Stimulus - Learn Tools to Crush It in Your Medical Career (Rob Orman, MD)

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:

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling consults.

Free Resources Link

1 on 1 Physician Coaching

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.

Physician Coaching FAQ

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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]

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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:

1 on 1 Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. It’s free, low-pressure, and will give you clarity on your next steps.

Physician Coaching FAQ

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite...

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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...

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:

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

Never Lame. Never Spammy. Always Fresh.

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5 Free Tools To Make Medical Practice Easier

Scripts for your least favorite conversations. The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.

Free Resources Link

It’s 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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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.

Sign up for our Newsletter

Awake + Aware | May 5–7, 2025

Bend, Oregon | A 3-day, in-person workshop with world-class faculty to challenge your mindset, recharge your purpose, and connect with people who get it. 18 Hours Category 1 CME

Awake + Aware Bend 2025

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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...

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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 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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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]

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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...

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!

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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];...

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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:

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

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 Flameproof Course

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

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:

1 on 1 Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. It’s free, low-pressure, and will give you clarity on your next steps.

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4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling consults.

Free Resources Link

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

Scripts for your least favorite conversations. The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.

Free Resources Link

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

Ready to reset, recharge, and level up? Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited. 🎓 P.S. Yes, this is a CME event!

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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:

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

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

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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

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

Upcoming Programs You Won’t Want to Miss!

Awake and AwareMay 5–7 | Bend, Oregon - A 3-day, in-person workshop to challenge your mindset, recharge your purpose, and connect with people who get it. The Unburnable CourseStarts September | Online - A 6-month, online program with bi-weekly live coaching. Real strategies for career longevity and resilience. Spots are limited. Check the show notes for details!

Our Current Courses

Doctoring Done Well | Bite-Sized Wins

Every other week, a few minutes of career-elevating insight delivered straight to your inbox. The Doctoring Done Well Newsletter is never lame, never spammy, and always fresh.

Sign up for our Newsletter

NY Times bestselling author Michele Harper, MD on setting boundaries, pre-shift routines, guarding the vulnerable, microaggressions, racism in the emergency department, and why inaction is just as much a choice as action. 

Guest Bio: Dr. Michele Harper, is an emergency physician and author of The New York Times best selling memoir, The Beauty in Breaking. She's been interviewed on Trevor Noah, Fresh Air, CNN, NBC, amongst many others. Michele is also a widely published essayist, often focusing on race and medicine. Her writing shares her personal journey that started as a child in an abusive household, then to undergrad at Harvard, medical school at Stony Brook, New York, and now her life as an attending physician. And as you'll hear, she's got a personal mission to be a guardian for the vulnerable.

This episode is brought to you by RingRescue, the new standard for stuck ring removal. RingRescue helps remove stuck rings in a non-destructive way and, when used with their non-hydrating lubricant, significantly reduces the need for ring cutting.  Use the code stimulus at checkout when you purchase your RingRescue finger compression device to get an extra bottle of their lube. Extra lube, free fifty free! Ringrescue.com, checkout code stimulus.

Awake + Aware | Our 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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...

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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. 

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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].

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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.

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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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 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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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:

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

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

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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].

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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,

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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].

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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

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

1 on 1 Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. It’s free, low-pressure, and will give you clarity on your next steps.

Physician Coaching FAQ

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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. 

Guest Bio:  Joshua Russell, MD is clinician, writer, and educator.  Since completing residency training in Emergency Medicine, Dr. Russell has had a varied career including supervising PAs and NPs as a medical director for a regional Urgent Care network, contributing to various Hippo Education podcasts, and serving as the Editor-in-Chief of the Journal of Urgent Care Medicine (JUCM). Most recently, he has completed fellowship training in Hospice and Palliative Medicine at the University of Chicago Medical Center.

This episode is in support of World Bicycle Relief -- delivering specially designed, locally assembled, rugged bicycles for people in need. 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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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].

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:

Awake +...

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. 

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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!

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...

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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]

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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:

1 on 1 Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. It’s free, low-pressure, and will give you clarity on your next steps.

Physician Coaching FAQ

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations. The Driveway...

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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...

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:

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

Scripts for your least favorite conversations. The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.

Free Resources Link

Never Lame. Never Spammy. Always Fresh.

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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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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;

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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 

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:

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

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.

Sign up for our Newsletter

5 Free Tools To Make Medical Practice Easier

Scripts for your least favorite conversations. The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.

Free Resources Link

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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];

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

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

The UnBurnable Course

Career Longevity. Self Mastery. Anti-Burnout. Next cohort begins Sept 2025.

The UnBurnable Course

Doctoring Done Well | Bite-Sized Wins

Every other week, a few minutes of career-elevating insight delivered straight to your inbox. The Doctoring Done Well Newsletter is never lame, never spammy, and always fresh.

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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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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].

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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. 

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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. 

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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].

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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:

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

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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

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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?

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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

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.

Physician Coaching FAQ

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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!

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

Mentioned in this episode:

1 on 1 Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. It’s free, low-pressure, and will give you clarity on your next steps.

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

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.

Sign up for our Newsletter

1 on 1 Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. It’s free, low-pressure, and will give you clarity on your next steps.

Physician Coaching FAQ

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling...

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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].

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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?

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:

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling consults.

Free Resources Link

1 on 1 Physician Coaching

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.

Physician Coaching FAQ

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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:

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

Scripts for your least favorite conversations. The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.

Free Resources Link

Never Lame. Never Spammy. Always Fresh.

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

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Mass casualty events are rare and thus the mistakes made and lessons learned are often repeated, over and over. In this episode, emergency physician and former Special Forces medic Mike Shertz, MD walks us through the steps on how to be an effective first receiver of mass casualty victims and shares the lessons written in blood from previous events. 

Guest Bio: Mike Shertz MD is an emergency physician who spent 13 years as a Green Beret and a Special Forces medic. He is the founder and purveyor of Crisis Medicine which teaches and trains first responders in tactical casualty care. Check out this video that we did together in 2019 on how to place and remove a tourniquet and this one on how to pack a gunshot wound with combat gauze. 

Awake + Aware | Our 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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].

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

Scripts for your least favorite conversations. The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.

Free Resources Link

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

Ready to reset, recharge, and level up? Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited. 🎓 P.S. Yes, this is a CME event!

Awake +

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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.

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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].

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

Awake + Aware | Our 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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]

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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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 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

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 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 2025 Live Event

⭐ Join us at Awake and Aware 2025, 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!

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:

1 on 1 Physician Coaching

I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. It’s free, low-pressure, and will give you clarity on your next steps.

Physician Coaching FAQ

4 Free Resources specifically designed to address pain points in medical practice

Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling consults.

Free Resources Link