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 Baumbach, MD  is an Assistant Professor of Emergency Medicine at The Ohio State University and Assistant Director of the Kiehl Resident Wellness Endowment Awake and Aware | Our 2024 Live EventJoin us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.Website: Awakeandawarebend.comEarly bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024CME? Yes! This is a CME eventººººººººººººººººººººººººººººººººººLove medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.4 free resources specifically designed to address pain points in emergency medicine practiceThe Driveway DebriefScripting your least favorite conversationsThe quick and dirty guide to calling consultsMy 4 favorite documentation templateFor full show notes of this episode and all sorts of other goodies, visit our podcast website

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, MDChris 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, MDDr. 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.ººººººººººººººººººººººººººººººººººAwake and Aware | Our 2024 Live EventJoin us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.Website: Awakeandawarebend.comEarly bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024CME? Yes! This is a CME event ººººººººººººººººººººººººººººººººººLove medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.4 free resources specifically

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.   Awake and Aware | Our 2024 Live Event Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.  Website: Awakeandawarebend.com Early bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024 CME: Yes! This is a CME event. The Flameproof Course | Self mastery and anti-burnout This course will make you so burnout-resistant that when they tell you to see 5 patients an hour with only a rusty spoon in your pocket and a unit clerk at your side, you will just smile (results not guaranteed). The next cohort begins Feb 1, 2024. Learn more here.   Love medicine, but the job itself leaves a lot to be desired? I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.   3 free resources specifically designed to address pain points in emergency medicine practice Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates   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 positivity action How to overcome resistance. Strategy 1 – Phil Stutz’s The Tools Even the best feel fear, it can almost never 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

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.   Our 2024 Live Event Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.  Website: Awakeandawarebend.com Early bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024 CME: Yes! This is a CME event.   REGISTRATION FOR THE FLAMEPROOF COURSE IS NOW OPEN This course will make you so burnout-resistant that when they tell you to see 5 patients an hour with only a rusty spoon in your pocket and a unit clerk at your side, you will just smile (results not guaranteed). The next cohort begins Feb 1, 2024. Learn more here.   Love medicine, but the job itself leaves a lot to be desired? I work with many docs in your shoes. To learn more about 1 on 1 coaching, start here   3 free resources specifically designed to address pain points in emergency medicine practice Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates   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

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.   Our 2024 Live Event Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.  Website: Awakeandawarebend.com Early bird discount code: FULLYAWAKE24 $100 off registration. Expires Jan 31, 2024 CME: Yes! This is a CME event.   The FlameProof Course: Next cohort begins Feb 1, 2024 This course will make you so burnout resistant that they can tell you to 5 patients an hour with only a rusty spoon in your pocket and a unit clerk at your side. And you will just smile (results not guaranteed). Learn more here.   Love medicine, but the job itself leaves a lot to be desired? I work with many docs in your shoes. To learn more about 1 on 1 coaching, start here   3 free resources specifically designed to address pain points in emergency medicine practice Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates   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.    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

Just as none of us are born with the skills to build and sustain a campfire, neither do we have the innate knowledge to foster 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   Our 2024 Live Event Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots.  Website: Awakeandawarebend.com Early bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024 CME: Yes! This is a CME event.   REGISTRATION FOR THE FLAMEPROOF COURSE IS NOW OPEN This course will make you so burnout resistant that they can tell you to 5 patients an hour with only a rusty spoon in your pocket and a unit clerk at your side. And you will just smile (results not guaranteed). The next cohort begins Feb 1, 2024. Learn more here.   LOVE MEDICINE, BUT THE JOB ITSELF LEAVES A LOT TO BE DESIRED? I work with many docs in your shoes. To learn more about 1 on 1 coaching, start here   3 FREE RESOURCES SPECIFICALLY DESIGNED TO ADDRESS PAIN POINTS IN EMERGENCY MEDICINE PRACTICE Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates   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   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 For Complete Shownotes, click here  

What: Awake and Aware. Our 3-day live event When: May 1-3 2024 Where: Bend, Oregon. USA Website: Awakeandawarebend.com Early bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024 CME: Yes! Category 1 AMA continuing medical education credit  

Burnout is not a foregone conclusion. While individual efforts play a pivotal role, continually battling systemic challenges can be exhausting. In this episode, we delve into a simple and cost-effective systemic intervention that not only mitigates burnout but also enhances job satisfaction. We then discuss how you can recognize when your colleagues might be in distress, what to do about it, what to say, what not to say, and how to break through the stigma of seeking help.    Registration for the Flameproof course is now open This course will make you so burnout resistant that they can tell you to 5 patients an hour with only a rusty spoon in your pocket and a unit clerk at your side. And you will just smile (results not guaranteed). The next cohort begins Feb 1, 2024. Learn more here.   Love medicine, but the job itself leaves a lot to be desired? I work with many docs in your shoes. To learn more about 1 on 1 coaching, start here   3 free resources specifically designed to address pain points in emergency medicine practice Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates   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   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  

What’s the impact of private equity’s increasingly large footprint in medicine? The results so far have not been promising.  We dissect: what is private equity, the recent bankruptcy of the largest emergency medicine staffer in the US and how that impacts clinicians, can corporations practice medicine,  the American Academy of Emergency Medicine has jumped into the fray, does profit-driven medicine ever serve patient care, HCA has been accused of naughty deeds, performance metrics versus the one metric that really matters, the No Surprises Act, and  physician unions. 3 free resources specifically designed to address pain points in emergency medicine practice Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates Registration for the Flameproof course is now open The next cohort begins Feb 1, 2024. Learn more here. Love medicine but the job itself leaves a lot to be desired? I work with many docs in your shoes. To learn more about 1 on 1 coaching, start here   Guest Bio: Leon Adelman, MD, MBA, FACEP, FAAEM is an emergency physician and co-founder of Ivy Clinicians, a software company that simplifies the emergency medicine job search through transparency. Dr. Adelman is the author and publisher of the Emergency Medicine Workforce Newsletter, which explores the business of emergency medicine. As medical director at Tennova Healthcare Clarksville and Johnston Health UNC (large rural EDs in Tennessee and North Carolina), Leon led emergency department teams to exceptional patient-centered outcomes. Leon is a graduate of Brown University, the University of North Carolina School of Medicine, the Harvard-Affiliated Emergency Medicine Residency at Beth Israel Deaconess Medical Center, and the University of Tennessee Haslam College of Business. Leon is married to an emergency nurse and has two adorable dogs.   We Discuss:  What does 'venture capital/private equity' in medicine really mean? The largest emergency medicine staffer in the US, Envision, recently went bankrupt. What happens with all of those clinicians and hospitals when the staffing company implodes? A corporation cannot practice medicine in most states in the US (but can in some!). The American Academy of Emergency Medicine is suing Envision and their corporate entity for the illegal corporate practice of medicine Is there a functional difference between the old-school CMG (contract management groups) and modern-day private equity-owning medical groups? Does profit-driven medicine ever serve patient care? HCA has been accused of funneling patients into end-of-life care to improve hospital mortality metrics.  Has private equity made universal healthcare impossible in the US? The group you want to work for sees physicians as the business rather than an expense to minimize Quality of shift is a metric you rarely see on your monthly performance stats, but it should be at the top of the list Would you ever wash your rental car? The downstream of not having ownership in a group The No Surprises Act was set up to protect patients. It’s kind of a mess.  Physician unions. Can doctors go on strike? Leon’s guess outlook for the emergency medicine job market in the coming years  

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.  Stay Connected Sign up for our newsletter here. Never spammy, always fresh. Our best stuff delivered to your inbox.  Elevate Your Career To learn more about 1 on 1 coaching, start here Registration for The Flameproof Course is Now Open The second cohort begins Feb 1, 2024. Learn more here.  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. 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  

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.  Stay Connected Sign up for our newsletter here Read our last newsletter “The Kids Who Hated Math Have Something to Teach Us” here Elevate Your Career To learn more about 1 on 1 coaching, start here 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. 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  

It’s tempting to think of accepting the reality of the moment as acquiescence or giving up, but the opposite is true. Awareness and acceptance of what’s going on inside of you and around you is a recipe for equanimity. With this equanimity, you are able to operate at a higher level as well as be an effective agent for change in the system. Sounds like a paradox! In this episode, we look at mindfulness as a tool for addressing and mitigating burnout, fostering self-compassion, promoting a sense of well-being, squashing imposter syndrome, restoring autonomy, working through our ‘specialness’, getting out of a scarcity mindset, doubting self-doubt, and getting charts done so you can get home on time (yes, it’s true!)  For complete show notes, click here.    Stay Connected Sign up for our newsletter here Read our last newsletter “The Kids Who Hated Math Have Something to Teach Us” here Elevate Your Career To learn more about 1 on 1 coaching, start here   Guest Bio Gail Gazelle, MD, MCC is an assistant professor at Harvard Medical School and Master Certified Coach for physicians. She is the author of Everyday Resilience. A Practical Guide to Build Inner Strength and Weather Life’s Challenges, and most recently Mindful MD. 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout. To hear more of Gail, she’s the featured guest on Stimulus Episode 27.    We Discuss What the heck is mindfulness anyway? The thinking mind can be overwhelming. Mindfulness training helps us gain autonomy. Apps and other methods to assist with meditation and mindfulness. Mindfulness helps in gaining awareness and insight into one's inner dialogue. Recognizing that we are not our thoughts helps restore autonomy and cure burnout. Imposter beliefs contribute to burnout and prevent recognition of our own accomplishments. Steps that can be taken to challenge and overcome imposter beliefs. Combatting the "special syndrome" experienced by many physicians? The role self-compassion plays in reducing burnout and improving motivation. Shifting from inner criticism to inner ally. How does the focus on comparison affect healthcare professionals' well-being? Practicing gratitude and abundance mindset shifts physiology and wellbeing Emotional reactivity and resistance to accepting reality impact healthcare providers. Mindfulness helps healthcare providers appreciate the present and avoid a "milestone mindset" There's often confusion between acceptance of the moment and acquiescence to an external issue that you want to change  

Investigative journalist Scott Carney is our guest as we dive into: Why you might want to consider getting in cold water, the technique for staying in cold water for more than a few seconds, how to take your first step into the freeze, brown fat, the power of lightly held beliefs, how people are dying with the Wim Hof method, and the law of speedy gains.    Shield yourself from bullsh*t Want to re-spark the joy in your practice, get home on time, unstick what’s feeling stuck, or even just build a shied for all the BS you face in a workday? Start here to learn more about 1 on 1 coaching. You’ll be glad you did.   Guest Bio: Scott Carney is an anthropologist, investigative journalist, author, and a seeker of both the fringes of human experience and the core of what makes us human. Scott has written four books to date, including The Vortex, The Enlightenment Trap, The Red Market,  What Doesn’t Kill Us, and The Wedge, and produced the recent film The Rise and Fall of the Wim Hof Empire. Scott’s work has been featured in many magazines — Wired, Mother Jones, Playboy, Foreign Policy, Men’s Journal, and National Public Radio. He has won the Payne Award for Ethics in Journalism and is a multi-finalist for the Livingston Award for International Journalism. You can find all his goodies on his website.   Check out our new (free!) Mini Book Scripting Your Least Favorite Conversations   We Discuss:  The mindset method for staying in cold water Detailed steps for entering cold water The benefit of breaking through walls and physiologic control using ice water exposure The power of lightly held beliefs Cold exposure as a lightly-held belief People are dying using the Wim Hof method The Bitcoin Enema Does Brown Fat matter? The law of speedy gains  

The Drama Triangle identifies our roles in dysfunctional interpersonal dynamics. It can be a potent tool for understanding conflict and miscommunication within personal and professional relationships. In this episode, we break down the core components of the Drama Triangle, strategies to disentangle ourselves from ‘drama’, and explore practical tools to identify and navigate the dynamics of our own interactions. Check out our new (free!) Mini Book on Scripting Your Least Favorite Conversations   Kickassery Want to re-spark the joy in your practice, get home on time, or just unstick what’s feeling stuck? Start here to learn more about 1 on 1 coaching. You’ll be glad you did.   In this podcast, we discuss: What is the Drama Triangle? The Empowerment Dynamic Recalibrating from drama to neutrality

How do you make important decisions? Do you go by your gut, some sort of defined process, or perhaps a combination of the two? When we're offered an opportunity to participate in something that seems amazing, 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.   For full show notes visit our podcast page Interested in one-on-one coaching? Learn more at roborman.com Subscribe to our kickass newsletter here

Are you often quick to give advice? You're not alone, but sometimes our advice may not be as helpful as we think. In this podcast episode, we explore the concepts of the advice trap and humble inquiry, which shift communication from telling to asking and encourage us to stay curious a little longer.   For complete show notes with way more detail than you see on this podcatcher summary, click here. If you’re not into that kind of detail, have an aversion to websites, don’t really care about show notes, or are contrarian in nature, by all means, do not click here.    Guest Bio: The late Edgar Schein, PhD. was a renowned figure in the field of organizational psychology, with significant contributions to the understanding of organizational culture and leadership. As a Professor Emeritus at the Massachusetts Institute of Technology's Sloan School of Management, his academic work spanned several decades, educating countless leaders and thinkers. Holding a Ph.D. in Social Psychology from Harvard University, Dr. Schein was widely recognized for his groundbreaking theories on corporate culture and process consultation. His seminal works, including “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. Kickassery: Want to re-spark the joy in your practice, get home on time, or just unstick what’s feeling stuck? Start here to learn more about 1 on 1 coaching.    Mentioned in this episode:  Our recent newsletter on communicating with patients  Newsletter Signup Here Freebies with documentation phrases and tips on calling consults Here The Advice Trap Link Humble Inquiry Link   Registration is open for the FlameProof Course This is a small cohort six-month course specifically for emergency and acute care clinicians that will build and strengthen tools for career longevity, strategies for well-being, life balance, and so much more. Learn more here.    In this pod, we 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 The take-home challenge Ed Schein quotes from this episode  

How often do you walk into work hoping it will be a good day or at least not a bad one? What if it 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.    For complete and detailed show notes, visit our website  If you’re interested in 1 on 1 coaching, start here    Guest Bio: Christina Shenvi MD, MBA, PhD is an emergency physician at the University of North Carolina, Chapel Hill.  She is president of the Association of Professional Women and Medical Sciences, director of the UNC Office of Academic Excellence, and a world-class time management coach www.timeforyourlife.org. A selection of her previous Stimulus episodes includes Procrastination,  Habits, and ‘Too Much on My Plate.’   Registration is now open for the Flameproof Course.  Scott Weingart and I are launching the FlameProof Course starting September 2023. This is a small cohort six-month course specifically for emergency and acute care clinicians that will build and strengthen tools for career longevity, strategies for well-being, life balance, and so much more. Learn more on the brand-spanking new website.   Mentioned in this episode:  The Quick and Dirty Guide to Calling Consults and My 4 Favorite Documentation Templates Zen Driving Be Water documentary   We Discuss: How do you define a nearly perfect shift? What to do when you 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 

In this episode, we explore the 10% rule - the idea that in disagreement, the other person is at least 10% right. This is a tool for conflict abatement as well as resolution.  Registration is now open for the Flameproof Course The big kahuna! After a year in the making, Scott Weingart and I are launching the FlameProof Course starting September 2023. This is a small cohort six-month course specifically for emergency and acute care clinicians that will build and strengthen tools for career longevity, strategies for well-being, life balance, and so much more. Learn more on the brand-spanking new website. Half day in person. Flameproof: Shift KickAssery workshop on May 29, 2023, at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here.   Interested in one-on-one coaching? Learn more at roborman.com For full show notes visit our podcast page We discuss The sublime feeling of basking in our own rightness How to operationalize the 10% rule Don't lie and try to appease Yes vs No. And vs But. All the buts in your day The 10% Rule in real-time

Transitions, by their nature, involve ambiguity and disorientation. It's important to recognize that this zone is a natural part of the process of growth and change. In this episode we break down the nature of the being in a transitional/liminal space, embracing it as an identity, and navigating it through small and tectonic changes.    Registration is now open for the Flameproof Course The big kahuna! After a year in the making, Scott Weingart and I are launching the FlameProof Course starting September 2023. This is a small cohort six-month course specifically for emergency and acute care clinicians that will build and strengthen tools for career longevity, strategies for well-being, life balance, and so much more. Learn more at the Flameproof website. Half day in person. Flameproof: Shift KickAssery workshop on May 29, 2023, at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here.   Mentioned in this episode:  The Quick and Dirty Guide to Calling Consults  https://roborman.com/free-resources/   Interested in one-on-one coaching? Learn more at roborman.com For full show notes visit our podcast page   In this episode, we discuss: What is a liminal space? Situational awareness and the big picture Embracing a transitional identity Essential tools and strategies for navigating uncertainty  

Hidden in plain sight is the most important procedure we do. Listening. And not just listening, but listening to understand. Measurable, improvable, and, when done well, can have an incredibly positive impact. Intention is key with listening: are we doing it to understand or to win? In this episode, we break down specific strategies for quality listening, potential pitfalls, and how to know when you've got it right. Guest bio: Lon Setnik MD is an Emergency Physician and Associate Director of Clinical Programs at the Center for Medical Simulation with expertise in communication Registration is now open for the FlameProof Course The big kahuna! A year in the making, Scott Weingart and I are launching the FlameProof Course starting in September 2023. This is a small cohort six-month course specifically for emergency and acute care physicians that will build and strengthen tools for career longevity, strategies for well-being, life balance, and so much more. Learn more on the brand-spanking new website. Half day in person. Flameproof: Shift KickAssery workshop on May 29, 2023, at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here. Our first-ever listener survey Your feedback helps us improve the quality of our podcast. We'd really appreciate it if you could spare a few minutes to answer this survey.    In this episode, we discuss: The concept of listening as a procedure Two modes of listening: listening to understand and listening to win  Specific tools for listening to understand Separating the problem from the person The external marker of quality listening Finding the optimized solution in patient interactions Negotiation strategies for success Active vs empathic listening How to stay present during conversation Interested in one-on-one coaching? Learn more at roborman.com For full shownotes visit our podcast page    

Have you ever wondered what it takes to reach the highest level of mastery?Are you a medical student looking for ways to achieve excellence in medical school or a physician wanting to become an expert in your field? If so, you’re in luck! Join us as we explore a fascinating conversation with Dr. Jeff Riddell, a leading expert in medical education as he talks about strategies to develop any skill, how medical school curriculum is adapting, the importance of context and relationships for comprehension, and so much more. Mentioned in this episode: Scott Weingart and I are putting on the Flameproof: Shift KickAssery workshop on May 29, 2023, at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here. Guest bio: Dr. Jeff Riddell is an Assistant Professor of Clinical Emergency Medicine at the Keck School of Medicine of the University of Southern California. His research on digital technology in medical education has made him a sought-after teacher, speaker, and researcher. He has won numerous accolades and awards for his work in both teaching and research, including the 2019 CORD/EMF Emergency Medicine Education Research Grant and the 2019 Academy Scholar Award in the category of Education Research from the CORD Academy for Scholarship in Education in Emergency Medicine. For full show notes visit our podcast page We Discuss:  Mastering Learning Mental Models of Expertise Evolving Medical Education Learning Retention from Podcasts Threaded Cognition - A Theory of Concurrent Multitasking Is There Gender Bias in Medical Education? Resident Burnout  

Have you ever had a day at work that was so difficult and draining, it felt like it took a toll on your entire being? You're not alone. Meet Dr. Sara Gray, an expert in wellness, resilience, and resuscitation team performance. In this episode, Dr. Gray dives deep into her special framework for coping with difficult days and how to recover and even come out of them a little stronger. She has outlined a process to help you identify and acknowledge the struggles, practice self-care, and ultimately, learn from the experience. This framework will provide you with a roadmap for navigating the complex emotions that come with these difficult moments. The Flameproof Course on Shift KickAssery: Scott Weingart and I are putting on the Flameproof: Shift KickAssery workshop on May 29, 2023, at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here. Guest Bio: Dr. Sara Gray is an Emergency Medicine & Critical Care Physician, Associate Professor at the University of Toronto, and Chief Medical Director with Advisory Services by Cleveland Clinic Canada. Dr. Gray was once named Toronto’s best ER doctor by Toronto Life Magazine. She is also a professional coach and a public speaker.   Interested in one-on-one coaching? Learn more at roborman.com For full show notes visit our podcast page   We discuss: Why it's important for medical professionals to prepare for a bad shift or traumatic event. The framework steps in coping with bad shifts and difficult cases. What is a failure friend and what are their characteristics?   Quote of the pod "We train to manage all sorts of disasters, to manage the worst cases, but nobody teaches you how to recover when it goes badly...If you have a plan, you can make your recovery so much easier." - Dr. Sara Gray

Part of practicing medicine is telling patients NO. 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.  Mentioned in this episode: Scott Weingart and I are putting on the Flameproof: Shift KickAssery workshop on May 29, 2023, at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here. (The Flameproof reg is halfway down the page)  Interested in one-on-one coaching? Learn more at roborman.com For full show notes visit our podcast page   We Discuss: What is the Spock Retreat? The scenario: a patient pushes for something that they think will help but will actually harm. A common response when we get pushback on our logic. You 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. For full show notes visit our podcast page

When you have a patient who requests a Z-pack for what is almost certainly an acute viral respiratory infection, you probably respond internally or externally (possibly both) that antibiotics do not treat viruses. But could there be some effect on their symptoms, or the viral infection itself, that is not part of the common discussion when it comes to such things? We know that azithromycin is an antibiotic, but it turns out that azithromycin actually has some activity in the viral arena. This absolutely shocked me. The question is, does it matter?  Interested in one-on-one coaching? Learn more at roborman.com To support the show - visit our Patreon site and help keep the wind in the sails.  For our full catalog of shows with complete show notes, visit our podcast page To wit… In vitro studies show azithromycin reduces rhinovirus replication and release.  Another in vitro study on respiratory cells from lung transplant patients found azithromycin reduces rhinovirus-associated cellular inflammation. Kids with coronavirus (the pre-COVID, old-school coronavirus)  had reduced viral load with azithromycin.  In enterovirus-infected mice, azithromycin improved survival.  Patients infected with influenza a who were given azithromycin had reduced interleukins 6, 8, 17, tumor necrosis factor, and CRP, indicating anti-inflammatory properties in flu patients. This study, however, did not show improved clinical outcomes with azithromycin. Another study using a similar methodology did not see any change in inflammatory markers but had a slight improvement in sore throat and fever resolution in the azithromycin group.  A 2009 paper found that azithromycin did not improve disease course in hospitalized infants with a respiratory synovial virus. There has been signal of clarithromycin decreasing hospitalization in patients with severe RSV, but the preponderance of data are fairly consistent that there is no benefit in hospital stay, length of illness, or oxygen utilization.   Selective poison Every medication is a selective poison and azithromycin poisons a lot of stuff: interleukin beta production, PGE2 synthesis, tumor necrosis factor, cytokine expression, it slows membrane trafficking towards lysosomes, and inhibits the fluid phase of endocytosis of macromolecules. Suffice it to say, there's a lot going on here.  When we see these changes in inflammatory markers or in vitro decreased viral loads, it isn’t far-fetched. By extension, it frankly wouldn’t be far-fetched if this drug improved resolution and severity of illness in viral upper respiratory infections. When it comes to the flu, an illness with cytokine dysregulation, a medication such as azithromycin, with its immunomodulatory and anti-inflammatory effects, looks very tasty.  Bottom line: It's pretty clear that something happens when a patients take this drug. It's even possible that they may even have a sense of feeling better. I can't refute that.  My assumption is that their cold or acute sinusitis improves despite their taking an antibiotic, but maybe there is something subtle afoot that is as yet unmeasured. Unfortunately, the data to date do not show observable clinical outcome benefits with azithromycin and viral infections. 

Most of us are motivated to have compassion for those in need, but sometimes it can feel like the tank is running on empty. In this episode, wellness expert Kim Baumbach, MD gives insight into compassion fatigue and strategies to thwart it.  Guest Bio: Kim Baumbach, MD  is an Assistant Professor of Emergency Medicine at The Ohio State University and Assistant Director of the Kiehl Resident Wellness Endowment. 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.    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. For full shownotes visit our podcast page

Our guest today is Dr. Stephanie Pearson, founder and CEO of Pearson Ravitz, an insurance advisory firm that specializes in disability and life insurance for healthcare professionals. In this episode we break down disability insurance start to finish: what to look for in a policy, pitfalls and traps, the deal with disability coverage through work, the steps you need to take in order to collect disability, why insurance companies so often put up a fight in paying, and much more.  To see our most recent newsletter, click here. Interested in one-on-one coaching? Learn more at roborman.com A full transcript of this episode is available on our podcast page Guest bio: Before beginning her career in insurance, Dr. Pearson was in the prime of her career as an OB/GYN when she suffered a shoulder injury at work that soon prevented her from practicing medicine. Her struggle navigating the disability claims process and the challenges of losing her identity as a physician drove her to become a passionate advocate and advisor to her peers on the importance of disability insurance. Stephanie dedicated herself to educating others on the vital need to have the appropriate policy (something she had lacked) and decided to become an insurance broker; specifically, the rare type of broker who follows her clients throughout their careers, advising them continuously as their life circumstances change.   We discuss: Getting paid a disability benefit from a group vs private policy The history behind insurance companies heavily scrutinizing physician disability claims The fundamental differences between a disability policy you get through work vs. one you buy on your own The important fine print in a private policy: specialty specific and own occupation Can you still have a job that makes money and collect disability payments? The essential questions to ask an insurance agent when shopping for a disability policy What in insurance expert looks for in a policy to see if 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?

Financial expert and raconteur Vitaliy Katsenelson gives his approach to the scarcity mindset, personal finance advice that changed his life, key strategies for making a budget, why people argue about money, geofencing as a diet tool, and a Stoic take on social media.    Guest Bio: Vitaliy Katsenelson was born in Murmansk, USSR, and immigrated to the United States with his family in 1991. After joining Denver-based value investment firm IMA in 1997, Vitaliy became Chief Investment Officer in 2007, and CEO in 2012. Vitaliy has written two books on investing and is an award-winning writer. Known for his uncommon common sense, Forbes Magazine called him “The New Benjamin Graham.” He’s written for publications including Financial Times, Barron’s, Institutional Investor and Foreign Policy. His articles are also published on his website, ContrarianEdge, and in audio format on his Intellectual Investor Podcast. Vitaliy lives in Denver with his wife and three kids, where he loves to read, listen to classical music, play chess, and write about life, investing, and music. Soul in the Game is his third book, and first noninvesting book.   Awake and Aware Jan 13-15 2023: The Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (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 The value of a scarcity mindset; Personal finance advice that changed a financial expert’s life; Loose vs strict budgeting; Finishing books vs stopping early; Why people argue about money; Geofencing as a diet strategy; Habit vs. identity vs. willpower; How a Stoic philosopher might view social media.

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 show notes and links to what’s discussed on this pod, visit our podcast page    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.  Awake and Aware Jan 13-15 2023: The Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (that’s 15% off the whole package – lodging, meals, the course).  

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.  

It’s a tough time to practice medicine right now, which makes paying attention to self care even more important. In this episode we break down three specific strategies for: improving mental and physical performance, sustaining shift endurance, and building a scaffolding for joy at work.   Interested in one-on-one coaching? Learn more at roborman.com To support the show - visit our Patreon site and help keep the wind in the sails.  For full show notes visit our podcast page   Episode Sponsor: Ivy Clinicians. Curious if 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. 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)   We Discuss A perennial nocturnist shares his approach to career longevity; An unexpected thread in the origin story of medical training in the US; Three strategies to focus on self care and improve endurance during shifts; Fuel like an Ironman triathlete; Does the patient always come first? Using the dynamic between tension and relaxation to conserve energy; Using intention as a tool for self care.

28 years ago, the die was cast for how emergency department encounters were documented.  Since then, we've had note bloat, click fatigue, and too much attention placed on things that really 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.    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. Guest bio: Jason Adler, MD is  a clinical assistant professor of emergency medicine at the  University of Maryland where he is also the director of compliance and reimbursement. He is also the vice  president of acute care solutions at LogixHealth. Mentioned in this episode: The Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (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: 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.

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.  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. 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.   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:  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 email; Self compassion after a bad patient outcome; Exercises to help build compassion; The decision point between accepting people how they are and trying to change them; And More.

Verbal de-escalation is a tool that can be learned by almost anyone. In this episode, we learn from two masters in the art of de-escalating those who are agitated and upset:  Jose Pacheco, RN, known affectionately to his co-workers as ‘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.  Mentioned in this episode: Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (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: 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]; Jose Pacheco’s tips for interacting with difficult patients in the ED. [42:30]; Non-verbal cues [53:30].

What happens at the end of an event can disproportionately impact our perception and memory of it. In this episode, we investigate the research behind the peak end pattern and how you can use this phenomenon to improve your own experience at work (and life).   Interested in one-on-one coaching? Learn more at roborman.com To support the show - visit our Patreon site and help keep the wind in the sails. For full show notes visit our podcast page   We discuss: Research identifying a peculiar aspect of how memories and impressions are formed; The peak end phenomenon is often portrayed as a bug in our operating system, but it can also be used as a feature; Michael Jordan was a master of finishing time; Focusing on a peak end can not only lead to a better memory of events, but possibly better patient care; Is there evidence that focusing on the peak end will improve job satisfaction and lessen burnout? Two types of peak endings.

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.   For full show notes visit our podcast page Interested in one-on-one coaching? Learn more at roborman.com To support the show - our Patreon site is https://www.patreon.com/stimuluspod   We discuss: Availability Bias and how it relates to everyday decision making.  What is availability bias; Where this shows up in clinical practice; Learning is not availability bias; Whether more testing is the right path for subtle presentations of life threatening diseases; Testing thresholds; Tips for avoiding availability bias in our practices; Real world example of availability bias; Justin’s tools for addressing bias; Ways to hack the bias.

Specific strategies to improve workflow and manage overwhelm during an emergency department shift. Guest Bio: Landon Mueller, MD is an emergency physician and fellowship trained sports medicine specialist who gave the best talk I’ve ever seen on managing workflow in the emergency department. Now he's our guest on the show.    For full show notes visit our podcast page Interested in one-on-one coaching? Learn more at roborman.com To support the show - our Patreon site https://www.patreon.com/stimuluspod   We discuss: 3 phases of the ED visit Why disposition is king, until it isn’t Hierarchy of tasks Blocking time Linear vs parallel processing Swarming Batching The quick hit charting nidus Task switching Running the board Managing interruptions For full show notes visit our podcast page

What does it mean to act like a true professional? I’m not sure it’s been fully fleshed out in medicine but I’ve met those who are exemplars of it. This pod is a conversation with my partner in hundreds of critical resuscitations, Ben Peery, MD. We talk about wins, losses, lessons learned and, even more than that, I get to introduce you to someone who, for me, was a role model in how to carry yourself as a physician.  Guest Bio: Ben Peery, MD is a 20 year veteran of the emergency department, spending the bulk of that time working in a rural hospital. A former SWAT team member and tactical medicine expert, he is now host of The Grit Podcast with Ben Peery that you can find on Spotify, iTunes, and all the rest. Ben’s show is conversations “with colleagues in medicine, law enforcement, EMS and anyone else who has been in the sh*t. By sharing stories and insights we hope to offload mental trauma.”   Interested in one-on-one coaching? Learn more at roborman.com Support our work on Patreon For full show notes visit our podcast page

An inside look at what it takes to launch a ketamine clinic including: first steps, navigating hurdles, potential pitfalls, which patients benefit from ketamine, and an exhortation about why you should (and shouldn’t) go into this type of business.  For full show notes visit our podcast page   Guest Bio: Dr. Samuel Ko is a Board Certified Emergency Physician and medical director of Reset Ketamine in Palm Springs, California. In addition to his medical practice, Dr. Ko is Co-Creator of an online course - Ketamine StartUp - which teaches other physicians how to start their own ketamine clinic.  During his free time, he practices yoga, meditation, reads voraciously, and relaxes with his amazing wife, daughter, and four-legged son. Find Sam on the Insta and Facebook.   Here is the link mentioned in this episode with some ketamine clinic startup SWAG (the ultimate checklist and business plan template) from Sam Ko for Stimulus listeners.    Interested in one-on-one coaching? Learn more at roborman.com   Support our work on Patreon  

When you are at the lowest of lows after a devastating case, how do you recover in real time? 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   Interested in one-on-one coaching? Learn more at roborman.com To support the show, visit our Patreon site https://www.patreon.com/stimuluspod For full show notes visit our podcast page

Have you ever had a situation where afterward you repeatedly questioned the choice you made at the time? You chewed on it, perseverated on it, kept coming back to it? If you are a clinician, there is an amplifier to this because someone 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.   Interested in one-on-one coaching? Learn more at roborman.com Support our work on Patreon For full shownotes visit our podcast page

At work, you are often activated, hyper focused, and fully absorbed.  There can also be stress points and challenges that don't get processed because, frankly, you've got to move on to the next thing. These factors, amongst others, can make it difficult to just jump right into 'home brain'. In addition, there's a lot to untangle in your 'work brain' at the end of the day. What many of us do is kind of push that tangle it to the side and get on with the rest of day or, taking that up a level, numb it or drown it out so that it doesn't make too much noise.  If any of this sounds or feels familiar to you, I encourage you to check out this guided exercise to help with the transition between work and home. Click here to go to the blog post with the exercise(s) What's in there.. A brief focused breathing cycle down-regulate, shift from that sympathetic - go go go -to parasympathetic/decompressed A guided review of the day . What went well, what was interesting? What was challenging? Why was it challenging, what happened, and how could you approach it differently the next time? Release. Release whatever you're holding on to from work. 

Medical Ethicist Abbott, MD walks us through her perspectives on myriad ethical quandaries including:  How to approach discordance between a patient's written wishes and a family member who says do the opposite, the ethics of operating on demented patients who have an acute life threatening critical illness, a case of a young man with an unsurvivable brain bleed and whether or not to extubate him before the family enters the resus room, strategies to skillfully guide families through withdrawal of life support, and the real consequences of restrictive hospital visitation policies.   Interested in one-on-one coaching? Learn more at roborman.com Support our work on Patreon For full shownotes visit our podcast page   Guest Bio: Dr. Jean Abbott is a medical ethicist and faculty at the Center for Bioethics and Humanities and Core Faculty, Master of Science in Palliative Care, University of Colorado Health Sciences Center. She is also Professor Emerita University of Colorado School of Medicine, and 30 year veteran of the emergency department.  Not part of her CV but germane to this show...she was my attending when I was a resident in the 1990s and had a profound impact on who I became as a physician. Irreverent, quick witted, and a tireless patient advocate, she is one of the finest physicians I have ever known.    We discuss: Visitor 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?;

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. Interested in one-on-one coaching? Learn more at roborman.com To support the show - our Patreon site https://www.patreon.com/stimuluspod For full shownotes visit our podcast page   We Discuss: The status quo for the way we handle mistakes creates multiple victims, but no winners.  [03:30] It was the aftermath of an unfortunate case that sparked 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 implementation of CARe programs? [28:45]

Sleep expert Mike Stone, MD joins us for a conversation about how to sleep well (and strategies to do it poorly!)  We cover: how sleep cleans your brain, alcohol, caffeine, a pragmatic approach to wearables, light exposure, the villainy of devices before bed, cannabinoids, heat, room temp, and night shifts.  Guest Bio: Dr. Mike Stone has been in medical practice for almost 20 years, and currently serves as the Chief Education Officer at Wild Health. Dr. Stone has held academic appointments at Harvard Medical School and UCSF, and has received multiple national awards for education, innovation, and leadership in medicine. He has spent the bulk of his career focusing on educating students, trainees, and colleagues. Mike is obsessed with optimal health and peak performance, with a deep interest in the effects of lifestyle interventions to improve longevity and cognitive function. He is currently focused on knowledge translation for healthcare practitioners, striving to empower practitioners with practical techniques to competently construct strategies and tactics for their patients' health optimization. Interested in one-on-one coaching? Learn more at roborman.com To support the show - our Patreon site https://www.patreon.com/stimuluspod For full shownotes visit our podcast page   We discuss: What is sleep and why it is important [04:00]; The benefits of exposure to morning sun early in the day and limiting light exposure later in the day [08:00]; A primer on sleep stages [09:30]; How to use wearable sleep trackers smartly [13:45]; Alcohol and sleep [16:40]; Light, blue light and screen time before bed [24:00]; The physiology of caffeine [26:15]; Cannabinoids as a sleep aid [29:30]; Heat – what is the ideal room temperature for optimal sleep? [34:00]; Other sleep hygiene ideas [38:20]; Natural predilection:  the early bird vs. the night owl [40:10];l.  Damage control for night shift associated sleep disturbance [43:45]; Melatonin questions [58:00];

None of us are immune from the Fundamental Attribution Error - chalking up the behavior of others to their character rather than the situation in which they find themselves. In this episode, we tease out the details of this common bias, its negative effects, and several strategies to address and work through it.  Interested in one-on-one coaching? Learn more at roborman.com To support the show - our Patreon site https://www.patreon.com/stimuluspod For full shownotes visit our podcast page   Episode Highlights: The core tenant of fundamental attribution error; The fact that nobody sees themselves as the villain of their own story; Marcus 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; This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob:  Twitter, Facebook, and Youtube.

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.    Interested in one-on-one coaching? Learn more at roborman.com To support the show - our Patreon site https://www.patreon.com/stimuluspod For full shownotes visit our podcast page   We Discuss: A Tiny Habits success story [04:55]; Why it may be better for habits to start tiny [07:10];  The three step process of Tiny Habits begins with an ANCHOR MOMENT [08:05];  The second step is the NEW TINY BEHAVIOR [10:25];  The third step and most often neglected: INSTANT CELEBRATION [12:45]; Celebrations that are intrinsically rewarding resonate better from some people than those that are extrinsic [14:50]; Behavior swarm refers to using multiple specific behaviors that can help you achieve a big aspiration [18:50]; Why temptation linking can be remarkably effective [23:10]; The two things that make an action more likely to happen:  motivation and the ease of doing it [26:00]; Scaling tiny habits to larger habits [30:00]; Atomic Habits by James Clear may be even more applicable to large behavioral change [32:35]; Willpower and behavioral change [35:20]; The psychological concept of streak perception [38:30]; Using a negative emotion as a prompt for behavioral change [40:00]; And more. This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob:  Twitter, Facebook, and Youtube.

Chances are that you have a robust inner critic. You might even believe that self criticism and castigation are the only ways to excel. As a high level performer, you are not alone. In this episode, we break down the nature of inner criticism and several ways to silence it (or nearly so).   Interested in one-on-one coaching? Learn more at roborman.com To support the show - our Patreon site https://www.patreon.com/stimuluspod For full shownotes visit our podcast page We Discuss: 3 objectives in the training of ski jumpers which can be applied to any moment or high stakes situation [02:30]; The importance of self talk [03:45]; What IS your inner critic? [05:40]; The first step to thwarting the inner critic is to be aware that it exists [08:00]; Judgment vs. discernment [09:10]; Dialogue of “the Judge” compared with “the Sage” in a complex resuscitation scenario [11:00];  Switching from “What if” to “What’s next” [13:15]; The second step to quieting the inner critic:  coming back to center [15:15]; Activating the voice of the Sage, that motivates through curiosity, empathy, and purpose [17:22]; One way to shift out of self judgment and into discernment is to speak (think) about yourself in the third person [21:20];   This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob:  Twitter, Facebook, and Youtube.

Finding time to debrief challenging or difficult cases can feel nearly impossible amidst the tumult and task saturation of medical practice. The reality, however, is that 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 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. Support the show (https://www.patreon.com/stimuluspod) For previous episodes, detailed show notes, or to sign up for our newsletter: https://roborman.com/category/stimulus/ This podcast streams free on iTunes, Spotify, and Stitcher. Interested in one-on-one coaching? https://roborman.com/ Follow Rob:  Twitter, Facebook, and Youtube.

It doesn’t look like performance metrics are going away any time soon. So why not make them a feature instead of a bug?  Guest Bio: Shawn Dowling MD is the medical director of The Physician Learning Program at the University of Calgary and Clinical Content Lead at the Calgary Zone Emergency Department.    We discuss: Why metrics are important and how reframing the process can make them  feel less punitive  How providing metrics can be an impactful tool to get physicians to identify improvement opportunities and implement changes in their practice The goal:  to improve the quality of care provided by making individual-level as well as system-level changes Audits are meant to be self-reflective, not punitive.  The fact that current metrics cannot identify the secret sauce for making the best ED provider. They are interrelated and need to be “balanced”.     Support the show (https://www.patreon.com/stimuluspod) For previous episodes, detailed show notes, or to sign up for our newsletter: https://roborman.com/category/stimulus/ This podcast streams free on iTunes, Spotify, and Stitcher. Interested in one-on-one coaching? https://roborman.com/ Follow Rob:  Twitter, Facebook, and Youtube.

There is no doubt that handing over care of a patient to another clinician is potentially fraught with peril. After all, 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. 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.   Support the show (https://www.patreon.com/stimuluspod) For previous episodes, detailed show notes, or to sign up for our newsletter: https://roborman.com/category/stimulus/ This podcast streams free on iTunes, Spotify, and Stitcher. Interested in one-on-one coaching? https://roborman.com/ Follow Rob:  Twitter, Facebook, and Youtube.

It can be hard enough managing critical tasks in the best of times, but when things start to go awry, you need to focus even more to keep moving in a positive direction. Back by popular demand, Dan Dworkis (our guest on episode 57) walks us through: navigating uncertainty when under situational pressure, powering down at the end of the day, managing the physiologic response to stress, the most thoughtful procedural time out we’ve ever heard, and transparent team communication.  Guest Bio: Dan Dworkis MD, PhD is an emergency physician who is a clinical professor of emergency medicine at USC Keck School of Medicine. He’s also host of the Emergency Mind podcast that focuses on helping individuals and teams perform better under pressure and the author of The Emergency Mind: Wiring Your Brain for Performance Under Pressure.  This episode brought to you by Wild Health!  Wild Health provides personalized medicine that takes into account DNA, biometrics, microbiome, and lifestyle factors to come up with your ideal diet, supplements, and lifestyle to optimize health and maximize healthspan. I have been through the Wild Health program and found it a game changer as far as optimizing diet and exercise. Use the code GET30 for 30% off the monthly subscription. Learn more at wildhealth.com.    We discuss: How Dan’s approach to resuscitation or stressful situations has changed since he started The Emergency Mind project [02:30]; Applying the core principles of prepare, perform, recover, and evolve to the scenario of a difficult intubation [05:20]; Breathing techniques to manage the physiologic response to stress [07:40]; Being cognizant of the other people in the systems around you and communicating what you think you might need next [09:00]; How to build a high-functioning culture [10:55]; Leave no trace emergency medicine and tale of the squeaky door [15:30]; The drama triangle:  victim, villain, and hero [17:15]; Altering the principles of behavioral economics when doing a timeout in the ED [19:15]; David Marquet’s fist to five [24:15]; Cognitive load theory and how it helps us guide trainees who struggle when it comes to knowledge under pressure [27:40]; Managing task saturation with systems and structure [31:30]; Powering down after a shift [32:45]; The fact that some days a win is simply not “throwing gas on the fire” [40:12]; Algorithmic vs creative thinking and the shape of uncertainty [42:20]; Dan’s recommendations for new listeners of his show [50:47]   For previous episodes, detailed show notes, or to sign up for our newsletter: https://roborman.com/category/stimulus/ This podcast streams free on iTunes, Spotify, and Stitcher. Interested in one-on-one coaching? https://roborman.com/ Follow Rob:  Twitter, Facebook, and Youtube.

A book I recommend to many coaching clients is “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.    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.   For previous episodes, detailed show notes, or to sign up for our newsletter: https://roborman.com/category/stimulus/ This podcast streams free on iTunes, Spotify, and Stitcher. Interested in one-on-one coaching? https://roborman.com/ Follow Rob:  Twitter, Facebook, and Youtube.

After a short sabbatical, Stimulus Podcast returns next week.  In this 6 minute pod: what we've been up to and what we'll be up to in the coming months. Our new website https://roborman.com/

Case studies using Nonviolent Communication in real world situations including:  how to give a proper compliment, perils of bringing up past issues, emergency empathy when speaking to a consultant, receiving gratitude, point of care compassion, and the limitations of NVC in the resus bay.  Guest bio:  Scott Weingart is an emergency physician who went on to complete fellowships in Trauma, Surgical Critical Care, and ECMO at the Shock Trauma Center in Baltimore. He is best known for his EMCrit Podcast which focuses on resuscitation and ED critical care, and most recently, On Deeper Reflection, an exploration of academic productivity, philosophy, and wellness. He is the author of two books:  Emergency Medicine Decision Making and the Resuscitation Crisis Manual.   We discuss:   The violence in communication that NVC is seeking to remedy [ 03:40]; Why you should avoid discussing the past in heated conversations [06:00]; How to give a compliment NVC-style [11:00]; Receiving gratitude [17:25]; Emergency empathy [18:45]; 4 levels of response evolution [22:30]; Limitations of using NVC in the emergency department [24:45]; Point of care compassion [27:00]; The last 3 words mirroring technique [28:50]; Using NVC when the person you’re talking with has a personality disorder [30:40]; What happens when you use NVC to “manipulate” someone who is astute and quickly realizes they’re being managed [35:00]; The fallacy of attribution [38:30]; And more.   For complete shownotes: https://roborman.com/category/stimulus/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/   This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.  

Nonviolent Communication is one of the most powerful ways of speaking with people that I have ever come across. It eliminates useless strategies like judgment and proving yourself right and instead gives you absolutely tactical techniques to get the things you need for happiness for yourself and your interlocutor. NVC is not a new, gimmicky set of dictum. It boils down the philosophies of Stoicism, the psychological approaches of cognitive behavioral therapy (CBT), and cognitive psychology.   For complete shownotes: https://roborman.com/stimulus/stimulus-podcast-69-a-primer-on-nonviolent-communication/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/   This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.  

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. 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.   For complete shownotes: https://roborman.com/category/stimulus/https://roborman.com/stimulus/68-taking-th/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.

We share two conversations about navigating the waters of interacting with unvaccinated COVID patients. Brit Long, MD and Jose Pacheco, RN are thoughtful healthcare providers with somewhat different approaches. The common thread is that both are intentional and compassionate.   Guest bios:  Brit Long is an assistant professor of emergency medicine in San Antonio, Texas and Editor-in-Chief of Clinical Content at emcdocs.net. He is one of the most published authors in the field of emergency medicine. Brit is working in a unique environment where he's running what is in effect a COVID emergency department in an underserved area with an incredibly high unvaccinated rate.  Jose Pacheco is an emergency department nurse who is a local legend for his kind personality and fully engaged approach to caring for patients. He is not just a legend among healthcare providers, but frankly, among the community.   We discuss: 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.   For complete shownotes: https://roborman.com/stimulus/67-caring-for-the-unapologetically-unvaccinated/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.  

How do you decide whether to say yes or no to something? In this 5 minute episode, we break down a simple yet incredibly effective heuristic taken from the book Hell Yeah or No by Derek Sivers. For complete shownotes: https://roborman.com/category/stimulus/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.

The nature of medical practice dictates that we will have tough cases. Patients will die, we will have to deliver bad news, and we will, at some point, make mistakes. We have high expectations of ourselves so when we get figuratively knocked down, how do we get back up? In this episode, performance coach Jason Brooks guides us through strategies for dealing with the emotional and intellectual fallout of a bad case as well as how to re-engage during a shift when the last thing we feel like doing is seeing the next patient.   Guest bio:  Jason Brooks Ph.D. is a performance coach helping healthcare providers, athletes, and other high-level performers live better, work better, and be better. Check him out at Phenomenal Docs and connect with Jason: Facebook, Twitter, email doctorjbro@Gmail.com   We discuss: The fact that no matter how good you are in your medical practice, you are not immune to a bad outcome [02:20]; How to manage the sense of failure and the anxiety that naturally occurs when you’re faced with the same situation again [04:00];The importance of getting prepared ahead of time and expecting bad things to happen [06:00]; Channeling the experience into something positive [08:25]; Learning to live with and honor these experiences, rather than dread them [10:00]; Drawing a lesson from a bad event and making a commitment to apply that lesson [16:30]; The value of talking to someone who is able to receive your emotional turmoil in the immediate aftermath of a bad outcome [18:40]; Why we shouldn’t think of it as “bouncing back” from a terrible outcome [23:00]; What do you do when you’ve had a bad outcome, but you don’t have the time to process what’s happened before your next shift [29:00]; The importance of having a process that you can trust to be effective in helping you shift your attention back to where it needs to be [32:25]; And more.   For complete shownotes: https://roborman.com/stimulus/65-bouncing-back-after-a-tough-case/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.  

Justin Bright MD, CPXP is an attending physician and the Assistant Medical Director for Patient Experience in the Department of Emergency Medicine at Henry Ford Hospital in Detroit. He is fascinated by the intersection of patient experience, interpersonal communication, customer service, and employee engagement. Check out his ideas at www.ptexpmd.com or on The Patient Experience podcast on Spotify, Apple Music, or any other listening platform you enjoy. In this episode, we learn that patient satisfaction and the patient experience are different things. We can improve the patient experience by asking open-ended questions, recognizing nonverbal cues, validating emotion, and pausing to listen.   We discuss: A patient satisfaction survey rant [02:45]; The “patient experience” and how it is influenced by every conceivable touchpoint, perception, and logistical thing that may happen to a patient [11:10]; How making a purposeful choice to care helps ensure that our patients have a positive experience [16:15]; The power of the pause [19:35]; Avoiding the “doorknob complaint” by asking open-ended rather than direct questions [22:00];  Efficiently handling the situation when a patient has extra questions after you thought you had already completed the encounter [24:50]; The best way to acknowledge a patient’s long wait [26:40]; How to respond to the disgruntled patient who voices complaints about other people involved in their care or their prolonged wait [29:30] Deescalating the unhappy patient whose expectations of care were not met [33:10]; Salvaging the situation when a patient threatens to call the nurse administrator or an attorney [39:10]; And more.   For complete shownotes: https://roborman.com/stimulus/63-the-patient-experience-with-justin-bright/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.  

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. This short segment is a preface to a deeper future conversation about the importance of purpose.   For complete shownotes: https://roborman.com/category/stimulus/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.    

In this episode we hear from eight leading physician educators about a core principle of patient care:  primum non nocere. We learn that limiting harm can translate into doing what’s medically right, putting the patient’s welfare first, judicious use of IV fluids, reducing opioid prescribing, making a habit of pausing when depleted, acknowledging the end of life, and allowing a natural death.  For complete shownotes: https://roborman.com/stimulus/62-primum-non-nocere-first-do-no-harm/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.

The treatment of non-hospitalized patients suffering from COVID-19 is a hot topic and constantly changing. Today we have a conversation with Salim Rezaie, MD whose dive into this literature couldn’t be much deeper. We discuss which subgroup of patients might benefit from monoclonal antibodies, why the jury is still out on the benefit of ivermectin, the role of inhaled budesonide, and outpatient anticoagulation which hasn’t been studied, but hopefully will be someday. Guest Bio:  Salim Rezaie completed his medical school training at Texas A&M Health Science Center and continued his medical education with a combined Emergency Medicine/Internal Medicine residency at East Carolina University.  He currently works as a community emergency physician at Greater San Antonio Emergency Physicians (GSEP) where he is the director of clinical education.  Salim is the creator and founder of REBEL EM and REBEL Cast, a free, critical appraisal blog and podcast that tries to cut down knowledge translation gaps of research to bedside clinical practice. Hear more from Salim on Stimulus #16 Accumulation of Marginal Gains.   We Discuss:   The fact that the best treatment of COVID is prevention through vaccination [2:30]; The value and purported benefit of monoclonal antibodies [03:21]; Whether a rapid antibody test would help predict seronegativity [06:30]; Specifically which monoclonal antibodies are being used in Salim’s shop [07:40]; The irony of people demanding monoclonal antibodies, but refusing vaccination because they don’t know what's in it [08:50]; Why you can’t trust everything you read about COVID therapy in a news headline [12:40]; One of the largest ivermectin studies which was based on falsified data, yet continues to influence the results of meta-analyses [15:30]; Inhaled budesonide for COVID-19 symptom control [22:00]; The slippery slope of outpatient anticoagulation [23:39]; The things Salim might do if he had symptomatic COVID-19 and was well enough to be managed as an outpatient [27:25]; And more.   For complete shownotes: https://roborman.com/stimulus/61-outpatient-covid-19-therapy-with-salim-rezaie-md/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.    

Scott Weingart and I will be hosting a book club. When: Nov 14th 20:00 EST Where: Via Zoom Who: Anyone who will actually read the book and wants to participate. We are limiting this first one, so please don't sign up unless you are genuinely interested. We will be releasing a recording for those folks that want a passive experience. Nonviolent Communication: A Language of Life: Life-Changing Tools for Healthy Relationships How: Sign-Up Here. If we are full, put your name on the waiting list

Thinking about a career as an  expert witness but now quite sure how to get started? Or perhaps you already have a side gig in this line of work but you want to up your game. In this episode we chat with Amal Mattu, MD who is an expert at being an expert witness. He shares pearls of wisdom including what inspires him to do this, how he does it, and why you should remain nice even when 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.   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.   For complete shownotes: https://roborman.com/category/stimulus/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.

What does your life have in common with that of an astronaut? A lot, it turns out. Dan Mccollum returns to Stimulus to break down the skills learned by International Space Station commander Chris Hadfield as explained in his autobiography An Astronaut's Guide to Life on Earth.   Guest Bio: Dan Mccollum, MD is an emergency physician, associate professor, and associate residency director at the Medical College of Georgia. Hear more of Dan on Stimulus episodes #1 Verbal Judo #14 Stoic With A Capital S and #25 Digital Minimalism.   We Discuss:   The pitfalls of thinking too highly of yourself [1:46]; The importance of being a “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.   For complete shownotes: https://roborman.com/category/stimulus/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.  

Mass casualty events are rare and thus the mistakes made and lessons learned are often repeated, over and over. In this episode, emergency physician and former Special Forces medic Mike Shertz, MD walks us through the steps on how to be an effective first receiver of mass casualty victims and shares the lessons written in blood from previous events.    Guest Bio: Mike Shertz MD is an emergency physician who spent 13 years as a Green Beret and a Special Forces medic. He is the founder and purveyor of Crisis Medicine which teaches and trains first responders in tactical casualty care. Check out this video that we did together in 2019 on how to place and remove a tourniquet and this one on how to pack a gunshot wound with combat gauze.  We discuss: The First Receiver who is in a singularly unique position as it applies to a mass casualty [03:55]; The difference between a 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.     For complete shownotes: https://roborman.com/category/stimulus/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.  

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.    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.   For complete shownotes: https://roborman.com/category/stimulus/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.  

A hike in the jungle takes an unexpected turn. In this episode: medical emergencies in austere environments, managing acute pain without medication, and using breath work vs distraction in high stress situations.   For complete shownotes and video of how it played out: https://roborman.com/stimulus/stimulus-podcast-56-rescue-in-the-jungle/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.

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.   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 makes [10:20]; The Japanese concept of Ikigai [13:30]; Becoming more efficient by shrinking the amount of time you spend on things that are on your plate [15:45]; The 5 Whys technique for understanding the fundamental bedrock of your motivation [19:30]; Self worth theory, which helps explain both why we overwork/overcommit as well as why we sometimes procrastinate [25:00]; The concept of Stoic meditation and the Ozymandias exercise [30:10]; The constant struggle of determining if your work is aligning with your values and using Stoic indifference to suspend self-judgement [32:00]; Choosing to do things vs. “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.   For complete shownotes: https://roborman.com/stimulus/stimulus-podcast-55-too-much-on-my-plate-with-christina-shenvi-md-phd/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.  

What gives you fulfillment in your job? If you know it, do you make purposeful choices to keep pointed in that direction? With special guests: Amal Mattu Scott Weingart Greg Henry  Mizuho Morrison Haney Mallemat Reuben Strayer Mike Weinstock Victoria Brazil Ilene Claudius   For complete shownotes: https://roborman.com/category/stimulus/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.

Scott Weingart is arguably one of the most influential and polarizing physicians on the planet. He is not one to mince words and often comes across as definitive in how he describes his practice of medicine.  What people don't realize, he says, is that his clinical care is often guided by fear, not bravado, ego, or machismo. In this episode, Scott breaks down his five fears when it comes to medical practice and thinks that those who seek to follow his advice should take these fears into account before acting. Guest Bio:  Scott Weingart is an emergency physician who went on to complete fellowships in Trauma, Surgical Critical Care, and ECMO at the Shock Trauma Center in Baltimore. He is currently chief of the Division of Emergency Critical Care at Stony Brook Hospital and a tenured professor of emergency medicine at Stony Brook Medicine. He is best known for his podcast on Resuscitation and ED Critical Care called the EMCrit Podcast; it currently is downloaded > 400,000 times per month. Scott is the author of multiple books including Emergency Medicine Decision Making and the Resuscitation Crisis Manual.    We discuss: The distinction between carrying fear and being afraid [06:50]; Delayed sequence intubation (DSI) as an example for how healthy fear can keep things safe in the emergency department [09:30]; The importance of embracing the idea that sick patients don’t take a joke [13:40]; Scott’s fear number one: lawyers [15:15]; A common fear that Scott does not personally experience: being an imposter [21:00]; Fear of Monday morning quarterbacking [28:10]; Fear of procedural complications [33:15]; How Scott Weingart is not a jerk. He’s an acquired taste. [41:35]; Scott’s final fear: a patient dying on his watch [46:55]; And more.   For complete shownotes: https://roborman.com/stimulus/53-the-five-fears-of-scott-weingart/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.      

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. We discuss:   Strategies for maximizing retention of podcast content [04:20]; Listen to educational podcasts when your mind is fresh, such as when on your way to work rather than commuting home after a long day. Our limited amount of attention is relatively fixed, but it does depreciate as the day goes on and our energy wanes. Many choose to listen to podcasts during “interstitial time”, like when driving, exercising, or grocery shopping. You’re more likely to retain information if you’re doing a task that doesn’t require your full attention.   How your working memory is like the RAM of your brain [08:40]; Just like a computer will become bogged down and slow when it’s overloaded, so too does your brain processing speed diminish when cognitively overloaded. If your working memory is doing something fairly simple, like driving down the highway, then you have a fair amount of residual attention that you can spend on something like listening to a podcast. While driving through a busy city, however, the residual attention is going to be much less.   Why Josh prefers to listen to podcasts in the morning as this is when he is best able to focus [10:20]; Josh is often trying to cram podcasts into the interstitial spaces of life, but he finds that his mental ability to focus and vigilance are highest in the morning. This is the time that it makes the most sense to devote attention to something that involves integrating new information. As his ability to focus wanes, it becomes less and less productive to listen to informational podcasts. Similarly, it is common for people to do their “deep work” (that which requires the most attention) during the morning hours and “shallow work” later in the day.   The importance of using your brain for tasks that are appropriate for the state that it’s in [12:45]; When we first wake up, the vigilance that we have is very helpful for detail oriented tasks where we have to focus and pay attention. Conversely, we’re not so great at coming up with creative and innovative solutions to problems at that time. As the day goes on and attention wanes, napping or taking a deliberate break can help restore vigilance. Towards the end of the day, we do better at solving creative problems and “thinking outside the box”.   The fact that not every interstitial moment needs to be occupied by something educational or entertaining [15:55]; Lost among our culture is the value of a quiet moment while you’re sitting alone. “Go for a walk and leave your phone at home. Enjoy the silence. Enjoy the solitude.”   “A lot of the insights that we have come from quiet moments when we're actually not focused.”   How Rob consumes podcasts [17:10]; On road trips or long drives with his wife, they will pause and discuss points that come up. There is a spaced repetition element to this, but it also enhances the listening experience. For educational podcasts (of which this is one) he reads the show notes and occasionally reads the linked references. When deciding which podcast to listen to, first looks at the podcatcher summary and time stamped topics to see if it’s interesting. The title doesn’t always reveal what’s inside. Educational podcasts only when fresh, such as on the way to work. If had time, would teach pearls from that show to the ED staff. Usually, it’s not so high brow, it’s listening while cleaning the garage or folding laundry.   A recent study which evaluated the knowledge gained from listening to podcasts while driving compared to that gained from undistracted listening [20:40]; The authors presented 2 competing theories for this type of knowledge acquisition and tried to determine which applied to driving and listening. Limited capacity theory: “Humans have a limited capacity for the cognitive processing of information, because humans have finite resources available for learning. Each simultaneous task theoretically reduces available cognitive resources and may decrease their potential capacity for learning.” Theory of threaded cognition: “Tasks that do not require the same form of cognitive processing (e.g. walking and talking) may not compete for the same resources, thereby allowing for the performance of two distinct tasks without inhibiting the success of either component.” This was a randomized, crossover trial of 100 emergency medicine residents who listened to an educational podcast either while driving or when sitting undistracted in a room. After each podcast they took a test on the content. The findings: There was no significant difference between the driving and undistracted cohorts on the initial recall (74.2% vs. 73.3%) or delayed recall (52.2% vs. 52.0%). Bottom line: Getting your education or trying to learn while driving seems to be an effective strategy, at least as far as retention goes.   The value of silence [24:10]; Leave some of the interstitial cracks of time in your life open or free. Don’t fill all of them with things like podcasts. “Sitting in silence can have a rejuvenating, calming or stilling effect.” One of the most famous studies on the effect of silence was published in 2006. Study subjects were exposed to 5 different types of music of varying tempo and type, from slow sitar to fast Vivaldi. They found that passive listening to music accelerates respiratory rate, increases blood pressure and raises heart rate. The sympathetic activation of music was proportional to the tempo of the rhythm. The authors theorized that it was the level of concentration and attention that led to the arousal and sympathetic activation. The most striking part of the study was that a randomly inserted short pause of 2 minutes decreased blood pressure, minute ventilation, and heart rate. This relaxation effect was even greater than that seen at the end of 5 minutes of quiet relaxation at baseline. Bottom line: Inserting a few minutes of silence had a significant effect on relaxation, even more than listening to what is ostensibly relaxing music. Further, the effect of interspersed silence had an even greater relaxation impact than just baseline levels, giving importance to the contrast between listening and silence.   A functional MRI study which shows that listening to a story-based podcast lights up huge areas of the brain [28:35];     A study in mice which found that 2 hours of silence per day led to neurogenesis whereas background or white noise didn't [29:00]; In this study, the nerve growth was in the hippocampus which is associated with memory, learning, emotion, and memory. The results infer the benefit of silence.   And more.     References: Gottlieb M, et al. Maximizing the Morning Commute: A Randomized Trial Assessing the Effect of Driving on Podcast Knowledge Acquisition and Retention. Ann Emerg Med. 2021 Apr 27:S0196-0644(21)00162-1. Epub ahead of print. PMID: 33931254.   Bernardi L, et al. Cardiovascular, cerebrovascular, and respiratory changes induced by different types of music in musicians and non-musicians: the importance of silence. Heart. 2006 Apr;92(4):445-52. PMID: 16199412.   Huth AG, et al. Natural speech reveals the semantic maps that tile human cerebral cortex. Nature. 2016 Apr 28;532(7600):453-8. doi: 10.1038/nature17637. PMID: 27121839.   Kirste I, et al. Is silence golden? Effects of auditory stimuli and their absence on adult hippocampal neurogenesis. Brain Struct Funct. 2015 Mar;220(2):1221-8. PMID: 24292324.     This podcast streams free on iTunes, Spotify, and Stitcher. Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Follow Rob: Twitter,  Facebook, and Youtube.   Shownotes by Melissa Orman, MD

  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.  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.   For complete shownotes: https://roborman.com/stimulus/stimulus-podcast-51-five-specific-techniques-for-excellent-presentations-with-ross-fisher/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.  

Investigative journalist and bestselling author Scott Carney is our guest as we discuss: what it means to be human, going deep in the Wim Hof method, benefits of cold exposure, climbing Kilimanjaro without a shirt, using The Wedge to change conversations with your limbic system, kettlebell throwing, and why you might want to embrace failure. Guest Bio: Scott Carney is an anthropologist, investigative journalist, author, and a seeker of both the fringes of human experience and the core of what makes us human. Scott has written four books to date, including The Enlightenment Trap, The Red Market, and What Doesn't Kill Us.  Most recently, he authored The Wedge, which dives deeply into understanding the space between stimulus and response. Scott's work has been featured in many different magazines -- Wired, Mother Jones, Playboy, Foreign Policy, Men's Journal, National Public Radio. He has won the Payne Award for Ethics in Journalism and is a multi-finalist for the Livingston Award for International Journalism. This episode is in support of the Altruism in Medicine Institute, an organization founded by Barry Kerzin, a physician, teacher, author, and Tibetan Buddhist monk. The mission is to increase compassion and resilience among health care professionals and their patients. Compassion fatigue is a very real thing, especially in health care. Building your compassion muscle is one of the most potent tools not only for avoiding burnout, but for finding joy in what you do. We discuss:   The common theme of Scott’s books -- what does it mean to be human? [05:00]; In The Enlightenment Trap, The Red Market, and What Doesn't Kill Us, Scott writes about organ trafficking, cults, and ice/cold exposure. His most recent book, The Wedge, is about how to change the way one reacts to different stimuli and how changing that reaction changes your physiology. Who is “The Iceman” Wim Hof and and why might cold water immersion lead to general resilience [09:10]; Wim Hof is a Dutch athlete who developed a method of ice water immersion and breathwork protocols that give him what appears to be superhuman powers. Wim claims that his techniques can boost the immune system and cure autoimmune disease. Scott was initially dubious of Wim’s assertions and was eager to meet him. He quickly learned that Wim’s program works. Extreme cold exposure combined with breathwork creates a stressful internal state and triggers a fight-or-flight response. With Wim Hof training, you tell yourself, “I can do this, the stress isn’t so bad”, and the amount of cortisol, adrenaline, and other stress hormones that are secreted is reduced. By being able to handle that stress, your physiology adapts and contributes to overall resilience. Link to the science behind the Wim Hof method.   “We live in relatively static environments, having manipulated the environment to make us feel comfortable. Wim’s message is to get into places that make you feel uncomfortable from an environmental perspective and then learn to be OK with that. You start activating biological systems that have let us survive for all of the millennia before central heating and electric lighting.”   The three elements of the Wim Hof method and how they relate to the wedge [15:10]; Deliberate cold exposure. A breath protocol where you do rounds of controlled hyperventilation followed by exhalation and a breath hold. (Note: the cold immersion and breathing protocols are not meant to be done concurrently.) Your mindset during the stressful states of cold or hypoxia. This mindset led Scott to the concept of the wedge. If you put a wedge between challenging stimuli and your brain’s response to it, it gives you an opportunity to realize that this is something you can do. “You can find the benefits of the wedge in everything you do, because you’re constantly interacting with the environment. That environment is sending sensations to your body, and you have a choice on how you respond to that sensation.”   “That's really the point of being alive. Who I am is not the person you see when I’m sitting on the couch watching Netflix. I am the person engaged in something that is difficult. By expanding those limits to where you can exist in challenging places and yet do so comfortably is really the measure of who you are as a person.”   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]; Ice water immersion is a rapid exposure to a stimulus and the body responds immediately. Tuomo is a Tibetan practice with a similar goal, but it takes approximately 10 years to master.   Scott’s weekly cold water immersion practice with benefits that last 4-5 days [22:20]; Every weekend Scott joins a group of friends at a private lake where he does long immersions, at times lasting 26 minutes. He loves the anticipation, yet wonders why he keeps coming back for what many would consider to be torture. He enters the water calmly, and when his mind tells him that he should get out early, there’s another part of him that replies, “What if I just want to see how far I can go?” “It's so valuable to see my body go through these changes in the ice. It's this conversation between the words in my head and then what my body is actually telling me. When I get out, I feel warm with the sun on me. This good feeling can last 4-5 days where I'm in a better mood, knowing I've done something hard. It's almost addictive, to be put under these stresses and then come out and want to do it again.” Why ‘gritting it out’ is not an effective strategy for prolonged cold exposure [27:30]; If you approach an ice bath fighting the environment, trying to soldier through, you’re doing the method wrongly. Don’t tell yourself this is the hardest thing you’ll ever do, because those words are counterproductive. You need to relax, let the environment in, know you can do it, and zone out.   Climbing up to Gilman’s Point on Kilimanjaro shirtless and without oxygen [30:15]; Scott pushed through the hypoxia by doing the Wim Hof method of overbreathing (without the apneic breath retention) for 28 hours. He found he could counter the problems of altitude sickness by increasing his respiratory rate, adapting his conscious breathing to the environment that he was inhabiting. Scott’s sauna routine and the value of giving his body contrasts to adapt to new environments [33:25]; Scott enjoys a hot tub or sauna session after cold immersion. “The bigger the shift, the more response that your body is going to have.”   His latest book, The Wedge, and how the wedge is activating something within yourself in order to thrive in a difficult moment [36:25]; When you anticipate a remote stimulus that you’ve previously experienced (such as an ice bath), many expect it to be horrible and enter panic mode. The actual stimulus is your experience upon jumping in the water. In that moment, you get to decide how important those previous assumptions about the ice water are. You can make it worse or you can make it better, depending on whether you fire the limbic system. Once you’re in the ice water, you can redefine whether the experience is good or bad and whether it’s making you better or not better. The wedge is a tool that can be applied to any environmental experience: heat, psychedelics, relationships.   Using a library as a metaphor for the limbic system [39:20]; In the library of the limbic system there is a librarian, and when someone first enters the library they come with no history of prior experiences. All of the shelves which represent sensations are empty. When someone experiences a strong sensation, the librarian contacts the bookbinder (the paralimbic system) a few structures away in order to categorize this for future experiences. The bookbinder takes this signal and links it with your current emotional state at the moment. For the cold stimulus, the instinctual emotional state is panic, so this book (panic = cold) is sent down to the librarian to be stored on the shelf. The next time you go into ice water, the librarian has a book on the shelf which immediately links the cold with the unmitigated pain of your prior experience. “Your brain wires everything this way -- we are always living in our emotional past.” We can add new books to the library, however, because each stimulus can have more than one sensation linked to it. Cold can be terrible, but it can also make us feel really good.   “If we add more books to the library, we have more neural grammar in which to exist in the world. And we find that we can do that with all sorts of things.”   The philosophical question -- do we experience a shared reality? [44:20]; For the most part, everyone feels raw sensation (such as cold) the same way. As stimuli get more complex, we start to diverge because our own backgrounds (our “limbic libraries”) are different. “We need to realize two things. One, that we are all individuals. Two, that we're all connected. Everyone’s wedge is going to be different.” “We're given this one package of life. And the thing about life is you have to make choices about the things you want to do. We need to follow the things that bring joy, and we can find our wedge even within those things.”   Applying the wedge in the emergency department when your heart is racing and you’re profusely sweating because you’re having difficulty with a critical procedure[49:25]; Scott’s advice is to visualize failure. There are multiple things that can go wrong, and you should have some degree of professional detachment knowing that bad things can happen. Once you know that there is the potential of failure, of course you try not to do whatever might lead to failure. You do your very best in the present moment. We must accept that from time to time people are going to die. “Why are you even attempting to save someone if you can't accept the fact that you might fail?” “We valorize success. We do not accept failure in general. Do your best, but realize that you could fail and then realize that that failure breaks down into not just one error, but multiple errors before you get there.”   The solution (or wedge) for the mental irritation that often comes with reading opinions on social media [58:30]; What makes social media so impactful is that we automatically respond to things like tweets in fight-or-flight mode. “You can insert a wedge, but you're never going to overpower all biology on this. It’s just our limbic system playing out on the internet. Social media is toxic for a million reasons, and this is just one more reason to delete those accounts.”   Going from fear to joy to almost a spiritual place with kettlebell partner passing [01:04:30]; While the movement of kettlebell throwing is easy, the stakes are real. You must pay very close attention to the stimulus. It turns into an exercise of empathy. “I don't want to hurt you, you don't want to hurt me. And we're doing this thing that's actually a little dangerous. It really puts you into this moment of bonding.” You're throwing the kettle bell with love and you're catching the love from the other person. It's a spiritual practice. You realize that what the external world sees and what you are experiencing are totally different. And more. This podcast streams free on iTunes, Spotify, and Stitcher. Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Follow Rob: Twitter,  Facebook, and Youtube. Shownotes by Melissa Orman, MD

Recent evidence suggests that sex to orgasm can improve nasal airflow equal in degree to nasal decongestant spray. We break down the literature (which totals 1 article). Listen on: iTunes Spotify Stitcher   Based on: Bulut, Olcay Cem, et al. "Can Sex Improve Nasal Function?—An Exploration of the Link Between Sex and Nasal Function." Ear, Nose & Throat Journal: Full text   For previous episodes or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob: Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

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.  We discuss:   The fact that skill decay sets in rather quickly following an absence from the emergency department [03:50]; When emergency providers return to work after a long vacation, medical leave, or sabbatical, it is the norm to feel rusty and out of practice. It doesn’t matter how many prior years of experience you had; nobody is immune to it. Managing the complexities of an ED is not like ‘riding a bike’.   How motor skills, like riding a bike, decay much more slowly than cognitive skills [05:20]; Emergency medicine is a cognitively demanding pursuit. Effective clinical practice requires an enormous and varied base of knowledge integrated with a wide array of habits, behaviors, and communication strategies that allow us to evaluate and manage large numbers of patients seemingly simultaneously. This is the typical scenario: It is 15 minutes into your shift and you have to manage a crashing infant, an impatient lawyer/patient who’s demanding antibiotics for a cough, a weak and dizzy elderly patient who may have a life threat (or nothing at all), and a consultant on the phone who’s refusing to help a patient. We have to be efficient at problem solving and addressing all of these situations rapidly, while also being able to task switch quickly from one to the next. All the while, we have to make sure that we don’t miss anything dangerous. It’s not easy.   The principles behind skill decay: cognitive load theory and cognitive overload [07:66]; According to cognitive load theory, we have a limited amount of processing bandwidth at any given moment. Our working memory defines the maximum amount of tasks that we can simultaneously process. Most research suggests that only 5-9 tasks can be effectively processed by our working memory at any given time. Cognitive load theory also suggests that when we exceed our working memory’s capacity, our performance immediately suffers. This is called cognitive overload. With increasing practice and experience, any given task will take up less of our working memory’s overall capacity. When we are working often, the intellectual processes for a given situation will take up less of our overall cognitive bandwidth than if we are out of practice. Also, we are less likely to become cognitively overloaded.   Strategies for combating skill decay [09:30]; The surefire tactic is to simply work clinically as often as necessary to prevent skill decay. How often this is depends on the individual. Every clinician needs to answer this for themselves. Given that competence with cognitive tasks reliably will decay within several months, what do you do if you have no choice but to take a prolonged break from work? How we think is much more important than what we know. Listening to podcasts, reading, and going to conferences will help slow skill decay, but unfortunately the requisite medical knowledge is a relatively small part of the job. Simulation of tasks can serve as a meaningful way of maintaining skill during a period of non-use. Refresher interventions such as airway courses can be helpful, though clinical emergency medicine is much more complex and unpredictable than any one simulation can recreate. Proctoring is a reliable way to rebuild the necessary cognitive faculties we need to be an effective emergency physician.   Rob’s approach after a short absence which centered around visualization [12:50]; Step 1 -- Visualize resuscitations in the particular resuscitation bay in which he’ll be working. Work through in his mind complex procedures, such as intubations, chest tubes, and central lines. Step 2 -- Visualize an actual resuscitation from the point of the patient coming in, to receiving report from the paramedics, to going through the primary/secondary surveys, to managing medications, to working the EMR, and to speaking with consultants. Step 3 -- Visualize straightforward patients, such as lacerations, fractures, and headaches, and how he’s going to juggle it all. And more.   Shownotes by Melissa Orman, MD

New data this week has shed light on risks associated with COVID infection and the safety profile of mRNA vaccines in pregnant patients.  Listen on: iTunes Spotify Stitcher References Villar J, Ariff S, Gunier RB, et al. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr. Published online April 22, 2021. doi:10.1001/jamapediatrics.2021.1050 Full Text Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. The New England Journal of Medicine: Apr 21, 2021. Full Text   For previous episodes or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here

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. 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. We will match donations up to $1,000. We discuss:   The Las Vegas mass casualty and the wide range of emotional responses of those who were involved [03:50]; While everyone agrees this mass casualty was tragic, some trauma surgeons and emergency personnel described the experience of caring for the victims as deeply fulfilling. These specialists had dedicated their careers training to run a disaster, and when it finally happened, it was game on. For others, the experience brought shock and distress.   The fact that trauma is different for every single nervous system [05:50]; What’s traumatic for one person may not be for another. When people have a reaction to trauma (with recurring thoughts, difficulty functioning, etc), that’s their system trying to integrate the event and make sense of it all. It’s important that we normalize some of the response patterns. Factors that might increase the likelihood of having difficulty with trauma include a history of adverse childhood experiences or developmental trauma. Protective factors: taking action (vs. freezing) after a traumatic event and having a strong sense of meaning/purpose.   “Life is never made unbearable by circumstances, but only by lack of meaning and purpose.” ― Victor Frankl   Training to handle stressful events in a better way [08:15]; You can work on building resilience and learning how to modulate your nervous system. Having the right mindset, understanding your purpose, and incorporating a healthy lifestyle (breathwork, mindfulness, relationships, playtime) can all make a difference.   What’s happening physiologically when you have PTSD after a traumatic event [10:40]; Trauma is experienced through sight, taste, touch, sound, smell. It travels through your body into your brainstem and then into the limbic system. When you are exposed to the sensations associated with the initial traumatic event, your limbic system is flooded with the emotions of that event. This deep limbic system holds onto negative things more strongly than positive ones. Over time, for many people, the trauma starts to ‘integrate’ and one's memory of the event changes. Positive thoughts will emerge, like “I made a difference that day”. For others, their nervous system gets stuck. They stay in that trauma response. Strategies that are protective of your nervous system DURING a traumatic event [14:20]; Taking action (vs. the mindset of helplessness) is a protective factor when your nervous system spikes into the sympathetic zone. Giving yourself compassion is important if you’re feeling overwhelmed. You can recite the mantra, “We are doing the best we can, and that’s good enough.” Sending compassion to the people you’re taking care of and wishing them well is another “in the moment” strategy. The importance of PRE-TRAINING so that you have tools to down-regulate your nervous system in the moment [19:20]; Opening vision has an immediate calming effect. Looking up and opening your peripheral vision stimulates the vagus nerve. Breathing is the second best thing for managing the nervous system. Elongating the exhale for a few moments will instantly bring the nervous system down in a chaotic environment. Many people like cycles of breathing: in for a count of 3, hold for a count of 1, and exhale for 6. These tools can be used to modulate your daily activities and response to stress. They can help keep you in the sweet spot of your performance zone where you’re ramped up, but not overwhelmed or frozen. “Practice equanimity and awareness mindset so that it becomes automatic.”   Protective, positive strategies that can be used AFTER a traumatic event to reduce the risk of PTSD [25:50]; Connecting with your team or friends who can relate to the trauma you’ve been through is a far better option than isolating yourself and stewing. In medicine, critical stress debriefing is a big part of connection. While isolation generally puts you in a negative place, intentional solitude (especially if in nature) can be healing. Similarly, journaling helps quiet down the amygdala and integrate events. The Body Keeps the Score is a book that discusses how you can work with your body to move it towards integrating a trauma response. The role movement plays in down-regulation and why dosage matters [31:40]; Intense exercise can impart an extra-sympathetic dose on your nervous system which might help release your thoughts, but it adds stress to your system. Walking, hiking in nature, yoga, Tai Chi, and Qi Gong are down regulatory movement processes that quiet the amygdala and ramp up the parasympathetic nervous system, so that things can recover, repair, and integrate. The benefit of EMDR (Eye Movement Desensitization and Reprocessing) and other body-based therapies for processing acute trauma [35:10]; While talk therapy has a role, it engages a ‘higher level thinking brain’ which is not where the stuck trauma is stored. EMDR research shows that trauma reprocessing therapy should happen as soon as possible after a traumatic event, before it’s solidified in the limbic system. “Sometimes our system gets stuck in certain states, and we need help getting back to a nervous system that can modulate freely, like it's supposed to.”   The process of intentionally letting go, or “cutting strings”, when something is weighing heavily on you (such as a client, patient, etc.) [37:30]; Notice what state you’re in from a place of equanimity. Are you overwhelmed, amped up, stressed, anxious? Ask yourself if there’s something you need to learn from this. Take deep breaths, open your vision, or go for a walk to put yourself into neutral. Now, it's time to go into the place of emotional control, to let go, and to move on. Bring to mind something that makes you feel joy or gratitude, and then think about that client or patient that's weighing on you in this new state of compassion. Wish them well. Ryan recommends envisioning a pair of scissors or a sword cutting the tie with that person, wishing them the best and watching them drift away. The brain loves storytelling and imagining, so creating a visualization of letting go can be powerful. The more you do this, the quicker you get at it. “I like to be proactive in this way so that we're not waiting until someone's got full blown PTSD. How do we get in front of that? How do we become more resilient? How do we build these practices to modulate the day?”   And more. Shownotes by Melissa Orman, MD

The news this week has been replete with stories about increased clot risk in those who have received the AstraZeneca and Johnson & Johnson COVID-19 vaccines. In this episode, we break down: what we know so far about vaccine induced thrombotic thrombocytopenia (VITT), the research that has revealed an underlying mechanism, CDC and NHS recommendations, and a primer on cerebral venous thrombosis -- the primary clot site associated with VITT. We Discuss:   Vaccine induced thrombotic thrombocytopenia (VITT)   The similar mechanism of AstraZeneca's and Johnson & Johnson's COVID-19 vaccines [01:00];   Proposed mechanism of VITT [03:20]; Greinacher, Andreas, et al. "Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination." New England Journal of Medicine (2021). PDF Brief Report: Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination PDF   Types of clots associated with VITT [04:00];   Below is a breakdown of the first 6 US patients with reported VITT. Note that they all ended up having cerebral venous thrombosis, but half of them had additional clot locations. Image source CDC.   Incidence of VITT in the US and UK [05:00];   A frequent question in the conversation of this newly recognized phenomenon is, "How is this different than the regular background rate of disease? Isn't this consistent with the number of people who would get it anyway?" This CDC graphic suggests not.       In the UK, there have been 79 reported cases of VITT, over half with CVT. Like the US, there is female predominance.   The CDC rallying cry to treat this differently that other causes of cerebral venous thrombosis (CVT) [06:30];   Image source CDC CDC and FDA Statement Here   The Guy and St. Thomas UK algorithm for evaluating and managing patients with suspected VITT [08:00];     Thank you to St. Emlyn’s for posting this doc!   A primer on CVT   Why CVT can cause problems [10:30] Spadaro, Anthony, et al. "Cerebral venous thrombosis: Diagnosis and management in the emergency department setting." The American Journal of Emergency Medicine (2021).   Presenting symptoms of CVT [11:00] Headache is present in 90%, meaning it's common, but also means that 10% won't have headache (at least initially). 25% present with headache alone, but the majority also have another sign or symptom. Image source Spadaro, Anthony, et al. "Cerebral venous thrombosis: Diagnosis and management in the emergency department setting." The American Journal of Emergency Medicine (2021).   Physical exam findings and the sensitivity of papilledema [15:00]   Using D-dimer in the evaluation of CVT [16:50]; Ferro, José M., et al. "European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis–endorsed by the European Academy of Neurology." European stroke journal 2.3 (2017): 195-221. Tanislav, Christian, et al. "Cerebral vein thrombosis: clinical manifestation and diagnosis." BMC neurology 11.1 (2011): 1-5. A new clinical score for CVT [19:00]; Heldner, Mirjam R., et al. "Prediction of cerebral venous thrombosis with a new clinical score and D-dimer levels." Neurology 95.7 (2020): e898-e909. Full Text Image source Spadaro, Anthony, et al. "Cerebral venous thrombosis: Diagnosis and management in the emergency department setting." The American Journal of Emergency Medicine (2021). Utility of spinal tap as a rule out test [21:00];     Imaging options (CT venogram vs MR venogram) [22:00];     CDC treatment recommendations for VITT associated CVT and how it’s different than most other CVT’s [25:00]; CDC full slide deck Here   Testing patients with VITT for heparin-PF4 antibodies and how that may guide whether or not to use IVIG [26:35].   PF4 HIT antibodies are a common finding in VITT, consistent with the current thinking that VITT is a variant of HIT. Image source CDC CDC recs for testing and IV IG treatment   Refs Padmanabhan, Anand, et al. "IVIg for treatment of severe refractory heparin-induced thrombocytopenia." Chest 152.3 (2017): 478-48

The August 4, 2020 explosion in Beirut, Lebanon is thought to be one of the most powerful artificial, non-nuclear explosions ever, causing over 200 deaths and 7500 injuries. In 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. Listen on: iTunes Spotify Stitcher   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. We will match donations up to $1,000. Essentials of Emergency Medicine, the conference I host each year, is happening May 25-27, 2021.  For an additional $100 off registration, use the code 'orman' at checkout. We discuss: The moment of the Beirut explosion, when the ceiling started to fall in, the room started to shake, and then everything went dark [04:40]; 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.   For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob: Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

Our 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. 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. We discuss:   The barrier to sustainable happiness and the technique to overcome that [04:15];  Frederik’s strategies for preparing to speak publicly [06:40]; How becoming a soccer referee helped him strengthen his muscle of not taking things personally [12:04]; What it means if you feel hurt after receiving criticism [15:44]; The fact that thinking negatively is natural [22:46];  What you can do if you’re being dragged down by negative thoughts [24:10];  Body language and how that can affect your mood and self-confidence [26:30]; The difference between being called an orange and being told you’re selfish [28:36]; How Frederik reframes when he feels himself taking something personally [30:20]; A choice -- Do you want to be right, or do you want to be happy? [36:05]; Using empathy to manage conflict with a consultant in the emergency department [39:45]; Strategies for not taking it personally when you receive a poor patient satisfaction score or Yelp review [44:00]; Handling a scenario where your best friend forgets your birthday [48:45]; Why when giving gifts, be more like of the sun -- not expecting anything in return [52:25]; If Frederik were to design a bumper sticker [55:30]; And More   For complete shownotes: https://roborman.com/stimulus/stimulus-podcast-43-how-to-not-take-things-personally/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.

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.  This episode is in support of World Bicycle Relief. World Bicycle Relief delivers 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.  We discuss:   Zen and the art of scheduling [05:30]; Adams coaches his chief residents on making the work schedule. He has some unique ideas and approaches that are well thought out and have years of field testing. He recommends that they lay out the ground rules and expectations in advance (ie. how many days off will be honored), arguing that this is an enormously important part of management (and of life). He also makes sure everyone understands that life’s not fair (and maybe your schedule won’t seem fair as well).   Why you might not want to be a complainer [07:05]; When making the schedule for the attendings, Adams makes sure everyone understands that he’s going to give the extra bad decisions (for example, fewer weekend days off) to the person who’s most likely to complain. “The complainers are going to complain no matter what. I might as well give you something to complain about.” We can extinguish those behaviors (and the tendency to complain) by not rewarding them.   “You can't reward bad behavior. Otherwise everybody's going to behave badly. That's tactical management rules.” The benefit of assuming people are unreasonable and crazy [08:10]; If your expectation is that it’s normal human behavior to be unreasonable, then you won’t be perturbed or irritated when someone acts that way. And you’ll be pleasantly surprised when instead they’re nice and reasonable!   A strategy for handling people who degrade social capital [10:30]; You’re either building social capital or degrading it. People who send nasty emails, are the target of complaints, or talk negatively in the ED are not building culture or camaraderie. They’re degrading social capital. Adams charges those people at an hourly rate for the time it took him to handle the complaint. Then he distributes the money back to the people who never complain. “If people are creating problems, we charge for the cleanup of the problems because that takes time away from us building and advancing the department”. Since enforcing this a decade ago, the department rarely gets complaints and morale has improved significantly.   “It starts with extinguishing the negative behaviors and rewarding the heck out of good behavior.”   Blend and redirect, a technique for negotiation and collaboration that’ll make you much happier than combat [14:00]; When confronted with a conflict, instead of fighting and butting heads against the other person, blend your ideas and put them on the same frequency. When you're on the same frequency, you redirect in a way that's in everyone's interest.   “You can be right or you can be happy. Choose a path that is not going to cultivate resistance. Try to solve the problem together, because combat's not going to make you happy.”   This idea: “People are not against you. They're just for themselves.” [16:15]; When you realize that people are just asserting something for themselves, then you don't take it personally. You don't get angry, feel belittled, or offended. When you don't act offensively or angrily, you can get to better solutions.   “Nobody's against you, they’re for you. Everybody's on your team, they just don't know it yet. You can get them there.”   And more.   Shownotes by Melissa Orman, MD

We have a choice in how we perceive and act on any situation. Using that knowledge in an intentional way to shift perspective is at the core of cognitive reframing. Epictetus, the great Stoic philosopher, said it best,  "It is our attitude toward events, not events themselves, which we can control." Listen on: iTunes Spotify Stitcher Guest Bio: Jaime Hope, MD  is an attending emergency physician at Beaumont hospital in Detroit, Michigan. She is the author of Habit That!: How You Can Health Up in Just 5 Minutes a Day, leads the Better Health Habits online course, and teaches the Behavior Change and Motivational Interviewing Courses to future physicians at Oakland University William Beaumont School of Medicine. Essentials of Emergency Medicine, the conference I host each year, is happening May 25-27, 2021. Early bird discount ends April 3.  For an additional $100 off registration, use the code 'orman' at the bottom of the checkout page. We discuss: Reframing, a psychological technique which involves thinking about something from a different perspective [04:30]; How reframing can be used in the ED when 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. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx  

In this episode: Effect of Israel’s full bore vaccine program, protection after a single vaccine dose, immunity after a single dose in those with COVID antibodies from previous infection, evidence of decreased transmission following AstraZeneca vaccine, vaccine potency and viral variants. We Discuss:   Israel’s full bore vaccination program and the effect on new cases, hospitalizations, and severe disease [00:01:18]; In patients over 60 41% Decrease in new cases 31% decrease hospitalizations 24% decrease critically ill Article Link How much protection is there after a single dose of mRNA vaccine? [00:04:56]; Pfizer vaccine reduced infection 13-24 days after first vaccination by 51% compared to 1-12 days after infection Inflection point 18 days post vaccination This doesn’t mean to get one shot and be done, but gives insight on immunity following first vaccine dose and when it arises Article Link   Effect of a single vaccine dose on those who have pre-existing COVID immunity [00:07:00]; 109 people getting vaccinated divided into two groups. Those with and without SARS-CoV-2 immunity/seropositive vs seronegative for SARS-CoV-2 immunity IgG. Seropositive patients’ antibody response to the first vaccine was equal to or even exceeded the titers found in naive/seronegative individuals after a second dose. In other words -- one vaccine in this study led to a higher antibody level than those who didn't have existing immunity and got two shots . Antibody titers in those with previous covid/seropositive who got a shot had up to 10 fold the antibody levels compared to those who were COVID naïve/seronegative (see below graphic) This preliminary data also suggests that those with previous immunity didn't get much of an antibody bump after the second dose . Is the second dose worth it in those with previous immunity? Well, first immunity needs to be proven by blood testing. Using an intense reaction to the first vaccine is a poor man’s marker of previous immunity, but that’s not what this study looked at. Immunologists are divided on what to do here. Some say a second dose isn’t necessary if there are COVID antibodies prior to inoculation (or there is a strong reaction after first shot in those with a previous history of infection) while others cite the data- the studies look at a 2 shot program, so stick with that Article Link   Graphic from Krammer, Florian, Komal Srivastava, and Viviana Simon. "Robust spike antibody responses and increased reactogenicity in seropositive individuals after a single dose of SARS-CoV-2 mRNA vaccine." medRxiv (2021).   Evidence that the new Oxford AstraZeneca vaccine decreases asymptomatic infection and transmission [00:12:11]; Study participants regularly swabbed after vaccination The vaccine group had up to 67 percent fewer positive swabs suggesting decreased asymptomatic infection and transmissibility Study results also call into question dosing between shots Interval between shots and vaccine efficacy Under 6 weeks, 55% effective 12 weeks, 82% effective Article Link   Vaccine potency against UK and South African variants [00:16:06]; Article Link Why you shouldn’t plan a hootenanny quite yet, even if you’ve had 2 shots of vaccine [00:17:00];  

Vinay Prasad pulls no punches in this wide ranging conversation about the realities (and delusions) about chemotherapy research, principle centered social media engagement, flipping votes, the FDA drug approval process, the importance of early palliative care, the dangers of embellishing therapeutic benefit, medical reversals, effective vs efficacious, and trade offs in decision making.  Listen on: iTunes Spotify Stitcher Guest Bio: Dr Vinay Prasad is a practicing hematologist-oncologist and Associate Professor in the Department of Epidemiology and Biostatistics at the University of California San Francisco.  He studies cancer drugs, health policy, clinical trials and better decision making. He is author of over 250 academic articles, and the books Ending Medical Reversal (2015), and Malignant (2020).  He hosts the oncology podcast Plenary Session. Follow Vinay on Twitter. Episode Sponsors:  Today’s episode is sponsored by Stages Cycling, makers of industry leading cycling computers, power meters, heart rate monitors, and indoor studio bikes. When I say industry leading, I’m talking about last year's Tour de France winner Tadej Pogacar uses a Stages power meter and cycling computer. Stimulus listeners get 20% off your order of all Stages outdoor products (excepting the SB20 Smartbike which is awesome, just no discount). Use this link to go to Stagescycling.com and your 20% discount will be applied at checkout.  This podcast is also brought to you by Panacea Financial, a financial services company created for doctors, by doctors -- aiming to improve the lives of physicians and physicians in training with products and services tailored to the medical community.  Spotlighted in this episode is the Panacea Financial Foundation which provides grants to underrepresented minorities in medicine. Panacea Financial is a Division of Sonabank, Member FDIC. We discuss: The realities of the dissemination of scientific information on Twitter [05:12]; Vinay’s intent when he posts a controversial tweet [09:00]; Why he’s an outlier in the cancer drug policy circle [16:15]; A recent JAMA article which raises the question:  Do we have a collective delusion about the potential benefits of chemotherapy? [18:20]; The FDA drug approval process [20:25]; The discrepancy between what's measured in cancer clinical trials and what actually would matter to cancer patients [22:38]; Questions to ask when being offered treatment options for cancer [24:30]; The importance of having rich discussion with patients about treatment side effects and potential toxicities [28:30]; The value of early palliative care and a common cognitive pitfall in oncology [31:25]; The dangers of empathy and the better alternative:  compassion [35:00]; Why embellishing the benefit of a treatment is the wrong thing to do [39:20]; Prasad’s book Ending Medical Reversal and the potential harms of sudden flip-flopping of standards of care in medicine [44:00]; The difference between ‘effective’ and ‘efficacious’ as it relates to public health and policy [47:46]; Prasad’s thoughts on the language surrounding masks vs. the data surrounding masks [54:40]; How not wearing a mask might be the product of a lot of long-standing failures in American economic policy and upward mobility [01:02:00]; A deficiency of the pandemic which is to not thoroughly consider the trade-offs of the decisions we make [01:06:24]; What the data tells us about the risk of COVID transmission in schools [01:08:34]; And more. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob: Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

Master meditation teacher Robert Beatty walks us through: the basics of meditation, how to start a meditation practice, principles of mindfulness, understating the roots of suffering, how concentrating on the breath can lead to insight, and healthy vs unhealthy coping.  Listen on: iTunes Spotify Stitcher Guest Bio: Robert Beatty is co-author of Mindfulness for a Happy Life as well as founder and guiding teacher of the Portland Insight Meditation Community. He has worked with thousands of students and, as a practicing therapist, has created a unique synthesis of Buddhist methods of awakening and healing and those of western psychotherapy. Episode Sponsor:  Today’s episode is sponsored by Stages Cycling, makers of industry leading cycling computers, power meters, heart rate monitors, and indoor studio bikes. When I say industry leading I’m talking about last year's Tour de France winner Tadej Pogacar uses a Stages power meter and cycling computer. They are legit! Stimulus listeners get 20% off your order of all Stages outdoor products (excepting the SB20 Smartbike which is awesome, just no discount). Use this link to go to Stagescycling.com and your 20% discount will be applied at checkout.  We discuss: When starting a meditation practice, the importance of knowing what your ‘fantasy’ is about meditation [06:50]; Why having a meditation teacher is essential and how Ruth Denison influenced Beatty’s practice [08:30]; The paradox of 2 truths:  skillful effort to restrain unwholesome mental states and the effort to bring into being wholesome mental states [12:30]; Beatty’s guided meditation for the novice [15:00]; What it is in mindfulness that we’re actually being mindful of [25:10]; Driving a car The Headless Way [28:50]; Why it is almost universal in meditation practices to use the breath as the primary meditation object [30:15]; Beatty’s opinion of meditation apps [35:37]; How intentionally letting go of your thoughts and concentrating on your breath can lead to deep insight [38:38]; The 3 characteristics of existence and how they provide spiritual insight [42:30]; Using meditation as a purification process to help you let go of stuff (or people) that cause negative emotions [48:50]; A skillful way to come back to your meditation object that is not self-criticizing [51:30]; The metaphor of the two arrows and how it can be applied in daily life [54:50]; Healthy vs. unhealthy coping mechanisms [01:00:00]; The reasons people come to meditation [01:06:00]; Beatty’s aspirations [01:09:30]; Why ‘should’ is such a violent word [01:10:00]; And more. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

We break down three techniques to inoculate yourself against the stress of time critical tasks. Guest Bio: Jason Hine, MD is a community emergency medicine physician at Southern Maine Healthcare where he is the Medical Director of Education. He is a graduate of Tufts University School of Medicine and the Temple EM Residency program where he served as chief.  He serves as an Associate Editor and Author on the DownEast EM blog and podcast and has an interest in procedural skill set decay as well as the role of academics in improving the recruitment, retention, and satisfaction of community physicians.   Episode Sponsor: Panacea Financial is a financial services company created for doctors, by doctors -- aiming to improve the lives of physicians and physicians in training with products and services tailored to the medical community.  Whether it's scheduling residency interviews, trying to buy a house during training, or looking for ways to fund your practice, Panacea Financial was created to remove the unique financial hurdles of physicians and allow you to better serve your communities. Panacea Financial is a Division of Sonabank, Member FDIC. You can follow them on the Insta, Twitter, Facebook, and everybody's well dressed favorite, Linkedin.  Listen on: iTunes Spotify Stitcher We discuss: The importance of stress inoculation training when you need to perform a HALO (High Acuity Low Opportunity) procedure [05:15]; How inoculating against stress helps you 1) perform well when confronted with the situation in real life and 2) serves as a memory aid [07:05]; 3 techniques for stress inoculation [08:00]; Why you should not only ask people to observe you, but also request that they provide feedback on your imperfections [16:40]; The advantages of low-fidelity stress inoculation strategies as compared with simulation labs [18:00]; Additional tools for reducing stress [19:20]; And more. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob: Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

We break down what’s known about the new UK COVID variant: what it is, what’s meant by ‘more transmissible’, and potential effects on vaccine efficacy.  Listen on: iTunes Spotify Stitcher We discuss: A new COVID variant in the UK is reported to be 71% more transmissible than ‘wild type’ virus [00:01:45]; The epidemiologic data on the new variant [00:03:09]; NERVTAG has ‘moderate confidence’ of increased transmissibility [00:04:56]; UK technical briefing shows no increase in 28 day mortality for new variant (at least so far) [00:06:02] A South African variant shows similar behavior as UK virus [00:06:45]; Potential effects of new variant mutations on vaccine efficacy [00:09:00]; And More. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

Christiaan Maurer MD, was in his mid 40s when diagnosed with glioblastoma multiforme -- terminal brain cancer. In this episode, he and Rob discuss: what terminal illness taught him about time, what people with cancer do and don’t need, preparing your family for a future without you, the most/least admirable traits in physicians, and the secret of life.  We discuss:   The life-threatening diagnosis that helped Christiaan gain wisdom about life, death, and the practice of medicine [02:30]; Dr. Maurer was a 46 year old internal medicine hospitalist who was diagnosed with multicentric glioblastoma in February 2018. A neurosurgeon told him that without surgery, he had about a month to live. Following resection, he completed chemotherapy and radiation.   The right and wrong things to say to someone with a terminal illness [06:33]; At the time of the diagnosis or soon thereafter, say things that are gentle. As the diagnosing provider, you might say, “I’m sorry we’ve given you such bad news, but there are treatments for this.” As a friend, say, “I’m sorry, let’s go get a beer. I’m here for you if you need me.” Don’t say, “You can beat this,” especially if that’s not likely. Don’t say, “How are you? How do you feel?”   The fact that people with cancer often don’t call when they need help [08:00]; Be proactive. “Hey, I’m picking you up and I’m halfway there already. We’re going to the movies.” Just show up.   What people with cancer need and don’t need [08:45]; What you don’t need when you have terminal cancer is to hear about cancer. Don’t ask how the cancer is going. And don’t bring up the diagnosis in every future conversation. People with cancer don’t want to talk about cancer. And if they do, they’ll bring it up. Talk about other interesting events in your life.   How Christiaan reacted, emotionally, to his diagnosis [11:00]; When he first saw the tumor on his MRI, his reaction was a gasp of absolute shock and disbelief. Once the dexamethasone kicked in, he felt rage and anger. It was difficult to focus and concentrate. As time went on, he developed an intense immobilizing sadness. He was heartbroken for his children, far more so than for himself. “Every day is worth so much... It’s easy to lose sight of that when you think you have tens of thousands of days left. But remember your mortality and choose your big and small decisions accordingly.” -C. Maurer Preparing your family for the reality of your future. And their future without you [13:20]; Christiaan chose to be 100% direct. The information he shared with his children was unsugarcoated and sometimes slightly brutal. He tried to keep humor in it whenever he could. He found himself trying to compress the next 10-12 years of parenthood into 1 year, imparting wisdom that normally wouldn’t be shared until just before a child moved out for college.   “Fight for what is right, even if it costs you a job, money, a relationship, or a bad grade. Fight for the underdog, and don't give up.” -C. Maurer A hospitalist’s advice for emergency physicians [17:55]; When you call to admit a patient, be clear as to why the patient can’t go home. Rather than say, “He has gout”, say “He can’t walk, lives alone, and there are no family members who can help out.” And truly make an effort to contact and elicit help from family. The pushback from hospitalists often comes from chronic “bogus” admissions.   “If you're an E.R. doctor that's getting lots of pushback from lots of different hospitalists, then the problem might actually be you.” -C. Maurer   Qualities that make a “strong” ED provider [22:10]; Christiaan argues that you can only be one kind of ED doctor, and that’s a great one. You can’t be mediocre. Great ED doctors generate a broad differential diagnosis and rule out the top 6 on the list to the best of their ability. Providers should be able to present a patient clearly in one sentence.   The least admirable traits of ED doctors [23:00]; Christian gets very frustrated when a patient presentation begins with, “I don’t really know what is going on.” Upon hearing this, his brain instantly shuts off, and he just wants to end the call and figure the patient out himself.   The dangers of adhesive tape and advice for caregivers [24:00]; Remember that the interventions we do on patients (arterial lines, IVs, Foley catheters, removing adhesive tape, etc) cause significant suffering. Don’t do these procedures unnecessarily and remove them as quickly as you can.   The Mauer’s Sign of aortic stenosis [25:55]; Christiaan noticed that with severe or critical aortic stenosis, in addition to the murmur radiating to the carotids, it also could be heard over the left scapular spine (because bone transmits sound better).   Christiaan’s philosophy of medicine and message to the medical community [27:45]; Work hard, Don’t be lazy. Remember who this is really all for -- the patient, the patient, the patient..   And more. Shownotes by Melissa Orman, MD

The COVID vaccines are upon us! In this episode we disambiguate COVID vax side effects and the historical effects of acetaminophen and sleep on vaccine antibody response.  Listen on: iTunes Spotify Stitcher We Discuss: Listener questions about ERcast and how an mRNA vaccine works [0:00:30]; COVID mutations in Europe may increase transmissibility [00:04:40]; Recently published side effects and adverse reactions of Pfizer COVID vaccine [00:06:05] Impact of acetaminophen and ibuprofen on vaccine antibody response [00:10:13]; How sleep impacts vaccine antibody response [00:16:19].   For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

Most of us have habits we'd like to change -- both getting rid of bad ones and adopting good ones. It's easier said than done! Habits by nature are hardwired and happen without much activation energy. In this episode, Christina Shenvi MD, PhD breaks down the nature of willpower, how knowing it's a limited resource can play to our advantage, strategies for getting out of bad habits, and how to adopt the ones you want. Guest Bio: Christina Shenvi MD, PhD is an emergency physician at the University of North Carolina, Chapel Hill where she is the director of the UNC Office of Academic Excellence. A frequent guest on Stimulus, she has now started coaching and teaching more broadly on time management. Her goal is to help busy professionals find more peace with their schedules, feel less stressed, and use their time more effectively. Dr. Shenvi blogs at: www.timeforyourlife.org, and offers workshops on time management. Episode Sponsor: Panacea Financial is a financial services company created for doctors, by doctors -- aiming to improve the lives of physicians and physicians in training with products and services tailored to the medical community.  Whether it's scheduling residency interviews, trying to buy a house during training, or looking for ways to fund your practice, Panacea Financial was created to remove the unique financial hurdles of physicians and allow you to better serve your communities. Panacea Financial is a Division of Sonabank, Member FDIC. Listen on: iTunes Spotify Stitcher We discuss: Self-regulation and how it relates to willpower [06:00]; How willpower is a limited resource [08:00]; Tricks for building up your willpower muscle [14:45]; The habit cycle, and why we need to understand how habits work before we can change them [20:25]; Breaking bad habits using mental contrasting with implementation intention [24:55]; The process of strategic automatism, where you're strategically forming a habit so that you do it automatically [28:50]; Why it helps to think about the identity you want to have when you’re working on improving your habits [29:30]; Habit stacking [36:30]; And more. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

The Veterans Health Administration COVID-19 (VACO) Index for COVID-19 Mortality predicts 30 day mortality following a positive test. VACO co-creators Amy Justice MD, PhD and Joseph King Jr, MD, MSCE break down how to use VACO, what it does, and what it doesn’t. We’re also joined by Joe Habboushe MD, CEO of MDCalc, whose online VACO calculator makes using VACO far easier than doing it in your head. Here is a link to the VACO Calculator.  Listen on: iTunes Spotify Stitcher We discuss: The Veterans Health Administration COVID-19 (VACO) Index, what it is and how it helps us evaluate patients [01:20]; Why VACO doesn’t include race or BMI [03:40]; Whether VACO can be useful in the ED or the acute setting [08:20]; Potential applications of the VACO index [12:15]; What VACO does not do [18:30]; And more. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

A discussion with His Holiness the Dalai Lama’s personal physician Barry Kerzin, MD on: how he came to his unique job, why compassion might be better than empathy in healthcare, simple ways to develop compassion towards both others and yourself, the cure for jealousy, lessening the impact of errors, and a prescription for longevity in medicine and life.  Guest Bio:  Barry Kerzin, MD is a US born and trained family physician who for the past several decades has resided a monk in Dharamshala, India -- home of the Tibetan community in exile. In addition to serving as H.H. the Dalai Lama’s personal physician, Dr. Kerzin is the founder of the Altruism in Medicine Institute, whose mission is to increase compassion and resilience among healthcare professionals and extended professional groups, such as police officers, first responders, teachers and leaders. Self described as “...a doctor, a monk, a teacher, a lazy man. All of these things, yet none of these things,” you can follow Dr. Kerzin on Facebook, Youtube, Instagram or learn more about his story here.   We discuss:   How Barry Kerzin got the job of being the Dalai Lama’s personal physician [07:15]; It started with a request from His Holiness for a cholera vaccination so that he could safely travel to Brazil for an international environmental conference.   Why allopathic medical providers shouldn’t discount traditional health care systems [18:20]; Traditional Chinese medicine, Tibetan medicine and Ayurvedic medicine have a lot to offer. While we don’t have to accept these practices, we must be open and educate ourselves about them.   “Traditional health care systems are rich. They are almost always complementary with allopathic modern medicine.”   Advice Dr. Kerzin would give to his younger self upon graduation from family medicine residency in the late 1980s [24:25]; He would tell himself: “Open your mind and open your heart”.   The dangers of too much empathy [27:00]; Empathy is standing in the other person’s shoes. But you can become too close emotionally. You can inadvertently end up taking on or owning the pain of the person that you're trying to take care of. If you adopt a patient’s suffering and you don’t know how to clear it, the consequence can be a full-blown burnout syndrome.   “We're much more prone to go along the path to burnout if we practice empathy rather than compassion.”   Compassion, which is just about a half step back from empathy [29:15]; Kerzin teaches the importance of moving beyond empathy to compassion. By taking a half step back, it allows us to see more because we're less emotionally involved. It allows us to make better decisions on how to reduce the suffering for that patient and how to be more effective with our treatment, Compassion is the wish and the action, when we're able, to reduce or even eliminate pain and suffering.   “The feeling tone when we're practicing compassion is joy, because we're trying to help somebody. It's tinged with sadness because we feel their pain, though we're not overwhelmed by it.”   Methods of teaching compassion on a curricular level [33:20]; Kerzin founded the Altruism in Medicine Institute whose vision statement includes the aim to “transform medical education to incorporate curricula of self-compassion, compassion for others, mindfulness, and resilience as essential as anatomy, physiology, and pharmacology.” Studies have shown that compassion improves health in the fields of immunity, neurology, and cardiology. Additionally, it helps health professionals remain sane. Compassion is taught in a lecture-based format, small group setting, videos, and then applied in one’s daily routine. Kerzin recommends this mantra to cultivate compassion: “Just like I only want to be happy and not have pain, so does the other person just want happiness and not want to hurt.” If we recognize this commonality, it connects us.   The Buddhist practice of unconditional compassion [39:45]; Buddhism teaches that you should be equally compassionate to those you love as to those who might be torturing you. To reach this state is not easy.   The importance of mutual respect, even in the face of difference [43:35]; Compassion can be used as a tool to reduce divisiveness. If we can develop some respect for others, even if we don't agree, we can begin to bring back trust.   Replacing jealousy with rejoicing [46:00]; The first step is realizing the benefits of rejoicing and appreciating the deficits of jealousy. Jealousy robs you of your inner-peace. If you’re able to rejoice and appreciate the other’s success, you’ll feel much better. The second step is recognition of what you’re thinking and feeling, and being aware when jealousy is at play. The third step is learning how to replace (not suppress) jealousy with appreciation. This process takes practice.   “You're not suppressing jealousy, because we know that suppressing your negative emotions never works since they still are there.”     The pillars of self-compassion [49:48]; Spend more time in the present moment and observe your inner life/thoughts/feelings (this is Mindfulness with a capital “M”). When you’re undercutting, criticizing or doubting yourself, you’re remembering something from our past or fearing for the future. We can train ourselves to drop into the present moment through regular, daily mindfulness exercises. Tools include meditation, art, music, being in nature. Have concern for the welfare of others. Be kind to yourself. Cut yourself some slack. Forgive yourself and then forgive others. Start with forgiving yourself of the small things. This is a solo activity which allows you to open your heart and to be a more happy person.   Lessening the impact of an error [56:15]; All humans will make mistakes. Acknowledging that fact (and your mistake) is an important step forward.   Bodhisattvas -- people who have universal compassion that excludes no one [56:15]; People who have universal compassion relish difficult situations or being with difficult people because it gives them an opportunity to work on their negative reactions to transform them into positive ones.   What it’s like to live in Dharamshala and to be the Dalai Lama’s physician for the past 15 years [59:20]; Kerzin shares that His Holiness is, in many ways, beyond human. His mind is incredibly deep and profound. As a patient, he puts you at ease. As we should with every patient interaction, Kerzin does his best to inform the Dalai Lama of his medical options so that he can make his own decisions.   Dr. Kerzin’s prescription for longevity in medicine [01:07:45]; Compassion   And more.   This podcast streams free on iTunes, Spotify, and Stitcher. Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Follow Rob: Twitter,  Facebook, and Youtube.     Shownotes by Melissa Orman, MD

We review the false negative rates of different COVID tests (PCR and rapid antigen), the known knowns and known unknowns of the Moderna vaccine.  Listen on: iTunes Spotify Stitcher We discuss: Why the lack of a legitimate gold standard is a challenge when comparing different tests for COVID-19 [01:45]; RT-PCR:  why we shouldn't be reassured by a negative test result [03:45]; How your pretest probability of disease affects your interpretation of test results [07:00]; The COVID antigen test:  faster and more widely available, but less accurate [08:10]; A NYT report of a rapid antigen test study showing suboptimal test sensitivity when applied to asymptomatic people [10:15]; Why you can’t rely on a negative test to make your decision to travel or spend time with family/friends for the holidays [12:05]; Whether you need to quarantine if you’ve been in close contact with someone who themselves was exposed to a known COVID patient [13:30]; The Moderna vaccine which has a reported efficacy of 94.5% [14:00]; And more. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx  

Effective (and ineffective) leadership comes in many flavors, but there is an underlying quality to any good leadership that you know when you see it. In this episode, Colonel Jim Czarnik, MD and Josh Bucher, MD break down the lessons they’ve learned leading in both the military and civilian worlds of medicine and crisis situations. My favorite quote from this episode: “Purpose is embraced, not imposed.”   Listen on: iTunes Spotify Stitcher Guest Bios: Colonel Jim Czarnik, MD  is the Deputy Chief Of Staff, Surgeon United States Army Special Operations Command. He has previously served as Command Surgeon for US Army Africa and was instrumental in coordinating the multinational response to the recent western Africa Ebola outbreak. Josh Bucher, MD.is an assistant professor of emergency medicine at Rutgers- RWJMS. He is EMS-fellowship trained and currently holds the position of associate EMS Medical Director for RWJ-Barnabas MHS. An expert in tactical emergency medicine, he is medical director of the Middlesex and Somerset County SWAT team.  This episode is sponsored by Wild Health.. Wild Health provides personalized medicine that takes into account DNA, biometrics, microbiome, and lifestyle factors to come up with your ideal diet, supplements, and lifestyle to optimize health and maximize healthspan. Use the code "Stimulus” for  10% off any Wild Health care plan.   We discuss: What it means to be a leader and why leadership is a state of mind [03:15]; The culture that you want to create in your professional environment [04:10]; The ERO relationship (Event + Response= Outcome) [06:20]; Why self-motivation is so important for success in the emergency department [09:00]; How teamwork is directly related to your mission: a good patient outcome [10:40];  Keys to success when you transition to a position of leadership [13:40];  Mistakes young leaders or people newly in leadership positions commonly make [20:15]; The right mix of being respected and being liked [22:30]; Czarnik’s special skill for being able to start conversations with anybody, no matter who they are [27:25]; How Czarnik manages email [31:15]; Czarnik’s personal philosophy and approach to life [33:00];   Czarnik’s ask for the world of medicine and something he’d like to see change [34:10];  And more.   For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

In this Stimulus Thump: Should we be worried about COVID on surfaces? Tools to manage the third wave. A new study suggests there might be benefits from aspirin.  Having flu and COVID at the same time increases odds of mortality.  Listen on: iTunes Spotify Stitcher This episode is sponsored by Wild Health.  Wild Health provides personalized medicine that takes into account your DNA, biometrics, microbiome, and lifestyle factors to come up with your ideal diet, supplements, and lifestyle to optimize health and maximize healthspan. Use the code "Stimulus” for  10% off any Wild Health care plan. We Discuss: Two tools to mitigate mental health impacts of the third COVID surge [01:48]; Influenza and COVID co-infection increases mortality compared to COVD infection alone [06:40]; An association between aspirin use and decreased in-hospital mortality, ICU days, and need for a ventilator [10:00]; How long COVID exists on surfaces and does it remain infectious [14:57] More.    For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

  When things are going well, you may not notice how your mind is working. But sometimes, you are overtaken by events and it can feel like the gears are grinding in the worst possible way in both life and work.  In this episode, physician coach Gail Gazelle, MD,  walks us through the mental processes that happen in those gear grinding moments and how to not only work through them, but also come out the other side with resilience and a better understanding of ourselves. Guest Bio: Gail Gazelle, MD, MCC is a former hospice physician, part-time Harvard Medical School Assistant Professor, and Master Certified Coach for physicians. One of the leading pioneers in physician coaching, Dr. Gazelle has coached over 500 physicians and physician leaders on leadership development, mindfulness, emotional intelligence, resilience, and moving from burnout to balance. She is the author of Everyday Resilience. A Practical Guide to Build Inner Strength and Weather Life’s Challenges, (Free chapter here). You can contact Gail through her website and, if so inclined, schedule a complimentary coaching consultation. Today’s episode is sponsored by Wild Health.  Wild Health provides personalized medicine that takes into account DNA, biometrics, microbiome, and lifestyle factors to come up with the perfect diet, supplements, and lifestyle to optimize health and maximize healthspan. They also have a fellowship program to teach physicians, providers, and health coaches how to practice this new paradigm of medicine. Use the code "Stimulus” for  10% off any Wild Health care plan. We discuss: The fundamentals of mindfulness [02:55]; What burnout looked like for Dr. Gazelle before she embarked on a new career path as a physician coach [05:45]; The impact COVID-19 has had on her conversations with physician clients [07:15]; The response of front-line providers when referred to as a “hero” [10:10]; What it’s been like for physicians, trained to be the captain of the ship, when put in the position of managing COVID patients with little guidance from science [12:40]; How Gazelle helps physicians manage uncertainty and weather difficulty [17:30]; Tips for ensuring that the “daily dose of goodness” becomes a defined habit [21:30]; How accepting what is/isn’t in your control can help mitigate stress, frustration, and anger [29:50]; Different ways of handling a bad leader [33:00]; The importance of regulating your emotional temperature [38:00]; The problem with either/or thinking [42:00]; The STOP tool for applying mindfulness practice in the heat of an intense moment [45:50]; Anticipatory dread and catastrophic thinking in medicine [49:40]; The crossroads of imposter syndrome and perfectionism which makes for a cycle of perceived inadequacy [55:30]; An affirmation Gazelle created for her clients who struggle with perfectionism:  “I am good. I do my best. I cannot control all the rest.” [59:40]; And more.   For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx  

In this Thursday Thump: Is there a role for aspirin in COVID? Does vitamin D reduce the chance of getting COVID or being sicker once you have it?  Association between going to a restaurant and testing positive. Cardiac injury in athletes after mild and asymptomatic infection. Listen on: iTunes Spotify Stitcher We Discuss: Is there a role for aspirin in COVID infection? [01:42] ; The evidence for and against vitamin D in COVID infection [03:15]; COVID positive patients have increased odds of having been to a restaurant compared to COVID negative [09:57]; Understanding odds ratio [11:00]; Exercise with active covid infection isn’t a good idea [13:00]; Potential risks of exercise after COVID infection [14:00]; Ohio State University is going to get cardiac MRI on athletes to screen them for return to play [17:00]; Gadolinium Deposition Disease might or might not be a thing [17:54]; More. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

Our digital lives have become cluttered, scattered, and reflexive rather than intentional. Is it time for a change? In this episode, Rob and Dan McCollum, review the principles and exercises laid out in the book Digital Minimalism: Choosing a Focused Life in a Noisy World. Taking it a step further, they share what happened when they went full on guinea pig and dove deep into the process. Guest Bio: Dan McCollum, MD is an emergency physician, associate professor, and associate residency director at the Medical College of Georgia. Here more of Dan from Stimulus Episode #1 Verbal Judo.  This episode is brought to you by RingRescue, the new standard for stuck ring removal. RingRescue helps remove stuck rings in a non-destructive way and, when used with their non-hydrating lubricant, significantly reduces the need for ring cutting.  Use the code stimulus at checkout when you purchase your RingRescue finger compression device to get an extra bottle of their lube. Extra lube, free fifty free! Ringrescue.com/stimulus, checkout code stimulus. We discuss: Why digital minimalism is something we might want to consider doing [03:07]; The fact that most of the interactions that we have with social media are of low value [05:40]; The truth about why most people participate in social media [06:15]; The core principles of digital minimalism [07:20]; Cal 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]; And more.   For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

World-renowned vaccine expert Paul Offit discusses where we stand with the development of a COVID-19 vaccine, challenges ahead, and how clinicians can best focus our efforts in vaccine education and advocacy. This podcast is produced in partnership with Hippo Education How the COVID vaccine is being made and where it targets the virus Different variations of the vaccine The normal path to vaccine development and how it's different with this one Why Paul Offit would opt for wearing a mask vs getting a vaccine if he had to choose between the two How to balance the urgency for the need for a vaccine with safety concerns What happens in Phase 1, 2, and 3 trials Likelihood the vaccine will be rushed to market Guest Bio: Paul Offit is a pediatrician specializing in infectious diseases and an expert on vaccines, immunology, and virology. He is the co-inventor of a rotavirus vaccine that has been credited with saving hundreds of lives every day. Offit is the Maurice R. Hilleman professor of vaccinology, professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania and director of The Vaccine Education Center at  Children's Hospital of Philadelphia (CHOP). Offit is currently a member of National Institutes of Health (NIH) working group on vaccines, a subgroup of the "Accelerating COVID-19 Therapeutic Interventions and Vaccines" (ACTIV) comprised of experts to combat COVID-19. He is also a member of the FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC). Previously, he was a member of the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices. Offit is a board member of Vaccinate Your Family and Autism Science Foundation.  "Overkill" is his 11th book.    For show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

NY Times bestselling author Michele Harper, MD on setting boundaries, pre-shift routines, guarding the vulnerable, microaggressions, racism in the emergency department, and why inaction is just as much a choice as action.  Guest Bio: Dr. Michele Harper, is an emergency physician and author of The New York Times best selling memoir, The Beauty in Breaking. She's been interviewed on Trevor Noah, Fresh Air, CNN, NBC, amongst many others. Michele is also a widely published essayist, often focusing on race and medicine. Her writing shares her personal journey that started as a child in an abusive household, then to undergrad at Harvard, medical school at Stony Brook, New York, and now her life as an attending physician. And as you'll hear, she's got a personal mission to be a guardian for the vulnerable. This episode is brought to you by RingRescue, the new standard for stuck ring removal. RingRescue helps remove stuck rings in a non-destructive way and, when used with their non-hydrating lubricant, significantly reduces the need for ring cutting.  Use the code stimulus at checkout when you purchase your RingRescue finger compression device to get an extra bottle of their lube. Extra lube, free fifty free! Ringrescue.com, checkout code stimulus. We discuss: The importance of setting boundaries, especially when people are able to reach you 24/7 [03:20]; Her essay, “Sovereign Bodies” (The Cut), where Michelle shares a story demonstrating how difficult it can be for patients and providers to get the help they need [07:15]; Michele’s pregame routine before a shift in the ED (which includes probiotic chai tea and Eckhart Tolle) [12:00]; How growing up in an abusive household groomed Michele for a career in emergency medicine [16:45]; Why loving medicine is not enough to keep you in the game [19:15]; Patients who have a special place in Michele’s heart:  children and anyone who might be in danger [23:00]; An excerpt from The Beauty in Breaking which explores the notion that we can find our center through chaos and by transcending difficult experiences [30:15]; How meditation and yoga help Michele remain still and steady in moments of chaos [32:15]; Why there’s nothing “micro” about microaggressions [36:00]; How it’s not the job of the victim to plant a seed of understanding for someone who delivers a microaggression [38:10]; Why people who are in a position of power need to try harder to prevent and correct indignities [43:30];  Her article “When This War Is Over, Many of Us Will Leave Medicine” (Elemental) which presents the idea that “healthcare providers are regarded as more disposable than our PPE” [44:30]; Michele’s call to action [50:45]; And more. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

Who teaches doctors how to speak to patients (or each other)? 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.  We discuss: Why we should thank patients for coming in to the emergency department, regardless of their chief complaint [05:15]; Using humor to reframe something you dread into something that makes you laugh [10:10]; Tips for helping ease the anxiety many patients (especially kids) have when in the ED [11:40]; Pros and cons of wearing a white coat [19:10]; Different approaches to informing patients about what tests you plan to do [22:15]; How to deliver the bad news of a miscarriage [24:55]; Helping family members when their loved one is dying [30:30]; The importance of taking a mindful pause after a patient’s death [36:50]; The heightened responsibility of the team leader in the ED [41:00]; Why doctors need to have sympathy for themselves, and it is a lifetime of practice [42:00]; The value of being conflict avoidant in clinical practice [46:00]; The resentment that comes from comparing your tasks to someone else’s, and how this can suck the joy out of your work [49:15]; The ethical imperative of the well-deserved compliment [53;30]; Why our job isn’t to be right; our job is to be reasonable [56:20]; And more.   For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

When you react in anger, what is your intent? Often it's to lash out; the reflective and thoughtful part of your brain is taken out of picture. But if you think of a really clever and biting response, what do you hope will be the result of those words? It’s unlikely to persuade. More likely it’s a quasi-cognitive-orgasmic release of F*&k You. We Discuss: [00:00:29] The fires outside and in; [00:01:22] Considering your intent in responses; [00:04:17] When you react in anger, what is your intent? [00:04:55] How being in an extended legal action made me a monster while fighting a monster; [00:07:29] Responding with hate vs wisdom. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob:Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

Convalescent plasma has been a hot button news story over the past few weeks since the FDA approved its use in COVID patients. In this episode, hematologist Tom DeLoughery (@Bloodman) breaks down what it is, what it purportedly does, the evidence (or lack thereof) supporting its use, at what point in disease it might work, and potential dangers of indiscriminate use.  This episode is brought to you by Mar-Med, makers of the industry leading and #1 selling Tourni-Cot digital tourniquet. What you may not know is that Mar-Med also  makes a newly reengineered balloon extractor for nasal foreign bodies, a one size fits all Uni-Cot digital tourniquet, and the Derma-Stent drain that greatly simplifies loop abscess procedures. 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?  We Discuss What is convalescent plasma (CP)? [04:06]; How plasmapheresis can collect large volumes of donor plasma [4:53]; If donating plasma (and losing antibodies) can make one more susceptible to infection [5:32]; The potential folly of using CP in only the sickest patients and why it might be better used at the beginning of illness [06:25]; How much immunity a single unit of plasma might provide [10:51]; Adverse consequences of plasma use [12:00]; Does CP actually work? [14:16]; Would Tom want CP if he got COVID? [21:35]; What we’ve learned from the massive effort to accelerate CP collection [23:02]; And More. **** For Show Notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob: Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

Gender and racial bias are pervasive across all aspects of society, medicine notwithstanding.  In this episode, Esther Choo MD, MPH (@choo_ek), a titan for the cause of gender and racial equity discusses: a rubric for deciding 'yes or no', single payer healthcare, why confining medical practice to the bedside can be an exercise in futility, sexism and racism in medicine, the wage gap, workforce vs. leadership demographics, managing overtly racist patients, and why the culture of medicine is ripe for sexual harassment.   This episode is brought to you by Mar-Med, makers of the industry leading and #1 selling Tourni-Cot digital tourniquet. What you may not know is that Mar-Med also  makes a newly re-engineered balloon extractor for nasal foreign bodies, the one size fits all Uni-Cot digital tourniquet, and the Derma-Stent drain that greatly simplifies loop abscess procedures. 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?    We discuss: Esther’s first outward advocacy:  responding to the Trump administration’s attempts to dismantle the Affordable Care Act [03:44]; How you decide whether to say “yes” or “no” when you don’t have time to do everything that’s asked of you [06:15]; Why investing in the development of a single-payer health system would provide better care upstream so that we can save on our costly low-value care downstream [11:00];  What Esther will always stand up against:  inequity [17:20]; The importance of advocating for systems solutions to problems, and how confining your practice to the hospital is an “exercise in futility” [19:00]; Esther’s pre- and post-game routines before and after night shifts [25:20]; Lessons Esther tries to impart on her trainees in the ED [29:00]; The importance of meeting patients where they are, whether they’re a heroin addict, borderline personality, or an a-hole [32:50];  Esther’s podcast, Doctor’s Log, which is a diary of the experience treating patients during the COVID pandemic [34:40]; How Esther responds when a patient refuses to be treated by her because of her race [38:18]; Sexism in medicine and how to get everyone (not just women) on board as advocates for equality and reversing disparity [43:55]; How implicit bias is a side effect of being human [48:30]; The discrepancy of the demographics in the workforce vs. in leadership positions [58:00]; Explaining the gender wage gap in medicine [1:03:00]; Strategizing solutions to gender pay inequity [01:10:00]; Esther’s company, Equity Quotient, whose mission is to “work with standout health care organizations, employer groups and academic centers to create a culture of equity, safety, and respect” [01:11:34]; The NEJM article,  Time’s Up for Medicine? Only Time Will Tell, and why medicine is ill-prepared to make meaningful steps toward ending harassment [01:17:00]; Why change won’t happen if we don’t improve the diversity representation from the ground floor up to the highest leadership [01:19:45]; The reason Twitter became Esther’s social media medium and how Chelsea Clinton’s comment on her tweet took her to the next level [01:22:56]; Why patients of surgical attendings who are abusive to staff have worse outcomes [01:27:00]; and Esther’s call to action, [01:30:42];  And more. **** For Show Notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob: Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx

A fishing boat out of Seattle gives clues as to what COVID immunity looks like; an emergency department pulse ox study gives insight into the clinical course of patients discharged home who later develop low oxygen levels; and some staggering statistics on cardiac injury following COVID infection. We Discuss: The impact of neutralizing antibodies on immunity; The difference between neutralizing antibodies and what’s tested for in the Abbott Architect commercial antibody test; Why some who have a positive commercial antibody test might not be immune;; Sensitivity of Viral RT-PCR testing; What a negative PCR test means after a high risk exposure; An emergency department study found that patients who develop hypoxia after discharge home had an increased incidence of adverse outcome; A recent study found a 70% incidence of cardiac injury in 100 recovered COVID patients. For Complete Show Notes and References: Click Here To Learn More About Stimulus: https://www.stimuluspodcast.com/

Procrastination isn't what you might think. Do you really not have the time to get that thing done, or is there something else getting in the way? In this episode, Christina Shenvi MD, PhD breaks down: why we procrastinate and how to break free of that habit, reframing 'busyness', value based scheduling, how she decides on responding yes or no, how to say no in a skillful yet honest manner, and techniques to keep up with email. If you want to go deeper into all of this in a small group setting, Dr. Shenvi has an online time management course that's not to be missed. Guest Bio: Dr. Christina Shenvi MD, PhD is a fellowship trained geriatric emergency physician from the University of North Carolina, Chapel Hill where she is the director of the UNC Office of Academic Excellence. She's host of her own show, GEMCAST, focusing on clinical topics to help physicians, trainees, nurses, and paramedics who take care of older adults, particularly in the acute care setting. We Discuss: Why “I’m too busy” implies that you have no control over your situation or what you’re doing [01:50]; Value-based scheduling, which means evaluating tasks to be sure they align with your big values [08:20]; Techniques for saying “no” when invited to do something that doesn’t excite you [11:40]; Why procrastination at its core is more about emotions than productivity [18:00]; The determinants of self-worth:  ability, effort, and performance [21:30]; Procrastination, and how it is one of many self-worth protection strategies [22:50]; Reasons for large activation barriers for getting certain things done [25:00];  Tips for avoiding procrastination and self-sabotage [28:30]; Why we have to have a certain amount of tolerance for failure in order to succeed [37:30]; Ways to keep up with email (and other shallow work) [39:25];. And more. For Complete Show Notes: Click Here To Learn More About Stimulus: https://www.stimuluspodcast.com/

A conversation with Dr. Salim Rezaie on discipline vs stubbornness, working through depression, transforming his body from 260 lbs to super fit, the aggregation of marginal gains, and intentional living.  About our guest: Salim Rezaie is double board certified in internal medicine and emergency medicine. In addition to working clinically as an emergency physician, he runs one of the most popular medical education websites on the planet, Rebel EM.    We discuss: What has been most challenging for Salim while caring for patients in the ED during the COVID-19 pandemic [03:20]; The spark for 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];  And more. For Complete Show Notes: Click here To Learn More About Stimulus: https://www.stimuluspodcast.com/

The short answer is not at the moment, but that hasn't stopped the debate (and surprising culture war) from raging about this drug. A recent opinion piece in Newsweek with the damning title "The Key to Defeating COVID-19 Already Exists. We Need to Start Using It" written by Yale epidemiology professor Harvey A. Risch, MD, PhD, suggests that we are missing the boat by not widely using hydroxychloroquine (HCQ) and tens of thousands of patients are dying because of it. In addition, he poses that the evidence is clear and the FDA, NIH and others are in effect denying the proof of drug efficacy. What is the data to support these claims?   We discuss: Evidence supporting use of HCQ Evidence against using HCQ Why wearing a mask with your nose out is like wearing your underwear with, well, not everything covered More For Complete Show Notes: Click Here To Learn More: https://www.stimuluspodcast.com/

When we hear the word stoic, what often comes to mind is a repression of emotion, a stone-faced response to adversity. You can think of that kind of stoicism as using it with a lowercase 's'. What we're talking about today is the philosophical school of Stoicism, Stoic with a capital 'S'. At its core, Stoicism provides a way to find equanimity no matter the circumstance and take on whatever adversity is thrown at you. Our Guest: Dan McCollum, MD is an award winning educator and assistant professor of emergency medicine and Augusta University. His translation of philosophical ideas into real world practice (both in and outside of medicine) have garnered international acclaim. Dan was our guest on Stimulus episode 1: Verbal Judo. For Complete Show Notes: Click Here We discuss: The difference between stoicism (with a lowercase “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.  To Learn More About Stimulus: https://www.stimuluspodcast.com/

How long does immunity last after a COVID infection? News reports of two recent studies suggest that it wanes quickly and that some patients may never have immunity at all. In this episode, we take a look at those studies and explain why they don't exactly say what is being said about them.     Take home points Not everyone keeps detectable IgG after asymptomatic or symptomatic infection If you have asymptomatic COVID-19 infection, you are less likely to have detectable IgG at 8 weeks compared to someone who had symptoms   What we still don't know Does this drop or absence of IgG correlate to decreased immunity? The reflex answer would seem to be 'yes' but we still don't understand the COVID-19 correlates of protection (blood tests that can show whether or not someone has immunity). The likelihood of those who have had COVID-19 getting reinfected. The studies discussed in this podcast evaluated parts of the immune system that are involved in immunity, but we haven’t answered the real question: what is the likelihood of having a repeat illness (or repeat asymptomatic infection).  Mentioned in this show The Stimulus COVID Podcast Page: Click Here   For References and Links to the Studies: Click Here   To Learn More About Stimulus: https://www.stimuluspodcast.com/  

What is a flow state? When you feel it, you know it. 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.    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.  For Complete Show Notes: Click Here To Learn More About Stimulus:  https://www.stimuluspodcast.com/

Our guest today is Dr. Zubin Damania (aka ZDoggMD), an internist, hospitalist, and healthcare evangelist. ZDogg is dedicated to turning the practice of medicine into the healing art that it should be, rather than the leviathan of bureaucracy, roadblocks, and nonsense that it sometimes seems to be. In this episode we cover:  the morality of masks and not wearing them in public, racism, suspension of the scientific method in the early phases of the pandemic, Star Wars, and much more. We discuss: The RECOVERY Trial which found that steroids reduced mortality in certain COVID patients [02:10]; The optimal way to introduce Star Wars to someone who has never seen an episode [07:50]; How ZDogg prepares for the flow state of an unscripted live show or polemic [12:30]; Why wearing a mask in public during the COVID pandemic is like paying taxes [17:50]; Virtue signalling [23:00]; The time when Rob was most proud to be 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]; and Much more. To Learn More about Stimulus: https://www.stimuluspodcast.com/ For Complete Shownotes: Click here    

In this episode of Stimulus, we speak with Christina Shenvi MD, PhD about acting with agency -- what it means, some actionable skills, and how to apply it. We also talk about:  the importance of being specific and deliberate about your philosophy of life, how remembering your mortality puts the rest of life in perspective, Stoic philosophy, Viktor Frankl, and whether or not we have free will. Guest Bio: Dr. Christina Shenvi MD, PhD is a fellowship trained geriatric emergency physician from the University of North Carolina, Chapel Hill where she is the director of the UNC Office of Academic Excellence. She's host of her own show, GEMCAST, focusing on clinical topics to help physicians, trainees, nurses, and paramedics who take care of older adults, particularly in the acute care setting.   We discuss: Corporate vs. personal mission statements and how codifying your life philosophy can help you live with intent [03:00]; Rob and Christina’s personal mission statements [06:15]; The fact that even when we try our best to act in accordance with our values, it sometimes feels like there are magnetic forces pulling us away [08:30]; Martin Luther, the famous theologian, said that there are two days that matter, this day and judgement day [10:35]; The concept of Memento Mori [12:00]; The psychologist and Holocaust survivor, Viktor Frankl, whose writing about stimulus and response is like a look into the human soul [16:27]; Whether we have free will [18:10]; Stephen Covey’s book Seven Habits of Highly Effective People and what the word responsibility means from a Stoic perspective [19:45]; What it means to have agency and the way it relates to how you see yourself making decisions [22:55]; The importance of knowing that you are the author of your own story [26:10]; Learned helplessness and how it stifles creativity [28:00]; Barriers to acting with agency [29:50]; Different approaches to managing your emotions when criticized by a colleague or consultant [31:40]; How Shenvi skillfully manages negative swirls of emotion [41:10];   For complete shownotes: use this link To learn more about Stimulus: https://www.stimuluspodcast.com/

The thought of taking a break during a busy work day can sound impossible if not contrary to the ethos of our job. The reality, however, is that taking a break is not only possible, but will likely make you clinically sharper, more efficient, and possibly even happier. In this episode, Dr. Joshua Russell walks us through how to take a break within the constraints of our clinical responsibilities as well as pitfalls to avoid when taking a pause from patient care.   We Discuss: The importance of breaks and how they can positively impact your affective state and ability to care for patients; The abundant evidence that says that breaks are helpful; How mental vigilance naturally wanes and decision fatigue sets in as the day progresses. Nobody functions with the same efficiency throughout an entire day;  System 1 vs. system 2 thinking, and how when we’re in a negative affective state (ie. a “bad mood”), our ability to be deliberate in our decision-making is compromised; What a healthy break looks like; The notion that finding the time for a break takes intention; and More.  For complete shownotes: Click Here To learn more: https://www.stimuluspodcast.com/  

Bob Ross is best known as the mellifluous host of The Joy of Painting, yet there are things he can teach about how to effectively care for trauma patients. In this episode, we cover: how Bob Ross can help invoke calm during crisis, the Chuck Norris mode of trauma resuscitation, why Bob Ross is your trauma room spirit animal, finding your feet, the power of acknowledging mistakes.   To share this episode, use this link We Discuss: Who Bob Ross is and how he can help us remain calm in a crisis [00:24]; The tendency for trauma team leaders to stay in full-on warrior mode, even when that mode not only is no longer necessary, but also may be deleterious [02:30]; Why Bob Ross (not Chuck Norris or Wonder Woman) should be our spirit animal in the secondary survey [05:00];  Specific ways to be more like Bob Ross in the resus bay [05:50]; How “finding your feet” can help you when mistakes are made [07:44]; The value of acknowledging a mistake and validating how it makes you feel [09:35]; and More. For full shownotes of this episode: Use this link To learn more about Stimulus: https://www.stimuluspodcast.com/

Jim Dahle is an emergency physician who is widely known by his moniker, the White Coat Investor. He's become one of the leading voices for financial literacy and intelligent planning for those who 'wear the white coat'. In this conversation, Jim gives perspectives and strategies on managing finances during a bear market. We address the dangers of market timing, the value of a written investment plan, how Jim invests his money, and why a good financial advisor can sometimes be the best couple's therapist.   We Discuss: The definition of a bear market [02:00]; How bonds differ from stocks and why some believe bonds are safer in a bear market [03:10]; Why cashing out your whole portfolio when the market tanks may not be the best strategy [06:15]; The value of having a written investment plan which tells you what 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]; and More. For complete shownotes: Click Here To learn more about stimulus: https://www.stimuluspodcast.com/

None of us are immune from stress, especially now. This is a critical moment for us to look out not only for our own mental health but that of our colleagues. In this episode, psychiatrist Dr. Melissa Shepard sits down with our good friend Dr. Neda Frayha to discuss the mental health challenges facing health care workers in the COVID-19 pandemic, and some concrete, tangible tools to help us get through this period.    HIPPO Education COVID Resource Center. Link Free mental health crisis line for physicians impacted by Covid-19 related issues, staffed by US Psychiatrists (support only, cannot prescribe medications). 1-888-409-0141. www.physiciansupportline.com  COVID-19 Resource and Information Guide. National Alliance on Mental Illness. Link Darnall B. The COVID-19 Wellness and Coping Toolkit: 11 Tips for Health Care Workers, Patients, and the Public. Psychology Today, 31 March 2020. Link  Good Therapy. https://www.goodtherapy.org  Doxy.me Physician Support Line. https://doxy.me/physiciansupportline  Free access to Headspace Plus app (guided meditations) for healthcare professionals. Link Center for Mind-Body Medicine at Georgetown. Introduction to evidenced-based techniques for helping people through and after trauma (things like guided imagery, body scans, breathing techniques) Link  

We've been breathing since our first moments of life, but does that mean we are truly experts? In this episode of Stimulus, therapist and breathwork coach Ryan Cheney walks us through how we can make breath work for us, not just with us.   We Discuss:  How breathing can be used to create different mental and physiologic states [02:40]; Expanding your visual field to quickly adjust your psychological state [03:15]; The mechanics of breathing [07:00]; Chest breathing Diaphragmatic breathing Volume control The physiology of breathing [10:40]; The psychology of breathing [15:30]; 3 categories of breath exercises[16:05]; Apnea breath patterns Cadence protocols Super Ventilation Mouth vs. Nose Breathing [18:00]; Why stress can be a good thing, but we need to learn how to come down-regulate from it [26:00]; Specific breathing exercises and how they can change your mental state [28:45], The calming effect of ocean breathing and elongating the exhale [33:20]; and More. Complete shownotes: Click Here For more information: stimuluspodcast.com

Jason Brooks, PhD is a performance coach who works with physicians, athletes, and the military, helping them develop the cognitive skills not only to operate at the highest level, but to thrive no matter what the task. During the COVID-19 pandemic, Jason has been working with frontline clinicians, helping and guiding them through the cognitive and emotional aspects of 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.  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]; and More. To learn more: https://www.stimuluspodcast.com/ For complete shownotes: https://www.stimuluspodcast.com/post/4-talking-to-fear

At the end of the day, have you made the world a little better? My guess is that you have, even if only in a small way. 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.    We discuss: What it means to follow your bliss [00:45]   The best medicine is tangerines and socks. . [04:45] The goal of Portland Street Medicine [07:15] Working in an environment with constrained resources. [11:55] Design thinking [12:44] Portland Street Medicine origin story.[14:45] Homeless communities are complex, heterogeneous, vibrant, and cohesive.  [23:15] The secret sauce to success of Portland Street Medicine.[28:18] Portland Street Medicine serves three populations [29:00] Utility of the stethoscope.  [34:00] The case of Susannah [37:00] The homeless are at a minimum ignored and at a maximum shunned. [40:50] Getting to know the homeless has reformed Dan's thinking about how we structure health care. [42:20] Ask some honest questions.   [46:55] Slow down, find joy. [50:38] Learn More: https://www.stimuluspodcast.com/ Complete shownotes for this episode: https://www.stimuluspodcast.com/post/3-street-medicine

We can't immediately change the process of medicine, the stuff that is kind of a drag and wears us down. What we can change, however, is our mindset. In this episode, we dissect several practices for shift preparation with a common goal of operating at a peak level of performance and experiencing more joy in what we do. Today we learn how to pregame, like a pro.   We discuss: When the process of practicing medicine becomes your purpose for being a doctor, you’re at risk for burnout, if not worse. [00:30] The system will not adjust to what you need right now.  You have to adjust yourself. [1:45] How accepting gratitude, and other small changes in mindset, can have a logarithmic return on investment. [4:50] The ways that many elite-level performers pregame.  They rely on their rituals for peak performance. [07:15] Physicians are elite-level performers who rarely have the time to mentally prepare for each day. [8:40]   How some doctors pregame (or not).... Mike Weinstock doesn't pregame [12:06] Clay Smith's pregame distraction [13:20] Joshua Russell's sequence of physical, emotional and mental prep [15:10] Sabrina Adams the BAFERD [18:00] Jaime Hope thinks of her 4 professional identities [19:10] Mizuho Morrison's 3 steps of self talk [21:40] Ran Ran biking to work. [24:20] Joe Dubois walks to work Chris Nickson walks to work Ross Fisher calms during his commute. Haney Mallemat uses mental visualization. Luz Silverio's pregame ritual is to arrive to work 15 minutes early to “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]    Learn More: https://www.stimuluspodcast.com/ Complete shownotes for this episode: https://www.stimuluspodcast.com/post/2-pregame-like-a-pro

In this first episode of Stimulus, we learn from two masters in the art of de-escalating those who are agitated and upset.  Jose Pacheco, RN, known affectionately to his co-workers as ‘The Drunk Whisperer’, has a specific sequence to this approach, which he’s going to walk us through, step by step. The good news is that verbal de-escalation is a tool that can be learned by almost anyone. To that end, we’re also joined by Dan McCollum, emergency physician at Augusta University, to talk about conflict resolution that evolved from the martial arts principal of using your opponent's energy to resolve conflict, rather than simply butting heads. The name for this method? Verbal Judo. We discuss: Ways to de-escalate and defuse [00:50]   “Verbal Judo” is teachable and learnable. [03:31] McCollum’s de-escalation sequence [06:35]  Empathy can absorb tension [14:18]  Universal Upset Patient Protocol [22:30] “We treat people as ladies and gentleman not because they are, but because we are.” [32:52] You can’t control how an upset person is going to respond to conflict, you can control how you respond. [34:43] Seeing a situation from the other person’s eyes. [35:40] Sword of Insertion technique [36:58] Active listening [38:38] Jose Pacheco’s tips for interacting with difficult patients in the ED. [41:15] Non-verbal cues [51:46]   For complete shownotes: https://roborman.com/stimulus/1-verbal-judo/ Interested in one-on-one coaching? https://roborman.com/about-us/coaching/ Our landing page: https://roborman.com/ This podcast streams free on iTunes, Spotify, and Stitcher. Follow Rob: Twitter,  Facebook, and Youtube.

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.