Stimulus - Learn Tools to Crush It in Your Medical Career

How to Switch From Self Flagellation to Context Assessment

Mon, 23 Feb 2026 02:30:00 -0800

If you have ever lost it mid-shift, frozen when you should have acted, or spent the next two weeks asking yourself what's wrong with me, you already know what character assassination feels like.

In this episode, we break down a simple and effective reframe that interrupts the self-flagellation shame spiral without making excuses or lowering standards. You will learn how to move from why did I to, of course, how to give yourself a legitimate and hard-earned break, and why self-compassion is not softness but one of the most underutilized performance tools in medicine. Topics include physician burnout, self-compassion, cognitive reappraisal, shame and self-criticism, communication under stress, and physician coaching.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

We discuss:

Why self-criticism after a hard moment often hurts more than the moment itself
The difference between first-order distress and second-order distress
What the research on rumination and shame actually shows
Why your brain treats harsh self-evaluation like a physical threat
The biology of performance under load and why grit has a limit
The of 'course' reframe and how to use it in real time
Four steps to move from character assassination to context assessment
Why suppression makes it worse, and reappraisal changes the signal
Pre-shift dread and how to take the shame out of it
Why self-compassion is a performance tool, not a soft skill
What this reframe is not: excuses, lowered standards, or avoiding accountability
How to start today with one sentence

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.

The Out-On-Time Course

Built for emergency clinicians who are tired of chart debt and getting derailed by interruptions and overwhelm. Learn practical, real-time documentation and shift-efficiency strategies to finish your shift and actually leave on time.

Learn More About The Out-On-Time Course

How to Handle Interruptions Without Alienating Your Team

Mon, 02 Feb 2026 02:30:00 -0800

Emergency medicine has an interruption-based workflow. There's no getting around some of that, but recurrent interruptions erode quality of care, accuracy of documentation, concentration, and ultimately the ability to leave work on time. While some interruptions are unavoidable, most are predictable and preventable. Reclaiming control over interruptions is more than a way to improve efficiency; it's about patient safety, reducing medical errors, and safeguarding your mental health. Constant task switching creates cognitive load, contributing to emergency physician burnout and compromising clinical decision-making.

In this episode, we explore tactical and mindset shifts that emergency clinicians can use to reduce interruptions, enhance documentation efficiency, and avoid the hidden costs of task switching. We'll cover practical strategies for managing EKG interruptions, skillful ways to manage nursing questions, and setting boundaries all while maintaining team dynamics and patient care quality. Whether you're an emergency physician, PA, NP, or resident, these evidence-based strategies will help you work smarter, reduce stress, and reclaim control of your clinical day.

Finishing emergency department shifts with a stack of charts to complete gets old fast. This chart debt also contributes to burnout.

We will help you break bad habits and equip you with the skills to walk out the door unencumbered.

Out-On-Time is a course for emergency physicians and clinicians that teaches shift efficiency and real-time documentation, enabling you to write fast, focused charts that bill well and are medicolegally sound.

Learn More About The Out-On-Time Course

We Discuss:

The Cost of Interruptions in Emergency Medicine
Not All Interruptions Are Urgent
The Cognitive Cost of Task Switching
Becoming a Non-Interruptible Clinician
Deferring Without Alienating Your Team
Protecting Focus at the End of the Shift
Fixing the EKG Interruption Problem
Asynchronous Communication That Actually Works

Why You Might Be Chasing the Wrong Dream

Tue, 20 Jan 2026 02:30:00 -0800

So many of our choices are shaped less by desire and more by expectation. We chase prestige, status, or recognition, only to arrive and realize we were climbing the wrong ladder. Beneath burnout and the friction, there’s often the truth that we were never pursuing what we truly wanted. In this episode, we explore the concept of mimetic desire, how it misguides our ambitions, and how to reclaim our decisions. Finally, we examine how fear of judgment and shame shape our careers more than we think, and what it takes to break free.

Guest bio: Josh Russell, MD, is double board-certified in Emergency Medicine and Palliative Care. He’s held leadership roles as a Chief Medical Officer in telehealth, artificial intelligence, and urgent care systems. He’s an experienced clinician, writer, educator, and medical editor with a passion for making complex topics accessible.

LinkedIn article that spurred this podcast

Josh’s Website

We Discuss:

Mimetic Desire: Chasing What Others Want
The Trap of “Should”: Internalized Shame
The Concentric Circles of Stressors
Finding What You Really Want
The Ladder Against the Wrong Wall
Actionable Reflection Practices

Mentioned in this episode:

The Out-On-Time Course

Learn More About The Out-On-Time 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.

Dan Millman on How to Practice Life

Mon, 29 Dec 2025 02:30:00 -0800

What if the true test of strength is focusing less on what we feel and more on what we do? In this episode, we explore a practical philosophy of action, presence, and personal agency with Dan Millman, author of Way of the Peaceful Warrior. Finally, we dig into how small mindset shifts can transform both high-stakes moments and the quiet struggles of everyday life.

Guest bio: Dan Millman is a world champion athlete turned author, educator, and teacher of practical wisdom. With a background that spans competitive sports, university-level coaching, martial arts, and academic instruction, Dan brings a rare blend of physical discipline and philosophical insight to his work.

Following two decades of spiritual exploration, he developed what would become known as the Peaceful Warrior’s Way, an action-based approach to living with purpose. Dan is the author of 18 books, including the international bestseller Way of the Peaceful Warrior, which was adapted into a feature film. His writings have reached millions across 29 languages and continue to influence readers around the world.

We Discuss:

Peaceful Warrior Philosophy in Action
What We Control (And What We Don’t)
Action Over Emotion
The Three Rules of Wise Living
The Power of Present Moment Awareness
Mastery Through Deliberate Practice
Purpose as a Practical Tool
Growth Without Perfection
Working Within Broken Systems
Practicing Life

Mentioned in this episode:

Free Tools To Make Medical Practice Easier

No fluff. Just good stuff.

Free Resources Link

The Out-On-Time Course

Learn More About The Out-On-Time 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.

Supranormal

Mon, 15 Dec 2025 02:30:00 -0800

Your work world is built on endurance, intensity, and mastery. The culture is 'always on,' and you were trained to perform in conditions no one would call normal. The work is supranormal. It sits at the edge of reasonable and regularly exceeds what is sustainable by most standards. High performers like you often find themselves on an above-the-fray pedestal, expected to be tireless and self-sacrificing. Supranormal work can unlock extraordinary performance, but the cost adds up if it goes unchecked.

In this episode, we look at where this culture came from, the cortisol spikes that shape your days, the hidden curriculum of self-sacrifice, and the countermeasures that keep you from burning out. It is a straight look at the supranormal experience and what it takes to do this work without losing yourself to it.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

We discuss:

• Why medical culture expects you to perform inside conditions no one would call normal

• What makes supranormal work different from ordinary high-stress work

• How the “always on” ethos formed and why it persists

• The hidden curriculum of self-sacrifice and the pedestal of being above the fray

• Cortisol spikes, sympathetic load, and what chronic activation does to your body

• Why self-preservation feels selfish in medicine and why that belief is wrong

• The roots of modern training from monastic care to Halsted’s cocaine-fueled stamina

• Why emergency medicine is an outlier in burnout, longevity, and physiological strain

• The concept of parasympathetic nurturing as a countermeasure

• How mindset changes biology and shifts performance

• What it takes to last in supranormal work without losing yourself

How To Not Overthink Simple Decisions

Mon, 24 Nov 2025 02:30:00 -0800

What if the best decision is to not decide at all? We waste valuable mental energy overthinking simple choices, especially when the outcomes are nearly identical. That kind of cognitive drain reduces our capacity to think clearly when decisions actually matter. In this episode, we explore how to reduce cognitive load, identify low-risk choices that can be automated or ignored, and recognize when deliberation is just noise. Finally, we break down how framing, values, and the right question can make even complex decisions frictionless.

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:

The Three Types of Cognitive Load
Harvesting Free Rolls
Applying Dominance and Cutting Through Decisional Noise
How to Stop Fretting Over Equivalent Decisions
Navigating Equipoise
Making Big Life Decisions

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

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.

The Out-On-Time Course

Learn More About The Out-On-Time Course

What Every Premed Parent Needs to Know

Mon, 27 Oct 2025 02:30:00 -0800

As students navigate an increasingly complex, competitive, and costly path to medical school, parents often find themselves uncertain about how to help without hindering growth. Meanwhile, institutions maintain opaque admissions practices, amplifying anxiety for both students and families. In this episode, we explore what parents need to know to truly support, not sabotage, their aspiring doctors. Finally, we pull back the curtain on everything from shadowing to AI in essays, offering a brutally honest look at what really matters in the application process.

Guest bio: Dr. Ryan Gray, a former Flight Surgeon in the United States Air Force, is the founder of Medical School Headquarters and Meded Media, where he has become a leading voice in guiding pre-med and medical students toward careers in medicine. He is the author of The Premed Playbook series, including Guide to the Medical School Application Process, Guide to the Medical School Personal Statement, Guide to the Medical School Interview, and Guide to the MCAT. Dr. Gray also hosts several popular podcasts, including The Premed Years, OldPreMeds Podcast, The MCAT Podcast, and Specialist Stories.

We Discuss:

Support vs. Sabotage
The Myth of the Perfect Applicant
Why Checklists Aren't Really Checklists
What Shadowing Really Tells You
What's the Deal With Volunteering Hours?
Service for the Right Reasons
Why Pre-Med Doesn't Mean Pre-Doctor
Using AI When Writing Med School Essays
Compressing Preclinical Education
The Price of Applying and the Sneaky Secondaries
Why Don't Schools Post MCAT Cutoffs?
How to Write a Good Letter of Recommendation and When to Say No
Thank You Notes
Letters of Intent
Should Premeds Attend Non-Interview Info Sessions?
Why Clinical Hours Are Non-Negotiable

Mentioned in this episode:

Free Tools To Make Medical Practice Easier

No fluff. Just good stuff.

Free Resources Link

The Out-On-Time Course

Learn More About The Out-On-Time 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.

Why You Have More Power Than You Think to Change Healthcare

Mon, 06 Oct 2025 02:30:00 -0800

A broken system won’t fix itself, and no one is coming to the rescue. Medicine is fraying under the weight of burnout, misaligned incentives, and systemic inertia. Yet, hope isn’t lost. Change is still possible, but it won’t come from the top down. In this episode, we explore how grassroots leadership, inner work, and community involvement can become the antidote to despair in modern medicine. Finally, we dig into the personal cost of service and the tools we need to heal ourselves while fighting for change.

Guest bio: Dr. Andrea Austin is the inaugural Emergency Medicine Program Director at Sacred Heart in Pensacola, Florida. As a Navy veteran, her military service taught her how to perform under pressure and lead teams in high-stakes environments. She brings that same focus to her work in medical education, physician well-being, and healthcare systems change. Dr. Austin is the author of Revitalized: A Guidebook to Following Your Healing Heartline and host of the Heartline: Changemaking in Healthcare podcast.

Books mentioned in this episode

What My Bones Know by Stephanie Foo

We Discuss:

The Case for a New Residency Program
What It Means to Be a Change Maker
Working Within the Domains of Change
Overcoming Social Loafing in Medicine
Rethinking Suicide Risk in Emergency Medicine
The Call for Psychiatric Fellowships in EM
Reclaiming Wellness Through the “Heart Line”
The Inner Work is the System Work
Building a Portfolio Career

Mentioned in this episode:

Coming Soon! The Out On Time Course

If you are on our mailing list, you will have early access and a few other surprises as well.

The Out-On-Time Course

Learn More About The Out-On-Time Course

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

Do You Know the Difference Between Competence and Capacity?

Mon, 22 Sep 2025 02:30:00 -0800

How can a person who’s clearly lucid still be deemed incapable of making their own medical decisions? The answer lies in the misunderstood yet critical distinction between competence and decision-making capacity. While these terms are often used interchangeably in clinical settings, they carry vastly different meanings in law and medicine—differences that can determine whether a patient is treated, restrained, or left alone. In this episode, we explore how doctors can (and should) assess capacity, the legal boundaries of competence, and how not to get destroyed on the witness stand. Finally, we unpack a story involving a dog, a scrotum, and a tour of Colorado’s emergency departments.

Guest Bio: Rich Orman began his legal career as a public defender before moving into private practice. He soon joined the district attorney’s office, where he spent most of his career and ultimately rose to the position of deputy district attorney. Over three decades in the courtroom, he tried some of the most complex and high-profile cases in the state. After retiring from law, Rich turned to filmmaking. He is the writer and director of the critically acclaimed Boundary Layer.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

We Discuss:

What Competence Actually Means in Legal Terms
Defining Medical Decision-Making Capacity
Real-Life Dilemmas in Emergency Medicine
The Right Terminology in Documentation
What Physicians Get Wrong in Court
How to Testify Like a Pro
How to Handle Yes/No Cross-Examinations
One Legal Nugget You Should Never Forget

Mentioned in this episode:

The Out-On-Time Course

Learn More About The Out-On-Time Course

Decision Making Capacity Free Template

Need to document decision-making capacity quickly and accurately? I created this free resource so you don’t have to waste time looking up the elements each time. It’s an example of how it can be done—use it as a guide and make it your own.

Free Resources Link

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

Boundary Rituals: How to Keep Work from Following You Home

Mon, 25 Aug 2025 02:30:00 -0800

Ever walk out of a shift and feel like the hospital came home with you? In medicine, the mental residue can cling long after the work day is done. One way to address this is boundary rituals, deliberate actions designed to process the day and allow you to leave work at work, be more present when you get home, and possibly even sleep better. As a bonus, the ability to disengage from work is one of the strongest predictors of reduced burnout.

In this episode, Mohamed Hagahmed, MD, shares how he creates this boundary—through small rituals of gratitude, stillness, and reflection. From growing up as a refugee to serving as a sideline physician for the Pittsburgh Steelers, Dr. Hagahmed’s path has been shaped by resilience, culture, and care. He explains how he learned to stop carrying unfixable wounds home, why kindness is clinical armor, and how tiny acts of self-compassion can protect meaning in medicine.

Guest Bio: Mohamed Hagahmed, MD a Clinical Assistant Professor of Emergency Medicine at the University of Pittsburgh, Associate Medical Director at the Center for Emergency Medicine, and EMS Medical Director for several systems in Western Pennsylvania. On top of that, he works in high-acuity emergency departments across the region. He’s a graduate of Johns Hopkins Bloomberg School of Public Health, passionate about resuscitation, critical care, and toxicology education. And he’s the creator and host of EMERGE in EM, a podcast focused on emergency medicine education and global health empowerment.

We Discuss:

Growing up as a refugee and finding purpose in emergency medicine
The toll of moral injury and why staying closed and rigid nearly broke him
Small rituals that help shed the emotional residue of a shift
Using gratitude and stillness as tools for resilience
How changing clothes, music, and even snacks can protect emotional health
Turning frustration into advocacy for immigrant health and systemic change
Advice for new attendings on protecting the threshold between work and home

Mentioned in this episode:

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Distilled Kickassery Every Other Saturday

Crystal-Clear and Error-Free | Three Essential Tools for High-Stakes Communication

Mon, 28 Jul 2025 02:30:00 -0800

The best communication in high-stakes environments isn’t complicated. Quite the opposite - it’s structured, clear, and consistent. Small, deliberate shifts in how we transfer information can dramatically improve patient safety, team efficiency, and workplace culture. In this episode, we explore three simple but transformative communication habits that reduce errors and build trust among teams. Finally, we share practical tools you can use today to tighten your communication and improve safety without adding extra workload.

We Discuss:

The Three-Way Repeat-Back: “That’s Correct” Changes Everything
Phonetic Clarifications: Stop the “Norman” Problem
Numbers: Say the Digits
Whiteboards: The Cheapest Safety Tool in the Room
Checklists: Mastering the Basics
Cheaper Than Dirt, More Precious Than Gold

Mentioned in this episode:

The Out-On-Time Course

Learn More About The Out-On-Time 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.

How to Stop Spiralling When Massively Stressed with Scott Weingart

Mon, 07 Jul 2025 02:30:00 -0800

Stressful events can hijack cognition, cloud judgment, and leave emotional residue that can fuel long-term burnout. For acute care clinicians, those moments of emotional overwhelm, when heart rate spikes and the thinking brain goes offline, can have consequences that last far beyond the shift. While long-term resilience is essential, it’s often the just-in-time strategies that determine whether we break down or rise to the moment. In this episode, we explore the physiology and psychology of real-time emotional regulation with Scott Weingart, MD, co-creator of the Beat the Stress Fool protocol. Finally, we uncover how practices like gratitude flooding and negative visualization can inoculate against burnout and offer emotional integrity in the most harrowing moments of care.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Scott Weingart, MD, is an emergency department intensivist and physician coach based in New York. He completed fellowships in Trauma, Surgical Critical Care, and ECMO, and is internationally recognized for his expertise in resuscitation and critical care. As the creator of the EMCrit podcast, with over 40 million downloads, he has shaped how clinicians think and perform under pressure. Together, Scott and I co-founded Guidewire Coaching, where we create and teach tailored courses to address the real-world pain points of acute care medicine.

We Discuss:

Rapid stress reset with “Beat the Stress Fool”
Breathing techniques that calm the nervous system
Self-talk under pressure
Mental rehearsal that ends in success
Trigger words for fast de-escalation
Gratitudinal flooding as a shield during emotional overload
Real-time tools for grief resilience
The quiet strength of negative visualization
Teaching stress tools to trainees without pushback

Mentioned in this episode:

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

The Out-On-Time Course

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

Free Resources Link

How I Coach Doctors With A Performance Improvement Plan

Mon, 09 Jun 2025 02:30:00 -0800

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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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:

Distilled Kickassery Every Other Saturday

5 Free Tools To Make Medical Practice Easier

Free Resources Link

An Insider’s Look at Addiction Medicine

Mon, 26 May 2025 02:30:00 -0800

What if addiction isn’t 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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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 — 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:

The Out-On-Time Course

Learn More About The Out-On-Time Course

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Are You Still Lit Up by the Core of Your Work?

Mon, 12 May 2025 02:30:00 -0800

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.

🧭 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 🚀

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 “look-around test” to evaluate other institutions.
Identifying “gravity problems.” 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. What’s burning bright, and what’s 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 doesn’t have to mean burning it down. What might rediscovery look like instead?
You don’t have to burn it all down to rediscover what lights you up.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

The White Coat Investor | Avoiding the Money Mistakes That Sink Physicians

Mon, 28 Apr 2025 02:30:00 -0800

Burnout isn’t just emotional, it’s financial. Many doctors put off financial planning until they’re 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 you’re 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 make—and when it’s 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 Investor—then 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: “help those who wear the white coat get a fair shake on Wall Street.”

We Discuss:

Financial goals as the “game,” 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 “basement” (minimum monthly needs)
Lifestyle creep and how to monitor it
The “live like a resident” strategy post-training
Net worth versus income, and why physicians sometimes retire broke
The financial “waterfall” (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

Mentioned in this episode:

5 Free Tools To Make Medical Practice Easier

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. It’s free, low-pressure, and will give you clarity on your next steps.

Learn more about 1-on-1 coaching

The Out-On-Time Course

Learn More About The Out-On-Time Course

From Fried to Fired Up | How One Doctor Rebuilt His Career

Mon, 14 Apr 2025 02:30:00 -0800

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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest bio: Dr. Patrick O’Malley 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. O’Malley 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:

🔥 New Free Resource! 🔥

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. You’ll 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 driver’s seat.

Free Resources Link

Recalibrate Your Career

Learn more about 1-on-1 coaching

The Out-On-Time Course

Learn More About The Out-On-Time Course

A Guide to Skillful Death Communication with Alex Jabr, PhD

Mon, 24 Mar 2025 02:30:00 -0800

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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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 job—especially when it came to death communication. She went on to earn a Master’s 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, she’s redefining continuing education, ensuring first responders get the training they truly need—not 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.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

The Out-On-Time Course

Learn More About The Out-On-Time Course

Your First Leadership Role? Start With These 8 Principles

Mon, 10 Mar 2025 02:30:00 -0800

Leadership impacts everyone—whether you're steering an entire organization or simply navigating team dynamics. It’s 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 inbox—strategies to work smarter, lead better, and build a career that lasts.

We Discuss:

Don’t 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 Don’t Want to Be
Model the Values
With Behavioral Issues, Build the Pathway, Not Just the Expectation
You Don’t Know What You’re Doing—And That’s OK
People Do Things for Their Reasons, Not Yours

Mentioned in this episode:

The Out-On-Time Course

Learn More About The Out-On-Time Course

Active Shooter: Run, Hide, or Fight?

Mon, 24 Feb 2025 02:30:00 -0800

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 environment—an 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 inbox—strategies 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

The Upset Patient Protocol

Mon, 10 Feb 2025 02:30:00 -0800

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. That’s where the Universal Upset Patient Protocol comes in—a 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 Drummond’s original protocol, breaking down each step with specific language to use in the heat of the moment. Finally, we’ll add a few practical tweaks to help make these conversations even more natural and effective in real-world practice.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest Bio: Dike Drummond, MD, is a physician coach, burnout prevention expert, and creator of the Universal Upset Patient Protocol—a 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, he’s 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

Free Resources Link

The Out-On-Time Course

Learn More About The Out-On-Time 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.

The Emergency Mindset: What Med School Got Wrong

Mon, 27 Jan 2025 02:30:00 -0800

What defines the unique mindset of an emergency clinician? It’s not just the fast pace or the chaotic environment—it’s 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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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

Free Resources Link

The Out-On-Time Course

Learn More About The Out-On-Time 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.

Nonverbal Communication | From facial expressions to tonal authority

Mon, 13 Jan 2025 02:30:00 -0800

Mastering nonverbal communication can be an elusive task, but the fact remains: what’s 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 patient’s eye color can pay dividends.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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 Physician’s 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 Physician’s Guide to Doctoring! The topics quickly expanded to “everything we should have been learning while we were memorizing Kreb’s Cycle.”

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:

The Out-On-Time Course

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

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.

Why You Can't Be Bad at Meditation

Mon, 30 Dec 2024 02:30:00 -0800

What’s the biggest mistake people make about meditation? Thinking they’re bad at it. Why do they think this? Because they’ve tried meditating, and their mind just won’t shut up!

It’s a common misconception that meditation means clearing your mind of all thoughts. But in reality, meditation has little—or nothing—to do with that. If your mind wanders or feels like a crowded room full of shouting voices when you close your eyes, you’re not alone. That’s exactly what’s supposed to happen!

A wandering mind isn’t failure—it’s 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 thoughts—popping up like popcorn—doesn’t mean you’re bad at meditation. In fact, it means your mind is working exactly as it should. Ultimately, meditation isn’t about thinking less; it’s about changing how you engage with your thoughts, making it a skill you simply can’t fail.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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.

What's It Like To Be A Transgender Physician?

Mon, 16 Dec 2024 02:30:00 -0800

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 behaviors—snickers, 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, what’s it like simply to be transgender? What challenges do transgender patients face—physically, 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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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 “completed” 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:

The Out-On-Time Course

Learn More About The Out-On-Time Course

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Regression to the Mean Isn’t as Boring as it Sounds

Mon, 02 Dec 2024 02:30:00 -0800

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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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

Free Resources Link

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

The Out-On-Time Course

Learn More About The Out-On-Time Course

Five Ways to Connect With Patients

Mon, 18 Nov 2024 02:30:00 -0800

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 ‘Presence 5 Practices’ from this article.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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:

The Out-On-Time Course

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

Mel Herbert on Mediocrity, Forgiveness, and the Cost of Holding Grudges

Mon, 04 Nov 2024 02:30:00 -0800

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 that’s lingered for over half a decade—and 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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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. Mel’s 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 – Healing Without Compromising Safety
Entrepreneurial Challenges and Lessons: Balancing Vision and Collaboration

Mentioned in this episode:

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, 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 pressure’s on and lock in the mindset you need to flourish. Space is limited. 🎓 P.S. Yes, this is a CME event!

Awake + Aware Bend 2025

5 Free Tools To Make Medical Practice Easier

Free Resources Link

The Fine Print of Crushing It | Small actions for big impact

Mon, 21 Oct 2024 02:30:00 -0800

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 “yes” or “no,” and the art of timely, respectful communication.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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. Luke’s 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
We’re 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

Free Resources Link

The Out-On-Time Course

Learn More About The Out-On-Time Course

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

Registration for Awake + Aware 2025 is Now Open!

Fri, 18 Oct 2024 11:30:00 -0800

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 pressure’s on and lock in the mindset you need to flourish. Space is limited.

🖱️ Website: Awakeandawarebend.com

🎓 P.S. Yes, this is a CME event!

The Lowest Common Denominator of Communication

Mon, 14 Oct 2024 02:30:00 -0800

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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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

How to be a Good Boss and Navigate a Bad One

Mon, 07 Oct 2024 02:30:00 -0800

It’s 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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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. He’s 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 Like—Doesn’t 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 Else’s Emergencies as a New Leader
Day One as a New Physician Leader, You’re 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 Won’t 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

Free Resources Link

The Out-On-Time Course

Learn More About The Out-On-Time Course

Tax Secrets Every Doctor Should Know

Mon, 23 Sep 2024 02:30:00 -0800

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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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 master’s degrees. Alexis grew up in a family of physicians and is married to a private practice physician. That’s 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:

The Out-On-Time Course

Learn More About The Out-On-Time Course

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

5 Free Tools To Make Medical Practice Easier

Free Resources Link

The Mistake Most of Us Make When Work Feels Crappy

Tue, 17 Sep 2024 02:30:00 -0800

A cautionary tale about how I mismanaged my own physician burnout for many years, doing the easy thing instead of the right thing.

More coaching goodness with a side of practical nuggets

YouTube
Instagram
Our bi-weekly newsletter with short form, evidence based articles you won't find anywhere else.

Is Your Hospital Toxic? | The Critical Role of Psychological Safety

Mon, 09 Sep 2024 02:30:00 -0800

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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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 “psychological safety”?
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:

The Out-On-Time Course

Learn More About The Out-On-Time Course

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

5 Free Tools To Make Medical Practice Easier

Free Resources Link

What If Your Job Ended Tomorrow?

Mon, 26 Aug 2024 02:30:00 -0800

What would you do if your job ended tomorrow? Even though you might want to say, “Take this job and shove it,” that won’t help build stepping stones to your next job.

In this episode, we discuss: what it’s 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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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 Out-On-Time Course

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

So You Want To Start A Business | Going all in on the side hustle

Mon, 12 Aug 2024 02:30:00 -0800

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 that’s critical to walk through before you even consider jumping in on a new product or business.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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:

Distilled Kickassery Every Other Saturday

The Out-On-Time Course

Learn More About The Out-On-Time Course

Awake + Aware Bend May 5-7, 2025 | Our in person live event

Awake + Aware Bend 2025

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

Are You Betting On Yourself? | How locus of control makes all the difference

Mon, 29 Jul 2024 02:30:00 -0800

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

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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:

5 Free Tools To Make Medical Practice Easier

Free Resources Link

The Out-On-Time Course

Learn More About The Out-On-Time Course

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

The Strange History of Medical Debt

Mon, 15 Jul 2024 02:30:00 -0800

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 today’s 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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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 Women’s 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 Out-On-Time Course

Learn More About The Out-On-Time Course

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Impatience, Anger, and the Guilt of Abundance | Insights from the Dalai Lama’s Doctor

Mon, 01 Jul 2024 02:30:00 -0800

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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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 — home of the Tibetan community in exile. In addition to serving as H.H. the Dalai Lama’s 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 “…a doctor, a monk, a teacher, a lazy man. All of these things, yet none of these things,” 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 Lama’s 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:

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

The Out-On-Time Course

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Are Non-Compete Clauses About To Be History? | And what to consider before accepting a signing bonus

Mon, 17 Jun 2024 02:30:00 -0800

Non-compete clauses have plagued contracts for decades. It’s 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 bonuses—what 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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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 Out-On-Time Course

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

Why Cultural Context Matters in Patient Care and Clinician Burnout

Mon, 03 Jun 2024 02:30:00 -0800

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 ‘non-compliant’. We also touch on how these practices can make your job more rewarding and prevent burnout.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest Bio: Raj Sundar, MD, is a family physician and community organizer in Washington state. His podcast, Healthcare for Humans, “is dedicated to educating you on how to care for culturally diverse communities so we can be better healers.”

For full show notes of this episode and all sorts of other goodies, visit our podcast website

The Flameproof Course

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 it’s not the patient’s 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:

The Out-On-Time Course

Learn More About The Out-On-Time Course

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

Distilled Kickassery Every Other Saturday

Kicking The Can Down The Road | How to break up with deciding not to decide

Mon, 20 May 2024 02:30:00 -0800

"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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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 you’ll 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:

The Out-On-Time Course

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Never Lame. Never Spammy. Always Fresh.

If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.

How to Create a Team in 10 Seconds | Why time is not linear and every second not worth the same

Mon, 01 Apr 2024 02:30:00 -0800

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'—a 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

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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:

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:

The Out-On-Time Course

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Thinking Outside Your Retirement Account | Working harder vs creating value

Mon, 25 Mar 2024 02:30:00 -0800

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 ‘Elisa’ 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/

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
Elisa’s 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:

Distilled Kickassery Every Other Saturday

The Out-On-Time Course

Learn More About The Out-On-Time Course

Phantasia Kataleptike | The secret skill of Stoicism

Mon, 11 Mar 2024 02:30:00 -0800

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 employing it as a tool for equanimity and de-catastrophization.

For full show notes of this episode and all sorts of other goodies, visit our podcast website

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

We Discuss:

Defining Phantasia Kataptike
Acceptance of what is
A dog and a cart | Epictetus’ 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 ‘what if’ to ‘why did’ to ‘so what?’ to ‘what’s next’
The threat-challenge seesaw
What to do when the emperor banishes you
The counterarguments to Phantasia Kataleptike

Mentioned in this episode:

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Distilled Kickassery Every Other Saturday

Making the trade | How to know when it's time to change careers

Mon, 26 Feb 2024 02:30:00 -0800

Have you ever found yourself deep in “The Pit” 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.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

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 Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

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:

Distilled Kickassery Every Other Saturday

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Default Mode Network vs. Task Positive Network | How our brains balance mind wandering and focused attention

Tue, 06 Feb 2024 02:30:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

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:

The Out-On-Time Course

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

Free Resources Link

Moral Injury | The crossroads of conscience

Mon, 22 Jan 2024 02:30:00 -0800

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, we’ll explore individual and systemic actions that may help mitigate the impact of moral injury.

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

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

For full show notes of this episode and all sorts of other goodies, visit our podcast website

Mentioned in this episode:

The Out-On-Time Course

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

Free Resources Link

117. From Chaos to Control | Taming the tempest of task saturation

Mon, 08 Jan 2024 02:30:00 -0800

There’s no getting around the surges and potential chaos of an emergency department. The good news is that these events are predictable, you know they’re going to happen, just not when. So how do you prepare and then navigate the storm once you’re in the thick of it?

In today’s 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 ACEP’s “Over-the-Top” 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

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
Don’t 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:

1 on 1 Physician Coaching

Physician Coaching FAQ

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 tension *Establish a boundary between professional and personal life *Be more present with your loved ones after a day's work

The Driveway Debrief

116. Resistance | How to crack inertia

Mon, 25 Dec 2023 09:30:00 -0800

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 Pressfield’s adopting a professional mindset.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

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 – Phil Stutz’s The Tools
Even the best feel fear, it can rarely be overcome
How to overcome resistance. Strategy 2 – 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:

1 on 1 Physician Coaching

Physician Coaching FAQ

115. Zero Warning | Scott Weingart on frameworks for no-notice critical patients

Mon, 11 Dec 2023 09:30:00 -0800

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 — 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? What’s 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.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

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

The Driveway Debrief

1 on 1 Physician Coaching

Physician Coaching FAQ

114. An Insider’s Guide to Medical Malpractice | Why the US system is so peculiar and how to navigate the morass

Mon, 27 Nov 2023 09:30:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

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

113. Understanding Healthy (and Unhealthy) Relationship Dynamics

Mon, 13 Nov 2023 09:30:00 -0800

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

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

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

112. Pizza doesn’t work | An evidence-based intervention that reduced physician burnout and increased job satisfaction

Mon, 30 Oct 2023 08:30:00 -0800

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

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

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 group’s 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
It’s not just talking about medicine and logistics. There’s 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. James’ vision for medicine

111. Does Private Equity Belong in Medicine?

Mon, 16 Oct 2023 08:30:00 -0800

What’s the impact of private equity’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

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. It’s kind of a mess.
Physician unions. Can doctors go on strike?
Leon’s guess outlook for the emergency medicine job market in the coming years

110. A Strategy Mid-Shift Overwhelm | Conquer the deluge and get home on time

Mon, 02 Oct 2023 08:30:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

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
Brit’s plan for triaging tasks
Why deferring charts is so seductive and a slippery slope

109. Is Your Identity Holding You Back?

Tue, 19 Sep 2023 08:30:00 -0800

We wear many hats in life, and one of them can become disproportionately large: our professional identity. Don’t 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

You are more than ‘just’ a doctor
Pranay’s 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 ‘Just’
The Power of Alter Egos
Belief impacts outcome

108. How To Not Argue With Reality | The paradox of accepting the present moment, even when seems really sh*tty

Mon, 04 Sep 2023 08:30:00 -0800

It’s tempting to think of accepting the reality of the moment as acquiescence or giving up, but the opposite is true. Awareness and acceptance of what’s 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 ‘specialness’, getting out of a scarcity mindset, doubting self-doubt, and getting charts done so you can get home on time (yes, it’s true!)

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 Life’s Challenges, and most recently Mindful MD. 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout. To hear more of Gail, she’s the featured guest on Stimulus Episode 27.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss

What is mindfulness?
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

107. The Power of Lightly Held Beliefs | Bitcoin enemas, cold exposure, and the law of speedy gains

Mon, 14 Aug 2023 08:30:00 -0800

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.

Scott’s work has been featured in many magazines — Wired, Mother Jones, Playboy, Foreign Policy, Men’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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

106. The Drama Triangle | Rewriting the script for conflict and broken communication

Mon, 24 Jul 2023 08:30:00 -0800

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 ‘drama’, and explore practical tools to identify and navigate the dynamics of our own interactions.

Conceived by Stephen Karpman, the Drama Triangle highlights a particular type of destructive interaction that can occur between individuals in a conflict.

The model delineates three distinct roles: the Victim, who experiences a sense of oppression, incapacity, and externalizes responsibility for their predicament; the Hero, who embodies an overly helpful persona and frequently fosters dependency, thus indirectly sustaining the Victim’s sense of helplessness; and the Villain, characterized by blaming, controlling, and authoritative behavior, fostering a power dynamic that aggravates the Victim’s sense of oppression.

These roles are not fixed, and participants in the drama often rotate through them, perpetuating a cycle of destructive, non-productive interactions. Understanding this model provides insight into dysfunctional communication patterns, offering a starting point for transformation and healthier relationship dynamics

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

What is the Drama Triangle?
The Empowerment Dynamic
Recalibrating from drama to neutrality

105. How Do You Decide When to Say Yes or No | Steps to develop a heuristic for decision making

Mon, 10 Jul 2023 08:30:00 -0800

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, it’s almost always associated with a cost. That cost is time. Every ‘yes’ is accompanied by even more ‘no’s’.

In today’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

104. Trapped in a World of Bad Advice | The tightrope between asking and telling with Edgar Schein, PhD

Mon, 26 Jun 2023 08:30:00 -0800

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.

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 “Humble Inquiry”, "Organizational Culture and Leadership" and "The Corporate Culture Survival Guide", continue to be pillars of study in the field. Dr. Schein’s 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.

The Advice Trap Link

Humble Inquiry Link

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

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
It’s not just to fill the awkward silence
Asking questions is not straightforward
Critical skills for implementing humble inquiry
Take-home challenge: The next time you engage in a conversation, particularly in a setting where you’re accustomed to ‘telling’, try implementing the principles of Humble Inquiry and notice if there is an advice trap. See how just noticing, not even doing, influences the dynamics of the conversation and the outcomes that unfold.

103. How to Have a Nearly Perfect Shift | Reversing frustration and identifying the opposite outcome

Mon, 05 Jun 2023 08:30:00 -0800

How often do you walk into work hoping it will be a good day or at least not a bad one? What if it didn’t matter what happened and the good/bad was entirely in your control? In today’s episode, Christina Shenvi MD, MBA, PhD gives insight and specific strategies for a nearly perfect shift.

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 ‘Too Much on My Plate.’

Mentioned in this episode:

Zen Driving

Be Water documentary

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

How do you define a nearly perfect shift?
What to do when you can’t get something done or things don’t 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

102. Ten Percent of a Bad Idea | Why your gut reaction may lead you astray

Mon, 15 May 2023 08:30:00 -0800

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 and resolution.

It’s easy to get caught up in the rightness of our own opinions and ideas – whether it’s in medicine, business, leadership, relationships, or any time we interact with others. However, this can be detrimental to collaboration and creativity.

The basics of the 10% rule are simple. When presented with an idea that your gut reaction is to reject, find the 10% value.

For example, someone says to you, “I’m thinking of buying one of the decommissioned space shuttles so I can get to work faster.” On the surface, you might think that’s moronic. But what’s the 10% in there? Maybe it’s that they’re thinking of a way to improve the commute to work. So instead of completely rejecting the idea, you could say, “What I like about that idea is less commuting stress and getting to work faster. Let’s build on that and see what other ideas we can come up with.”

The 10% rule is different than saying you like the idea itself because that might be a lie. You might not like the idea in total, but there’s almost certainly 10% in there that you do like. By finding that 10%, you can build on it and create a more collaborative interaction.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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

101. Being In-Between | How to navigate big and small transitions

Mon, 01 May 2023 08:30:00 -0800

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.

The liminal space is a transitional or in-between state where you’re in a place of vagueness or uncertainty. It’s a place of being ‘in-between’. In architecture, it’s often a passageway. What a perfect metaphor. You’re neither in the room you were before nor arrived at the one where you’re heading.

You’re neither here nor there. You are becoming. You have not yet become.”

We often don’t like it as it feels unsettling and disorienting because we don’t know what to expect.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

What is a liminal space?
Situational awareness and the big picture
Embracing a transitional identity
Essential tools and strategies for navigating uncertainty

100. Listening to Understand versus Listening to Win | Strategies for quality listening and how to know when you've got it right

Sun, 09 Apr 2023 08:30:00 -0800

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

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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

99. Unlocking the Secrets of Learning | Mental models of expertise, threaded cognition, and tactics for information retention

Mon, 27 Mar 2023 08:30:00 -0800

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, you’re 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.

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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

98. How to recover from a horrible, rotten, no-good shift

Mon, 13 Mar 2023 08:30:00 -0800

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.

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 Toronto’s best ER doctor by Toronto Life Magazine. She is also a professional coach and a public speaker.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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

97. The Spock Retreat | Using logic to solve emotional situations (and how to stop it)

Tue, 21 Feb 2023 21:46:00 -0800

Part of practicing medicine is telling patients 'no'. It’s never fun to do so and it can be a draining daily task. It doesn’t 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, The Spock Retreat - falling back on logic to solve an emotional situation, what happens when we get pushback on our logical responses, when embracing logic is the right and wrong move, how to approach frustrating and illogical interactions, and saying 'no' in a positive way.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 can’t 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 “no” 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.

96.5 The curious case of Zithromax and viral respiratory infections

Mon, 06 Feb 2023 09:30:00 -0800

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?

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

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.

96. Compassion Fatigue

Mon, 30 Jan 2023 09:30:00 -0800

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 Bambach, MD gives insight into compassion fatigue and strategies to thwart it.

Compassion fatigue is cumulative emotional and physical exhaustion stemming from exposure to the suffering of others. It is the “cost” of caring for others who are suffering. It leads to a diminished ability to manifest empathy compared to your normal baseline (this is important- it does not mean you are no longer a compassionate or empathetic person!)

Compassion fatigue is distinct from burnout. Burnout comes from factors in the external environment that are not necessarily related to empathy, such as increased administrative burden or lack of autonomy. CF is unique because it includes secondary trauma.

There are many similarities, including depersonalization, a reduced sense of personal accomplishment and meaning, and physical exhaustion.

In a study of PEM docs, burnout score was the most significant determinant of CF.

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

What is compassion fatigue?
The signs and symptoms of compassion fatigue;
How compassion fatigue is different from burnout;
The “dark side” of empathy;
How to combat compassion fatigue.

95. A Disability Insurance Deep Dive | What to look for in a policy, why it's so often a fight with insurance companies, and how to collect

Mon, 16 Jan 2023 09:30:00 -0800

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.

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 it’s 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 don’t file it?
Why some specialties pay more for disability than others
The importance of getting private disability insurance when you’re a trainee/resident
The disability insurance trainee package
The big question - why should you get disability insurance in the first place?

94. Why We Argue About Money | Finance advice and the value of a scarcity mindset

Mon, 02 Jan 2023 09:30:00 -0800

Financial expert, raconteur, and finance CEO 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 “The New Benjamin Graham.”

He’s written for publications including Financial Times, Barron’s, 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 + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss

The value of a scarcity mindset;
Personal finance advice that changed a financial expert’s 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.

93. Five Sleep Tools We've Tested and Like

Mon, 19 Dec 2022 09:30:00 -0800

In a follow up to our episode on sleep, we break down five sleep tools we’ve tested, like, and are still using.

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. What’s discussed in this episode is 100% opinion and anecdote but hopefully there is something in here that you’ll find useful.

For full show notes of this episode and all sorts of other goodies, visit our podcast website

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

93. Feedback can be hard to give and harder to receive. Here are techniques to do both better.

Mon, 05 Dec 2022 09:30:00 -0800

Feedback comes in many forms and oftentimes we aren’t even aware that it’s 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 (that’s 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:

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 it’s dark underbelly;
Why feedback is not mandatory;
The three forms of feedback;
The Advocacy Inquiry Molecule;
Pendleton model for feedback;
Self-feedback isn’t easy and usually poorly executed;
Effective receiving of feedback is about the ‘what’ and not the ‘who’;
Embracing your hypocrisy;
Barriers to feedback.

92. Strategies for Shift Endurance

Mon, 21 Nov 2022 04:58:00 -0800

It’s a tough time to practice medicine, 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 during a long shift, sustaining shift endurance, and building a scaffolding for joy at work.

For full show notes of this episode and all sorts of other goodies, visit our podcast website

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

Episode Sponsor: Ivy Clinicians. Curious if there’s 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.

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.

91. Is this the end of note bloat? | Breaking down the 2023 documentation guidelines

Mon, 07 Nov 2022 09:30:00 -0800

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 didn’t matter. All of that is slated to change in 2023 with dramatic new documentation guidelines (that today’s guest calls ‘refreshing’) are implemented. When was the last time you heard the word ‘refreshing’ 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.

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.

Episode Sponsor: Ivy Clinicians. Curious if there’s 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.

For full show notes of this episode and all sorts of other goodies, visit our podcast website

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

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);
Jason’s take home points;
And More.

90. The Dalai Lama’s Doctor Has a Prescription for You | The critical distinction between empathy and compassion

Sun, 23 Oct 2022 03:55:00 -0800

Barry Kerzin, MD, the Dalai Lama’s 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.

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 — home of the Tibetan community in exile. In addition to serving as H.H. the Dalai Lama’s 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.

For full show notes of this episode and all sorts of other goodies, visit our podcast website

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

We Discuss:

The difference between empathy and compassion;
Can compassion be taught?
Listener email about having a hard time switching between empathy and compassion;
Barry’s response to the listener's 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.

89. The Drunk Whisperer | Verbal de-escalation for the agitated, upset, and unruly

Mon, 10 Oct 2022 08:30:00 -0800

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 ‘The Drunk Whisperer’, 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 opponent’s 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 doesn’t always mean physical escalation (though sometimes it does), it can simply mean removing yourself from the physical space of the escalating situation.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

Jose Pacheco's tactics to de-escalate and defuse agitated patients in the emergency department [03:13];
Dan McCollum’s 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];
“We treat people as ladies and gentlemen not because they are, but because we are.” [35:50];
You can’t 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 person’s eyes. [37:50];
Sword of Insertion technique aka How to politely interrupt [38:20];
Active listening [40:50];
Tips for interacting with difficult patients in the ED. [42:30];
Non-verbal cues [53:30].

88. Peak Ending | How closings color our recollections and using that to our advantage at work

Mon, 26 Sep 2022 08:00:00 -0800

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).

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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.

87. Availability Bias | Skewed risk assessments from a pervasive cognitive distortion

Mon, 12 Sep 2022 08:30:00 -0800

We’re all guilty of it, basing decisions on the most recent event. It’s 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, I’ve found that he is a rare mix of humility, genius, and kindness.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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;
Justin’s tools for addressing bias;
Ways to hack the bias.

86. Mastering Workflow and Overwhelm | Task hierarchy, rate limiting steps, parallel processing, swarming, and the forgotten art of running the board

Sun, 21 Aug 2022 08:30:00 -0800

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 I’ve ever seen on managing workflow in the emergency department. Now he's our guest on the show.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

3 phases of an emergency department visit
Why disposition is king, until it isn’
Hierarchy of tasks
Blocking time
Linear vs parallel processing
Swarming
Batching
The quick hit charting nidus
Task switching
Running the board
Managing interruptions

85. The Professional's Mindset | Embracing the pact and extreme ownership

Mon, 15 Aug 2022 08:30:00 -0800

What does it mean to act like a true professional? I’m not sure it’s been fully fleshed out in medicine but I’ve 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 oneself 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 the host of The Grit Podcast with Ben Peery which you can find on Spotify, iTunes, and all the rest. Ben’s show is conversations “with 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.”

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

84. A Look Inside Ketamine Clinics (and how to start your own)

Mon, 08 Aug 2022 02:22:00 -0800

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 shouldn’t) go into this type of business.

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

Why Sam started a ketamine clinic [04:45];
What patients report after awakening from a ketamine procedural sedation in the ED [09:30];
What it takes to open a ketamine clinic [11:45];
How ketamine is administered [17:30];
Adverse events during the infusion are rare [20:55];
What happens when the patient enters the clinic [23:05];
Mental preparation prior to the ketamine session [25:50];
The 4 stages of ketamine therapy [28:10];
Monitoring the patient during the experience [28:50];
Liability, price, insurance coverage, and intranasal ketamine [30:10];
Online telemedicine ketamine prescribing and therapy [35:30];
What people get wrong when they start a ketamine clinic [40:40];
Indications for ketamine therapy [43:20];
Ketamine for neuropathic pain [44:50];
Ketamine vs. antidepressants for mood disorders [49:15];

83. Recalibrating when it all falls apart | In real time strategies to reset during a calamity

Mon, 25 Jul 2022 06:11:00 -0800

When you are at the lowest of lows after a devastating case, how do you recover in real-time? It’s 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

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

82. Letter to My Future Self | Proactively managing self-doubt

Mon, 11 Jul 2022 08:30:00 -0800

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 else’s life is also involved - the patient’s. 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: the letter to your future self.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

81. Medical Ethics in the Heat of the Moment | Withdrawing and withholding care, delaying death, over-treatment, and the daughter from California,

Mon, 27 Jun 2022 08:30:00 -0800

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.

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

Visitor policy– one of the enduring tragedies of the COVID-19 pandemic;
A case of a 45 year old with an unsurvivable brain bleed – 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 patient’s 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 can’t get informed consent from a patient;
Navigating the “Daughter from California”;
When does the medical Power of Attorney kick in?

80. The False Assumption of Apologizing for Medical Mistakes

Mon, 13 Jun 2022 04:19:00 -0800

There’s no denying that mistakes happen in medicine. When they do, what’s 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 ‘risk management’ to ‘patient management’, 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 Smulowitz’ 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 the implementation of CARe programs? [28:45]

79. The Sleep Expert | Get to sleep and stay asleep

Tue, 31 May 2022 04:38:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 – 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];

78. I Was Unlucky, But You Frankly Suck | The fundamental attribution error

Mon, 16 May 2022 08:30:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

The core tenant of fundamental attribution error;
The fact that nobody sees themselves as the villain of their own story;
Marcus Aurelius’ approach;
Ways to address and manage fundamental attribution error;
Stephen Covey’s simple yet powerful technique: first seek to understand, then be understood;
Empathic listening;
An exercise to understand the other person’s perspective and sort out if you were truly wronged;
“Could malice be misunderstanding?”;
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;

77. Tiny Habits | Anchors, micro moves, and upward scaling

Mon, 02 May 2022 05:57:00 -0800

Habit change doesn’t 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 Fogg’s 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 you’ll 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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.

76. Inner Criticism | How to keep a negative inner voice from taking over

Mon, 18 Apr 2022 08:30:00 -0800

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 manage it.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 “the Judge” compared with “the Sage” in a complex resuscitation scenario [11:00];
Switching from “What if” to “What’s next” [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];

75. Hot Debriefing | Processing events while you're still in the arena

Sun, 03 Apr 2022 09:30:00 -0800

Finding time to debrief challenging cases can feel nearly impossible amidst the tumult and task saturation of medical practice. The reality, however, is that it’s 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

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss

A particularly stressful resuscitation that was taxing, emotionally and physically, and an approach to the “hot offload” [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];
Ashley’s Credo: work hard, be respectful, be kind [36:40];
And more.

74. Flipping the Narrative on Performance Metrics | Why we're bad at self assessment, crafting meaningful metrics, balancing data

Mon, 21 Mar 2022 08:30:00 -0800

It doesn’t look like performance metrics are going away any time soon. So why not make them a feature instead of a bug? We discuss: reframing audits so they help elevate and don't feel punitive, why we're not good at self-assessment, creating clinician-relevant (and friendly) metrics, the best way to present metrics to providers, 3 high-yield metrics that make a difference.

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 “balanced”.

73. The Value and Pitfalls of Signout Culture with Mike Weinstock, MD

Sun, 06 Mar 2022 09:30:00 -0800

There is no doubt that handing over care of a patient to another clinician is potentially fraught with peril. After all, it’s in the transitional moments when error is most likely to occur. But there’s 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 University’s 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 How’d it Go?. Mike has practiced medicine nationally and internationally including volunteer work in Papua New Guinea, Nepal, and the West Indies.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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];
Rob’s 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 plaintiff’s 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];
Mike’s 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.

72. Navigating Uncertainty and Powering Down at the End of the Day with Dan Dworkis MD, PhD

Mon, 21 Feb 2022 04:24:00 -0800

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 we’ve 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. 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.

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

How Dan’s 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 Marquet’s 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 “throwing gas on the fire” [40:12];
Algorithmic vs creative thinking and the shape of uncertainty [42:20];
Dan’s recommendations for new listeners of his show [50:47]

Follow Rob: Twitter, Facebook, and Youtube.

71. Designing Your Life | How an engineer recommends evaluating your work, health, love, and play

Mon, 07 Feb 2022 09:30:00 -0800

A book I recommend to many coaching clients is “Designing Your Life” by Bill Burnett and Dave Evans. I’ve 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 today’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

“Designing Your Life” thinking is about approaching life from the perspective of engineering and design, building prototypes to see what does/doesn’t 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.

70. Real World Applications of Nonviolent Communication

Mon, 27 Dec 2021 09:30:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 you’re talking with has a personality disorder [30:40];
What happens when you use NVC to “manipulate” someone who is astute and quickly realizes they’re being managed [35:00];
The fallacy of attribution [38:30];
And more.

69. A Primer on Nonviolent Communication

Tue, 21 Dec 2021 09:30:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

68. Take the Suck out of Documentation | Making the most of scribes, documenting in the room (and in front of the patient), efficient workflows

Mon, 13 Dec 2021 09:30:00 -0800

Nobody goes into medicine hoping they can have a long career in data entry, but that’s 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 that’s already in your pocket to chart at the bedside. These might seem like ‘tech hacks’ 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 Setnik’s 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 patient’s 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.

67. Caring for the Unapologetically Unvaccinated

Mon, 29 Nov 2021 09:30:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

Brit’s 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 one’s 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];
Jose’s 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 they’ve 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.

66. Hell Yeah or No

Thu, 25 Nov 2021 09:30:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

65. Bouncing Back After a Tough Case

Mon, 15 Nov 2021 03:53:00 -0800

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

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 you’re 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 committing 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 shouldn’t think of it as “bouncing back” from a terrible outcome [23:00];
What do you do when you’ve had a bad outcome, but you don’t have the time to process what’s 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.

64. Why Focusing on Patient Experience and Not Satisfaction Is the Right Move

Mon, 01 Nov 2021 08:30:00 -0800

Patient satisfaction and the patient experience are vastly different different things. In this pod we discuss: how experience is influenced by every conceivable touchpoint, and perception, how making a purposeful choice to care helps ensure that our patients have a positive experience, efficiently handling the situation when a patient has extra questions, the best way to acknowledge a patient’s long wait, and de-escalating the unhappy patient.

Guest Bio: 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

A patient satisfaction survey rant [02:45];
The “patient experience” 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 “doorknob complaint” 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 patient’s 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.

63. The Pillars of Your Professional Life | Do you own or rent your career?

Thu, 21 Oct 2021 08:30:00 -0800

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 Hope’s four roles as an emergency physician are to excel as a public safety officer, a resuscitationist, a diagnostician, and a patient advocate. Rob’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

62. Primum Non Nocere | How 8 doctors practice 'first do no harm'

Mon, 18 Oct 2021 08:30:00 -0800

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 what’s medically right, putting the patient’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

60. How to Be A Medical Expert Witness with Amal Mattu, MD and Rich Orman, JD

Mon, 04 Oct 2021 08:30:00 -0800

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 it’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 you’re 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 they’ll be brought up in court) [20:30];
An attorney’s 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];
Rich’s advice for responding to ‘yes/no’ questions when there isn’t a ‘yes/no’ 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.

59. Aim to be a Zero | An astronaut's guide to life on Earth

Mon, 20 Sep 2021 08:30:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

The pitfalls of thinking too highly of yourself [1:46];
The importance of being a “plus one” and the wisdom of not proclaiming your plus-oneness. “If you’re really a plus one, people will notice” [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 they’re 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 you’ve 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, “get up, dust off, reload, recalibrate, re-engage, and go out on the attack” [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.

58. Lessons Learned in Blood | Mass casualty response effectiveness with Green Beret and physician Mike Shertz, MD

Mon, 06 Sep 2021 08:30:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 hospital’s 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 you’re 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: ‘All lessons are written in blood’ [43:27];
The question Shertz thinks people should ask of their hospital disaster planners [45:45];
And more.

57. Cultivating the Emergency Mind | Graduated pressure, sangfroid, and acknowledging the suboptimal

Mon, 23 Aug 2021 08:30:00 -0800

The emergency mind is cool under pressure. But how do you get there? For most us, it’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

Deploying psychological countermeasures when you’re 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 Yerkes–Dodson 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 “regroup, recover, and evolve out of any crisis” [41:50];
What does it mean to train your “tired moves” [42:55];
Dan’s challenge for the Stimulus audience [52:44];
And more.

56. Rescue in the Jungle | Rob and Melissa meet a hiker with a medical emergency

Mon, 09 Aug 2021 08:30:00 -0800

A hike in the jungle takes an unexpected turn when Rob and Melissa meet a traveler with a medical emergency.

In this episode: medical emergencies in austere environments, managing acute pain without medication, and using breath work vs distraction in high stress situations.

Pics and videos on our website.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

55. Too Much On My Plate | Getting un-busy, procrastination, and pulling back from overcommitment

Mon, 26 Jul 2021 08:30:00 -0800

The phrase “too much on my plate” and word “busy” are pervasive in modern discourse. But does it have to be so? We certainly didn’t start out that way as children! In this episode, Dr. Christina Shenvi walks us through the path to clear our ‘schedule plates’ 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 “yes” or “no” to things [05:45];
The 4 pillars Rob uses to help guide “yes” or “no” decisions [08:30];
Why it’s problematic to think of life as a zero sum game[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 aligns with your values and using Stoic indifference to suspend self-judgement [32:00];
Choosing to do things vs. “I should” [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.

54. Spanish matador Juan Belmonte practiced naked | Defining success and developing character through the medium of career

Mon, 12 Jul 2021 08:00:00 -0800

What gives you fulfillment in your job? If you know it, do you make purposeful choices to keep pointed in that direction?

We start with the tale of Juan Belmonte...

Juan Belmonte's journey to becoming a master of the bullfighting arena is a tale of resilience and unparalleled determination. Born into modest circumstances, Belmonte initially faced a series of setbacks, including an early attempt at being a shopkeeper, which failed, compounded by a physical disability that could have easily derailed his ambitions. Undeterred, Belmonte turned to bullfighting, an arena where his physical limitations were not merely obstacles but challenges to overcome. He spent countless hours practicing, developing a unique style that would later revolutionize the sport. His technique, marked by standing motionless and allowing the bull to pass dangerously close, contrasted sharply with the more dynamic and agile styles of his contemporaries. This daring approach not only compensated for his physical limitations but also turned them into an advantage, captivating audiences with its sheer audacity and grace. Belmonte's mastery of bullfighting was not just in his physical prowess but in his ability to transform weakness into strength, earning him a legendary status in the history of the sport. His life story is a testament to the power of resilience and the pursuit of excellence against all odds.

"No life worthy of the name consists of anything more than the continual series of struggles to develop one's character through the medium of whatever one has chosen as a career." Juan Belmonte

With special guests:

Amal Mattu
Scott Weingart
Greg Henry
Mizuho Morrison
Haney Mallemat
Reuben Strayer
Mike Weinstock
Victoria Brazil
Ilene Claudius

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

53. The Five Fears of Scott Weingart

Mon, 28 Jun 2021 08:00:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 don’t take a joke [13:40];
Scott’s 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. He’s an acquired taste. [41:35];
Scott’s final fear: a patient dying on his watch [46:55];

And more.

52. Listening to Podcasts for Maximal Retention | Interstitial time, task type, hour of day, driving vs undivided attention

Mon, 14 Jun 2021 08:00:00 -0800

Most of us don’t 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

Strategies for maximizing retention of podcast content [04:20];
How your working memory is like the RAM of your brain [08:40];
Why Josh prefers to listen to podcasts in the morning as this is when he is best able to focus [10:20];
The importance of using your brain for tasks that are appropriate for the state that it’s in [12:45];
Not every interstitial moment needs to be occupied by something educational or entertaining [15:55];
How Rob consumes podcasts [17:10];
A recent study which evaluated the knowledge gained from listening to podcasts while driving compared to that gained from undistracted listening [20:40];
The value of silence [24:10];
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];
And more.

51. Excellent Presentations with Ross Fisher, MD | Detailed instructions for how to slay it on stage (or online)

Mon, 31 May 2021 08:00:00 -0800

Pediatric surgeon Ross Fisher, the mind behind p cubed presentations, breaks down how to finish a talk (teaser, it’s not a random vacation slide or you saying, “Thank you,” 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

Presentation feedback can be hard to take and hard to give. What is the best way to do it? [03:00]; What’s 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, “Message, not story, is the basis of a good presentation”? [28:20];
And More.

50. The Wedge | An internal shift to thrive under duress

Mon, 17 May 2021 08:00:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

The common theme of Scott’s books -- what does it mean to be human? [05:00];
Who is “The Iceman” Wim Hof and and why might cold water immersion lead to general resilience [09:10];
The three elements of the Wim Hof method and how they relate to the wedge [15:10];
An advantage of the Wim Hof method vs. other mind-body connection practices (like Tuomo) -- it’s fast and you can learn it in about 3 days [20:00];
Scott’s weekly cold water immersion practice with benefits that last 4-5 days [22:20];
Why ‘gritting it out’ is not an effective strategy for prolonged cold exposure [27:30];
Climbing up to Gilman’s Point on Kilimanjaro shirtless and without oxygen [30:15];
Scott’s sauna routine and the value of giving his body contrasts to adapt to new environments [33:25];
His latest book, The Wedge, and how the wedge is activating something within yourself in order to thrive in a difficult moment [36:25];
Using a library as a metaphor for the limbic system [39:20];
The philosophical question -- do we experience a shared reality? [44:20];
Applying the wedge in the emergency department when your heart is racing and you’re profusely sweating because you’re having difficulty with a critical procedure[49:25];
The solution (or wedge) for the mental irritation that often comes with reading opinions on social media [58:30];
And more.

49. Can Sex Improve Nasal Function?

Thu, 06 May 2021 08:00:00 -0800

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).

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

48. Skill Decay | How to get back in the game

Mon, 03 May 2021 08:00:00 -0800

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 today’s episode we explore the phenomenon of skill decay and ways to mitigate its effects.

This episode is in support of World Bicycle Relief -- delivering specially designed, locally assembled, rugged bicycles for people in need. They’ve developed an efficient, innovative, and scalable model to empower students, health workers, and entrepreneurs in rural developing regions with life-changing mobility. Donate here.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

Skill decay sets in rather quickly following an absence from the emergency department [03:50];
Motor skills, like riding a bike, decay much more slowly than cognitive skills [05:20];
The principles behind skill decay: cognitive load theory and cognitive overload [07:66];
Strategies for combating skill decay [09:30];
Rob’s approach after a short absence which centered around visualization [12:50];
And more.

46. Strategies to De-Stress Your Nervous System | Before, during, and after intense events

Mon, 19 Apr 2021 08:00:00 -0800

We are often witness to, or sometimes in the middle of, traumatic events. Whether it’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

The Las Vegas mass casualty and the wide range of emotional responses of those who were involved [03:50];
Trauma is different for every nervous system -What’s traumatic for one person may not be for another [05:50];
Training to handle stressful events in a better way [08:15];
What’s happening physiologically when you have PTSD after a traumatic event [10:40];
Strategies that are protective of your nervous system DURING a traumatic event [14:20];
The importance of PRE-TRAINING so that you have tools to down-regulate your nervous system in the moment [19:20];
Protective, positive strategies that can be used AFTER a traumatic event to reduce the risk of PTSD [25:50];
The role movement plays in down-regulation and why dosage matters [31:40];
The benefit of EMDR (Eye Movement Desensitization and Reprocessing) and other body-based therapies for processing acute trauma [35:10];
The process of intentionally letting go, or “cutting strings”, when something is weighing heavily on you (such as a client, patient, etc.) [37:30];
And more.

44. The Beirut Explosion and Mass Casualty | A First Hand Account

Mon, 05 Apr 2021 08:00:00 -0800

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 today’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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];
Sarah’s 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 it’s 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.

43. How to Not Take Things Personally

Mon, 22 Mar 2021 08:00:00 -0800

Our ego is always on patrol and, when it’s 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 don’t 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.

Frederik’s TED talk on how to not take things personally has been viewed 6 million times.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

The barrier to sustainable happiness and the technique to overcome that [04:15];
Frederik’s 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 you’re 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 you’re 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

42. Tough Love and Managing Complainers | Unapologetic expectations with Jim Adams, MD

Mon, 08 Mar 2021 09:00:00 -0800

Jim Adams, MD is direct, transparent, and unapologetic in his ‘tough love’ 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 others’ 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

Zen and the art of scheduling [05:30];
Why you might not want to be a complainer [07:05];
The benefit of assuming people are unreasonable and crazy [08:10];
A strategy for handling people who degrade social capital [10:30];
Blend and redirect, a technique for negotiation and collaboration that’ll make you much happier than combat [14:00];
“People are not against you. They're just for themselves.” [16:15].

41. Cognitive Reframing | Shifting the approach with addiction, end of life, and catastrophizing

Mon, 22 Feb 2021 09:00:00 -0800

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."

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 you’re engaging with a patient or a patient’s 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.

39. Vinay Prasad Wants to Flip Your Vote | Chemotherapy delusions, overstating benefit, trade offs, and medical reversal

Mon, 08 Feb 2021 09:00:00 -0800

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.

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 Sponsor:

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

The realities of the dissemination of scientific information on Twitter [05:12];
Vinay’s intent when he posts a controversial tweet [09:00];
Why he’s 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];
Prasad’s book Ending Medical Reversal and the potential harms of sudden flip-flopping of standards of care in medicine [44:00];
The difference between ‘effective’ and ‘efficacious’ as it relates to public health and policy [47:46];
Prasad’s 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.

38. How to Meditate

Mon, 25 Jan 2021 09:00:00 -0800

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.

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

When starting a meditation practice, the importance of knowing what your ‘fantasy’ is about meditation [06:50];
Why having a meditation teacher is essential and how Ruth Denison influenced Beatty’s 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];
Beatty’s guided meditation for the novice [15:00];
What it is in mindfulness that we’re 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];
Beatty’s 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];
Beatty’s aspirations [01:09:30];
Why ‘should’ is such a violent word [01:10:00];
And more.

37. Stress Inoculation | HALO procedures, racing the clock, low fi sim, and the power of an audience

Mon, 11 Jan 2021 09:00:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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.

35. A Physician's Terminal Diagnosis | Facing mortality and sharing wisdom

Mon, 28 Dec 2020 09:00:00 -0800

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 don’t need, preparing your family for a future without you, the most/least admirable traits in physicians, and the secret of life.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

34. How Tylenol and Sleep Impact Vaccine Antibody Response

Mon, 21 Dec 2020 09:00:00 -0800

The historical effects of acetaminophen and sleep on vaccine antibody response.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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]

33. Willpower Depletion and the Limits of Self Regulation

Mon, 14 Dec 2020 09:00:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 you’re working on improving your habits [29:30];
Habit stacking [36:30];
And more.

31. The Dalai Lama’s Doctor, Barry Kerzin MD

Mon, 30 Nov 2020 09:00:00 -0800

A discussion with His Holiness the Dalai Lama’s 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 Lama’s 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 “...a doctor, a monk, a teacher, a lazy man. All of these things, yet none of these things,” you can follow Dr. Kerzin on Facebook, Youtube, Instagram or learn more about his story here.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

How Barry Kerzin got the job of being the Dalai Lama’s personal physician [07:15];
Why allopathic medical providers shouldn’t discount traditional health care systems [18:20];
Advice Dr. Kerzin would give to his younger self upon graduation from family medicine residency in the late 1980s [24:25];
The dangers of too much empathy [27:00];
Compassion, which is just about a half step back from empathy [29:15];
Methods of teaching compassion on a curricular level [33:20];
The Buddhist practice of unconditional compassion [39:45];
The importance of mutual respect, even in the face of difference [43:35];
Replacing jealousy with rejoicing [46:00];
The pillars of self-compassion [49:48];
Lessening the impact of an error [56:15];
Bodhisattvas -- people who have universal compassion that excludes no one [56:15];
What it’s like to live in Dharamshala and to be the Dalai Lama’s physician for the past 15 years [59:20];
Dr. Kerzin’s prescription for longevity in medicine [01:07:45];
And more.

29. How To Be An Effective Leader

Mon, 16 Nov 2020 09:00:00 -0800

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 they’ve learned leading in both the military and civilian worlds of medicine and crisis situations. My favorite quote from this episode: “Purpose is embraced, not imposed.”

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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];
Czarnik’s special skill for being able to start conversations with anybody, no matter who they are [27:25];
How Czarnik manages email [31:15];
Czarnik’s personal philosophy and approach to life [33:00];
Czarnik’s ask for the world of medicine and something he’d like to see change [34:10];
And more.

27. Imposter Syndrome, Either/Or Thinking, and the Daily Dose of Goodness

Mon, 02 Nov 2020 09:00:00 -0800

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 Life’s Challenges, (Free chapter here). You can contact Gail through her website and, if so inclined, schedule a complimentary coaching consultation.

Today’s 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 "Stimulus” for 10% off any Wild Health care plan.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 “hero” [10:10];
What it’s 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 “daily dose of goodness” becomes a defined habit [21:30];
How accepting what is/isn’t 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: “I am good. I do my best. I cannot control all the rest.” [59:40];
And more.

25. Digital Minimalism

Mon, 19 Oct 2020 08:00:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

Why digital minimalism is something we might want to consider doing [03:07];
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 Newport’s method for using phones, computers, and apps in a way that they are net positive [11:00];
Tips and observations from Rob’s and Dan’s 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];
Dan’s bottom line about digital minimalism [27:25].

23. Michele Harper on Being a Guardian of the Vulnerable

Mon, 05 Oct 2020 08:00:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

The importance of setting boundaries, especially when people are able to reach you 24/7 [03:20];
Her essay, “Sovereign Bodies” (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];
Michele’s 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 Michele’s 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 there’s nothing “micro” about microaggressions [36:00];
How it’s 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 “When This War Is Over, Many of Us Will Leave Medicine” (Elemental) which presents the idea that “healthcare providers are regarded as more disposable than our PPE” [44:30];
Michele’s call to action [50:45];
And more.

22. Mastering Communication When It Matters Most

Mon, 21 Sep 2020 08:00:00 -0800

Who teaches doctors how to speak to patients (or each other)? It’s usually something that’s picked up as you go. Let’s be honest though, some clinicians are much better at clear and empathetic communication than others. It’s an under taught skill that’s 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. I’ve 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 you’d like to try at marmed.com/stimulus. Who doesn’t love free samples, especially when it’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 patient’s 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 else’s, 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 isn’t to be right; our job is to be reasonable [56:20];
And more.

21. Responding in Anger | Impulse vs intent

Mon, 14 Sep 2020 08:00:00 -0800

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? It’s unlikely to persuade. More likely it’s a quasi-cognitive-orgasmic release of F*&k You.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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.

19. Esther Choo and the Equity Quotient

Mon, 07 Sep 2020 08:00:00 -0800

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. I’ve 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 you’d like to try at marmed.com/stimulus. Who doesn’t love free samples, especially when it’s awesome stuff?

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

Esther’s first outward advocacy: responding to the Trump administration’s attempts to dismantle the Affordable Care Act [03:44];
How you decide whether to say “yes” or “no” when you don’t have time to do everything that’s 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 “exercise in futility” [19:00];
Esther’s 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 they’re a heroin addict, borderline personality, or an a-hole [32:50];
Esther’s podcast, Doctor’s 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];
Esther’s company, Equity Quotient, whose mission is to “work with standout health care organizations, employer groups and academic centers to create a culture of equity, safety, and respect” [01:11:34];
The NEJM article, Time’s 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 won’t happen if we don’t improve the diversity representation from the ground floor up to the highest leadership [01:19:45];
The reason Twitter became Esther’s social media medium and how Chelsea Clinton’s 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
Esther’s call to action, [01:30:42].

17. Why We Procrastinate

Mon, 24 Aug 2020 08:00:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

Why “I’m too busy” implies that you have no control over your situation or what you’re doing [01:50];
Value-based scheduling, which means evaluating tasks to be sure they align with your big values [08:20];
Techniques for saying “no” when invited to do something that doesn’t 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.

16. The Accumulation of Marginal Gains With Salim Rezaie | From 260 pounds to super fit

Mon, 10 Aug 2020 08:00:00 -0800

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.

Guest Bio: 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 Salim’s transformation from being “festively plump” 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 don’t 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];
Salim’s core principles and priorities [44:30];
The most unexpected book that Salim has read in the last year [48:20].

14. Stoic With a Capital S

Mon, 27 Jul 2020 08:00:00 -0800

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.

Guest Bio: 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

The difference between stoicism (with a lowercase “s”) and Stoicism (with a capital “S”);
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.

12. How to Achieve Flow State

Thu, 09 Jul 2020 06:31:00 -0800

What is a flow state? When you feel it, you know it. It’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

How achieving a flow state is as much about knowing yourself as it is knowing the skill [02:00];
Michael Jordan’s superpower -- being 100% present in every moment of every game [06:00];
The nuanced distinction between a flow state and being “in the zone” [07:50];
The TED talk by Mihaly Csikszentmihalyi and how a state of “flow” 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 you’re lost [44:00];
Whether it’s better to capitalize on your strengths, or shore up your weaknesses [51:40]; and
More.

11. ZDoggMD | Race, Star Wars, virtue signaling, and prepping for a live show

Mon, 29 Jun 2020 05:15:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 ZDogg’s 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 they’re influenced by FLICC [46:20];
How infrequent hand-washing demonstrates that quality in healthcare is equated with what’s financially incentivized rather than what really makes a difference [51:20].

10. The Space Between Stimulus and Response

Thu, 11 Jun 2020 08:30:00 -0800

Sometimes it feels like we’re buffeted by the winds of life and have little control over what happens to us. The more this cycle recurs, the more helplessness embeds itself into our psyche. Chances are that some of the decisions you make (or don’t make) come from a place of internally throwing your hands up and feeling like you have no say in the matter. The opposite of this mind-frame is called 'agency', or acting with agency. When you act with agency, you own your decisions and act with specific intent. It’s not always easy to get there, however.

In this episode of Stimulus, we speak with Christina Shenvi MD, PhD about acting with agency - what it means, 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

Corporate vs. personal mission statements and how codifying your life philosophy can help you live with intent [03:00];
Rob and Christina’s 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 Covey’s 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];

9. The Master Skill of Taking Breaks

Mon, 25 May 2020 09:00:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 we’re in a negative affective state (ie. a “bad mood”), 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.

8. The Bob Ross School of Trauma | Don't rush but don't linger, full chill, talk the process

Thu, 14 May 2020 00:39:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

Who Bob Ross was 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 “finding your feet” can help you when mistakes are made [07:44];
The value of acknowledging a mistake[09:35].

7. The White Coat Investor | Bear markets, investing plans, income loss, and cushion cash

Thu, 07 May 2020 08:30:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 you’re going to do if and when the market changes [10:00];
Stock investments, and why it’s 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 we’ve 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 there’s spousal income inequality [36:00];
Why having a no-questions-asked allowance can help your marriage [39:50];
The wisdom of this advice: “Be generally frugal, but selectively extravagant” [42:15];
What physicians should do if they’ve 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].

5. The Art of Breathing

Thu, 23 Apr 2020 08:00:00 -0800

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.

Despite breathing being an automatic process since birth, most of us have yet to harness breath's potential to consciously improve our well-being. The discussion covers various aspects of breathing techniques and their effects, including influence on mental and physiological states, visual field expansion for psychological adjustment, and the three pillars of breath physiology. Cheney also delves into specific breath patterns for nervous system regulation, the advantages of nose versus mouth breathing, and the significance of intentional breathwork in managing stress.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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].

4. Talking to Fear

Fri, 17 Apr 2020 01:12:00 -0800

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 what’s 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 we’re constantly running defense, we’re actually on offense.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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 “pregame” 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].

3. Street Medicine

Thu, 12 Mar 2020 07:30:00 -0800

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. That’s certainly true of today’s guest, Dan Bissell, MD. Dan is co-founder of Portland Street Medicine, a medically focused non-profit dedicated to caring for the homeless. What’s 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

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]

2. Pregame Like a Pro | Walk into your shift ready to rock

Thu, 12 Mar 2020 07:00:00 -0800

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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

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 “chit-chat” 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 it’s a competitive sport. [38:30]
Rob's 2 pregame exercises. [41:10]
Jocko Willink’s “Good” [44:06]

1. Verbal Judo | The art of verbal de-escalation

Thu, 12 Mar 2020 06:30:00 -0800

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 ‘The Drunk Whisperer’, has a specific sequence to this approach, which he’s 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, we’re 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.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

Ways to de-escalate and defuse [00:50]
“Verbal Judo” is teachable and learnable. [03:31]
McCollum’s de-escalation sequence [06:35]
Empathy can absorb tension [14:18]
Universal Upset Patient Protocol [22:30];
“We treat people as ladies and gentlemen not because they are, but because we are.” [32:52]
You can’t 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 person’s eyes. [35:40]
Sword of Insertion technique [36:58]
Active listening [38:38]
Jose Pacheco’s tips for interacting with difficult patients in the ED. [41:15]
Non-verbal cues [51:46]

What this show is about.

Sun, 01 Mar 2020 21:57:00 -0800

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, you’ve 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.