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

In this episode, we discuss: what it’s like for physician coaches who regularly work with docs in this situation, getting fired, dealing with unexpected events that shake up professional stability, planning for career disruption, the importance of networking, and finding your clinical practice N plus one.

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

Guest Bio: Health Joliff, DO, is dual-boarded in Emergency Medicine and Medical Toxicology. He is a certified executive coach and can be found at Physician Coaching Solutions.

We Discuss:

1. We plan for what happens at the bedside. Why don't we plan for what might happen to our careers?
2. What happens to the majority of docs who come to coaching wanting to get out of medicine
3. The importance of clinical medicine + 1
4. Networking doesn't have to be a massive labor. Small steps can make a big difference.
5. Great doctors getting fired
6. First steps after losing employment: be humble and don't burn bridges
7. Strategies for bringing up having been fired in an interview
8. The therapeutic power of venting (versus dumping)
9. Should you accept your group's director position?
10. The distinction between imposter syndrome and inexperience
11. Your contract has not been renewed
12. You are a new resident, and your health system suddenly closes
13. An older physician plans to retire in a year and is uncertain what to do next
14. Your first job out of training will likely not be your last

Mentioned in this episode:

The Out-On-Time Course

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

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

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

Free Resources Link

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Many of us have ideas that could make a great business. Most of the ideas, however, never see the light of day. It can feel like a big leap from physician to entrepreneur. So how do you do it? We speak with Dr. Jason Hine, the founder of SimKit, and see how he went from community emergency medicine doctor to successful business owner.

In this episode, we cover how Jason started his business, accounting for the knowledge gap between clinician and entrepreneur, setting boundaries, why saying hell yes has a critical proviso, the inevitable oscillation between passion and money, and a marketing exercise that’s critical to walk through before you even consider jumping in on a new product or business.

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

Guest Bio: Jason Hine, MD, is an emergency physician in southern Maine, where he is the Director of Education for his community hospital. He is a graduate of Tufts University School of Medicine and completed his residency at Temple University Hospital, where he served as chief resident. His interests include procedural skillset decay and the role of academics in improving the recruitment, retention, and satisfaction of community physicians. He is the founder of SimKit, a medical education company focusing on delivering convenient and effective hands on procedural skills practice.

We Discuss:

1. Sharks and boulders
2. Build a business plan early
3. Effective resources and dead-end rabbit holes
4. The first thing to consider before starting a business: the pain point and value proposition
5. Getting out of the Lone Wolf mindset and forming an advisory committee
6. What challenge surprised Jason as he got the business rolling
7. How do you pay your advisory committee before your business makes money?
8. What it means money-wise to give someone equity in your company
9. Negotiating equity stake and why contracts are by nature adversarial
10. The tipping point from dreamer to doer
11. A self-reflective prompt that puts endeavors in proper perspective
12. It might be a hell yes for you but a no for your family
13. Protecting immutable boulders
14. Logistics of setting and keeping boundaries
15. Nothing super cool happened because someone just wanted to make a bunch of money
16. Finding your ideal customer before the product even exists
17. A marketing exercise to do when a product is still an idea

Mentioned in this episode:

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The Out-On-Time Course

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

Learn More About The Out-On-Time Course

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Phantasia Kataleptike, a lesser-known gem from Stoic philosophy, offers a transformative approach to life's challenges. This practice of 'objective representation' strips away the layers of subjective judgment that often cloud our perceptions. Imagine the power of viewing a setback not as a disaster but simply as a fact of life, a moment ripe with potential for growth. How does this shift affect our inner turmoil? The Stoics had insights that might surprise you, blending ancient wisdom with actionable strategies for modern living.

In this pod, we break down the essence of Phantasia Kataleptike and multiple methods for employing it as a tool for equanimity and de-catastrophization.

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

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

We Discuss:

1. Defining Phantasia Kataptike
2. Acceptance of what is
3. A dog and a cart | Epictetus’ classic simile
4. Why the words we use impact us as much as (or more than) they impact others
5. The lost ship
6. The A-hole in a Jaguar
7. Operationalziing Phantasia Kataleptike
8. Valence | Awareness of emotion and narrative
9. The Dichotomy of Control
10. How to Think Like a Roman Emperor
11. Actively de-catastrophizing
12. Shifting from ‘what if’ to ‘why did’ to ‘so what?’ to ‘what’s next’
13. The threat-challenge seesaw
14. What to do when the emperor banishes you
15. The counterarguments to Phantasia Kataleptike

Mentioned in this episode:

5 Free Tools To Make Medical Practice Easier

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

Free Resources Link

Distilled Kickassery Every Other Saturday

Sign up for our Newsletter

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

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

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

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🎓 P.S. This is a CME event.

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

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

We discuss:

• The importance of setting boundaries, especially when people are able to reach you 24/7 [03:20];
• Her essay, “Sovereign Bodies” (The Cut), where Michelle shares a story demonstrating how difficult it can be for patients and providers to get the help they need [07:15];
• Michele’s pregame routine before a shift in the ED (which includes probiotic chai tea and Eckhart Tolle) [12:00];
• How growing up in an abusive household groomed Michele for a career in emergency medicine [16:45];
• Why loving medicine is not enough to keep you in the game [19:15];
• Patients who have a special place in Michele’s heart:  children and anyone who might be in danger [23:00];
• An excerpt from The Beauty in Breaking which explores the notion that we can find our center through chaos and by transcending difficult experiences [30:15];
• How meditation and yoga help Michele remain still and steady in moments of chaos [32:15];
• Why there’s nothing “micro” about microaggressions [36:00];
• How it’s not the job of the victim to plant a seed of understanding for someone who delivers a microaggression [38:10];
• Why people who are in a position of power need to try harder to prevent and correct indignities [43:30]; 
• Her article “When This War Is Over, Many of Us Will Leave Medicine” (Elemental) which presents the idea that “healthcare providers are regarded as more disposable than our PPE” [44:30];
• Michele’s call to action [50:45];
• And more.

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. 

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🎓 P.S. This is a CME event.

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

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

We discuss:

• Why we should thank patients for coming in to the emergency department, regardless of their chief complaint [05:15];
• Using humor to reframe something you dread into something that makes you laugh [10:10];
• Tips for helping ease the anxiety many patients (especially kids) have when in the ED [11:40];
• Pros and cons of wearing a white coat [19:10];
• Different approaches to informing patients about what tests you plan to do [22:15];
• How to deliver the bad news of a miscarriage [24:55];
• Helping family members when their loved one is dying [30:30];
• The importance of taking a mindful pause after a patient’s death [36:50];
• The heightened responsibility of the team leader in the ED [41:00];
• Why doctors need to have sympathy for themselves, and it is a lifetime of practice [42:00];
• The value of being conflict-avoidant in clinical practice [46:00];
• The resentment that comes from comparing your tasks to someone else’s, and how this can suck the joy out of your work [49:15];
• The ethical imperative of the well-deserved compliment [53;30];
• Why our job isn’t to be right; our job is to be reasonable [56:20];
• And more.

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.

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🎓 P.S. This is a CME event.

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

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

We Discuss:

[00:00:29] The fires outside and in;

[00:01:22] Considering your intent in responses;

[00:04:17] When you react in anger, what is your intent?

[00:04:55] How being in an extended legal action made me a monster while fighting a monster;

[00:07:29] Responding with hate vs wisdom.

Gender and racial bias are pervasive across all aspects of society, medicine notwithstanding.  In this episode, Esther Choo MD, MPH (@choo_ek), a titan for the cause of gender and racial equity discusses: a rubric for deciding 'yes or no', single payer healthcare, why confining medical practice to the bedside can be an exercise in futility, sexism and racism in medicine, the wage gap, workforce vs. leadership demographics, managing overtly racist patients, and why the culture of medicine is ripe for sexual harassment.

This episode is brought to you by Mar-Med, makers of the industry leading and #1 selling Tourni-Cot digital tourniquet. What you may not know is that Mar-Med also  makes a newly re-engineered balloon extractor for nasal foreign bodies, the one size fits all Uni-Cot digital tourniquet, and the Derma-Stent drain that greatly simplifies loop abscess procedures. I’ve used Mar-Med's products hundreds of times and can attest to their efficacy and simplicity of use. You can check out all of their products and get free samples of whatever you’d like to try at marmed.com/stimulus. Who doesn’t love free samples, especially when it’s awesome stuff? 

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We discuss:

• Esther’s first outward advocacy:  responding to the Trump administration’s attempts to dismantle the Affordable Care Act [03:44];
• How you decide whether to say “yes” or “no” when you don’t have time to do everything that’s asked of you [06:15];
• Why investing in the development of a single-payer health system would provide better care upstream so that we can save on our costly low-value care downstream [11:00]; 
• What Esther will always stand up against:  inequity [17:20];
• The importance of advocating for systems solutions to problems, and how confining your practice to the hospital is an “exercise in futility” [19:00];
• Esther’s pre- and post-game routines before and after night shifts [25:20];
• Lessons Esther tries to impart on her trainees in the ED [29:00];
• The importance of meeting patients where they are, whether they’re a heroin addict, borderline personality, or an a-hole [32:50]; 
• Esther’s podcast, Doctor’s Log, which is a diary of the experience treating patients during the COVID pandemic [34:40];
• How Esther responds when a patient refuses to be treated by her because of her race [38:18];
• Sexism in medicine and how to get everyone (not just women) on board as advocates for equality and reversing disparity [43:55];
• How implicit bias is a side effect of being human [48:30];
• The discrepancy of the demographics in the workforce vs. in leadership positions [58:00];
• Explaining the gender wage gap in medicine [1:03:00];
• Strategizing solutions to gender pay inequity [01:10:00];
• Esther’s company, Equity Quotient, whose mission is to “work with standout health care organizations, employer groups and academic centers to create a culture of equity, safety, and respect” [01:11:34];
• The NEJM article,  Time’s Up for Medicine? Only Time Will Tell, and why medicine is ill-prepared to make meaningful steps toward ending harassment [01:17:00];
• Why change won’t happen if we don’t improve the diversity representation from the ground floor up to the highest leadership [01:19:45];
• The reason Twitter became Esther’s social media medium and how Chelsea Clinton’s comment on her tweet took her to the next level [01:22:56];
• Why patients of surgical attendings who are abusive to staff have worse outcomes [01:27:00]; and
• Esther’s call to action, [01:30:42].

Procrastination isn't what you might think. Do you really not have the time to get that thing done, or is there something else getting in the way? In this episode, Christina Shenvi MD, PhD breaks down: why we procrastinate and how to break free of that habit, reframing 'busyness', value based scheduling, how she decides on responding yes or no, how to say no in a skillful yet honest manner, and techniques to keep up with email. If you want to go deeper into all of this in a small group setting, Dr. Shenvi has an online time management course that's not to be missed.

Guest Bio: Dr. Christina Shenvi MD, PhD is a fellowship trained geriatric emergency physician from the University of North Carolina, Chapel Hill where she is the director of the UNC Office of Academic Excellence. She's host of her own show, GEMCAST, focusing on clinical topics to help physicians, trainees, nurses, and paramedics who take care of older adults, particularly in the acute care setting.

Awake + Aware | Our 2026 Retreat

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🎓 P.S. This is a CME event.

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

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

We Discuss:

• Why “I’m too busy” implies that you have no control over your situation or what you’re doing [01:50];
• Value-based scheduling, which means evaluating tasks to be sure they align with your big values [08:20];
• Techniques for saying “no” when invited to do something that doesn’t excite you [11:40];
• Why procrastination at its core is more about emotions than productivity [18:00];
• The determinants of self-worth:  ability, effort, and performance [21:30];
• Procrastination, and how it is one of many self-worth protection strategies [22:50];
• Reasons for large activation barriers for getting certain things done [25:00]; 
• Tips for avoiding procrastination and self-sabotage [28:30];
• Why we have to have a certain amount of tolerance for failure in order to succeed [37:30];
• Ways to keep up with email (and other shallow work) [39:25];.
• And more.

A conversation with Dr. Salim Rezaie on discipline vs stubbornness, working through depression, transforming his body from 260 lbs to super fit, the aggregation of marginal gains, and intentional living. 

Guest Bio: Salim Rezaie is double board certified in internal medicine and emergency medicine. In addition to working clinically as an emergency physician, he runs one of the most popular medical education websites on the planet, Rebel EM. 

We discuss:

• What has been most challenging for Salim while caring for patients in the ED during the COVID-19 pandemic [03:20];
• The spark for Salim’s transformation from being “festively plump” to super fit [06:30]; 
• Tips for embarking on a diet and exercise program, and the importance of actually scheduling time to do it [10:35];
• How intermittent fasting was a way for Salim to engage in the cultural practice of Ramadan [15:45];
• The distinction between discipline and being stubborn [19:30];
• Why success relies on the aggregation of marginal gains [22:46];
• Social media and how these tools are only as good as the person who uses it [26:00];
• The lifestyle of instant gratification and how people often don’t appreciate the hard work that goes into something for it to be successful [26:55]
• Why comparing yourself to others is the opposite of gratitude [31:00];
• The stigma of mental illness and 3 things Salim learned in psychotherapy [00:35:12];
• The value of embracing failure equally as you would success [43:30];
• Salim’s core principles and priorities [44:30];
• The most unexpected book that Salim has read in the last year [48:20].

When we hear the word stoic, what often comes to mind is a repression of emotion, a stone-faced response to adversity. You can think of that kind of stoicism as using it with a lowercase 's'. What we're talking about today is the philosophical school of Stoicism, Stoic with a capital 'S'. At its core, Stoicism provides a way to find equanimity no matter the circumstance and take on whatever adversity is thrown at you.

Guest Bio: Dan McCollum, MD is an award winning educator and assistant professor of emergency medicine and Augusta University. His translation of philosophical ideas into real world practice (both in and outside of medicine) have garnered international acclaim. Dan was our guest on Stimulus episode 1: Verbal Judo.

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🎓 P.S. This is a CME event.

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

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

We discuss:

• The difference between stoicism (with a lowercase “s”) and Stoicism (with a capital “S”);
• The 3 disciplines of Stoicism;
• How you can apply Stoic principles to common (unpleasant) scenarios;
• How to develop some of the Stoic habits and responses to stress;
• How a Stoic processes anger;
• And more. 

What is a flow state? When you feel it, you know it. It’s an almost effortless ease of action. To define it, you could say it's a feeling of being in control without making any conscious effort to do so, or being completely immersed in an activity with energized focus. In this episode, performance coach Jason Brooks, PhD breaks down the steps to achieving flow and how to get it back when it slips away. 

Awake + Aware | Our 2026 Retreat

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🎓 P.S. This is a CME event.

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

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

We discuss:

• How achieving a flow state is as much about knowing yourself as it is knowing the skill [02:00];
• Michael Jordan’s superpower -- being 100% present in every moment of every game [06:00];
• The nuanced distinction between a flow state and being “in the zone” [07:50];
• The TED talk by Mihaly Csikszentmihalyi and how a state of “flow” promotes lasting satisfaction [09:20];
• Why training and skill are prerequisites to a flow state [10:50];
• Tools to bring yourself back into an optimal state when distractions hijack your attention [14:45];
• Why having joy in what you do is essential to achieving flow [17:30];
• Self-distraction theory and how that contributes to performance [25:30];
• Ways we can set ourselves up for success to be in a flow state [32:40];
• How practicing basic techniques will give you something to fall back on when you’re lost [44:00];
• Whether it’s better to capitalize on your strengths, or shore up your weaknesses [51:40]; and
• More. 

Our guest today is Dr. Zubin Damania (aka ZDoggMD), an internist, hospitalist, and healthcare evangelist. ZDogg is dedicated to turning the practice of medicine into the healing art that it should be, rather than the leviathan of bureaucracy, roadblocks, and nonsense that it sometimes seems to be. In this episode we cover:  the morality of masks and not wearing them in public, racism, suspension of the scientific method in the early phases of the pandemic, Star Wars, and much more.

Awake + Aware | Our 2026 Retreat

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

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🎓 P.S. This is a CME event.

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

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

We discuss:

• The RECOVERY Trial which found that steroids reduced mortality in certain COVID patients [02:10];
• The optimal way to introduce Star Wars to someone who has never seen an episode [07:50];
• How ZDogg prepares for the flow state of an unscripted live show or polemic [12:30];
• Why wearing a mask in public during the COVID pandemic is like paying taxes [17:50];
• Virtue signalling [23:00];
• The time when Rob was most proud to be ZDogg’s friend [23:55];
• Pandemic & Protest: Racism As A Social Determinant Of Health [23:55];
• The fundamental unfairness when judged on something that you cannot control [28:30];
• The challenge of being both authentic to yourself but also using your large social media platform to spread important messages [34:40];
• Things that surprised ZDogg about COVID-19 [37:25];
• The danger (and benefits) of dissemination of anecdotes [40:15];
• How distancing has disrupted the fabric of society [41:35];
• The importance of recognizing your emotional response and biases [44:25];
• Victims of misinformation and how they’re influenced by FLICC [46:20];
• How infrequent hand-washing demonstrates that quality in healthcare is equated with what’s financially incentivized rather than what really makes a difference [51:20].

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

In this episode of Stimulus, we speak with Christina Shenvi MD, PhD about acting with agency - what it means, actionable skills, and how to apply it. We also talk about: the importance of being specific and deliberate about your philosophy of life, how remembering your mortality puts the rest of life in perspective, Stoic philosophy, Viktor Frankl, and whether or not we have free will.

Awake + Aware | Our 2026 Retreat

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

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🎓 P.S. This is a CME event.

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

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

We discuss:

• Corporate vs. personal mission statements and how codifying your life philosophy can help you live with intent [03:00];
• Rob and Christina’s personal mission statements [06:15];
• The fact that even when we try our best to act in accordance with our values, it sometimes feels like there are magnetic forces pulling us away [08:30];
• Martin Luther, the famous theologian, said that there are two days that matter, this day and judgement day [10:35];
• The concept of Memento Mori [12:00];
• The psychologist and Holocaust survivor, Viktor Frankl, whose writing about stimulus and response is like a look into the human soul [16:27];
• Whether we have free will [18:10];
• Stephen Covey’s book Seven Habits of Highly Effective People and what the word responsibility means from a Stoic perspective [19:45];
• What it means to have agency and the way it relates to how you see yourself making decisions [22:55];
• The importance of knowing that you are the author of your own story [26:10];
• Learned helplessness and how it stifles creativity [28:00];
• Barriers to acting with agency [29:50];
• Different approaches to managing your emotions when criticized by a colleague or consultant [31:40];
• How Shenvi skillfully manages negative swirls of emotion [41:10];

Have you ever found yourself deep in “The Pit” where the mere thought of going back to work triggers an existential crisis? You wonder if your current job is the right choice. Sometimes, all it takes are a few adjustments to the current job and you'll feel fully refreshed and stoked to tackle that next shift. It may also, however, be time for The Trade.

In this episode, we delve into the critical juncture many professionals, particularly physicians, find themselves in when their once-aspired career paths no longer bring fulfillment. We tackle:

1. Whether to deepen commitments to your current role or brave the uncertainty of switching careers
2. What it means to tolerate another yesterday
3. The silent tax paid by grinding it out
4. The emotional and practical implications of making significant life changes
5. How a well-cultivated professional identity can become an albatross
6. A step-by-step guide on how to transition towards a more satisfying career

So, whether you're a physician on the brink, a professional in a pickle, or just someone who enjoys a good existential quandary with their morning coffee, tune in. Let's laugh in the face of the status quo and ponder if the grass is greener, or if it's just astroturf.

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

Guest bio: Lon Stroschein is the purveyor of the Normal 40 podcast and author of The Trade. In past career interactions, he was an aide to a US senator and brokered billion-dollar deals in the aerospace industry. He now guides professionals in finding their second-half stories.

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

We Discuss:

1. Do I double down on what I'm doing right now or consider making a career change?
2. Tolerating another yesterday
3. The Pit: A Signal for Change
4. Recognizing and Overcoming the Tax of Discontent
5. Working yourself into The Box | We strive for years to get into it, but then it can feel like a trap.
6. The two things that keep high-level professionals stuck in a career or position
7. Work identity takes a long time to build. It gives amazing opportunities but also takes some away
8. The Trade: Step by Step
9. The mindset to thwart inertia #JFDS
10. Has this job given me all it has to give and have I gotten all I have to get?
11. A lifetime is a long time, but it doesn't take long to live it

Mentioned in this episode:

Distilled Kickassery Every Other Saturday

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5 Free Tools To Make Medical Practice Easier

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

Free Resources Link

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.

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🎓 P.S. This is a CME event.

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

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

We Discuss:

• The importance of breaks and how they can positively impact your affective state and ability to care for patients;
• The abundant evidence that says that breaks are helpful;
• How mental vigilance naturally wanes and decision fatigue sets in as the day progresses. Nobody functions with the same efficiency throughout an entire day; 
• System 1 vs. system 2 thinking, and how when we’re in a negative affective state (ie. a “bad mood”), our ability to be deliberate in our decision-making is compromised;
• What a healthy break looks like;

The notion that finding the time for a break takes intention.

Bob Ross is best known as the mellifluous host of The Joy of Painting, yet there are things he can teach about how to effectively care for trauma patients. In this episode, we cover: how Bob Ross can help invoke calm during crisis, the Chuck Norris mode of trauma resuscitation, why Bob Ross is your trauma room spirit animal, finding your feet, the power of acknowledging mistakes.

Awake + Aware | Our 2026 Retreat

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

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🎓 P.S. This is a CME event.

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

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

We Discuss:

• Who Bob Ross was and how he can help us remain calm in a crisis [00:24];
• The tendency for trauma team leaders to stay in full-on warrior mode, even when that mode not only is no longer necessary, but also may be deleterious [02:30];
• Why Bob Ross (not Chuck Norris or Wonder Woman) should be our spirit animal in the secondary survey [05:00];
• Specific ways to be more like Bob Ross in the resus bay [05:50];
• How “finding your feet” can help you when mistakes are made [07:44];
• The value of acknowledging a mistake[09:35].

Jim Dahle is an emergency physician who is widely known by his moniker, the White Coat Investor. He's become one of the leading voices for financial literacy and intelligent planning for those who 'wear the white coat'. In this conversation, Jim gives perspectives and strategies on managing finances during a bear market. We address the dangers of market timing, the value of a written investment plan, how Jim invests his money, and why a good financial advisor can sometimes be the best couple's therapist.

Awake + Aware | Our 2026 Retreat

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

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🎓 P.S. This is a CME event.

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

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

We Discuss:

• The definition of a bear market [02:00];
• How bonds differ from stocks and why some believe bonds are safer in a bear market [03:10];
• Why cashing out your whole portfolio when the market tanks may not be the best strategy [06:15];
• The value of having a written investment plan which tells you what you’re going to do if and when the market changes [10:00];
• Stock investments, and why it’s better to invest in a low-cost, broadly diversified index funds rather than individual stocks [12:15];
• Different ways for coming up with your individualized written investment plan [14:15];
• The importance of having an emergency fund in the event that your income drops dramatically, and how this money should be invested with the goal of having the best return OF the principal, not the return ON the principal [16:40];
• Ideas for alternate sources of income for physicians that can serve as another buffer in an economic downturn [25:00];
• Advantages and disadvantages of federal student loans [29:30];
• What we should do with leftover money, once we’ve fully funded our emergency cushion, 401k and Backdoor Roth IRA and contributed to our 529 [34:10];
• How to handle discretionary spending and the conflict that can arise when there’s spousal income inequality [36:00];
• Why having a no-questions-asked allowance can help your marriage [39:50];
• The wisdom of this advice: “Be generally frugal, but selectively extravagant” [42:15];
• What physicians should do if they’ve lost their job, but are still several years away from retirement [46:00];
• How we can help our retired parents who may have lost their nest egg in the stock market [48:50];
• The cost of health insurance and how it might be far more expensive than you think [52:50];
• Why renting your home to your business might be more than hoodwinkery [54:20
• The best financial mindset in an economic downturn is to take a long-term perspective and know that this too shall pass. [58:20].

We've been breathing since our first moments of life, but does that mean we are truly experts? In this episode of Stimulus, therapist and breathwork coach Ryan Cheney walks us through how we can make breath work for us, not just with us.

Despite breathing being an automatic process since birth, most of us have yet to harness breath's potential to consciously improve our well-being. The discussion covers various aspects of breathing techniques and their effects, including influence on mental and physiological states, visual field expansion for psychological adjustment, and the three pillars of breath physiology. Cheney also delves into specific breath patterns for nervous system regulation, the advantages of nose versus mouth breathing, and the significance of intentional breathwork in managing stress.  

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We Discuss: 

• How breathing can be used to create different mental and physiologic states [02:40];
• Expanding your visual field to quickly adjust your psychological state [03:15];
• The mechanics of breathing [07:00];
• Chest breathing
• Diaphragmatic breathing
• Volume control
• The physiology of breathing [10:40];
• The psychology of breathing [15:30];
• 3 categories of breath exercises[16:05];
• Apnea breath patterns
• Cadence protocols
• Super Ventilation
• Mouth vs. Nose Breathing [18:00];
• Why stress can be a good thing, but we need to learn how to come down-regulate from it [26:00];
• Specific breathing exercises and how they can change your mental state [28:45],
• The calming effect of ocean breathing and elongating the exhale [33:20].

Jason Brooks, PhD is a performance coach who works with physicians, athletes, and the military, helping them develop the cognitive skills not only to operate at the highest level, but to thrive no matter what the task. During the COVID-19 pandemic, Jason has been working with frontline clinicians, helping and guiding them through the cognitive and emotional aspects of what’s happening. This episode will give us strategies to mentally prepare for each day. It will show us how to find an anchor to ground us so that rather than feeling like we’re constantly running defense, we’re actually on offense. 

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We discuss:

• How pandemic medicine may be more dangerous to the healthcare provider than battlefield medicine, from the Happy MD blog [02:24];
• Two big emotions experienced by people on the frontline of the COVID-19 pandemic:  the fear of uncertainty and the lack of control [05:42];
• How we should keep our focus small and put our attention on the things that we feel some degree of certainty about [07:25];
• Ways people have created leadership and command centers to handle information overload [09:40];
• Strategies for managing the stress, anxiety, and fear that comes with working in the COVID-19 environment [11:55];
• The 2 things fear needs to know:  that you hear it and that you have a plan to keep yourself safe [14:35];
• The tipping point between being scared and feeling panic [15:35];
• The importance of flipping your perspective from being on the defense to being on the offense [17:45];
• The value of adding purpose where there is uncertainty and fear [19:00];
• Tools for handling moments of stress, panic or fear [22:30];
• Anti-fragility and how it compares with resilience [23:52];
• How some people perform better as the favorite, but others prefer being the underdog [29:00];
• Ways to “pregame” before entering the COVID-19 environment, and how your pre-performance plan can be thought of as a prayer [31:30];
• Why showing compassion to your fear and embracing it as a part of you is far better than resisting it [42:00];
• How the aftermath of COVID-19 will need space for healing, processing, and recovery [44:10].

At the end of the day, have you made the world a little better? My guess is that you have, even if only in a small way. That’s certainly true of today’s guest, Dan Bissell, MD. Dan is co-founder of Portland Street Medicine, a medically focused non-profit dedicated to caring for the homeless. What’s unique about the care delivered is that it happens in the austere environment of homeless camps, underpasses, and street corners. In this episode, Dan and I cover what a day of the street medicine team looks like, how his group started, and how street care has impacted his everyday medical practice. 

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We discuss:

• What it means to follow your bliss [00:45];
• The best medicine is tangerines and socks. . [04:45]
• The goal of Portland Street Medicine [07:15]
• Working in an environment with constrained resources. [11:55]
• Design thinking [12:44]
• Portland Street Medicine origin story.[14:45]
• Homeless communities are complex, heterogeneous, vibrant, and cohesive.  [23:15]
• The secret sauce to success of Portland Street Medicine.[28:18]
• Portland Street Medicine serves three populations [29:00]
• Utility of the stethoscope.  [34:00]
• The case of Susannah [37:00]
• The homeless are at a minimum ignored and at a maximum shunned. [40:50]
• Getting to know the homeless has reformed Dan's thinking about how we structure health care. [42:20]
• Ask some honest questions.   [46:55]
• Slow down, find joy. [50:38]

We can't immediately change the process of medicine, the stuff that is kind of a drag and wears us down. What we can change, however, is our mindset. In this episode, we dissect several practices for shift preparation with a common goal of operating at a peak level of performance and experiencing more joy in what we do. Today we learn how to pregame, like a pro.

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We discuss:

• The system will not adjust to what you need right now.  You have to adjust yourself. [1:45]
• How accepting gratitude, and other small changes in mindset, can have a logarithmic return on investment. [4:50]
• The ways that many elite-level performers pregame.  They rely on their rituals for peak performance. [07:15]
• Physicians are elite-level performers who rarely have the time to mentally prepare for each day. [8:40]

How some doctors pregame (or not)....

• Mike Weinstock doesn't pregame [12:06]
• Clay Smith's pregame distraction [13:20]
• Joshua Russell's sequence of physical, emotional and mental prep [15:10]
• Sabrina Adams the BAFERD [18:00]
• Jaime Hope thinks of her 4 professional identities [19:10];
• Mizuho Morrison's 3 steps of self talk [21:40]
• Ran Ran biking to work. [24:20]
• Joe Dubois walks to work
• Chris Nickson walks to work
• Ross Fisher calms during his commute.
• Haney Mallemat uses mental visualization.
• Luz Silverio's pregame ritual is to arrive to work 15 minutes early to “chit-chat” with members of her team.[28:40]
• Alan Sielaff allows sufficient time before the shift to get prepared. [29:30]: 
• Dan McCollum starts the day mentally preparing with the 5 Minute Journal.[31:00] 
• Reuben Strayer mentally prepare for a shift by practicing mindfulness [32:50] 
• Salim Rezaie isolates himself from social media and email for at least 1-2 hours prior to each shift.[35:30] 
• Mike Mallin uses intermittent fasting to improve his focus, attitude, and endurance at work. [37:15]  
• Rich Hamilton treats a shift like it’s a competitive sport. [38:30] 
• Rob's 2 pregame exercises. [41:10] 
• Jocko Willink’s “Good” [44:06]

In this first episode of Stimulus, we learn from two masters in the art of de-escalating those who are agitated and upset.  Jose Pacheco, RN, known affectionately to his co-workers as ‘The Drunk Whisperer’, has a specific sequence to this approach, which he’s going to walk us through, step by step. The good news is that verbal de-escalation is a tool that can be learned by almost anyone. To that end, we’re also joined by Dan McCollum, emergency physician at Augusta University, to talk about conflict resolution that evolved from the martial arts principal of using your opponent's energy to resolve conflict, rather than simply butting heads. The name for this method? Verbal Judo.

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We discuss:

• Ways to de-escalate and defuse [00:50]  
• “Verbal Judo” is teachable and learnable. [03:31]
• McCollum’s de-escalation sequence [06:35] 
• Empathy can absorb tension [14:18]
•  Universal Upset Patient Protocol [22:30];
• “We treat people as ladies and gentlemen not because they are, but because we are.” [32:52]
• You can’t control how an upset person is going to respond to conflict, you can control how you respond. [34:43];
• Seeing a situation from the other person’s eyes. [35:40]
• Sword of Insertion technique [36:58]
• Active listening [38:38]
• Jose Pacheco’s tips for interacting with difficult patients in the ED. [41:15]
• Non-verbal cues [51:46]

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. 

The interplay between the Default Mode Network (DMN) and the Task Positive Network (TPN) is crucial for our cognitive and emotional health. The DMN, active during restful states and wandering mind, facilitates introspection, memory recall, and creativity, serving as a foundational element in our mental processes. On the other hand, the TPN takes charge during focused, goal-oriented tasks, enabling attention, decision-making, and problem-solving. They operate in balance - when one is active, the other quiescent and this dynamic is essential for optimal mental functioning.

However, imbalances in these networks can lead to mental health challenges. For instance, excessive DMN activity is linked to conditions like depression and anxiety, where rumination and negative self-referential thoughts prevail. In contrast, overreliance on the TPN without adequate rest can lead to burnout and stress.

Mindfulness meditation offers a practical approach to equilibrating the DMN and TPN, promoting mental well-being by fostering a state of alert relaxation and enhancing self-awareness. Moreover, incorporating regular breaks into the workday, particularly those that allow for mental disengagement from task-focused activities, is vital for sustaining cognitive performance and preventing decision fatigue. Engaging in activities that stimulate the DMN, such as spending time in nature or practicing mindfulness, during these breaks can further enhance cognitive restoration and emotional balance.

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

1. What is the Default Mode Network?
2. What is the Task Positive Network?
3. Interplay of the TPN and DMN
4. Default Mode Network out of Balance | Mental Illness
5. The Neurophysiology Behind How Taking a Small Step of Action Can Decrease Rumination and Anxiety
6. The Default Mode Network and Insomnia
7. What Happens with the DMN in Meditation?
8. The Task Positive Network's Role in Meditation
9. Why Your Task Positive Network is Begging You to Take a Break in the Workday
10. How to Take a Break That Effectively Recharges Your Task Positive Network

Mentioned in this episode:

The Out-On-Time Course

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

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

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

Free Resources Link

Moral injury, a term initially used in the military context during the Vietnam War to describe the psychological trauma soldiers experienced, has become increasingly relevant in medicine. In this episode, we discuss how moral injury manifests as psychological distress when healthcare professionals' actions, or inactions, contradict their moral or ethical codes, leading to feelings of guilt, inadequacy, and a sense of betrayal.

Our conversation will navigate through the history of this term, its definition, relationship with burnout, PTSD, and moral distress. We'll examine real-life scenarios where healthcare workers face moral dilemmas, feeling trapped in a system that often works contrary to their values.

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

Guest Bio: Kim Bambach, MD is an Assistant Professor of Emergency Medicine at The Ohio State University and Assistant Director of the Kiehl Resident Wellness Endowment

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

Mentioned in this episode:

The Out-On-Time Course

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

Learn More About The Out-On-Time Course

5 Free Tools To Make Medical Practice Easier

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

Free Resources Link

Chris Hicks, MD

Chris is an emergency physician and trauma team leader at St. Michael's Hospital in Toronto.  He has innovated in several areas of resuscitation and psychological skills, including mental practice, stress inoculation training.  These days he enjoys a quieter life, free from the problematic corporate jib-jab of academic deliverables.  In 2018, as a partial rebuke of the status quo, Chris co-created and chaired resusTO, an inter-professional simulation-based resuscitation conference in Toronto with international acclaim.  In 2020, he co-founded Advanced Performance Healthcare Design, consulting with hospitals and industry using simulation to inform the design of systems, spaces and teams.  Chris is an avid speaker and lecturer, staunch #FOAMed supporter, occasional runner and cyclist, fledgling boxer, semi-retired pianist, and proud father of three lunatic boys.

Thom Mayer, MD

Dr. Mayer is the Medical Director for the NFL Players Association, Clinical Professor of Emergency Medicine at George Washington University and a Senior Lecturing Fellow at Duke University. 

Dr. Mayer was named the ACEP Outstanding Speaker of the Year in the second year the award was given and has twice been named ACEP’s “Over-the-Top” award winner. 

On September 11, 2001 Dr. Mayer served as one of the Command Physicians at the Pentagon Rescue Operation, coordinating medical assets at the site.  Dr. Mayer has served on the Department of Defense on Defense Science Board Task Forces on Bioterrorism, Homeland Security and Consequences of Weapons of Mass Destruction. Dr. Mayer also serves as a Medical Director for the Studer Group.

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

• Setting Yourself Up for Success at the Beginning of a Busy Shift
• Counting Down the Hours Til the Shift is Over
• Energy Packets - Closing the Loop on Open-Ended Attention Vampires
• Identifying Your Stress Tolerance Level
• When You Feel Like You're a Victim and Losing Control
• Multitasking Makes You Stupid
• Systems and Scribes to Mitigate Repeated Interruptions and Breaks in Task
• Don’t Be Boring, Get to the Point, and Stay on a Level Playing Field
• What Stresses Out the Teacher's Teacher of Emergency Department Systems Excellence
• How to Keep Things from Falling Apart When You're Slammed with Patients
• Putting Patients into Orbit
• Taking a Pre-defined Pause to Review and Decide on Action
• Reframing the End of Shift When You're Way Behind
• Starting a Shift with a Ritual
• The Mental Checklist When Walking into the Room of an Unknown Trauma Patient
• The Three Things to Learn (or Teach) for Equanimity in a Crisis
• How to Effectively Answer a Challenge from a Team Member During Trauma Resuscitation
• Making Sure Decisions are Focused on Patient Care and Not Ego

Mentioned in this episode:

1 on 1 Physician Coaching

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

Physician Coaching FAQ

The Driveway Debrief

A free resource to help you transition from work to home life. Developed from extensive experience with one-on-one physician clients, The Driveway Debrief is a structured exercise for decompression and processing the day's events. *Release work tension *Establish a boundary between professional and personal life *Be more present with your loved ones after a day's work

The Driveway Debrief

We all have an internal drive that propels us forward, inspiring us to achieve and create. Yet, there's also an innate anti-drive, a subtle yet powerful force that holds us back. This episode delves deeply into the nature of this anti-drive. We explore the foundations of resistance, drawing insights from Stephen Pressfield's 'The War of Art' and linking it to entropy and the Second Law of Thermodynamics. We'll examine why resistance occurs, how it manifests in both our personal and professional lives, and the various ways it can be hidden, even under the guise of positivity. We'll discuss practical strategies to overcome this resistance, ranging from the psychological tools developed by Phil Stutz to Stephen Pressfield’s adopting a professional mindset.

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

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

We Discuss:

• What is Resistance?
• The link between resistance and entropy 
• Resistance is always on patrol and ready to thwart creativity
• Where does resistance come from, and how does it work? The pain of leaving the comfort zone
• Resistance can be hidden in positive action
• How to overcome resistance. Strategy 1 – Phil Stutz’s The Tools
• Even the best feel fear, it can rarely be overcome 
• How to overcome resistance. Strategy 2 – Going Pro
• Why being process vs goal-oriented is a key to overcoming resistance but nearly impossible to execute fully 
• How criticism can be a manifestation of resistance
• Overcoming resistance in documentation habits
• Making your bed and small acts that squeeze resistance out of the picture

Mentioned in this episode:

1 on 1 Physician Coaching

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

Physician Coaching FAQ

When a critical patient lands on your department's doorstep without prior notice, even the most seasoned professionals can find themselves momentarily at a loss — wondering what steps to take first and how to prioritize actions in those crucial initial seconds. What do I do first, what do I do next? What’s REALLY important in the first few seconds? In this episode, emergency intensivist and physician coach Scott Weingart breaks down how to get your mind unstuck and move into action. 

Guest Bio: Scott Weingart, MD is a physician coach and emergency department intensivist from New York. He did fellowships in Trauma, Surgical Critical Care, and ECMO. He is best known for talking about Resuscitation and Critical Care on the EMCRIT podcast , which has been downloaded > 40 million times.

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

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

We Discuss: 

• Temporizing vs. Stabilizing: Why Seconds Count but Don't Really Count
• The Emergency Action Drill
• Get Off the Spot: Taking Action to Get Out of the White Noise
• Beat The Stress Fool: Breathe, Self Talk, See (Mental Rehearsal), Focus with a Trigger Word
• Using Operant Conditioning to Train a De-escalating Trigger Word
• You Don't Need to Be Everything, Everywhere, All at Once: The Critical Steps to Start Unfreezing
• The transition from temporizing to definitive care in a trauma arrest
• Why ACLS Fails as an Emergency Action Drill: Strategy vs Logistics
• The Reason Why Cognitive Freeze Happens in a Zero Warning Critical Situation
• How to Craft Your Own Emergency Action Drills: The Difference Between Thinky Time and Pure Action
• Building an Emergency Action Drill from the Ground Up for a New Disease
• A Hospital's Resuscitation Readiness Contributes to an Individual Clinician Freezing in a Zero Warning Situation
• Making an Emergency Department Resuscitation Ready on an Individual Level
• Emergency Department Resuscitation Readiness on a Systems Level: The Four Steps to Become a Resus World Champion
• Potential Objections to Becoming Resuscitation Ready
• How to Communicate Uncertainty in a Critical Situation

Mentioned in this episode:

The Driveway Debrief

A free resource to help you transition from work to home life. Developed from extensive experience with one-on-one physician clients, The Driveway Debrief is a structured exercise for decompression and processing the day's events. *Release work tension *Establish a boundary between professional and personal life *Be more present with your loved ones after a day's work

The Driveway Debrief

1 on 1 Physician Coaching

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

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The specter of medical malpractice lawsuits looms large for many clinicians, but according to Mark Brown, MD, JD, this anxiety may be disproportionate to the actual risk. In this discussion, we explore the contrasting nature of law and medicine, the unpredictable and capricious nature of legal proceedings, the systemic elements that fuel the high number of medical malpractice lawsuits in the United States, and several practices to reduce the risk of lawsuits.

Guest Bio:

Mark W. Brown, M.D., J.D., holds a JD from Harvard Law School (1970), and an MD from Dartmouth Medical School (1982). His career includes roles in the Los Angeles District Attorney's Office, criminal defense practice, and teaching law at Southwestern School of Law. In medicine, he completed his internship and residency in Emergency Medicine at Presbyterian Hospital, San Francisco, and UCLA and is currently an emergency physician at Antelope Valley Medical Center and clinical faculty member at UCLA School of Medicine. 

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🎓 P.S. This is a CME event.

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

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

We Discuss: 

• The Fundamental Difference Between Law and Medicine
• Should you be worried about the National Practitioner Data Bank?
• Can Getting Sued Lead to Getting Sanctioned by the Medical Board?
• The Odds of Getting Sued
• Three Reasons Why The US Has So Many Malpractice Suits
• Should You Push For Settling a Lawsuit?
• The Plaintiff's Attorney Is Not Your Friend, Even If They Act Like It
• When the Doctor's Med Mal Fear Supersedes the Patient's Risk Tolerance
• What's Really Happening in a Deposition
• High Yield and Low-Cost Ways to Reduce Med Mal Risk and Anxiety
• There's a Big Ticket Item That Your Documentation Doesn't Capture
• What to do About Hindsight Bias

None of us are born with the skills to build and sustain healthy relationships. These things are learned. In this episode, our guest is Ryan Cheney, an experienced psychotherapist and behavioral leadership coach, guiding us through the intricacies of healthy and unhealthy relationship dynamics. Our conversation will explore the importance of interdependence, the negative impacts of codependency, and the nuanced practice of attunement, including how to rectify misattunements. Further, we will delve into the role of healthy boundaries in building resilience and trust, how resistance and perfectionism can hinder growth, acceptance and self-awareness, and the difference between appeasement and compromise

Guest Bio:

Ryan Cheney MS, LPC, is a licensed professional counselor, wellness specialist, certified behavioral leadership coach, breath work specialist, and certified XPT (extreme performance training) coach. 

He received his Master of Science in clinical mental health from Oregon State University and has dedicated himself to learning how to help others through continued research, education, and practice for over 15 years. He has worked in many settings, including community mental health crisis work, clinical outpatient work within medical settings, and as a clinical supervisor for Deschutes County Behavioral Health. He works in his private practice as a clinical mental health therapist specializing in trauma work and as a performance coach, helping others gain self-mastery and thrive.

Connect with Ryan Here

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🎓 P.S. This is a CME event.

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

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

We Discuss:

• The Campfire Metaphor for Relationships
• Interacting with Others' Campfires
• The Difference Between Healthy Interdependence and Codependency
• The Dynamics of Healthy Relationships
• Identifying Healthy vs. Unhealthy Relationships
• Blaming Never Helps, But It Sure Happens A Lot
• Understanding Resistance in Personal Growth and Relationships
• Resistance is a Struggle Against Acceptance
• Confronting and Recovering from Perfectionism
• The Impact of Attunement on Personal and Professional Interactions
• The Importance of Boundaries in Healthy Relationships
• The Distinction Between Appeasement and Compromise

Burnout is not a foregone conclusion. While individual efforts play a pivotal role, continually battling systemic challenges can be exhausting. In this episode, we delve into a simple and cost-effective systemic intervention that not only mitigates burnout but also enhances job satisfaction. We then discuss how you can recognize when your colleagues might be in distress, what to do about it, what to say, what not to say, and how to break through the stigma of seeking help. 

Guest Bio: 

Dr. Tricia James is an internist and the Director of Wellness at Providence Portland Medical Center. A champion of local and regional clinician wellness, she is the first author of the groundbreaking HOSP-CPR study

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🎓 P.S. This is a CME event.

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

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

We Discuss

• A study of two hospitalist groups. One struggled. One thrived.
• The intervention group’s mandate was threefold: Listen, identify the pain points, find agency
• The Role of regular debriefing, sharing experiences, and addressing uncertainty
• Engagement levels were high
• The Intervention Group continued meeting after the study, and it helped. A lot
• It’s not just talking about medicine and logistics. There’s a sense of cohesion and mutual support:
• Outcome of the Non-Intervention Group
• Challenges in wellness funding
• The value of funding and compensation for wellness initiatives
• Approach to securing grants
• Data and stories are great for persuasion. But it's empathy and curiosity that will win the day. 
• Most start by approaching administration for grants
• The first step when creating an in-house clinician-run program to build agency and thwart hopelessness
• Staffing is a significant stress for many and can seem insurmountable. What can you as an individual do about it?
• Emotional suppression in healthcare professionals 
• Our tendency to conceal weakness
• How to identify when one of your colleagues is in distress
• Approaching a distressed colleague
• What to do if you ask a distressed colleague how they're doing and they repeatedly say, "I'm fine," but it's clear they are not
• It's not our job to fix our colleagues that we're worried about. But we can step in and offer an invitation.
• The hardest part about reaching out to offer support is trying not to fix it
• Importance of asking hard questions
• The internal and external barriers to seeking help when we're struggling | Tricia paid for counseling out of pocket, so no one would know about it
• Dr. James’ vision for medicine

Success and happiness are often determined by where we place our focus: within ourselves or on external factors. Mastery lies in asking the right questions, and understanding the locus of control is a key part of this. Those who focus on what they can influence are generally happier and more successful. In this episode, we explore the philosophy behind the locus of control, its impact on burnout, the importance of small bets in making significant changes, and state vs. trait gratitude. Finally, we delve into practical strategies to cultivate a more resilient mindset

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

Guest Bio: Dan Mccollum, MD is an emergency physician and Director of Teaching and Learning at the Medical College of Georgia. Hear more of Dan on Stimulus episodes #1 Verbal Judo #14 Stoic With A Capital S, #25 Digital Minimalism, and #59 Aim to Be A Zero.

We Discuss:

1. Waiting room medicine has become the norm. It's not ideal. So what do you do about it?
2. The power of placing small bets
3. Stoicism and the philosophy behind locus of control
4. Some things in the world are up to us; others are not
5. Sextus, "The crowd is irrelevant."
6. What is the locus of control?
7. Shades of gray in the locus of control
8. The Stoic approach to patient complaints
9. Taming the blame ogre
10. Domains of control and the paradox of varied strength
11. The Stoic approach to patient complaints
12. How a mishandled aspirin overdose led to a major recalibration of control locus
13. A tactical approach to developing an internal locus of control
14. The 'Good' reframe
15. The five slices of gift exercise
16. The jar of awesome
17. Power of an end-of-day debrief
18. Trait vs. state of gratitude
19. Not every approach is for everybody
20. Book recommendations for operationalizing an internal locus of control

Mentioned in this episode:

5 Free Tools To Make Medical Practice Easier

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

Free Resources Link

The Out-On-Time Course

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

Learn More About The Out-On-Time Course

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What’s the impact of private equity’s increasingly large footprint in medicine? The results so far have not been promising. 

We dissect: what is private equity, the recent bankruptcy of the largest emergency medicine staffer in the US and how that impacts clinicians, can corporations practice medicine,  the American Academy of Emergency Medicine has jumped into the fray, does profit-driven medicine ever serve patient care, HCA has been accused of naughty deeds, performance metrics versus the one metric that really matters, the No Surprises Act, and  physician unions.

Guest Bio: Leon Adelman, MD, MBA, FACEP, FAAEM is an emergency physician and co-founder of Ivy Clinicians, a software company that simplifies the emergency medicine job search through transparency. Dr. Adelman is the author and publisher of the Emergency Medicine Workforce Newsletter, which explores the business of emergency medicine. As medical director at Tennova Healthcare Clarksville and Johnston Health UNC (large rural EDs in Tennessee and North Carolina), Leon led emergency department teams to exceptional patient-centered outcomes. Leon is a graduate of Brown University, the University of North Carolina School of Medicine, the Harvard-Affiliated Emergency Medicine Residency at Beth Israel Deaconess Medical Center, and the University of Tennessee Haslam College of Business. Leon is married to an emergency nurse and has two adorable dogs.

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🎓 P.S. This is a CME event.

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

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

We Discuss: 

• What does 'venture capital/private equity' in medicine really mean?
• The largest emergency medicine staffer in the US, Envision, recently went bankrupt.
• What happens with all of those clinicians and hospitals when the staffing company implodes?
• A corporation cannot practice medicine in most states in the US (but can in some!).
• The American Academy of Emergency Medicine is suing Envision and their corporate entity for the illegal corporate practice of medicine
• Is there a functional difference between the old-school CMG (contract management groups) and modern-day private equity-owning medical groups?
• Does profit-driven medicine ever serve patient care?
• HCA has been accused of funneling patients into end-of-life care to improve hospital mortality metrics. 
• Has private equity made universal healthcare impossible in the US?
• The group you want to work for sees physicians as the business rather than an expense to minimize
• Quality of shift is a metric you rarely see on your monthly performance stats, but it should be at the top of the list
• Would you ever wash your rental car? The downstream of not having ownership in a group
• The No Surprises Act was set up to protect patients. It’s kind of a mess. 
• Physician unions. Can doctors go on strike?
• Leon’s guess outlook for the emergency medicine job market in the coming years 

In this real-life coaching session, we walk Dr. Brit Long through building a framework to help navigate being overwhelmed during the middle part of an emergency department shift. Since this session, he has become more efficient, gotten home earlier on a consistent basis, lowered his stress level, felt less burnout, and experienced more joy in his career. 

Guest Bio

Brit Long is an assistant professor of emergency medicine in San Antonio, Texa, and Editor-in-Chief of Clinical Content at emcdocs.net. He is one of the most published authors in the field of emergency medicine. In addition to that, he is a father of two and works in both academic and community settings.

Awake + Aware | Our 2026 Retreat

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

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🎓 P.S. This is a CME event.

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

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

We Discuss: 

• The fundamental differences between the beginning, midpoint, and end of the shift
• Why mid-shift is so fraught
• What we usually do when feeling overwhelmed
• Why willpower will almost always fail as a sole strategy for keeping up with documentation
• The specific steps for navigating mid-shift overwhelm
• Early detection of overwhelm
• A mid-shift action plan
• How to keep up with documentation
• The real reason timely documentation is important
• Breaking through your comfort zone
• Brit’s plan for triaging tasks 
• Why deferring charts is so seductive and a slippery slope

We wear many hats in life, and one of them can become disproportionately large: our professional identity. Don’t get me wrong, being a physician is amazing and the associated identity is imbued with meaning and purpose. The challenge comes when identity becomes calcified and too narrowly defined. When that happens, it can limit us. 

In this episode, we delve into the diverse and often unforeseen roles of a physician, the constraints placed on one's identity due to deeply entrenched beliefs about our own capacities, strategies to overcome limiting beliefs,  how the term "just" can undermine one's potential, the significance of embracing alternate identities, and the common thread between Ted Lasso and Deion Sanders. 

Guest Bio:

Pranay Parikh is a principal of Ascent Equity Group, a real estate, private equity company, predominantly for physicians with over 310 million in assets. Pranay is also the purveyor of the Passive Real Estate Income Academy course, which teaches doctors to be able to find vet and invest in real estate syndications; part of the Passive Income MD podcast, and most recently The Effective Living Formula Course - doing more of what matters. (here's his free webinar) On the side, he is a hospitalist, nocturnist, husband, and father of two young sons.

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🎓 P.S. This is a CME event.

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

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

We Discuss:

• You are more than ‘just’ a doctor
• Pranay’s system for how he approaches life
• An over-the-top identity exercise
• What assumptions do you make about yourself?
• Unpacking the word 'Just' 
• Exercises to Overcome ‘Just’ 
• The Power of Alter Egos
• Belief impacts outcome

It’s tempting to think of accepting the reality of the moment as acquiescence or giving up, but the opposite is true. Awareness and acceptance of what’s going on inside of you and around you is a recipe for equanimity. With this equanimity, you are able to operate at a higher level as well as be an effective agent for change in the system. Sounds like a paradox!

In this episode, we look at mindfulness as a tool for addressing and mitigating burnout, fostering self-compassion, promoting a sense of well-being, squashing imposter syndrome, restoring autonomy, working through our ‘specialness’, getting out of a scarcity mindset, doubting self-doubt, and getting charts done so you can get home on time (yes, it’s true!) 

Guest Bio

Gail Gazelle, MD, MCC is an assistant professor at Harvard Medical School and Master Certified Coach for physicians. She is the author of Everyday Resilience. A Practical Guide to Build Inner Strength and Weather Life’s Challenges, and most recently Mindful MD. 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout. To hear more of Gail, she’s the featured guest on Stimulus Episode 27. 

Awake + Aware | Our 2026 Retreat

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

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🎓 P.S. This is a CME event.

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

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

We Discuss

• What is mindfulness?
• The thinking mind can be overwhelming.
• Mindfulness training helps us gain autonomy.
• Apps and other methods to assist with meditation and mindfulness.
• Mindfulness helps in gaining awareness and insight into one's inner dialogue.
• Recognizing that we are not our thoughts helps restore autonomy and cure burnout.
• Imposter beliefs contribute to burnout and prevent recognition of our own accomplishments.
• Steps that can be taken to challenge and overcome imposter beliefs.
• Combatting the "special syndrome" experienced by many physicians?
• The role self-compassion plays in reducing burnout and improving motivation.
• Shifting from inner criticism to inner ally.
• How does the focus on comparison affect healthcare professionals' well-being?
• Practicing gratitude and abundance mindset shifts physiology and wellbeing
• Emotional reactivity and resistance to accepting reality impact healthcare providers.
• Mindfulness helps healthcare providers appreciate the present and avoid a "milestone mindset"
• There's often confusion between acceptance of the moment and acquiescence to an external issue that you want to change

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. 

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.  

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🎓 P.S. This is a CME event.

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

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

We Discuss: 

• The mindset method for staying in cold water
• Detailed steps for entering cold water
• The benefit of breaking through walls and physiologic control using ice water exposure
• The power of lightly held beliefs
• Cold exposure as a lightly-held belief
• People are dying using the Wim Hof method
• The Bitcoin Enema
• Does Brown Fat matter?
• The law of speedy gains

The Drama Triangle identifies our roles in dysfunctional interpersonal dynamics. It can be a potent tool for understanding conflict and miscommunication within personal and professional relationships. In this episode, we break down the core components of the Drama Triangle, strategies to disentangle ourselves from ‘drama’, and explore practical tools to identify and navigate the dynamics of our own interactions.

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

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

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

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🎓 P.S. This is a CME event.

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

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

We discuss:

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

How do you make important decisions? Do you go by your gut, some sort of defined process, or perhaps a combination of the two? When we're offered an opportunity to participate in something that seems amazing, it’s almost always associated with a cost. That cost is time. Every ‘yes’ is accompanied by even more ‘no’s’.

In today’s episode, we take a look inside a real coaching session that addresses just this scenario. Our client is a physician who wants to develop a decision-making process so that he can derive meaning from his professional life and not take on projects or jobs that on the surface sound intriguing but may end up draining rather than fueling him. 

Client Bio: Josh Russell MD is the editor-in-chief of the Journal of Urgent Care Medicine and is double board-certified in Palliative Care and Emergency Medicine. Apart from his clinical practice, he is a writer, educator, entrepreneur, and trivia enthusiast.

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

Are you often quick to give advice? You're not alone, but sometimes our advice may not be as helpful as we think. In this podcast episode, we explore the concepts of the advice trap and humble inquiry, which shift communication from telling to asking and encourage us to stay curious a little longer.

Guest Bio: The late Edgar Schein, PhD. was a renowned figure in the field of organizational psychology, with significant contributions to the understanding of organizational culture and leadership. As a Professor Emeritus at the Massachusetts Institute of Technology's Sloan School of Management, his academic work spanned several decades, educating countless leaders and thinkers. Holding a Ph.D. in Social Psychology from Harvard University, Dr. Schein was widely recognized for his groundbreaking theories on corporate culture and process consultation. His seminal works, including “Humble Inquiry”, "Organizational Culture and Leadership" and "The Corporate Culture Survival Guide", continue to be pillars of study in the field. Dr. Schein’s dedication and influence earned him prestigious accolades, including the Lifetime Achievement Award in Workplace Learning and Performance from the American Society for Training and Development. His insights continue to shape modern approaches to organizational development and leadership.

The Advice Trap Link

Humble Inquiry Link

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We Discuss:

• We love to solve problems, and that can be a problem
• The Advice Trap
• Why even good advice can be bad
• The paradoxical pitfall of how we see our value
• The demotivator
• Where this comes up in coaching
• You are in the coffee shop with your best friend
• Hearing yourself think
• Humble inquiry
• It’s not just to fill the awkward silence
• Asking questions is not straightforward 
• Critical skills for implementing humble inquiry
• Take-home challenge: The next time you engage in a conversation, particularly in a setting where you’re accustomed to ‘telling’, try implementing the principles of Humble Inquiry and notice if there is an advice trap. See how just noticing, not even doing, influences the dynamics of the conversation and the outcomes that unfold. 

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

Guest Bio: Christina Shenvi MD, MBA, PhD is an emergency physician at the University of North Carolina, Chapel Hill.  She is president of the Association of Professional Women and Medical Sciences, director of the UNC Office of Academic Excellence, and a world-class time management coach www.timeforyourlife.org. A selection of her previous Stimulus episodes includes Procrastination,  Habits, and ‘Too Much on My Plate.’

Mentioned in this episode: 

Zen Driving

Be Water documentary

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We Discuss:

• How do you define a nearly perfect shift?
• What to do when you can’t get something done or things don’t go your way?
• Why do we experience frustration?
• The irony of power and powerlessness
• Point of care frustration reversal
• Even out your standard deviation and raise your mean
• Mental contrasting with implementation intentions
• What Bruce Lee can teach you about adaptability
• Identify the opposite outcome
• Change your own mind
• Minimaize vs maximize 

In this episode, we explore the 10% rule - the idea that in disagreement, the other person is at least 10% right. This is a tool for conflict abatement and resolution. 

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

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

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

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

Awake + Aware | Our 2026 Retreat

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

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🎓 P.S. This is a CME event.

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

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

We discuss

• The sublime feeling of basking in our own rightness
• How to operationalize the 10% rule
• Don't lie and try to appease
• Yes vs No. And vs But.
• All the buts in your day
• The 10% Rule in real-time

Medical debt has a strange and storied history in America. Stretching back to colonial times, physicians and patients alike have grappled with its harsh realities. In recent years, hospitals have resorted to selling medical debt to third parties, who then aggressively pursue patients. In today’s episode, medical historian Luke Messac, MD, PhD, guides us through the past and present landscape of medical debt, examining perspectives from patients, providers, hospitals, and governments. We delve into a form of indentured servitude in the name of debt clearance, the birth of nonprofit hospitals, a pivotal shift in the 1980s, feasibility of operating healthcare under free market principles, medical economics in the 1600s, hospitals suing patients, and the emergence of medical debt as its own thriving industry.

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

Guest Bio: Luke Messac MD, PHD emergency physician and medical historian whose research focuses on health care's history and political economy. Luke is an attending physician at Brigham and Women’s Hospital, an Instructor in Emergency Medicine at Harvard Medical School, and the author of two books, No More to Spend: Neglect and the Construction of Scarcity in Malawi's History of Health Care and most recently, Your Money or Your Life: Debt Collection in American Medicine.

We Discuss:

1. Hospitals suing patients over debt
2. The Service Credit Program | Indentured servitude in the name of debt clearance
3. Nonprofit hospitals were born out of the almshouse tradition, where charity care was part of the mission
4. The 1980s were a turning point for medical debt in the United States
5. With cuts in government medical spending, hospitals cut costs by limiting charity care and aggressively pursuing unpaid debts
6. Why healthcare cannot operate in a pure free market
7. Hospitals used to refuse care to patients and the courts supported it
8. Patient dumping and the rise of EMTALA
9. Collecting money from patients has been an issue for hundreds of years
10. In the 1600s, doctors could be arrested for charging too much
11. Debtor's prison
12. Does suing patients to recover medical debt improve a hospital's bottom line?
13. In the early 2000s, Yale New Haven Hospital put liens and foreclosing on patients' homes as part of a debt collection strategy
14. Medical debt collection has now become a thriving industry
15. How third-party medical debt collectors operate
16. RIP Medical Debt buys and forgives medical debt
17. Is buying and forgiving medical debt better or just forgiving it upfront?
18. Dollar For is a nonprofit focused on helping patients navigate financial assistance programs
19. Some hospitals are making financial assistance easier to access
20. State legislation is starting to address medical debt collection
21. National approaches to medical debt
22. Medical debt is prevalent around the world, but the US stands apart among wealthy countries
23. The consequence of copays
24. Paul Farmer and caring for the destitute sick.
25. The jungle hospital that's carrying out Paul Farmer's vision in Guatemala
26. Rudolf Virchow - Physicians are the natural attorneys for the poor

Mentioned in this episode:

The Out-On-Time Course

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

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5 Free Tools To Make Medical Practice Easier

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

Free Resources Link

Transitions, by their nature, involve ambiguity and disorientation. It's important to recognize that this zone is a natural part of the process of growth and change. In this episode we break down the nature of the being in a transitional/liminal space, embracing it as an identity, and navigating it through small and tectonic changes. 

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

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

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

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We Discuss:

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

Hidden in plain sight is the most important procedure we do. Listening. And not just listening, but listening to understand. Measurable, improvable, and, when done well, can have an incredibly positive impact. Intention is key with listening: are we doing it to understand or to win? In this episode, we break down specific strategies for quality listening, potential pitfalls, and how to know when you've got it right.

Guest bio: Lon Setnik MD is an Emergency Physician and Associate Director of Clinical Programs at the Center for Medical Simulation with expertise in communication

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We discuss:

• The concept of listening as a procedure
• Two modes of listening: listening to understand and listening to win 
• Specific tools for listening to understand
• Separating the problem from the person
• The external marker of quality listening
• Finding the optimized solution in patient interactions
• Negotiation strategies for success
• Active vs empathic listening
• How to stay present during conversation

Have you ever wondered what it takes to reach the highest level of mastery?Are you a medical student looking for ways to achieve excellence in medical school or a physician wanting to become an expert in your field? If so, you’re in luck! Join us as we explore a fascinating conversation with Dr. Jeff Riddell, a leading expert in medical education as he talks about strategies to develop any skill, how medical school curriculum is adapting, the importance of context and relationships for comprehension, and so much more.

Guest bio: Dr. Jeff Riddell is an Assistant Professor of Clinical Emergency Medicine at the Keck School of Medicine of the University of Southern California. His research on digital technology in medical education has made him a sought-after teacher, speaker, and researcher. He has won numerous accolades and awards for his work in both teaching and research, including the 2019 CORD/EMF Emergency Medicine Education Research Grant and the 2019 Academy Scholar Award in the category of Education Research from the CORD Academy for Scholarship in Education in Emergency Medicine.

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We Discuss: 

• Mastering Learning
• Mental Models of Expertise
• Evolving Medical Education
• Learning Retention from Podcasts
• Threaded Cognition - A Theory of Concurrent Multitasking
• Is There Gender Bias in Medical Education?
• Resident Burnout

Have you ever had a day at work that was so difficult and draining, it felt like it took a toll on your entire being? You're not alone. Meet Dr. Sara Gray, an expert in wellness, resilience, and resuscitation team performance. In this episode, Dr. Gray dives deep into her special framework for coping with difficult days and how to recover and even come out of them a little stronger. She has outlined a process to help you identify and acknowledge the struggles, practice self-care, and ultimately, learn from the experience. This framework will provide you with a roadmap for navigating the complex emotions that come with these difficult moments.

Guest Bio:

Dr. Sara Gray is an Emergency Medicine & Critical Care Physician, Associate Professor at the University of Toronto, and Chief Medical Director with Advisory Services by Cleveland Clinic Canada. Dr. Gray was once named Toronto’s best ER doctor by Toronto Life Magazine. She is also a professional coach and a public speaker.

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We discuss:

• Why it's important for medical professionals to prepare for a bad shift or traumatic event.
• The framework steps in coping with bad shifts and difficult cases.
• What is a failure friend and what are their characteristics?

Quote of the pod

"We train to manage all sorts of disasters, to manage the worst cases, but nobody teaches you how to recover when it goes badly...If you have a plan, you can make your recovery so much easier." - Dr. Sara Gray

Part of practicing medicine is telling patients 'no'. It’s never fun to do so and it can be a draining daily task. It doesn’t have to be that way! In this episode, we break down pitfalls and pearls in these situations as well as specific scripting to help the medicine go down, The Spock Retreat - falling back on logic to solve an emotional situation, what happens when we get pushback on our logical responses, when embracing logic is the right and wrong move, how to approach frustrating and illogical interactions, and saying 'no' in a positive way.  

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We Discuss:

• What is the Spock Retreat?
• The scenario: a patient pushes for something that they think will help but will actually harm.
• A common response when we get pushback on our logic.
• You can’t please all the people all of the time.
• When embracing our inner Spock is the right move.
• When embracing our inner Spock could be the wrong move.
• Introducing Bones McCoy.
• Why scripting is important.
• How to approach a situation that is frustrating and illogical.
• What do you want to avoid? 
• How to say “no” in a positive way: The Yes, No, Yes framework, compliments of the Harvard Program on Negotiation.
• What does Yes, No, Yes sound like in real-time?
• A script for pushback.

When you have a patient who requests a Z-pack for what is almost certainly an acute viral respiratory infection, you probably respond internally or externally (possibly both) that antibiotics do not treat viruses. But could there be some effect on their symptoms, or the viral infection itself, that is not part of the common discussion when it comes to such things? We know that azithromycin is an antibiotic, but it turns out that azithromycin actually has some activity in the viral arena. This absolutely shocked me. The question is, does it matter? 

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We Discuss:

• In vitro studies show azithromycin reduces rhinovirus replication and release. 
• Another in vitro study on respiratory cells from lung transplant patients found azithromycin reduces rhinovirus-associated cellular inflammation.
• Kids with coronavirus (the pre-COVID, old-school coronavirus)  had reduced viral load with azithromycin. 
• In enterovirus-infected mice, azithromycin improved survival. 
• Patients infected with influenza a who were given azithromycin had reduced interleukins 6, 8, 17, tumor necrosis factor, and CRP, indicating anti-inflammatory properties in flu patients.
• This study, however, did not show improved clinical outcomes with azithromycin.
• Another study using a similar methodology did not see any change in inflammatory markers but had a slight improvement in sore throat and fever resolution in the azithromycin group. 
• A 2009 paper found that azithromycin did not improve disease course in hospitalized infants with a respiratory synovial virus. There has been signal of clarithromycin decreasing hospitalization in patients with severe RSV, but the preponderance of data are fairly consistent that there is no benefit in hospital stay, length of illness, or oxygen utilization. 

Most of us are motivated to have compassion for those in need, but sometimes it can feel like the tank is running on empty. In this episode, wellness expert Kim Bambach, MD gives insight into compassion fatigue and strategies to thwart it. 

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

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

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

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

Guest Bio: Kim Bambach, MD  is an Assistant Professor of Emergency Medicine at The Ohio State University and Assistant Director of the Kiehl Resident Wellness Endowment.

Awake + Aware | Our 2026 Retreat

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

Learn More Here

🎓 P.S. This is a CME event.

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

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

We discuss:

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