Job satisfaction increases when the work we do aligns with our purpose. One way of looking at it is by creating pillars that support your career and being intentional about using those pillars to help guide your decisions. In this episode, we learn that Jaime Hope’s four roles as an emergency physician are to excel as a public safety officer, a resuscitationist, a diagnostician, and a patient advocate. Rob’s pillars are to spark joy in the lives of others, to be present as much as possible, to be of service, and to facilitate awesomeness.

Awake + Aware | Our 2025 Live Event

⭐ Join us at Awake and Aware 2025, a game-changing 3-day workshop from May 5-7 in Bend, Oregon. Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.

🖱️ Website: Awakeandawarebend.com

🎓 P.S. Yes, this is a CME event!

The 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

In this episode we hear from eight leading physician educators about a core principle of patient care:  primum non nocere. We learn that limiting harm can translate into doing what’s medically right, putting the patient’s welfare first, judicious use of IV fluids, reducing opioid prescribing, making a habit of pausing when depleted, acknowledging the end of life, and allowing a natural death. 

Awake + Aware | Our 2025 Live Event

⭐ Join us at Awake and Aware 2025, a game-changing 3-day workshop from May 5-7 in Bend, Oregon. Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.

🖱️ Website: Awakeandawarebend.com

🎓 P.S. Yes, this is a CME event!

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

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

The treatment of non-hospitalized patients suffering from COVID-19 is a hot topic and constantly changing. Today we have a conversation with Salim Rezaie, MD whose dive into this literature couldn’t be much deeper. We discuss which subgroup of patients might benefit from monoclonal antibodies, why the jury is still out on the benefit of ivermectin, the role of inhaled budesonide, and outpatient anticoagulation which hasn’t been studied, but hopefully will be someday.

Guest Bio:  Salim Rezaie completed his medical school training at Texas A&M Health Science Center and continued his medical education with a combined Emergency Medicine/Internal Medicine residency at East Carolina University.  He currently works as a community emergency physician at Greater San Antonio Emergency Physicians (GSEP) where he is the director of clinical education.  Salim is the creator and founder of REBEL EM and REBEL Cast, a free, critical appraisal blog and podcast that tries to cut down knowledge translation gaps of research to bedside clinical practice. Hear more from Salim on Stimulus #16 Accumulation of Marginal Gains.

We Discuss:

• The fact that the best treatment of COVID is prevention through vaccination [2:30];
• The value and purported benefit of monoclonal antibodies [03:21];
• Whether a rapid antibody test would help predict seronegativity [06:30];
• Specifically which monoclonal antibodies are being used in Salim’s shop [07:40];
• The irony of people demanding monoclonal antibodies, but refusing vaccination because they don’t know what's in it [08:50];
• Why you can’t trust everything you read about COVID therapy in a news headline [12:40];
• One of the largest ivermectin studies which was based on falsified data, yet continues to influence the results of meta-analyses [15:30];
• Inhaled budesonide for COVID-19 symptom control [22:00];
• The slippery slope of outpatient anticoagulation [23:39];
• The things Salim might do if he had symptomatic COVID-19 and was well enough to be managed as an outpatient [27:25];
• And more.

For complete shownotes: https://roborman.com/stimulus/61-outpatient-covid-19-therapy-with-salim-rezaie-md/

Interested in one-on-one coaching? https://roborman.com/about-us/coaching/

Our landing page: https://roborman.com/

This podcast streams free on iTunes, Spotify, and Stitcher.

Follow Rob: Twitter,  Facebook, and Youtube.

Scott Weingart and I will be hosting a book club.

When: Nov 14th 20:00 EST

Where: Via Zoom

Who: Anyone who will actually read the book and wants to participate. We are limiting this first one, so please don't sign up unless you are genuinely interested. We will be releasing a recording for those folks that want a passive experience.

Nonviolent Communication: A Language of Life: Life-Changing Tools for Healthy Relationships

How: Sign-Up Here. If we are full, put your name on the waiting list

Thinking about a career as an  expert witness but now quite sure how to get started? Or perhaps you already have a side gig in this line of work but you want to up your game. In this episode we chat with Amal Mattu, MD who is an expert at being an expert witness. He shares pearls of wisdom including what inspires him to do this, how he does it, and why you should remain nice even when it’s getting heated in the courtroom.  Our second conversation is with Rich Orman, JD who has years of experience working with expert witnesses as a trial attorney. He gives his perspective on the mistakes expert physicians make and teaches us that preparation is the key to success.

Guest Bios: 

Amal Mattu, MD is a professor of emergency medicine at the University of Maryland. He's known worldwide for his expertise in educating on emergency cardiology issues as well as his medical legal expertise and experience. 

Rich Orman, JD spent nearly three decades as a trial lawyer, working across the spectrum of practice types - public defender, private practice, and most recently as Senior Chief Deputy District Attorney in Colorado's 18th judicial district.

Awake + Aware | Our 2025 Live Event

⭐ Join us at Awake and Aware 2025, a game-changing 3-day workshop from May 5-7 in Bend, Oregon. Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.

🖱️ Website: Awakeandawarebend.com

🎓 P.S. Yes, this is a CME event!

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

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

We Discuss:

• What inspires Amal to be an expert witness and why he usually works for the defense [1:59];
• How to review a chart [6:20];
• Reimbursement strategies and keeping track of hours [08:37];
• How being involved in court cases influences what you say in a podcast or teach publicly [10:00];
• The fact that medicine is not as clear cut as attorneys make it out to be [10:00];
• Why you should be even-keeled and nice when you’re on the stand and things get heated [13:55];
• The steps to getting started with med-mal work [18:30];
• The importance of knowing clinical policies and guidelines for your specialty (because they’ll be brought up in court) [20:30];
• An attorney’s perspective on the mistakes expert physicians make [29:50];
• Alleviating the fear of physicians who are terrified of being on the witness stand [34:15];
• Advice Rich would give to an expert physician witness who is being cross-examined in an antagonistic way and is clearly unsettled [37:35];
• Rich’s advice for responding to ‘yes/no’ questions when there isn’t a ‘yes/no’ answer [41:55];
• What do the best expert witnesses do that the worst ones never do: prepare [43:15];
• The difference between direct testimony and cross-examination [50:15];
• And more.

What does your life have in common with that of an astronaut? A lot, it turns out. Dan Mccollum returns to Stimulus to break down the skills learned by International Space Station commander Chris Hadfield as explained in his autobiography An Astronaut's Guide to Life on Earth.

Guest Bio: Dan Mccollum, MD is an emergency physician, associate professor, and associate residency director at the Medical College of Georgia. Hear more of Dan on Stimulus episodes #1 Verbal Judo #14 Stoic With A Capital S and #25 Digital Minimalism.

Awake + Aware | Our 2025 Live Event

⭐ Join us at Awake and Aware 2025, a game-changing 3-day workshop from May 5-7 in Bend, Oregon. Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.

🖱️ Website: Awakeandawarebend.com

🎓 P.S. Yes, this is a CME event!

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

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

We Discuss:

• The pitfalls of thinking too highly of yourself [1:46];
• The importance of being a “plus one” and the wisdom of not proclaiming your plus-oneness. “If you’re really a plus one, people will notice” [2:23];
• Aim to be a zero -- having neutral impact [5:08];
• What Mccollum looks for in EM residency applicants: people who treat the receptionist or program administrator well [8:00];
• Why we should focus on the simple core things which are most likely to save lives, as opposed to shooting for the stars with cutting edge treatment [8:48];
• How the weight and power of ego impairs our ability to learn and harms patients [11:04];
• Sweat the small stuff [13:01];
• The quintessential nature of EM and how they’re similar to flight rules: solving complex problems rapidly with incomplete information [13:49];
• The fact that perfectionism and zero likelihood of failure is not part of the flight rules for anything [15:49];
• Why early success is a terrible teacher. If you’ve always been the star and never experienced failure, this can be a barrier to learning [18:27]
• The Jocko Willink video, Good. When bad things happen and you get knocked down, “get up, dust off, reload, recalibrate, re-engage, and go out on the attack” [20:13];
• How to behave when you're in a position of leadership [22:00];
• Expeditionary behavior, which is the willingness to endure hardships for the sake of the mission, and why whining poisons the pool [24:13];
• And more.

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

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

Awake + Aware | Our 2025 Live Event

⭐ Join us at Awake and Aware 2025, a game-changing 3-day workshop from May 5-7 in Bend, Oregon. Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.

🖱️ Website: Awakeandawarebend.com

🎓 P.S. Yes, this is a CME event!

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

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

We discuss:

• The First Receiver who is in a singularly unique position as it applies to a mass casualty [03:55];
• The difference between a hospital’s surge capacity and mass casualty preparedness [05:30];
• The mindset of the medical provider after receiving a patient from EMS [10:32];
• The value of a field triage score which is a simple way to stratify casualties [12:50];
• How the success of a mass casualty event for the first receiver has to do with organization, throughput, and saving lives [16:15];
• Lessons learned from the Christchurch, New Zealand mass shooter incident [29:45];
• How your response to a mass casualty differs if you’re unsure about the safety of your facility (as was the case in the 2020 Beirut explosion) [41:15];
• One of the sayings of the Special Forces: ‘All lessons are written in blood’ [43:27]; 
• The question Shertz thinks people should ask of their hospital disaster planners [45:45];
• And more.

The emergency mind is cool under pressure. But how do you get there? For most us, it’s not an innate skill. Dan Dworkis MD, PhD lays out the path: graduated pressure, deliberate training, tired moves, and acknowledging the suboptimal.

Guest Bio: Dan Dworkis MD, PhD is an emergency physician who is a clinical professor of emergency medicine at USC Keck School of Medicine. He's also host of the Emergency Mind podcast that focuses on helping individuals and teams perform better under pressure and the author of The Emergency Mind: Wiring Your Brain for Performance Under Pressure. 

Awake + Aware | Our 2025 Live Event

⭐ Join us at Awake and Aware 2025, a game-changing 3-day workshop from May 5-7 in Bend, Oregon. Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.

🖱️ Website: Awakeandawarebend.com

🎓 P.S. Yes, this is a CME event!

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

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

We discuss:

• Deploying psychological countermeasures when you’re under stress and dealing with uncertainty [05:40];
• Whether the approach to managing pressure is universal for all stressful situations [11:15];
• Different modes of thought: system 1, system 2, and the recognition-primed decision-making model [15:50];
• The deliberate path to becoming an expert (beyond just repetition) [20:00];
• The value of training with an idea of graduated pressure [21:45];
• What it means to borrow pressure from other events to succeed in something that's unrelated [25:50];
• The Yerkes–Dodson law [28:45];
• Why sangfroid is a good thing and how you do it [35:20];
• The path to excellence which goes far beyond mastery of a specific skill [38:30];
• How acknowledging the suboptimal nature of a situation when something goes wrong can help you “regroup, recover, and evolve out of any crisis” [41:50];
• What does it mean to train your “tired moves” [42:55];
• Dan’s challenge for the Stimulus audience [52:44];
• And more.

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

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

Pics and videos on our website.

Awake + Aware | Our 2025 Live Event

⭐ Join us at Awake and Aware 2025, a game-changing 3-day workshop from May 5-7 in Bend, Oregon. Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.

🖱️ Website: Awakeandawarebend.com

🎓 P.S. Yes, this is a CME event!

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

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

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

Guest Bio: Christina Shenvi MD, PhD is an emergency physician at the University of North Carolina, Chapel Hill where she is the director of the UNC Office of Academic Excellence and the newly appointed president of the Association of Professional Women and Medical Sciences. A frequent guest on Stimulus, Dr. Shenvi is a world class time managment coach www.timeforyourlife.org where her goal is to help busy professionals find more peace with their schedules, feel less stressed, and use their time more effectively. Her most recent Stimulus episodes were on Procrastination and Habits.

Awake + Aware | Our 2025 Live Event

⭐ Join us at Awake and Aware 2025, a game-changing 3-day workshop from May 5-7 in Bend, Oregon. Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.

🖱️ Website: Awakeandawarebend.com

🎓 P.S. Yes, this is a CME event!

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

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

We discuss:

• The insidious path of getting to the point of having too much on your plate [02:00]; 
• A framework for deciding whether to say “yes” or “no” to things [05:45];
• The 4 pillars Rob uses to help guide “yes” or “no” decisions [08:30];
• Why it’s problematic to think of life as a zero sum game[10:20];
• The Japanese concept of Ikigai [13:30];
• Becoming more efficient by shrinking the amount of time you spend on things that are on your plate [15:45];
• The 5 Whys technique for understanding the fundamental bedrock of your motivation [19:30];
• Self-worth theory, which helps explain both why we overwork/overcommit as well as why we sometimes procrastinate [25:00];
• The concept of Stoic meditation and the Ozymandias exercise [30:10];
• The constant struggle of determining if your work aligns with your values and using Stoic indifference to suspend self-judgement [32:00];
• Choosing to do things vs. “I should” [33:40];
• Reframing the notion of being too busy [40:44];
• Deep work [43:30];
• The importance of creating a system for shallow work [46:15]; 
• The freedom gained from managing your email inbox [51:50];
• And more.