ERCAST

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 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 Empathic listening An exercise to understand the other person's perspective Could malice be misunderstanding? Navigating fundamental attribution error during conflict The Most Respectful Interpretation, JFK, and the Cuban missile crisis 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”.     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.