having manipulated the environment to make us feel comfortable. Wimâs message is to get into places that make you feel uncomfortable from an environmental perspective and then learn to be OK with that. You start activating biological systems that have let us survive for all of the millennia before central heating and electric lighting.â
The three elements of the Wim Hof method and how they relate to the wedge [15:10]; * Deliberate cold exposure. * A breath protocol where you do rounds of controlled hyperventilation followed by exhalation and a breath hold. (Note: the cold immersion and breathing protocols are not meant to be done concurrently.) * Your mindset during the stressful states of cold or hypoxia. This mindset led Scott to the concept of the wedge. * If you put a wedge between challenging stimuli and your brainâs response to it, it gives you an opportunity to realize that this is something you can do. * âYou can find the benefits of the wedge in everything you do, because youâre constantly interacting with the environment. That environment is sending sensations to your body, and you have a choice on how you respond to that sensation.â
âThat's really the point of being alive. Who I am is not the person you see when Iâm sitting on the couch watching Netflix. I am the person engaged in something that is difficult. By expanding those limits to where you can exist in challenging places and yet do so comfortably is really the measure of who you are as a person.â
An advantage of the Wim Hof method vs. other mind-body connection practices (like Tuomo) -- itâs fast and you can learn it in about 3 days [20:00]; * Ice water immersion is a rapid exposure to a stimulus and the body responds immediately. Tuomo is a Tibetan practice with a similar goal, but it takes approximately 10 years to master.
Scottâs weekly cold water immersion practice with benefits that last 4-5 days [22:20]; * Every weekend Scott joins a group of friends at a private lake where he does long immersions, at times lasting 26 minutes. * He loves the anticipation, yet wonders why he keeps coming back for what many would consider to be torture. He enters the water calmly, and when his mind tells him that he should get out early, thereâs another part of him that replies, âWhat if I just want to see how far I can go?â * âIt's so valuable to see my body go through these changes in the ice. It's this conversation between the words in my head and then what my body is actually telling me. When I get out, I feel warm with the sun on me. This good feeling can last 4-5 days where I'm in a better mood, knowing I've done something hard. It's almost addictive, to be put under these stresses and then come out and want to do it again.â
Why âgritting it outâ is not an effective strategy for prolonged cold exposure [27:30]; * If you approach an ice bath fighting the environment, trying to soldier through, youâre doing the method wrongly. Donât tell yourself this is the hardest thing youâll ever do, because those words are counterproductive. * You need to relax, let the environment in, know you can do it, and zone out.
Climbing up to Gilmanâs Point on Kilimanjaro shirtless and without oxygen [30:15]; * Scott pushed through the hypoxia by doing the Wim Hof method of overbreathing (without the apneic breath retention) for 28 hours. * He found he could counter the problems of altitude sickness by increasing his respiratory rate, adapting his conscious breathing to the environment that he was inhabiting.
Scottâs sauna routine and the value of giving his body contrasts to adapt to new environments [33:25]; * Scott enjoys a hot tub or sauna session after cold immersion. âThe bigger the shift, the more response that your body is going to have.â
His latest book, The Wedge, and how the wedge is activating something within yourself in order to thrive in a difficult moment [36:25]; * When you anticipate a remote stimulus that youâve previously experienced (such as an ice bath), many expect it to be horrible and enter panic mode. * The actual stimulus is your experience upon jumping in the water. In that moment, you get to decide how important those previous assumptions about the ice water are. You can make it worse or you can make it better, depending on whether you fire the limbic system. * Once youâre in the ice water, you can redefine whether the experience is good or bad and whether itâs making you better or not better. * The wedge is a tool that can be applied to any environmental experience: heat, psychedelics, relationships.
Using a library as a metaphor for the limbic system [39:20]; * In the library of the limbic system there is a librarian, and when someone first enters the library they come with no history of prior experiences. All of the shelves which represent sensations are empty. * When someone experiences a strong sensation, the librarian contacts the bookbinder (the paralimbic system) a few structures away in order to categorize this for future experiences. * The bookbinder takes this signal and links it with your current emotional state at the moment. For the cold stimulus, the instinctual emotional state is panic, so this book (panic = cold) is sent down to the librarian to be stored on the shelf. * The next time you go into ice water, the librarian has a book on the shelf which immediately links the cold with the unmitigated pain of your prior experience. âYour brain wires everything this way -- we are always living in our emotional past.â * We can add new books to the library, however, because each stimulus can have more than one sensation linked to it. Cold can be terrible, but it can also make us feel really good.
âIf we add more books to the library, we have more neural grammar in which to exist in the world. And we find that we can do that with all sorts of things.â
The philosophical question -- do we experience a shared reality? [44:20]; * For the most part, everyone feels raw sensation (such as cold) the same way. * As stimuli get more complex, we start to diverge because our own backgrounds (our âlimbic librariesâ) are different. * âWe need to realize two things. One, that we are all individuals. Two, that we're all connected. Everyoneâs wedge is going to be different.â
âWe're given this one package of life. And the thing about life is you have to make choices about the things you want to do. We need to follow the things that bring joy, and we can find our wedge even within those things.â
Applying the wedge in the emergency department when your heart is racing and youâre profusely sweating because youâre having difficulty with a critical procedure[49:25]; * Scottâs advice is to visualize failure. There are multiple things that can go wrong, and you should have some degree of professional detachment knowing that bad things can happen. * Once you know that there is the potential of failure, of course you try not to do whatever might lead to failure. You do your very best in the present moment. * We must accept that from time to time people are going to die. âWhy are you even attempting to save someone if you can't accept the fact that you might fail?â
âWe valorize success. We do not accept failure in general. Do your best, but realize that you could fail and then realize that that failure breaks down into not just one error, but multiple errors before you get there.â
The solution (or wedge) for the mental irritation that often comes with reading opinions on social media [58:30]; * What makes social media so impactful is that we automatically respond to things like tweets in fight-or-flight mode. * âYou can insert a wedge, but you're never going to overpower all biology on this. Itâs just our limbic system playing out on the internet. Social media is toxic for a million reasons, and this is just one more reason to delete those accounts.â
Going from fear to joy to almost a spiritual place with kettlebell partner passing [01:04:30]; * While the movement of kettlebell throwing is easy, the stakes are real. You must pay very close attention to the stimulus. * It turns into an exercise of empathy. âI don't want to hurt you, you don't want to hurt me. And we're doing this thing that's actually a little dangerous. It really puts you into this moment of bonding.â * You're throwing the kettle bell with love and you're catching the love from the other person. It's a spiritual practice. You realize that what the external world sees and what you are experiencing are totally different.
And more. This podcast streams free on iTunes, Spotify, and Stitcher.
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Shownotes by Melissa Orman, MD
Recent evidence suggests that sex to orgasm can improve nasal airflow equal in degree to nasal decongestant spray. We break down the literature (which totals 1 article).
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Based on: Bulut, Olcay Cem, et al. "Can Sex Improve Nasal Function?âAn Exploration of the Link Between Sex and Nasal Function." Ear, Nose & Throat Journal: Full text
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High demand jobs (like fighter pilot, emergency medicine, trauma surgery, etc.) require continued exposure to the field of operations for maintenance of top level sharpness. In todayâs episode we explore the phenomenon of skill decay and ways to mitigate its effects.
Guest Bio: Joshua Russell, MD is clinician, writer, and educator. Since completing residency training in Emergency Medicine, Dr. Russell has had a varied career including supervising PAs and NPs as a medical director for a regional Urgent Care network, contributing to various Hippo Education podcasts, and serving as the Editor-in-Chief of the Journal of Urgent Care Medicine (JUCM). Most recently, he has completed fellowship training in Hospice and Palliative Medicine at the University of Chicago Medical Center.
This episode is in support of World Bicycle Relief -- delivering specially designed, locally assembled, rugged bicycles for people in need. Theyâve developed an efficient, innovative, and scalable model to empower students, health workers, and entrepreneurs in rural developing regions with life-changing mobility. Donate here.
We discuss: The fact that skill decay sets in rather quickly following an absence from the emergency department [03:50]; * When emergency providers return to work after a long vacation, medical leave, or sabbatical, it is the norm to feel rusty and out of practice. It doesnât matter how many prior years of experience you had; nobody is immune to it. * Managing the complexities of an ED is not like âriding a bikeâ.
How motor skills, like riding a bike, decay much more slowly than cognitive skills [05:20]; * Emergency medicine is a cognitively demanding pursuit. Effective clinical practice requires an enormous and varied base of knowledge integrated with a wide array of habits, behaviors, and communication strategies that allow us to evaluate and manage large numbers of patients seemingly simultaneously. * This is the typical scenario: It is 15 minutes into your shift and you have to manage a crashing infant, an impatient lawyer/patient whoâs demanding antibiotics for a cough, a weak and dizzy elderly patient who may have a life threat (or nothing at all), and a consultant on the phone whoâs refusing to help a patient. * We have to be efficient at problem solving and addressing all of these situations rapidly, while also being able to task switch quickly from one to the next. All the while, we have to make sure that we donât miss anything dangerous. Itâs not easy.
The principles behind skill decay: cognitive load theory and cognitive overload [07:66]; * According to cognitive load theory, we have a limited amount of processing bandwidth at any given moment. Our working memory defines the maximum amount of tasks that we can simultaneously process. Most research suggests that only 5-9 tasks can be effectively processed by our working memory at any given time. * Cognitive load theory also suggests that when we exceed our working memoryâs capacity, our performance immediately suffers. This is called cognitive overload. * With increasing practice and experience, any given task will take up less of our working memoryâs overall capacity. When we are working often, the intellectual processes for a given situation will take up less of our overall cognitive bandwidth than if we are out of practice. Also, we are less likely to become cognitively overloaded.
Strategies for combating skill decay [09:30]; * The surefire tactic is to simply work clinically as often as necessary to prevent skill decay. How often this is depends on the individual. Every clinician needs to answer this for themselves. * Given that competence with cognitive tasks reliably will decay within several months, what do you do if you have no choice but to take a prolonged break from work? * How we think is much more important than what we know. Listening to podcasts, reading, and going to conferences will help slow skill decay, but unfortunately the requisite medical knowledge is a relatively small part of the job. * Simulation of tasks can serve as a meaningful way of maintaining skill during a period of non-use. Refresher interventions such as airway courses can be helpful, though clinical emergency medicine is much more complex and unpredictable than any one simulation can recreate. * Proctoring is a reliable way to rebuild the necessary cognitive faculties we need to be an effective emergency physician.
Robâs approach after a short absence which centered around visualization [12:50]; * Step 1 -- Visualize resuscitations in the particular resuscitation bay in which heâll be working. Work through in his mind complex procedures, such as intubations, chest tubes, and central lines. * Step 2 -- Visualize an actual resuscitation from the point of the patient coming in, to receiving report from the paramedics, to going through the primary/secondary surveys, to managing medications, to working the EMR, and to speaking with consultants. * Step 3 -- Visualize straightforward patients, such as lacerations, fractures, and headaches, and how heâs going to juggle it all.
And more. Shownotes by Melissa Orman, MD
New data this week has shed light on risks associated with COVID infection and the safety profile of mRNA vaccines in pregnant patients.
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References
Villar J, Ariff S, Gunier RB, et al. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr. Published online April 22, 2021. doi:10.1001/jamapediatrics.2021.1050 Full Text
Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. The New England Journal of Medicine: Apr 21, 2021. Full Text
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We are often witness to, or sometimes in the middle of, traumatic events. Whether itâs a mass casualty or cumulative stress over time, our nervous system can get stuck in an upregulated state. In this episode, we break down: training to handle stressful events, protective strategies to employ during and after traumatic events, the physiology of PTSD, specific techniques to downregulate your nervous system and getting to a place of equanimity.
Guest Bio: Ryan Cheney is a mental health therapist, breath work, and performance coach based in Bend Oregon. Our guest on Stimulus Episode 5: The Art of Breathing, Ryan is a thought leader in the field of wellness for health care professions. You can contact him here for further questions and consultations.
This episode is in support of World Bicycle Relief -- delivering specially designed, locally assembled, rugged bicycles for people in need. Theyâve developed an efficient, innovative, and scalable model to empower students, health workers, and entrepreneurs in rural developing regions with life-changing mobility. Donate here. We will match donations up to $1,000.
We discuss: The Las Vegas mass casualty and the wide range of emotional responses of those who were involved [03:50]; * While everyone agrees this mass casualty was tragic, some trauma surgeons and emergency personnel described the experience of caring for the victims as deeply fulfilling. These specialists had dedicated their careers training to run a disaster, and when it finally happened, it was game on. * For others, the experience brought shock and distress.
The fact that trauma is different for every single nervous system [05:50]; * Whatâs traumatic for one person may not be for another. * When people have a reaction to trauma (with recurring thoughts, difficulty functioning, etc), thatâs their system trying to integrate the event and make sense of it all. Itâs important that we normalize some of the response patterns. * Factors that might increase the likelihood of having difficulty with trauma include a history of adverse childhood experiences or developmental trauma. * Protective factors: taking action (vs. freezing) after a traumatic event and having a strong sense of meaning/purpose.
âLife is never made unbearable by circumstances, but only by lack of meaning and purpose.â
â Victor Frankl
Training to handle stressful events in a better way [08:15]; * You can work on building resilience and learning how to modulate your nervous system. * Having the right mindset, understanding your purpose, and incorporating a healthy lifestyle (breathwork, mindfulness, relationships, playtime) can all make a difference.
Whatâs happening physiologically when you have PTSD after a traumatic event [10:40]; * Trauma is experienced through sight, taste, touch, sound, smell. It travels through your body into your brainstem and then into the limbic system. * When you are exposed to the sensations associated with the initial traumatic event, your limbic system is flooded with the emotions of that event. This deep limbic system holds onto negative things more strongly than positive ones. * Over time, for many people, the trauma starts to âintegrateâ and one's memory of the event changes. Positive thoughts will emerge, like âI made a difference that dayâ. * For others, their nervous system gets stuck. They stay in that trauma response.
Strategies that are protective of your nervous system DURING a traumatic event [14:20]; * Taking action (vs. the mindset of helplessness) is a protective factor when your nervous system spikes into the sympathetic zone. * Giving yourself compassion is important if youâre feeling overwhelmed. You can recite the mantra, âWe are doing the best we can, and thatâs good enough.â * Sending compassion to the people youâre taking care of and wishing them well is another âin the momentâ strategy.
The importance of PRE-TRAINING so that you have tools to down-regulate your nervous system in the moment [19:20]; * Opening vision has an immediate calming effect. Looking up and opening your peripheral vision stimulates the vagus nerve. * Breathing is the second best thing for managing the nervous system. Elongating the exhale for a few moments will instantly bring the nervous system down in a chaotic environment. Many people like cycles of breathing: in for a count of 3, hold for a count of 1, and exhale for 6. * These tools can be used to modulate your daily activities and response to stress. They can help keep you in the sweet spot of your performance zone where youâre ramped up, but not overwhelmed or frozen.
âPractice equanimity and awareness mindset so that it becomes automatic.â
Protective, positive strategies that can be used AFTER a traumatic event to reduce the risk of PTSD [25:50]; * Connecting with your team or friends who can relate to the trauma youâve been through is a far better option than isolating yourself and stewing. In medicine, critical stress debriefing is a big part of connection. * While isolation generally puts you in a negative place, intentional solitude (especially if in nature) can be healing. Similarly, journaling helps quiet down the amygdala and integrate events. * The Body Keeps the Score is a book that discusses how you can work with your body to move it towards integrating a trauma response.
The role movement plays in down-regulation and why dosage matters [31:40]; * Intense exercise can impart an extra-sympathetic dose on your nervous system which might help release your thoughts, but it adds stress to your system. * Walking, hiking in nature, yoga, Tai Chi, and Qi Gong are down regulatory movement processes that quiet the amygdala and ramp up the parasympathetic nervous system, so that things can recover, repair, and integrate.
The benefit of EMDR (Eye Movement Desensitization and Reprocessing) and other body-based therapies for processing acute trauma [35:10]; * While talk therapy has a role, it engages a âhigher level thinking brainâ which is not where the stuck trauma is stored. * EMDR research shows that trauma reprocessing therapy should happen as soon as possible after a traumatic event, before itâs solidified in the limbic system.
âSometimes our system gets stuck in certain states, and we need help getting back to a nervous system that can modulate freely, like it's supposed to.â
The process of intentionally letting go, or âcutting stringsâ, when something is weighing heavily on you (such as a client, patient, etc.) [37:30]; * Notice what state youâre in from a place of equanimity. Are you overwhelmed, amped up, stressed, anxious? * Ask yourself if thereâs something you need to learn from this. * Take deep breaths, open your vision, or go for a walk to put yourself into neutral. * Now, it's time to go into the place of emotional control, to let go, and to move on. Bring to mind something that makes you feel joy or gratitude, and then think about that client or patient that's weighing on you in this new state of compassion. Wish them well. Ryan recommends envisioning a pair of scissors or a sword cutting the tie with that person, wishing them the best and watching them drift away. The brain loves storytelling and imagining, so creating a visualization of letting go can be powerful. * The more you do this, the quicker you get at it.
âI like to be proactive in this way so that we're not waiting until someone's got full blown PTSD. How do we get in front of that? How do we become more resilient? How do we build these practices to modulate the day?â
And more. Shownotes by Melissa Orman, MD
The news this week has been replete with stories about increased clot risk in those who have received the AstraZeneca and Johnson & Johnson COVID-19 vaccines. In this episode, we break down: what we know so far about vaccine induced thrombotic thrombocytopenia (VITT), the research that has revealed an underlying mechanism, CDC and NHS recommendations, and a primer on cerebral venous thrombosis -- the primary clot site associated with VITT.
We Discuss:
Vaccine induced thrombotic thrombocytopenia (VITT) The similar mechanism of AstraZeneca's and Johnson & Johnson's COVID-19 vaccines [01:00]; Proposed mechanism of VITT [03:20]; * Greinacher, Andreas, et al. "Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination." New England Journal of Medicine (2021). PDF * Brief Report: Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination PDF
Types of clots associated with VITT [04:00]; * Below is a breakdown of the first 6 US patients with reported VITT. Note that they all ended up having cerebral venous thrombosis, but half of them had additional clot locations. Image source CDC.
**Incidence of VITT in the US and UK [05:00];** * A frequent question in the conversation of this newly recognized phenomenon is, "How is this different than the regular background rate of disease? Isn't this consistent with the number of people who would get it anyway?" This CDC graphic suggests not.
* **In the UK, there have been 79 reported cases of VITT, over half with CVT. Like the US, there is female predominance.**
**The CDC rallying cry to treat this differently that other causes of cerebral venous thrombosis (CVT) [06:30];** * Image source CDC
CDC and FDA Statement Here The Guy and St. Thomas UK algorithm for evaluating and managing patients with suspected VITT [08:00]; Thank you to St. Emlynâs for posting this doc! A primer on CVT Why CVT can cause problems [10:30] * Spadaro, Anthony, et al. "Cerebral venous thrombosis: Diagnosis and management in the emergency department setting." The American Journal of Emergency Medicine (2021).
Presenting symptoms of CVT [11:00] * Headache is present in 90%, meaning it's common, but also means that 10% won't have headache (at least initially). * 25% present with headache alone, but the majority also have another sign or symptom.
* Image source Spadaro, Anthony, et al. "Cerebral venous thrombosis: Diagnosis and management in the emergency department setting." The American Journal of Emergency Medicine (2021).
Physical exam findings and the sensitivity of papilledema [15:00] Using D-dimer in the evaluation of CVT [16:50]; * Ferro, JosĂ© M., et al. "European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosisâendorsed by the European Academy of Neurology." European stroke journal 2.3 (2017): 195-221. * Tanislav, Christian, et al. "Cerebral vein thrombosis: clinical manifestation and diagnosis." BMC neurology 11.1 (2011): 1-5.
A new clinical score for CVT [19:00]; * Heldner, Mirjam R., et al. "Prediction of cerebral venous thrombosis with a new clinical score and D-dimer levels." Neurology 95.7 (2020): e898-e909. Full Text * Image source Spadaro, Anthony, et al. "Cerebral venous thrombosis: Diagnosis and management in the emergency department setting." The American Journal of Emergency Medicine (2021).
Utility of spinal tap as a rule out test [21:00]; Imaging options (CT venogram vs MR venogram) [22:00]; CDC treatment recommendations for VITT associated CVT and how itâs different than most other CVTâs [25:00]; * CDC full slide deck Here
Testing patients with VITT for heparin-PF4 antibodies and how that may guide whether or not to use IVIG [26:35]. * PF4 HIT antibodies are a common finding in VITT, consistent with the current thinking that VITT is a variant of HIT. Image source CDC
* **CDC recs for testing and IV IG treatment**
Refs Padmanabhan, Anand, et al. "IVIg for treatment of severe refractory heparin-induced thrombocytopenia." Chest 152.3 (2017): 478-48
The August 4, 2020 explosion in Beirut, Lebanon is thought to be one of the most powerful artificial, non-nuclear explosions ever, causing over 200 deaths and 7500 injuries. In todayâs episode, we walk through a firsthand account of what happened during this mass casualty event from the lens of an emergency physician who was there.
Guest Bio: Sarah Abdul-Nabi, MD is an emergency medicine resident at the American University of Beirut Medical Center. She is the author of Airway Breathing Circulation: An Emergency Medicine Resident's Experience of the Beirut Explosion.
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This episode is in support of World Bicycle Relief -- delivering specially designed, locally assembled, rugged bicycles for people in need. Theyâve developed an efficient, innovative, and scalable model to empower students, health workers, and entrepreneurs in rural developing regions with life-changing mobility. Donate here. We will match donations up to $1,000.
Essentials of Emergency Medicine, the conference I host each year, is happening May 25-27, 2021. For an additional $100 off registration, use the code 'orman' at checkout.
We discuss:
- The moment of the Beirut explosion, when the ceiling started to fall in, the room started to shake, and then everything went dark [04:40];
- Sarahâs first patient, and then the deluge that arrived within 2 minutes [07:10];
- The initial chaos of managing a mass casualty with minimal light, no electricity, and a damaged ED [11:10];
- Being unable to stop chest compressions on a young woman with a brain hemorrhage, even after your attending tells you itâs futile [16:15];
- What it was like to go back to work 2 days later and why Sarah needed to take a couple weeks off to recover emotionally [21:10];
- The catharsis of debriefing, staring at nature, and journaling [23:30];
- The unbearable fear and self-doubt that were part of her recovery [29:00];
- Reflective solitude vs. isolation [31:30];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
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Our ego is always on patrol and, when itâs insulted, watch out! That is the core of what it means to take things personally. In this episode, we break down: how to not take things personally, sustainable happiness, using body language to transform our internal state, why some insults hurt and others do not, and specific scenarios where you might feel insulted (but donât need to be).
Guest Bio: Frederik Imbo is the founder and head of Imboorling, a company dedicated to improving communication on both the micro and macro levels. Frederik is a formally trained actor with a masters in dramatic arts from the Royal Conservancy in Ghent and was a prolific actor on numerous television series. During his acting career, he began taking roles working in training videos for interpersonal communication. The insights from those role-plays resonated with him and set him on a path of many years of study and training in neurolinguistic programming and nonviolent communication. Over time, fostering communication has become his life focus and led to the founding of Imboorling.
Frederikâs TED talk on how to not take things personally has been viewed 6 million times.
This episode is in support of World Bicycle Relief -- delivering specially designed, locally assembled, rugged bicycles for people in need. Theyâve developed an efficient, innovative, and scalable model to empower students, health workers, and entrepreneurs in rural developing regions with life-changing mobility. Donate here.
We discuss:
- The barrier to sustainable happiness and the technique to overcome that [04:15];
- Frederikâs strategies for preparing to speak publicly [06:40];
- How becoming a soccer referee helped him strengthen his muscle of not taking things personally [12:04];
- What it means if you feel hurt after receiving criticism [15:44];
- The fact that thinking negatively is natural [22:46];
- What you can do if youâre being dragged down by negative thoughts [24:10];
- Body language and how that can affect your mood and self-confidence [26:30];
- The difference between being called an orange and being told youâre selfish [28:36];
How Frederik reframes when he feels himself taking something personally [30:20]; - A choice -- Do you want to be right, or do you want to be happy? [36:05];
Using empathy to manage conflict with a consultant in the emergency department [39:45];
Strategies for not taking it personally when you receive a poor patient satisfaction score or Yelp review [44:00];
Handling a scenario where your best friend forgets your birthday [48:45]; - Why when giving gifts, be more like of the sun -- not expecting anything in return [52:25];
- If Frederik were to design a bumper sticker [55:30];
- And More
For complete shownotes: https://roborman.com/stimulus/stimulus-podcast-43-how-to-not-take-things-personally/
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Our landing page: https://roborman.com/
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Jim Adams, MD is direct, transparent, and unapologetic in his âtough loveâ management strategy. In this episode, Jim breaks down: how setting expectations early helps to manage complaints later, managing those who degrade social capital, redirecting conflict to mutual benefit, and how understanding what motivates othersâ behavior keeps you from taking things personally.
Guest Bio: Jim Adams, MD is professor and chair of the Department of Emergency Medicine at Northwestern University Feinberg School of Medicine. He is also the senior vice president and chief medical officer at Northwestern Medicine.
This episode is in support of World Bicycle Relief. World Bicycle Relief delivers specially designed, locally assembled, rugged bicycles for people in need. Theyâve developed an efficient, innovative, and scalable model to empower students, health workers, and entrepreneurs in rural developing regions with life-changing mobility. Donate here.
We discuss: Zen and the art of scheduling [05:30]; * Adams coaches his chief residents on making the work schedule. He has some unique ideas and approaches that are well thought out and have years of field testing. * He recommends that they lay out the ground rules and expectations in advance (ie. how many days off will be honored), arguing that this is an enormously important part of management (and of life). * He also makes sure everyone understands that lifeâs not fair (and maybe your schedule wonât seem fair as well).
Why you might not want to be a complainer [07:05]; * When making the schedule for the attendings, Adams makes sure everyone understands that heâs going to give the extra bad decisions (for example, fewer weekend days off) to the person whoâs most likely to complain. * âThe complainers are going to complain no matter what. I might as well give you something to complain about.â * We can extinguish those behaviors (and the tendency to complain) by not rewarding them.
âYou can't reward bad behavior. Otherwise everybody's going to behave badly. That's tactical management rules.â
The benefit of assuming people are unreasonable and crazy [08:10]; * If your expectation is that itâs normal human behavior to be unreasonable, then you wonât be perturbed or irritated when someone acts that way. And youâll be pleasantly surprised when instead theyâre nice and reasonable!
A strategy for handling people who degrade social capital [10:30]; * Youâre either building social capital or degrading it. People who send nasty emails, are the target of complaints, or talk negatively in the ED are not building culture or camaraderie. Theyâre degrading social capital. * Adams charges those people at an hourly rate for the time it took him to handle the complaint. Then he distributes the money back to the people who never complain. * âIf people are creating problems, we charge for the cleanup of the problems because that takes time away from us building and advancing the departmentâ. * Since enforcing this a decade ago, the department rarely gets complaints and morale has improved significantly.
âIt starts with extinguishing the negative behaviors and rewarding the heck out of good behavior.â
Blend and redirect, a technique for negotiation and collaboration thatâll make you much happier than combat [14:00]; * When confronted with a conflict, instead of fighting and butting heads against the other person, blend your ideas and put them on the same frequency. When you're on the same frequency, you redirect in a way that's in everyone's interest.
âYou can be right or you can be happy. Choose a path that is not going to cultivate resistance. Try to solve the problem together, because combat's not going to make you happy.â
This idea: âPeople are not against you. They're just for themselves.â [16:15]; * When you realize that people are just asserting something for themselves, then you don't take it personally. You don't get angry, feel belittled, or offended. * When you don't act offensively or angrily, you can get to better solutions.
âNobody's against you, theyâre for you. Everybody's on your team, they just don't know it yet. You can get them there.â
And more. Shownotes by Melissa Orman, MD
We have a choice in how we perceive and act on any situation. Using that knowledge in an intentional way to shift perspective is at the core of cognitive reframing. Epictetus, the great Stoic philosopher, said it best, "It is our attitude toward events, not events themselves, which we can control."
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Guest Bio: Jaime Hope, MD is an attending emergency physician at Beaumont hospital in Detroit, Michigan. She is the author of Habit That!: How You Can Health Up in Just 5 Minutes a Day, leads the Better Health Habits online course, and teaches the Behavior Change and Motivational Interviewing Courses to future physicians at Oakland University William Beaumont School of Medicine.
Essentials of Emergency Medicine, the conference I host each year, is happening May 25-27, 2021. Early bird discount ends April 3. For an additional $100 off registration, use the code 'orman' at the bottom of the checkout page.
We discuss:
- Reframing, a psychological technique which involves thinking about something from a different perspective [04:30];
- How reframing can be used in the ED when youâre engaging with a patient or a patientâs family member who is hostile and upset [07:50];
- Discussing comfort measures with the family of a dying patient [12:12];
- 'Status dramaticus' -- the loud, demonstrative patient who catastrophizes their (often relatively minor) symptoms, triggering irritation for many providers [14:30];
- Reframing when treating patients who suffer from addiction [16:30];
- Ways to reframe yourself and your job to offset burnout [20:00];
- Advice to first year medical students [25:40];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
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In this episode: Effect of Israelâs full bore vaccine program, protection after a single vaccine dose, immunity after a single dose in those with COVID antibodies from previous infection, evidence of decreased transmission following AstraZeneca vaccine, vaccine potency and viral variants.
We Discuss: Israelâs full bore vaccination program and the effect on new cases, hospitalizations, and severe disease [00:01:18]; * In patients over 60 * 41% Decrease in new cases * 31% decrease hospitalizations * 24% decrease critically ill * Article Link
How much protection is there after a single dose of mRNA vaccine? [00:04:56]; * Pfizer vaccine reduced infection 13-24 days after first vaccination by 51% compared to 1-12 days after infection * Inflection point 18 days post vaccination * This doesnât mean to get one shot and be done, but gives insight on immunity following first vaccine dose and when it arises * Article Link
Effect of a single vaccine dose on those who have pre-existing COVID immunity [00:07:00]; * 109 people getting vaccinated divided into two groups. * Those with and without SARS-CoV-2 immunity/seropositive vs seronegative for SARS-CoV-2 immunity IgG. * Seropositive patientsâ antibody response to the first vaccine was equal to or even exceeded the titers found in naive/seronegative individuals after a second dose. In other words -- one vaccine in this study led to a higher antibody level than those who didn't have existing immunity and got two shots . * Antibody titers in those with previous covid/seropositive who got a shot had up to 10 fold the antibody levels compared to those who were COVID naiÌve/seronegative (see below graphic) * This preliminary data also suggests that those with previous immunity didn't get much of an antibody bump after the second dose . * Is the second dose worth it in those with previous immunity? Well, first immunity needs to be proven by blood testing. Using an intense reaction to the first vaccine is a poor manâs marker of previous immunity, but thatâs not what this study looked at. * Immunologists are divided on what to do here. Some say a second dose isnât necessary if there are COVID antibodies prior to inoculation (or there is a strong reaction after first shot in those with a previous history of infection) while others cite the data- the studies look at a 2 shot program, so stick with that * Article Link
Graphic from Krammer, Florian, Komal Srivastava, and Viviana Simon. "Robust spike antibody responses and increased reactogenicity in seropositive individuals after a single dose of SARS-CoV-2 mRNA vaccine." medRxiv (2021). **Evidence that the new Oxford AstraZeneca vaccine decreases asymptomatic infection and transmission [00:12:11];** * Study participants regularly swabbed after vaccination
- The vaccine group had up to 67 percent fewer positive swabs suggesting decreased asymptomatic infection and transmissibility
- Study results also call into question dosing between shots
- Interval between shots and vaccine efficacy
- Under 6 weeks, 55% effective
- 12 weeks, 82% effective
- Article Link
Vaccine potency against UK and South African variants [00:16:06]; * Article Link
Why you shouldnât plan a hootenanny quite yet, even if youâve had 2 shots of vaccine [00:17:00];
Vinay Prasad pulls no punches in this wide ranging conversation about the realities (and delusions) about chemotherapy research, principle centered social media engagement, flipping votes, the FDA drug approval process, the importance of early palliative care, the dangers of embellishing therapeutic benefit, medical reversals, effective vs efficacious, and trade offs in decision making.
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Guest Bio: Dr Vinay Prasad is a practicing hematologist-oncologist and Associate Professor in the Department of Epidemiology and Biostatistics at the University of California San Francisco. He studies cancer drugs, health policy, clinical trials and better decision making. He is author of over 250 academic articles, and the books Ending Medical Reversal (2015), and Malignant (2020). He hosts the oncology podcast Plenary Session. Follow Vinay on Twitter.
Episode Sponsors:
Todayâs episode is sponsored by Stages Cycling, makers of industry leading cycling computers, power meters, heart rate monitors, and indoor studio bikes. When I say industry leading, Iâm talking about last year's Tour de France winner Tadej Pogacar uses a Stages power meter and cycling computer. Stimulus listeners get 20% off your order of all Stages outdoor products (excepting the SB20 Smartbike which is awesome, just no discount). Use this link to go to Stagescycling.com and your 20% discount will be applied at checkout.
This podcast is also brought to you by Panacea Financial, a financial services company created for doctors, by doctors -- aiming to improve the lives of physicians and physicians in training with products and services tailored to the medical community. Spotlighted in this episode is the Panacea Financial Foundation which provides grants to underrepresented minorities in medicine. Panacea Financial is a Division of Sonabank, Member FDIC.
We discuss:
- The realities of the dissemination of scientific information on Twitter [05:12];
- Vinayâs intent when he posts a controversial tweet [09:00];
- Why heâs an outlier in the cancer drug policy circle [16:15];
- A recent JAMA article which raises the question: Do we have a collective delusion about the potential benefits of chemotherapy? [18:20];
- The FDA drug approval process [20:25];
- The discrepancy between what's measured in cancer clinical trials and what actually would matter to cancer patients [22:38];
- Questions to ask when being offered treatment options for cancer [24:30];
- The importance of having rich discussion with patients about treatment side effects and potential toxicities [28:30];
- The value of early palliative care and a common cognitive pitfall in oncology [31:25];
- The dangers of empathy and the better alternative: compassion [35:00];
- Why embellishing the benefit of a treatment is the wrong thing to do [39:20];
- Prasadâs book Ending Medical Reversal and the potential harms of sudden flip-flopping of standards of care in medicine [44:00];
- The difference between âeffectiveâ and âefficaciousâ as it relates to public health and policy [47:46];
- Prasadâs thoughts on the language surrounding masks vs. the data surrounding masks [54:40];
- How not wearing a mask might be the product of a lot of long-standing failures in American economic policy and upward mobility [01:02:00];
- A deficiency of the pandemic which is to not thoroughly consider the trade-offs of the decisions we make [01:06:24];
- What the data tells us about the risk of COVID transmission in schools [01:08:34];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
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Master meditation teacher Robert Beatty walks us through: the basics of meditation, how to start a meditation practice, principles of mindfulness, understating the roots of suffering, how concentrating on the breath can lead to insight, and healthy vs unhealthy coping.
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Guest Bio: Robert Beatty is co-author of Mindfulness for a Happy Life as well as founder and guiding teacher of the Portland Insight Meditation Community. He has worked with thousands of students and, as a practicing therapist, has created a unique synthesis of Buddhist methods of awakening and healing and those of western psychotherapy.
Episode Sponsor: Todayâs episode is sponsored by Stages Cycling, makers of industry leading cycling computers, power meters, heart rate monitors, and indoor studio bikes. When I say industry leading Iâm talking about last year's Tour de France winner Tadej Pogacar uses a Stages power meter and cycling computer. They are legit!
Stimulus listeners get 20% off your order of all Stages outdoor products (excepting the SB20 Smartbike which is awesome, just no discount). Use this link to go to Stagescycling.com and your 20% discount will be applied at checkout.
We discuss:
- When starting a meditation practice, the importance of knowing what your âfantasyâ is about meditation [06:50];
- Why having a meditation teacher is essential and how Ruth Denison influenced Beattyâs practice [08:30];
- The paradox of 2 truths: skillful effort to restrain unwholesome mental states and the effort to bring into being wholesome mental states [12:30];
- Beattyâs guided meditation for the novice [15:00];
- What it is in mindfulness that weâre actually being mindful of [25:10];
- Driving a car The Headless Way [28:50];
- Why it is almost universal in meditation practices to use the breath as the primary meditation object [30:15];
- Beattyâs opinion of meditation apps [35:37];
- How intentionally letting go of your thoughts and concentrating on your breath can lead to deep insight [38:38];
- The 3 characteristics of existence and how they provide spiritual insight [42:30];
- Using meditation as a purification process to help you let go of stuff (or people) that cause negative emotions [48:50];
- A skillful way to come back to your meditation object that is not self-criticizing [51:30];
- The metaphor of the two arrows and how it can be applied in daily life [54:50];
- Healthy vs. unhealthy coping mechanisms [01:00:00];
- The reasons people come to meditation [01:06:00];
- Beattyâs aspirations [01:09:30];
- Why âshouldâ is such a violent word [01:10:00];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
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We break down three techniques to inoculate yourself against the stress of time critical tasks.
Guest Bio: Jason Hine, MD is a community emergency medicine physician at Southern Maine Healthcare where he is the Medical Director of Education. He is a graduate of Tufts University School of Medicine and the Temple EM Residency program where he served as chief. He serves as an Associate Editor and Author on the DownEast EM blog and podcast and has an interest in procedural skill set decay as well as the role of academics in improving the recruitment, retention, and satisfaction of community physicians.
Episode Sponsor: Panacea Financial is a financial services company created for doctors, by doctors -- aiming to improve the lives of physicians and physicians in training with products and services tailored to the medical community. Whether it's scheduling residency interviews, trying to buy a house during training, or looking for ways to fund your practice, Panacea Financial was created to remove the unique financial hurdles of physicians and allow you to better serve your communities. Panacea Financial is a Division of Sonabank, Member FDIC. You can follow them on the Insta, Twitter, Facebook, and everybody's well dressed favorite, Linkedin.
Listen on:
- iTunes
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We discuss:
- The importance of stress inoculation training when you need to perform a HALO (High Acuity Low Opportunity) procedure [05:15];
- How inoculating against stress helps you 1) perform well when confronted with the situation in real life and 2) serves as a memory aid [07:05];
- 3 techniques for stress inoculation [08:00];
- Why you should not only ask people to observe you, but also request that they provide feedback on your imperfections [16:40];
- The advantages of low-fidelity stress inoculation strategies as compared with simulation labs [18:00];
- Additional tools for reducing stress [19:20];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
We break down whatâs known about the new UK COVID variant: what it is, whatâs meant by âmore transmissibleâ, and potential effects on vaccine efficacy.
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We discuss:
- A new COVID variant in the UK is reported to be 71% more transmissible than âwild typeâ virus [00:01:45];
- The epidemiologic data on the new variant [00:03:09];
- NERVTAG has âmoderate confidenceâ of increased transmissibility [00:04:56];
- UK technical briefing shows no increase in 28 day mortality for new variant (at least so far) [00:06:02]
- A South African variant shows similar behavior as UK virus [00:06:45];
- Potential effects of new variant mutations on vaccine efficacy [00:09:00];
- And More.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
Christiaan Maurer MD, was in his mid 40s when diagnosed with glioblastoma multiforme -- terminal brain cancer. In this episode, he and Rob discuss: what terminal illness taught him about time, what people with cancer do and donât need, preparing your family for a future without you, the most/least admirable traits in physicians, and the secret of life.
We discuss: The life-threatening diagnosis that helped Christiaan gain wisdom about life, death, and the practice of medicine [02:30]; * Dr. Maurer was a 46 year old internal medicine hospitalist who was diagnosed with multicentric glioblastoma in February 2018. A neurosurgeon told him that without surgery, he had about a month to live. * Following resection, he completed chemotherapy and radiation.
The right and wrong things to say to someone with a terminal illness [06:33]; * At the time of the diagnosis or soon thereafter, say things that are gentle. * As the diagnosing provider, you might say, âIâm sorry weâve given you such bad news, but there are treatments for this.â As a friend, say, âIâm sorry, letâs go get a beer. Iâm here for you if you need me.â * Donât say, âYou can beat this,â especially if thatâs not likely. * Donât say, âHow are you? How do you feel?â
The fact that people with cancer often donât call when they need help [08:00]; * Be proactive. âHey, Iâm picking you up and Iâm halfway there already. Weâre going to the movies.â * Just show up.
What people with cancer need and donât need [08:45]; * What you donât need when you have terminal cancer is to hear about cancer. Donât ask how the cancer is going. And donât bring up the diagnosis in every future conversation. * People with cancer donât want to talk about cancer. And if they do, theyâll bring it up. Talk about other interesting events in your life.
How Christiaan reacted, emotionally, to his diagnosis [11:00]; * When he first saw the tumor on his MRI, his reaction was a gasp of absolute shock and disbelief. Once the dexamethasone kicked in, he felt rage and anger. It was difficult to focus and concentrate. * As time went on, he developed an intense immobilizing sadness. He was heartbroken for his children, far more so than for himself.
âEvery day is worth so much... Itâs easy to lose sight of that when you think you have tens of thousands of days left. But remember your mortality and choose your big and small decisions accordingly.â -C. Maurer
Preparing your family for the reality of your future. And their future without you [13:20]; * Christiaan chose to be 100% direct. The information he shared with his children was unsugarcoated and sometimes slightly brutal. He tried to keep humor in it whenever he could. * He found himself trying to compress the next 10-12 years of parenthood into 1 year, imparting wisdom that normally wouldnât be shared until just before a child moved out for college.
âFight for what is right, even if it costs you a job, money, a relationship, or a bad grade. Fight for the underdog, and don't give up.â -C. Maurer
A hospitalistâs advice for emergency physicians [17:55]; * When you call to admit a patient, be clear as to why the patient canât go home. Rather than say, âHe has goutâ, say âHe canât walk, lives alone, and there are no family members who can help out.â And truly make an effort to contact and elicit help from family. * The pushback from hospitalists often comes from chronic âbogusâ admissions.
âIf you're an E.R. doctor that's getting lots of pushback from lots of different hospitalists, then the problem might actually be you.â -C. Maurer
Qualities that make a âstrongâ ED provider [22:10]; * Christiaan argues that you can only be one kind of ED doctor, and thatâs a great one. You canât be mediocre. * Great ED doctors generate a broad differential diagnosis and rule out the top 6 on the list to the best of their ability. * Providers should be able to present a patient clearly in one sentence.
The least admirable traits of ED doctors [23:00]; * Christian gets very frustrated when a patient presentation begins with, âI donât really know what is going on.â Upon hearing this, his brain instantly shuts off, and he just wants to end the call and figure the patient out himself.
The dangers of adhesive tape and advice for caregivers [24:00]; * Remember that the interventions we do on patients (arterial lines, IVs, Foley catheters, removing adhesive tape, etc) cause significant suffering. Donât do these procedures unnecessarily and remove them as quickly as you can.
The Mauerâs Sign of aortic stenosis [25:55]; * Christiaan noticed that with severe or critical aortic stenosis, in addition to the murmur radiating to the carotids, it also could be heard over the left scapular spine (because bone transmits sound better).
Christiaanâs philosophy of medicine and message to the medical community [27:45]; * Work hard, * Donât be lazy. * Remember who this is really all for -- the patient, the patient, the patient..
And more. Shownotes by Melissa Orman, MD
The COVID vaccines are upon us! In this episode we disambiguate COVID vax side effects and the historical effects of acetaminophen and sleep on vaccine antibody response.
Listen on:
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We Discuss:
- Listener questions about ERcast and how an mRNA vaccine works [0:00:30];
- COVID mutations in Europe may increase transmissibility [00:04:40];
- Recently published side effects and adverse reactions of Pfizer COVID vaccine [00:06:05]
- Impact of acetaminophen and ibuprofen on vaccine antibody response [00:10:13];
- How sleep impacts vaccine antibody response [00:16:19].
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
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Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
Most of us have habits we'd like to change -- both getting rid of bad ones and adopting good ones. It's easier said than done! Habits by nature are hardwired and happen without much activation energy. In this episode, Christina Shenvi MD, PhD breaks down the nature of willpower, how knowing it's a limited resource can play to our advantage, strategies for getting out of bad habits, and how to adopt the ones you want.
Guest Bio: Christina Shenvi MD, PhD is an emergency physician at the University of North Carolina, Chapel Hill where she is the director of the UNC Office of Academic Excellence. A frequent guest on Stimulus, she has now started coaching and teaching more broadly on time management. Her goal is to help busy professionals find more peace with their schedules, feel less stressed, and use their time more effectively. Dr. Shenvi blogs at: www.timeforyourlife.org, and offers workshops on time management.
Episode Sponsor: Panacea Financial is a financial services company created for doctors, by doctors -- aiming to improve the lives of physicians and physicians in training with products and services tailored to the medical community. Whether it's scheduling residency interviews, trying to buy a house during training, or looking for ways to fund your practice, Panacea Financial was created to remove the unique financial hurdles of physicians and allow you to better serve your communities. Panacea Financial is a Division of Sonabank, Member FDIC.
Listen on:
- iTunes
- Spotify
- Stitcher
We discuss:
- Self-regulation and how it relates to willpower [06:00];
- How willpower is a limited resource [08:00];
- Tricks for building up your willpower muscle [14:45];
- The habit cycle, and why we need to understand how habits work before we can change them [20:25];
- Breaking bad habits using mental contrasting with implementation intention [24:55];
- The process of strategic automatism, where you're strategically forming a habit so that you do it automatically [28:50];
- Why it helps to think about the identity you want to have when youâre working on improving your habits [29:30];
- Habit stacking [36:30];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
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The Veterans Health Administration COVID-19 (VACO) Index for COVID-19 Mortality predicts 30 day mortality following a positive test. VACO co-creators Amy Justice MD, PhD and Joseph King Jr, MD, MSCE break down how to use VACO, what it does, and what it doesnât. Weâre also joined by Joe Habboushe MD, CEO of MDCalc, whose online VACO calculator makes using VACO far easier than doing it in your head. Here is a link to the VACO Calculator.
Listen on:
- iTunes
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We discuss:
- The Veterans Health Administration COVID-19 (VACO) Index, what it is and how it helps us evaluate patients [01:20];
- Why VACO doesnât include race or BMI [03:40];
- Whether VACO can be useful in the ED or the acute setting [08:20];
- Potential applications of the VACO index [12:15];
- What VACO does not do [18:30];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
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A discussion with His Holiness the Dalai Lamaâs personal physician Barry Kerzin, MD on: how he came to his unique job, why compassion might be better than empathy in healthcare, simple ways to develop compassion towards both others and yourself, the cure for jealousy, lessening the impact of errors, and a prescription for longevity in medicine and life.
Guest Bio: Barry Kerzin, MD is a US born and trained family physician who for the past several decades has resided a monk in Dharamshala, India -- home of the Tibetan community in exile. In addition to serving as H.H. the Dalai Lamaâs personal physician, Dr. Kerzin is the founder of the Altruism in Medicine Institute, whose mission is to increase compassion and resilience among healthcare professionals and extended professional groups, such as police officers, first responders, teachers and leaders.
Self described as â...a doctor, a monk, a teacher, a lazy man. All of these things, yet none of these things,â you can follow Dr. Kerzin on Facebook, Youtube, Instagram or learn more about his story here.
We discuss: How Barry Kerzin got the job of being the Dalai Lamaâs personal physician [07:15]; * It started with a request from His Holiness for a cholera vaccination so that he could safely travel to Brazil for an international environmental conference.
Why allopathic medical providers shouldnât discount traditional health care systems [18:20]; * Traditional Chinese medicine, Tibetan medicine and Ayurvedic medicine have a lot to offer. While we donât have to accept these practices, we must be open and educate ourselves about them.
âTraditional health care systems are rich. They are almost always complementary with allopathic modern medicine.â
Advice Dr. Kerzin would give to his younger self upon graduation from family medicine residency in the late 1980s [24:25]; * He would tell himself: âOpen your mind and open your heartâ.
The dangers of too much empathy [27:00]; * Empathy is standing in the other personâs shoes. But you can become too close emotionally. You can inadvertently end up taking on or owning the pain of the person that you're trying to take care of. * If you adopt a patientâs suffering and you donât know how to clear it, the consequence can be a full-blown burnout syndrome.
âWe're much more prone to go along the path to burnout if we practice empathy rather than compassion.â
Compassion, which is just about a half step back from empathy [29:15]; * Kerzin teaches the importance of moving beyond empathy to compassion. * By taking a half step back, it allows us to see more because we're less emotionally involved. It allows us to make better decisions on how to reduce the suffering for that patient and how to be more effective with our treatment, * Compassion is the wish and the action, when we're able, to reduce or even eliminate pain and suffering.
âThe feeling tone when we're practicing compassion is joy, because we're trying to help somebody. It's tinged with sadness because we feel their pain, though we're not overwhelmed by it.â
Methods of teaching compassion on a curricular level [33:20]; * Kerzin founded the Altruism in Medicine Institute whose vision statement includes the aim to âtransform medical education to incorporate curricula of self-compassion, compassion for others, mindfulness, and resilience as essential as anatomy, physiology, and pharmacology.â * Studies have shown that compassion improves health in the fields of immunity, neurology, and cardiology. Additionally, it helps health professionals remain sane. * Compassion is taught in a lecture-based format, small group setting, videos, and then applied in oneâs daily routine. * Kerzin recommends this mantra to cultivate compassion: âJust like I only want to be happy and not have pain, so does the other person just want happiness and not want to hurt.â If we recognize this commonality, it connects us.
The Buddhist practice of unconditional compassion [39:45]; * Buddhism teaches that you should be equally compassionate to those you love as to those who might be torturing you. To reach this state is not easy.
The importance of mutual respect, even in the face of difference [43:35]; * Compassion can be used as a tool to reduce divisiveness. If we can develop some respect for others, even if we don't agree, we can begin to bring back trust.
Replacing jealousy with rejoicing [46:00]; * The first step is realizing the benefits of rejoicing and appreciating the deficits of jealousy. Jealousy robs you of your inner-peace. If youâre able to rejoice and appreciate the otherâs success, youâll feel much better. * The second step is recognition of what youâre thinking and feeling, and being aware when jealousy is at play. * The third step is learning how to replace (not suppress) jealousy with appreciation. * This process takes practice.
âYou're not suppressing jealousy, because we know that suppressing your negative emotions never works since they still are there.â
The pillars of self-compassion [49:48]; * Spend more time in the present moment and observe your inner life/thoughts/feelings (this is Mindfulness with a capital âMâ). When youâre undercutting, criticizing or doubting yourself, youâre remembering something from our past or fearing for the future. We can train ourselves to drop into the present moment through regular, daily mindfulness exercises. Tools include meditation, art, music, being in nature. * Have concern for the welfare of others. * Be kind to yourself. Cut yourself some slack. * Forgive yourself and then forgive others. Start with forgiving yourself of the small things. This is a solo activity which allows you to open your heart and to be a more happy person.
Lessening the impact of an error [56:15]; * All humans will make mistakes. Acknowledging that fact (and your mistake) is an important step forward.
Bodhisattvas -- people who have universal compassion that excludes no one [56:15]; * People who have universal compassion relish difficult situations or being with difficult people because it gives them an opportunity to work on their negative reactions to transform them into positive ones.
What itâs like to live in Dharamshala and to be the Dalai Lamaâs physician for the past 15 years [59:20]; * Kerzin shares that His Holiness is, in many ways, beyond human. His mind is incredibly deep and profound. As a patient, he puts you at ease. * As we should with every patient interaction, Kerzin does his best to inform the Dalai Lama of his medical options so that he can make his own decisions.
Dr. Kerzinâs prescription for longevity in medicine [01:07:45]; * Compassion
And more. This podcast streams free on iTunes, Spotify, and Stitcher.
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Follow Rob: Twitter, Facebook, and Youtube.
Shownotes by Melissa Orman, MD
We review the false negative rates of different COVID tests (PCR and rapid antigen), the known knowns and known unknowns of the Moderna vaccine.
Listen on:
- iTunes
- Spotify
- Stitcher
We discuss:
- Why the lack of a legitimate gold standard is a challenge when comparing different tests for COVID-19 [01:45];
- RT-PCR: why we shouldn't be reassured by a negative test result [03:45];
- How your pretest probability of disease affects your interpretation of test results [07:00];
- The COVID antigen test: faster and more widely available, but less accurate [08:10];
- A NYT report of a rapid antigen test study showing suboptimal test sensitivity when applied to asymptomatic people [10:15];
- Why you canât rely on a negative test to make your decision to travel or spend time with family/friends for the holidays [12:05];
- Whether you need to quarantine if youâve been in close contact with someone who themselves was exposed to a known COVID patient [13:30];
- The Moderna vaccine which has a reported efficacy of 94.5% [14:00];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
Effective (and ineffective) leadership comes in many flavors, but there is an underlying quality to any good leadership that you know when you see it. In this episode, Colonel Jim Czarnik, MD and Josh Bucher, MD break down the lessons theyâve learned leading in both the military and civilian worlds of medicine and crisis situations. My favorite quote from this episode: âPurpose is embraced, not imposed.â
Listen on:
- iTunes
- Spotify
- Stitcher
Guest Bios:
Colonel Jim Czarnik, MD is the Deputy Chief Of Staff, Surgeon United States Army Special Operations Command. He has previously served as Command Surgeon for US Army Africa and was instrumental in coordinating the multinational response to the recent western Africa Ebola outbreak.
Josh Bucher, MD.is an assistant professor of emergency medicine at Rutgers- RWJMS. He is EMS-fellowship trained and currently holds the position of associate EMS Medical Director for RWJ-Barnabas MHS. An expert in tactical emergency medicine, he is medical director of the Middlesex and Somerset County SWAT team.
This episode is sponsored by Wild Health.. Wild Health provides personalized medicine that takes into account DNA, biometrics, microbiome, and lifestyle factors to come up with your ideal diet, supplements, and lifestyle to optimize health and maximize healthspan. Use the code "Stimulusâ for 10% off any Wild Health care plan.
We discuss:
- What it means to be a leader and why leadership is a state of mind [03:15];
- The culture that you want to create in your professional environment [04:10];
- The ERO relationship (Event + Response= Outcome) [06:20];
- Why self-motivation is so important for success in the emergency department [09:00];
- How teamwork is directly related to your mission: a good patient outcome [10:40];
- Keys to success when you transition to a position of leadership [13:40];
- Mistakes young leaders or people newly in leadership positions commonly make [20:15];
- The right mix of being respected and being liked [22:30];
- Czarnikâs special skill for being able to start conversations with anybody, no matter who they are [27:25];
- How Czarnik manages email [31:15];
- Czarnikâs personal philosophy and approach to life [33:00];
- Czarnikâs ask for the world of medicine and something heâd like to see change [34:10];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
In this Stimulus Thump: Should we be worried about COVID on surfaces? Tools to manage the third wave. A new study suggests there might be benefits from aspirin. Having flu and COVID at the same time increases odds of mortality.
Listen on:
- iTunes
- Spotify
- Stitcher
This episode is sponsored by Wild Health. Wild Health provides personalized medicine that takes into account your DNA, biometrics, microbiome, and lifestyle factors to come up with your ideal diet, supplements, and lifestyle to optimize health and maximize healthspan. Use the code "Stimulusâ for 10% off any Wild Health care plan.
We Discuss:
- Two tools to mitigate mental health impacts of the third COVID surge [01:48];
- Influenza and COVID co-infection increases mortality compared to COVD infection alone [06:40];
- An association between aspirin use and decreased in-hospital mortality, ICU days, and need for a ventilator [10:00];
- How long COVID exists on surfaces and does it remain infectious [14:57]
- More.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
When things are going well, you may not notice how your mind is working. But sometimes, you are overtaken by events and it can feel like the gears are grinding in the worst possible way in both life and work. In this episode, physician coach Gail Gazelle, MD, walks us through the mental processes that happen in those gear grinding moments and how to not only work through them, but also come out the other side with resilience and a better understanding of ourselves.
Guest Bio: Gail Gazelle, MD, MCC is a former hospice physician, part-time Harvard Medical School Assistant Professor, and Master Certified Coach for physicians. One of the leading pioneers in physician coaching, Dr. Gazelle has coached over 500 physicians and physician leaders on leadership development, mindfulness, emotional intelligence, resilience, and moving from burnout to balance. She is the author of Everyday Resilience. A Practical Guide to Build Inner Strength and Weather Lifeâs Challenges, (Free chapter here). You can contact Gail through her website and, if so inclined, schedule a complimentary coaching consultation.
Todayâs episode is sponsored by Wild Health. Wild Health provides personalized medicine that takes into account DNA, biometrics, microbiome, and lifestyle factors to come up with the perfect diet, supplements, and lifestyle to optimize health and maximize healthspan. They also have a fellowship program to teach physicians, providers, and health coaches how to practice this new paradigm of medicine. Use the code "Stimulusâ for 10% off any Wild Health care plan.
We discuss:
- The fundamentals of mindfulness [02:55];
- What burnout looked like for Dr. Gazelle before she embarked on a new career path as a physician coach [05:45];
- The impact COVID-19 has had on her conversations with physician clients [07:15];
- The response of front-line providers when referred to as a âheroâ [10:10];
- What itâs been like for physicians, trained to be the captain of the ship, when put in the position of managing COVID patients with little guidance from science [12:40];
- How Gazelle helps physicians manage uncertainty and weather difficulty [17:30];
- Tips for ensuring that the âdaily dose of goodnessâ becomes a defined habit [21:30];
- How accepting what is/isnât in your control can help mitigate stress, frustration, and anger [29:50];
- Different ways of handling a bad leader [33:00];
- The importance of regulating your emotional temperature [38:00];
- The problem with either/or thinking [42:00];
- The STOP tool for applying mindfulness practice in the heat of an intense moment [45:50];
- Anticipatory dread and catastrophic thinking in medicine [49:40];
- The crossroads of imposter syndrome and perfectionism which makes for a cycle of perceived inadequacy [55:30];
- An affirmation Gazelle created for her clients who struggle with perfectionism: âI am good. I do my best. I cannot control all the rest.â [59:40];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
In this Thursday Thump: Is there a role for aspirin in COVID? Does vitamin D reduce the chance of getting COVID or being sicker once you have it? Association between going to a restaurant and testing positive. Cardiac injury in athletes after mild and asymptomatic infection.
Listen on:
- iTunes
- Spotify
- Stitcher
We Discuss:
- Is there a role for aspirin in COVID infection? [01:42] ;
- The evidence for and against vitamin D in COVID infection [03:15];
- COVID positive patients have increased odds of having been to a restaurant compared to COVID negative [09:57];
- Understanding odds ratio [11:00];
- Exercise with active covid infection isnât a good idea [13:00];
- Potential risks of exercise after COVID infection [14:00];
- Ohio State University is going to get cardiac MRI on athletes to screen them for return to play [17:00];
- Gadolinium Deposition Disease might or might not be a thing [17:54];
- More.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
Our digital lives have become cluttered, scattered, and reflexive rather than intentional. Is it time for a change? In this episode, Rob and Dan McCollum, review the principles and exercises laid out in the book Digital Minimalism: Choosing a Focused Life in a Noisy World. Taking it a step further, they share what happened when they went full on guinea pig and dove deep into the process.
Guest Bio: Dan McCollum, MD is an emergency physician, associate professor, and associate residency director at the Medical College of Georgia. Here more of Dan from Stimulus Episode #1 Verbal Judo.
This episode is brought to you by RingRescue, the new standard for stuck ring removal. RingRescue helps remove stuck rings in a non-destructive way and, when used with their non-hydrating lubricant, significantly reduces the need for ring cutting. Use the code stimulus at checkout when you purchase your RingRescue finger compression device to get an extra bottle of their lube. Extra lube, free fifty free! Ringrescue.com/stimulus, checkout code stimulus.
We discuss:
- Why digital minimalism is something we might want to consider doing [03:07];
- The fact that most of the interactions that we have with social media are of low value [05:40];
- The truth about why most people participate in social media [06:15];
- The core principles of digital minimalism [07:20];
- Cal Newportâs method for using phones, computers, and apps in a way that they are net positive [11:00];
- Tips and observations from Robâs and Danâs 30-day breaks from technology [13:10];
- The process for reintroducing technology after the 30 day declutter [19:00];
- Strategies Rob and Dan have employed for using technology differently, months after a declutter [21:00];
- Danâs bottom line about digital minimalism [27:25];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
World-renowned vaccine expert Paul Offit discusses where we stand with the development of a COVID-19 vaccine, challenges ahead, and how clinicians can best focus our efforts in vaccine education and advocacy.
This podcast is produced in partnership with Hippo Education
- How the COVID vaccine is being made and where it targets the virus
- Different variations of the vaccine
- The normal path to vaccine development and how it's different with this one
- Why Paul Offit would opt for wearing a mask vs getting a vaccine if he had to choose between the two
- How to balance the urgency for the need for a vaccine with safety concerns
- What happens in Phase 1, 2, and 3 trials
- Likelihood the vaccine will be rushed to market
Guest Bio: Paul Offit is a pediatrician specializing in infectious diseases and an expert on vaccines, immunology, and virology. He is the co-inventor of a rotavirus vaccine that has been credited with saving hundreds of lives every day. Offit is the Maurice R. Hilleman professor of vaccinology, professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania and director of The Vaccine Education Center at Children's Hospital of Philadelphia (CHOP). Offit is currently a member of National Institutes of Health (NIH) working group on vaccines, a subgroup of the "Accelerating COVID-19 Therapeutic Interventions and Vaccines" (ACTIV) comprised of experts to combat COVID-19. He is also a member of the FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC). Previously, he was a member of the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices. Offit is a board member of Vaccinate Your Family and Autism Science Foundation. "Overkill" is his 11th book.
For show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
NY Times bestselling author Michele Harper, MD on setting boundaries, pre-shift routines, guarding the vulnerable, microaggressions, racism in the emergency department, and why inaction is just as much a choice as action.
Guest Bio: Dr. Michele Harper, is an emergency physician and author of The New York Times best selling memoir, The Beauty in Breaking. She's been interviewed on Trevor Noah, Fresh Air, CNN, NBC, amongst many others. Michele is also a widely published essayist, often focusing on race and medicine. Her writing shares her personal journey that started as a child in an abusive household, then to undergrad at Harvard, medical school at Stony Brook, New York, and now her life as an attending physician. And as you'll hear, she's got a personal mission to be a guardian for the vulnerable.
This episode is brought to you by RingRescue, the new standard for stuck ring removal. RingRescue helps remove stuck rings in a non-destructive way and, when used with their non-hydrating lubricant, significantly reduces the need for ring cutting. Use the code stimulus at checkout when you purchase your RingRescue finger compression device to get an extra bottle of their lube. Extra lube, free fifty free! Ringrescue.com, checkout code stimulus.
We discuss:
- The importance of setting boundaries, especially when people are able to reach you 24/7 [03:20];
- Her essay, âSovereign Bodiesâ (The Cut), where Michelle shares a story demonstrating how difficult it can be for patients and providers to get the help they need [07:15];
- Micheleâs pregame routine before a shift in the ED (which includes probiotic chai tea and Eckhart Tolle) [12:00];
- How growing up in an abusive household groomed Michele for a career in emergency medicine [16:45];
- Why loving medicine is not enough to keep you in the game [19:15];
- Patients who have a special place in Micheleâs heart: children and anyone who might be in danger [23:00];
- An excerpt from The Beauty in Breaking which explores the notion that we can find our center through chaos and by transcending difficult experiences [30:15];
- How meditation and yoga help Michele remain still and steady in moments of chaos [32:15];
- Why thereâs nothing âmicroâ about microaggressions [36:00];
- How itâs not the job of the victim to plant a seed of understanding for someone who delivers a microaggression [38:10];
- Why people who are in a position of power need to try harder to prevent and correct indignities [43:30];
- Her article âWhen This War Is Over, Many of Us Will Leave Medicineâ (Elemental) which presents the idea that âhealthcare providers are regarded as more disposable than our PPEâ [44:30];
- Micheleâs call to action [50:45];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
Who teaches doctors how to speak to patients (or each other)? Itâs usually something thatâs picked up as you go. Letâs be honest though, some clinicians are much better at clear and empathetic communication than others. Itâs an under taught skill thatâs way more important than the attention it gets. In this episode we take a look into the mind and practices of master clinician Loren Rauch. Loren is one of the wisest clinicians we know and intentionally applies humanity to every aspect of his practice. Among the topics addressed are: the ethical imperative of the well-deserved compliment; navigating difficult conversations; communicating with trainees, nurses and new learners; and tips for dealing with patient anxiety.
This episode is brought to you by Mar-Med, makers of the industry leading and #1 selling Tourni-Cot digital tourniquet. What you may not know is that Mar-Med also makes a newly re-engineered balloon extractor for nasal foreign bodies, the one size fits all Uni-Cot digital tourniquet, and the Derma-Stent drain that greatly simplifies loop abscess procedures. Iâve used Mar-Medâs products hundreds of times and can attest to their efficacy and simplicity of use. You can check out all of their products and get free samples of whatever youâd like to try at marmed.com/stimulus. Who doesnât love free samples, especially when itâs awesome stuff? Check it out at marmed.com/stimulus.
Guest Bio: Loren Rauch, MD is a graduate of UCSF Medical School and holds masters degrees in both public health and health sciences from UC Berkeley. He completed his emergency medicine training at Harbor, UCLA and, in addition to decades of clinical experience in the United States, he has spent time as an instructor for first responders in the jungles of Southeast Asia.
We discuss:
- Why we should thank patients for coming in to the emergency department, regardless of their chief complaint [05:15];
- Using humor to reframe something you dread into something that makes you laugh [10:10];
- Tips for helping ease the anxiety many patients (especially kids) have when in the ED [11:40];
- Pros and cons of wearing a white coat [19:10];
- Different approaches to informing patients about what tests you plan to do [22:15];
- How to deliver the bad news of a miscarriage [24:55];
- Helping family members when their loved one is dying [30:30];
- The importance of taking a mindful pause after a patientâs death [36:50];
- The heightened responsibility of the team leader in the ED [41:00];
- Why doctors need to have sympathy for themselves, and it is a lifetime of practice [42:00];
- The value of being conflict avoidant in clinical practice [46:00];
- The resentment that comes from comparing your tasks to someone elseâs, and how this can suck the joy out of your work [49:15];
- The ethical imperative of the well-deserved compliment [53;30];
- Why our job isnât to be right; our job is to be reasonable [56:20];
- And more.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
When you react in anger, what is your intent? Often it's to lash out; the reflective and thoughtful part of your brain is taken out of picture. But if you think of a really clever and biting response, what do you hope will be the result of those words? Itâs unlikely to persuade. More likely itâs a quasi-cognitive-orgasmic release of F*&k You.
We Discuss:
[00:00:29] The fires outside and in;
[00:01:22] Considering your intent in responses;
[00:04:17] When you react in anger, what is your intent?
[00:04:55] How being in an extended legal action made me a monster while fighting a monster;
[00:07:29] Responding with hate vs wisdom.
For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
Convalescent plasma has been a hot button news story over the past few weeks since the FDA approved its use in COVID patients. In this episode, hematologist Tom DeLoughery (@Bloodman) breaks down what it is, what it purportedly does, the evidence (or lack thereof) supporting its use, at what point in disease it might work, and potential dangers of indiscriminate use.
This episode is brought to you by Mar-Med, makers of the industry leading and #1 selling Tourni-Cot digital tourniquet. What you may not know is that Mar-Med also makes a newly reengineered balloon extractor for nasal foreign bodies, a one size fits all Uni-Cot digital tourniquet, and the Derma-Stent drain that greatly simplifies loop abscess procedures. Iâve used Mar-Medâs products hundreds of times and can attest to their efficacy and simplicity of use. You can check out all of their products and get free samples of whatever youâd like to try at marmed.com/stimulus. Who doesnât love free samples, especially when itâs awesome stuff?
We Discuss
- What is convalescent plasma (CP)? [04:06];
- How plasmapheresis can collect large volumes of donor plasma [4:53];
- If donating plasma (and losing antibodies) can make one more susceptible to infection [5:32];
- The potential folly of using CP in only the sickest patients and why it might be better used at the beginning of illness [06:25];
- How much immunity a single unit of plasma might provide [10:51];
- Adverse consequences of plasma use [12:00];
- Does CP actually work? [14:16];
- Would Tom want CP if he got COVID? [21:35];
- What weâve learned from the massive effort to accelerate CP collection [23:02];
- And More.
For Show Notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
Gender and racial bias are pervasive across all aspects of society, medicine notwithstanding. In this episode, Esther Choo MD, MPH (@choo_ek), a titan for the cause of gender and racial equity discusses: a rubric for deciding 'yes or no', single payer healthcare, why confining medical practice to the bedside can be an exercise in futility, sexism and racism in medicine, the wage gap, workforce vs. leadership demographics, managing overtly racist patients, and why the culture of medicine is ripe for sexual harassment.
This episode is brought to you by Mar-Med, makers of the industry leading and #1 selling Tourni-Cot digital tourniquet. What you may not know is that Mar-Med also makes a newly re-engineered balloon extractor for nasal foreign bodies, the one size fits all Uni-Cot digital tourniquet, and the Derma-Stent drain that greatly simplifies loop abscess procedures. Iâve used Mar-Med's products hundreds of times and can attest to their efficacy and simplicity of use. You can check out all of their products and get free samples of whatever youâd like to try at marmed.com/stimulus. Who doesnât love free samples, especially when itâs awesome stuff?
We discuss:
- Estherâs first outward advocacy: responding to the Trump administrationâs attempts to dismantle the Affordable Care Act [03:44];
- How you decide whether to say âyesâ or ânoâ when you donât have time to do everything thatâs asked of you [06:15];
- Why investing in the development of a single-payer health system would provide better care upstream so that we can save on our costly low-value care downstream [11:00];
- What Esther will always stand up against: inequity [17:20];
- The importance of advocating for systems solutions to problems, and how confining your practice to the hospital is an âexercise in futilityâ [19:00];
- Estherâs pre- and post-game routines before and after night shifts [25:20];
- Lessons Esther tries to impart on her trainees in the ED [29:00];
- The importance of meeting patients where they are, whether theyâre a heroin addict, borderline personality, or an a-hole [32:50];
- Estherâs podcast, Doctorâs Log, which is a diary of the experience treating patients during the COVID pandemic [34:40];
- How Esther responds when a patient refuses to be treated by her because of her race [38:18];
- Sexism in medicine and how to get everyone (not just women) on board as advocates for equality and reversing disparity [43:55];
- How implicit bias is a side effect of being human [48:30];
- The discrepancy of the demographics in the workforce vs. in leadership positions [58:00];
- Explaining the gender wage gap in medicine [1:03:00];
- Strategizing solutions to gender pay inequity [01:10:00];
- Estherâs company, Equity Quotient, whose mission is to âwork with standout health care organizations, employer groups and academic centers to create a culture of equity, safety, and respectâ [01:11:34];
- The NEJM article, Timeâs Up for Medicine? Only Time Will Tell, and why medicine is ill-prepared to make meaningful steps toward ending harassment [01:17:00];
- Why change wonât happen if we donât improve the diversity representation from the ground floor up to the highest leadership [01:19:45];
- The reason Twitter became Estherâs social media medium and how Chelsea Clintonâs comment on her tweet took her to the next level [01:22:56];
- Why patients of surgical attendings who are abusive to staff have worse outcomes [01:27:00]; and
- Estherâs call to action, [01:30:42];
- And more.
For Show Notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/
If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!
Interested in sponsoring this podcast? Connect with us here
Follow Rob:
Twitter: https://twitter.com/emergencypdx
Facebook: https://www.facebook.com/stimuluswithrobormanmd
Youtube: https://www.youtube.com/c/emergencypdx
A fishing boat out of Seattle gives clues as to what COVID immunity looks like; an emergency department pulse ox study gives insight into the clinical course of patients discharged home who later develop low oxygen levels; and some staggering statistics on cardiac injury following COVID infection.
We Discuss:
- The impact of neutralizing antibodies on immunity;
- The difference between neutralizing antibodies and whatâs tested for in the Abbott Architect commercial antibody test;
- Why some who have a positive commercial antibody test might not be immune;;
- Sensitivity of Viral RT-PCR testing;
- What a negative PCR test means after a high risk exposure;
- An emergency department study found that patients who develop hypoxia after discharge home had an increased incidence of adverse outcome;
- A recent study found a 70% incidence of cardiac injury in 100 recovered COVID patients.
For Complete Show Notes and References: Click Here
To Learn More About Stimulus: https://www.stimuluspodcast.com/
Procrastination isn't what you might think. Do you really not have the time to get that thing done, or is there something else getting in the way? In this episode, Christina Shenvi MD, PhD breaks down: why we procrastinate and how to break free of that habit, reframing 'busyness', value based scheduling, how she decides on responding yes or no, how to say no in a skillful yet honest manner, and techniques to keep up with email. If you want to go deeper into all of this in a small group setting, Dr. Shenvi has an online time management course that's not to be missed.
Guest Bio: Dr. Christina Shenvi MD, PhD is a fellowship trained geriatric emergency physician from the University of North Carolina, Chapel Hill where she is the director of the UNC Office of Academic Excellence. She's host of her own show, GEMCAST, focusing on clinical topics to help physicians, trainees, nurses, and paramedics who take care of older adults, particularly in the acute care setting.
We Discuss:
- Why âIâm too busyâ implies that you have no control over your situation or what youâre doing [01:50];
- Value-based scheduling, which means evaluating tasks to be sure they align with your big values [08:20];
- Techniques for saying ânoâ when invited to do something that doesnât excite you [11:40];
- Why procrastination at its core is more about emotions than productivity [18:00];
- The determinants of self-worth: ability, effort, and performance [21:30];
- Procrastination, and how it is one of many self-worth protection strategies [22:50];
- Reasons for large activation barriers for getting certain things done [25:00];
- Tips for avoiding procrastination and self-sabotage [28:30];
- Why we have to have a certain amount of tolerance for failure in order to succeed [37:30];
- Ways to keep up with email (and other shallow work) [39:25];.
- And more.
For Complete Show Notes: Click Here
To Learn More About Stimulus: https://www.stimuluspodcast.com/
A conversation with Dr. Salim Rezaie on discipline vs stubbornness, working through depression, transforming his body from 260 lbs to super fit, the aggregation of marginal gains, and intentional living.
About our guest: Salim Rezaie is double board certified in internal medicine and emergency medicine. In addition to working clinically as an emergency physician, he runs one of the most popular medical education websites on the planet, Rebel EM.
We discuss:
- What has been most challenging for Salim while caring for patients in the ED during the COVID-19 pandemic [03:20];
- The spark for Salimâs transformation from being âfestively plumpâ to super fit [06:30];
- Tips for embarking on a diet and exercise program, and the importance of actually scheduling time to do it [10:35];
- How intermittent fasting was a way for Salim to engage in the cultural practice of Ramadan [15:45];
- The distinction between discipline and being stubborn [19:30];
- Why success relies on the aggregation of marginal gains [22:46];
- Social media and how these tools are only as good as the person who uses it [26:00];
- The lifestyle of instant gratification and how people often donât appreciate the hard work that goes into something for it to be successful [26:55]
- Why comparing yourself to others is the opposite of gratitude [31:00];
- The stigma of mental illness and 3 things Salim learned in psychotherapy [00:35:12];
- The value of embracing failure equally as you would success [43:30];
- Salimâs core principles and priorities [44:30];
- The most unexpected book that Salim has read in the last year [48:20];
- And more.
For Complete Show Notes: Click here
To Learn More About Stimulus: https://www.stimuluspodcast.com/
The short answer is not at the moment, but that hasn't stopped the debate (and surprising culture war) from raging about this drug. A recent opinion piece in Newsweek with the damning title "The Key to Defeating COVID-19 Already Exists. We Need to Start Using It" written by Yale epidemiology professor Harvey A. Risch, MD, PhD, suggests that we are missing the boat by not widely using hydroxychloroquine (HCQ) and tens of thousands of patients are dying because of it. In addition, he poses that the evidence is clear and the FDA, NIH and others are in effect denying the proof of drug efficacy. What is the data to support these claims? We discuss: * Evidence supporting use of HCQ * Evidence against using HCQ * Why wearing a mask with your nose out is like wearing your underwear with, well, not everything covered * More
For Complete Show Notes: Click Here
To Learn More: https://www.stimuluspodcast.com/
When we hear the word stoic, what often comes to mind is a repression of emotion, a stone-faced response to adversity. You can think of that kind of stoicism as using it with a lowercase 's'. What we're talking about today is the philosophical school of Stoicism, Stoic with a capital 'S'. At its core, Stoicism provides a way to find equanimity no matter the circumstance and take on whatever adversity is thrown at you.
Our Guest: Dan McCollum, MD is an award winning educator and assistant professor of emergency medicine and Augusta University. His translation of philosophical ideas into real world practice (both in and outside of medicine) have garnered international acclaim. Dan was our guest on Stimulus episode 1: Verbal Judo.
For Complete Show Notes: Click Here
We discuss:
- The difference between stoicism (with a lowercase âsâ) and Stoicism (with a capital âSâ);
- The 3 disciplines of Stoicism;
- How you can apply Stoic principles to common (unpleasant) scenarios;
- How to develop some of the Stoic habits and responses to stress;
- How a Stoic processes anger;
- And more.
To Learn More About Stimulus: https://www.stimuluspodcast.com/
How long does immunity last after a COVID infection? News reports of two recent studies suggest that it wanes quickly and that some patients may never have immunity at all. In this episode, we take a look at those studies and explain why they don't exactly say what is being said about them. Take home points * Not everyone keeps detectable IgG after asymptomatic or symptomatic infection * If you have asymptomatic COVID-19 infection, you are less likely to have detectable IgG at 8 weeks compared to someone who had symptoms
What we still don't know * Does this drop or absence of IgG correlate to decreased immunity? The reflex answer would seem to be 'yes' but we still don't understand the COVID-19 correlates of protection (blood tests that can show whether or not someone has immunity). * The likelihood of those who have had COVID-19 getting reinfected. The studies discussed in this podcast evaluated parts of the immune system that are involved in immunity, but we havenât answered the real question: what is the likelihood of having a repeat illness (or repeat asymptomatic infection).
Mentioned in this show The Stimulus COVID Podcast Page: Click Here For References and Links to the Studies: Click Here To Learn More About Stimulus: https://www.stimuluspodcast.com/
What is a flow state? When you feel it, you know it. Itâs an almost effortless ease of action. To define it, you could say it's a feeling of being in control without making any conscious effort to do so, or being completely immersed in an activity with energized focus. In this episode, performance coach Jason Brooks, PhD breaks down the steps to achieving flow and how to get it back when it slips away.
We discuss:
- How achieving a flow state is as much about knowing yourself as it is knowing the skill [02:00];
- Michael Jordanâs superpower -- being 100% present in every moment of every game [06:00];
- The nuanced distinction between a flow state and being âin the zoneâ [07:50];
- The TED talk by Mihaly Csikszentmihalyi and how a state of âflowâ promotes lasting satisfaction [09:20];
- Why training and skill are prerequisites to a flow state [10:50];
- Tools to bring yourself back into an optimal state when distractions hijack your attention [14:45];
- Why having joy in what you do is essential to achieving flow [17:30];
- Self-distraction theory and how that contributes to performance [25:30];
- Ways we can set ourselves up for success to be in a flow state [32:40];
- How practicing basic techniques will give you something to fall back on when youâre lost [44:00];
- Whether itâs better to capitalize on your strengths, or shore up your weaknesses [51:40]; and
- More.
For Complete Show Notes: Click Here To Learn More About Stimulus: https://www.stimuluspodcast.com/
Our guest today is Dr. Zubin Damania (aka ZDoggMD), an internist, hospitalist, and healthcare evangelist. ZDogg is dedicated to turning the practice of medicine into the healing art that it should be, rather than the leviathan of bureaucracy, roadblocks, and nonsense that it sometimes seems to be. In this episode we cover: the morality of masks and not wearing them in public, racism, suspension of the scientific method in the early phases of the pandemic, Star Wars, and much more.
We discuss:
- The RECOVERY Trial which found that steroids reduced mortality in certain COVID patients [02:10];
- The optimal way to introduce Star Wars to someone who has never seen an episode [07:50];
- How ZDogg prepares for the flow state of an unscripted live show or polemic [12:30];
- Why wearing a mask in public during the COVID pandemic is like paying taxes [17:50];
- Virtue signalling [23:00];
- The time when Rob was most proud to be ZDoggâs friend [23:55];
- Pandemic & Protest: Racism As A Social Determinant Of Health [23:55];
- The fundamental unfairness when judged on something that you cannot control [28:30];
- The challenge of being both authentic to yourself but also using your large social media platform to spread important messages [34:40];
- Things that surprised ZDogg about COVID-19 [37:25];
- The danger (and benefits) of dissemination of anecdotes [40:15];
- How distancing has disrupted the fabric of society [41:35];
- The importance of recognizing your emotional response and biases [44:25];
- Victims of misinformation and how theyâre influenced by FLICC [46:20];
- How infrequent hand-washing demonstrates that quality in healthcare is equated with whatâs financially incentivized rather than what really makes a difference [51:20]; and
- Much more.
To Learn More about Stimulus: https://www.stimuluspodcast.com/
For Complete Shownotes: Click here
In this episode of Stimulus, we speak with Christina Shenvi MD, PhD about acting with agency -- what it means, some actionable skills, and how to apply it. We also talk about: the importance of being specific and deliberate about your philosophy of life, how remembering your mortality puts the rest of life in perspective, Stoic philosophy, Viktor Frankl, and whether or not we have free will.
Guest Bio: Dr. Christina Shenvi MD, PhD is a fellowship trained geriatric emergency physician from the University of North Carolina, Chapel Hill where she is the director of the UNC Office of Academic Excellence. She's host of her own show, GEMCAST, focusing on clinical topics to help physicians, trainees, nurses, and paramedics who take care of older adults, particularly in the acute care setting.
We discuss:
- Corporate vs. personal mission statements and how codifying your life philosophy can help you live with intent [03:00];
- Rob and Christinaâs personal mission statements [06:15];
- The fact that even when we try our best to act in accordance with our values, it sometimes feels like there are magnetic forces pulling us away [08:30];
- Martin Luther, the famous theologian, said that there are two days that matter, this day and judgement day [10:35];
- The concept of Memento Mori [12:00];
- The psychologist and Holocaust survivor, Viktor Frankl, whose writing about stimulus and response is like a look into the human soul [16:27];
- Whether we have free will [18:10];
- Stephen Coveyâs book Seven Habits of Highly Effective People and what the word responsibility means from a Stoic perspective [19:45];
- What it means to have agency and the way it relates to how you see yourself making decisions [22:55];
- The importance of knowing that you are the author of your own story [26:10];
- Learned helplessness and how it stifles creativity [28:00];
- Barriers to acting with agency [29:50];
- Different approaches to managing your emotions when criticized by a colleague or consultant [31:40];
- How Shenvi skillfully manages negative swirls of emotion [41:10];
For complete shownotes: use this link
To learn more about Stimulus: https://www.stimuluspodcast.com/
The thought of taking a break during a busy work day can sound impossible if not contrary to the ethos of our job. The reality, however, is that taking a break is not only possible, but will likely make you clinically sharper, more efficient, and possibly even happier. In this episode, Dr. Joshua Russell walks us through how to take a break within the constraints of our clinical responsibilities as well as pitfalls to avoid when taking a pause from patient care.
We Discuss:
- The importance of breaks and how they can positively impact your affective state and ability to care for patients;
- The abundant evidence that says that breaks are helpful;
- How mental vigilance naturally wanes and decision fatigue sets in as the day progresses. Nobody functions with the same efficiency throughout an entire day;
- System 1 vs. system 2 thinking, and how when weâre in a negative affective state (ie. a âbad moodâ), our ability to be deliberate in our decision-making is compromised;
- What a healthy break looks like;
- The notion that finding the time for a break takes intention; and
- More.
For complete shownotes: Click Here
To learn more: https://www.stimuluspodcast.com/
Bob Ross is best known as the mellifluous host of The Joy of Painting, yet there are things he can teach about how to effectively care for trauma patients. In this episode, we cover: how Bob Ross can help invoke calm during crisis, the Chuck Norris mode of trauma resuscitation, why Bob Ross is your trauma room spirit animal, finding your feet, the power of acknowledging mistakes.
To share this episode, use this link
We Discuss:
- Who Bob Ross is and how he can help us remain calm in a crisis [00:24];
- The tendency for trauma team leaders to stay in full-on warrior mode, even when that mode not only is no longer necessary, but also may be deleterious [02:30];
- Why Bob Ross (not Chuck Norris or Wonder Woman) should be our spirit animal in the secondary survey [05:00];
- Specific ways to be more like Bob Ross in the resus bay [05:50];
- How âfinding your feetâ can help you when mistakes are made [07:44];
- The value of acknowledging a mistake and validating how it makes you feel [09:35]; and
- More.
For full shownotes of this episode: Use this link
To learn more about Stimulus: https://www.stimuluspodcast.com/
Jim Dahle is an emergency physician who is widely known by his moniker, the White Coat Investor. He's become one of the leading voices for financial literacy and intelligent planning for those who 'wear the white coat'. In this conversation, Jim gives perspectives and strategies on managing finances during a bear market. We address the dangers of market timing, the value of a written investment plan, how Jim invests his money, and why a good financial advisor can sometimes be the best couple's therapist.
We Discuss:
- The definition of a bear market [02:00];
- How bonds differ from stocks and why some believe bonds are safer in a bear market [03:10];
- Why cashing out your whole portfolio when the market tanks may not be the best strategy [06:15];
- The value of having a written investment plan which tells you what youâre going to do if and when the market changes [10:00];
- Stock investments, and why itâs better to invest in a low-cost, broadly diversified index funds rather than individual stocks [12:15];
- Different ways for coming up with your individualized written investment plan [14:15];
- The importance of having an emergency fund in the event that your income drops dramatically, and how this money should be invested with the goal of having the best return OF the principal, not the return ON the principal [16:40];
- Ideas for alternate sources of income for physicians that can serve as another buffer in an economic downturn [25:00];
- Advantages and disadvantages of federal student loans [29:30];
- What we should do with leftover money, once weâve fully funded our emergency cushion, 401k and Backdoor Roth IRA and contributed to our 529 [34:10];
- How to handle discretionary spending and the conflict that can arise when thereâs spousal income inequality [36:00];
- Why having a no-questions-asked allowance can help your marriage [39:50];
- The wisdom of this advice: âBe generally frugal, but selectively extravagantâ [42:15];
- What physicians should do if theyâve lost their job, but are still several years away from retirement [46:00];
- How we can help our retired parents who may have lost their nest egg in the stock market [48:50];
- The cost of health insurance and how it might be far more expensive than you think [52:50];
- Why renting your home to your business might be more than hoodwinkery [54:20]
- The best financial mindset in an economic downturn is to take a long-term perspective and know that this too shall pass. [58:20]; and
- More.
For complete shownotes: Click Here
To learn more about stimulus: https://www.stimuluspodcast.com/
None of us are immune from stress, especially now. This is a critical moment for us to look out not only for our own mental health but that of our colleagues. In this episode, psychiatrist Dr. Melissa Shepard sits down with our good friend Dr. Neda Frayha to discuss the mental health challenges facing health care workers in the COVID-19 pandemic, and some concrete, tangible tools to help us get through this period.
- HIPPO Education COVID Resource Center. Link
- Free mental health crisis line for physicians impacted by Covid-19 related issues, staffed by US Psychiatrists (support only, cannot prescribe medications). 1-888-409-0141. www.physiciansupportline.com
- COVID-19 Resource and Information Guide. National Alliance on Mental Illness. Link
- Darnall B. The COVID-19 Wellness and Coping Toolkit: 11 Tips for Health Care Workers, Patients, and the Public. Psychology Today, 31 March 2020. Link
- Good Therapy. https://www.goodtherapy.org
- Doxy.me Physician Support Line. https://doxy.me/physiciansupportline
- Free access to Headspace Plus app (guided meditations) for healthcare professionals. Link
- Center for Mind-Body Medicine at Georgetown. Introduction to evidenced-based techniques for helping people through and after trauma (things like guided imagery, body scans, breathing techniques) Link
We've been breathing since our first moments of life, but does that mean we are truly experts? In this episode of Stimulus, therapist and breathwork coach Ryan Cheney walks us through how we can make breath work for us, not just with us.
We Discuss:
- How breathing can be used to create different mental and physiologic states [02:40];
- Expanding your visual field to quickly adjust your psychological state [03:15];
- The mechanics of breathing [07:00];
- Chest breathing
- Diaphragmatic breathing
- Volume control
- The physiology of breathing [10:40];
- The psychology of breathing [15:30];
- 3 categories of breath exercises[16:05];
- Apnea breath patterns
- Cadence protocols
- Super Ventilation
- Mouth vs. Nose Breathing [18:00];
- Why stress can be a good thing, but we need to learn how to come down-regulate from it [26:00];
- Specific breathing exercises and how they can change your mental state [28:45],
- The calming effect of ocean breathing and elongating the exhale [33:20]; and
- More.
Complete shownotes: Click Here
For more information: stimuluspodcast.com
Jason Brooks, PhD is a performance coach who works with physicians, athletes, and the military, helping them develop the cognitive skills not only to operate at the highest level, but to thrive no matter what the task. During the COVID-19 pandemic, Jason has been working with frontline clinicians, helping and guiding them through the cognitive and emotional aspects of whatâs happening. This episode will give us strategies to mentally prepare for each day. It will show us how to find an anchor to ground us so that rather than feeling like weâre constantly running defense, weâre actually on offense.
We discuss:
- How pandemic medicine may be more dangerous to the healthcare provider than battlefield medicine, from the Happy MD blog [02:24];
- Two big emotions experienced by people on the frontline of the COVID-19 pandemic: the fear of uncertainty and the lack of control [05:42];
- How we should keep our focus small and put our attention on the things that we feel some degree of certainty about [07:25];
- Ways people have created leadership and command centers to handle information overload [09:40];
- Strategies for managing the stress, anxiety, and fear that comes with working in the COVID-19 environment [11:55];
- The 2 things fear needs to know: that you hear it and that you have a plan to keep yourself safe [14:35];
- The tipping point between being scared and feeling panic [15:35];
- The importance of flipping your perspective from being on the defense to being on the offense [17:45];
- The value of adding purpose where there is uncertainty and fear [19:00];
- Tools for handling moments of stress, panic or fear [22:30];
- Anti-fragility and how it compares with resilience [23:52];
- How some people perform better as the favorite, but others prefer being the underdog [29:00];
- Ways to âpregameâ before entering the COVID-19 environment, and how your pre-performance plan can be thought of as a prayer [31:30];
- Why showing compassion to your fear and embracing it as a part of you is far better than resisting it [42:00];
- How the aftermath of COVID-19 will need space for healing, processing, and recovery [44:10]; and
- More.
To learn more: https://www.stimuluspodcast.com/
For complete shownotes: https://www.stimuluspodcast.com/post/4-talking-to-fear
At the end of the day, have you made the world a little better? My guess is that you have, even if only in a small way. Thatâs certainly true of todayâs guest, Dan Bissell, MD. Dan is co-founder of Portland Street Medicine, a medically focused non-profit dedicated to caring for the homeless. Whatâs unique about the care delivered is that it happens in the austere environment of homeless camps, underpasses, and street corners. In this episode, Dan and I cover what a day of the street medicine team looks like, how his group started, and how street care has impacted his everyday medical practice.
We discuss:
- What it means to follow your bliss [00:45]
- The best medicine is tangerines and socks. . [04:45]
- The goal of Portland Street Medicine [07:15]
- Working in an environment with constrained resources. [11:55]
- Design thinking [12:44]
- Portland Street Medicine origin story.[14:45]
- Homeless communities are complex, heterogeneous, vibrant, and cohesive. [23:15]
- The secret sauce to success of Portland Street Medicine.[28:18]
- Portland Street Medicine serves three populations [29:00]
- Utility of the stethoscope. [34:00]
- The case of Susannah [37:00]
- The homeless are at a minimum ignored and at a maximum shunned. [40:50]
- Getting to know the homeless has reformed Dan's thinking about how we structure health care. [42:20]
- Ask some honest questions. [46:55]
- Slow down, find joy. [50:38]
Learn More: https://www.stimuluspodcast.com/
Complete shownotes for this episode: https://www.stimuluspodcast.com/post/3-street-medicine
We can't immediately change the process of medicine, the stuff that is kind of a drag and wears us down. What we can change, however, is our mindset. In this episode, we dissect several practices for shift preparation with a common goal of operating at a peak level of performance and experiencing more joy in what we do. Today we learn how to pregame, like a pro.
We discuss:
- When the process of practicing medicine becomes your purpose for being a doctor, youâre at risk for burnout, if not worse. [00:30]
- The system will not adjust to what you need right now. You have to adjust yourself. [1:45]
- How accepting gratitude, and other small changes in mindset, can have a logarithmic return on investment. [4:50]
- The ways that many elite-level performers pregame. They rely on their rituals for peak performance. [07:15]
- Physicians are elite-level performers who rarely have the time to mentally prepare for each day. [8:40]
How some doctors pregame (or not)....
- Mike Weinstock doesn't pregame [12:06]
- Clay Smith's pregame distraction [13:20]
- Joshua Russell's sequence of physical, emotional and mental prep [15:10]
- Sabrina Adams the BAFERD [18:00]
- Jaime Hope thinks of her 4 professional identities [19:10]
- Mizuho Morrison's 3 steps of self talk [21:40]
- Ran Ran biking to work. [24:20]
- Joe Dubois walks to work
- Chris Nickson walks to work
- Ross Fisher calms during his commute.
- Haney Mallemat uses mental visualization.
- Luz Silverio's pregame ritual is to arrive to work 15 minutes early to âchit-chatâ with members of her team.[28:40]
- Alan Sielaff allows sufficient time before the shift to get prepared. [29:30]:
- Dan McCollum starts the day mentally preparing with the 5 Minute Journal.[31:00]
- Reuben Strayer mentally prepare for a shift by practicing mindfulness [32:50]
- Salim Rezaie isolates himself from social media and email for at least 1-2 hours prior to each shift.[35:30]
- Mike Mallin uses intermittent fasting to improve his focus, attitude, and endurance at work. [37:15]
- Rich Hamilton treats a shift like itâs a competitive sport. [38:30]
- Rob's 2 pregame exercises. [41:10]
- Jocko Willinkâs âGoodâ [44:06]
Learn More: https://www.stimuluspodcast.com/
Complete shownotes for this episode: https://www.stimuluspodcast.com/post/2-pregame-like-a-pro
In this first episode of Stimulus, we learn from two masters in the art of de-escalating those who are agitated and upset. Jose Pacheco, RN, known affectionately to his co-workers as âThe Drunk Whispererâ, has a specific sequence to this approach, which heâs going to walk us through, step by step. The good news is that verbal de-escalation is a tool that can be learned by almost anyone. To that end, weâre also joined by Dan McCollum, emergency physician at Augusta University, to talk about conflict resolution that evolved from the martial arts principal of using your opponent's energy to resolve conflict, rather than simply butting heads. The name for this method? Verbal Judo.
We discuss:
- Ways to de-escalate and defuse [00:50]
- âVerbal Judoâ is teachable and learnable. [03:31]
- McCollumâs de-escalation sequence [06:35]
- Empathy can absorb tension [14:18]
- Universal Upset Patient Protocol [22:30]
- âWe treat people as ladies and gentleman not because they are, but because we are.â [32:52]
- You canât control how an upset person is going to respond to conflict, you can control how you respond. [34:43]
- Seeing a situation from the other personâs eyes. [35:40]
- Sword of Insertion technique [36:58]
- Active listening [38:38]
- Jose Pachecoâs tips for interacting with difficult patients in the ED. [41:15]
- Non-verbal cues [51:46]
For complete shownotes: https://roborman.com/stimulus/1-verbal-judo/
Interested in one-on-one coaching? https://roborman.com/about-us/coaching/
Our landing page: https://roborman.com/
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Launching March 12, 2020
When I was in medical school and residency, the ethos was that when times are tough, you suck it up. If times are tougher, you suck it up harder. I did that for a decade after I was an attending physician, sucking it up, and I burnt out... over and over again. Sucking it up is a great tool for short-term resilience but not ideal for excellence or longevity.
So you can suck it up, or you can think differently.
Regardless of your job title or description - doctor, nurse, EMS, fire, police, 911 operator, you get thrown into the fray with a basic set of medical skills, but little on HOW to REALLY do it. The skills to thrive beyond managing disease or living up to the title on your ID badge.
Think about what spark inside you motivated the decision for you to do what you do. And since making that decision, youâve put too much into it to lose the calling and sense of purpose.
That is what motivates this show, what you will find here. Walking through and deconstructing strategies to live and practice with intent. To not waste our time. And to tap into the joy of what we do.