How can a person who’s clearly lucid still be deemed incapable of making their own medical decisions? The answer lies in the misunderstood yet critical distinction between competence and decision-making capacity. While these terms are often used interchangeably in clinical settings, they carry vastly different meanings in law and medicine—differences that can determine whether a patient is treated, restrained, or left alone. In this episode, we explore how doctors can (and should) assess capacity, the legal boundaries of competence, and how not to get destroyed on the witness stand. Finally, we unpack a story involving a dog, a scrotum, and a tour of Colorado’s emergency departments.

Guest Bio:  Rich Orman began his legal career as a public defender before moving into private practice. He soon joined the district attorney’s office, where he spent most of his career and ultimately rose to the position of deputy district attorney. Over three decades in the courtroom, he tried some of the most complex and high-profile cases in the state. After retiring from law, Rich turned to filmmaking. He is the writer and director of the critically acclaimed Boundary Layer.

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

• What Competence Actually Means in Legal Terms
• Defining Medical Decision-Making Capacity
• Real-Life Dilemmas in Emergency Medicine
• The Right Terminology in Documentation
• What Physicians Get Wrong in Court
• How to Testify Like a Pro
• How to Handle Yes/No Cross-Examinations
• One Legal Nugget You Should Never Forget

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Decision Making Capacity Free Template

Need to document decision-making capacity quickly and accurately? I created this free resource so you don’t have to waste time looking up the elements each time. It’s an example of how it can be done—use it as a guide and make it your own.

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Ever walk out of a shift and feel like the hospital came home with you? In medicine, the mental residue can cling long after the work day is done. One way to address this is boundary rituals, deliberate actions designed to process the day and allow you to leave work at work, be more present when you get home, and possibly even sleep better. As a bonus, the ability to disengage from work is one of the strongest predictors of reduced burnout.

In this episode, Mohamed Hagahmed, MD, shares how he creates this boundary—through small rituals of gratitude, stillness, and reflection. From growing up as a refugee to serving as a sideline physician for the Pittsburgh Steelers, Dr. Hagahmed’s path has been shaped by resilience, culture, and care. He explains how he learned to stop carrying unfixable wounds home, why kindness is clinical armor, and how tiny acts of self-compassion can protect meaning in medicine.

Guest Bio:  Mohamed Hagahmed, MD a Clinical Assistant Professor of Emergency Medicine at the University of Pittsburgh, Associate Medical Director at the Center for Emergency Medicine, and EMS Medical Director for several systems in Western Pennsylvania. On top of that, he works in high-acuity emergency departments across the region. He’s a graduate of Johns Hopkins Bloomberg School of Public Health, passionate about resuscitation, critical care, and toxicology education. And he’s the creator and host of EMERGE in EM, a podcast focused on emergency medicine education and global health empowerment.

We Discuss:

• Growing up as a refugee and finding purpose in emergency medicine
• The toll of moral injury and why staying closed and rigid nearly broke him
• Small rituals that help shed the emotional residue of a shift
• Using gratitude and stillness as tools for resilience
• How changing clothes, music, and even snacks can protect emotional health
• Turning frustration into advocacy for immigrant health and systemic change
• Advice for new attendings on protecting the threshold between work and home

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5 Free Tools To Make Medical Practice Easier

Scripts for your least favorite conversations.

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The best communication in high-stakes environments isn’t complicated. Quite the opposite - it’s structured, clear, and consistent. Small, deliberate shifts in how we transfer information can dramatically improve patient safety, team efficiency, and workplace culture. In this episode, we explore three simple but transformative communication habits that reduce errors and build trust among teams. Finally, we share practical tools you can use today to tighten your communication and improve safety without adding extra workload.

We Discuss:

• The Three-Way Repeat-Back: “That’s Correct” Changes Everything
• Phonetic Clarifications: Stop the “Norman” Problem
• Numbers: Say the Digits
• Whiteboards: The Cheapest Safety Tool in the Room
• Checklists: Mastering the Basics
• Cheaper Than Dirt, More Precious Than Gold

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Free Tools To Make Medical Practice Easier

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UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course

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Stressful events can hijack cognition, cloud judgment, and leave emotional residue that can fuel long-term burnout. For acute care clinicians, those moments of emotional overwhelm, when heart rate spikes and the thinking brain goes offline, can have consequences that last far beyond the shift. While long-term resilience is essential, it’s often the just-in-time strategies that determine whether we break down or rise to the moment. In this episode, we explore the physiology and psychology of real-time emotional regulation with Scott Weingart, MD, co-creator of the Beat the Stress Fool protocol. Finally, we uncover how practices like gratitude flooding and negative visualization can inoculate against burnout and offer emotional integrity in the most harrowing moments of care.

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

Scott Weingart, MD, is an emergency department intensivist and physician coach based in New York. He completed fellowships in Trauma, Surgical Critical Care, and ECMO, and is internationally recognized for his expertise in resuscitation and critical care. As the creator of the EMCrit podcast, with over 40 million downloads, he has shaped how clinicians think and perform under pressure. Together, Scott and I co-founded Guidewire Coaching, where we create and teach tailored courses to address the real-world pain points of acute care medicine.

• Rapid stress reset with “Beat the Stress Fool”
• Breathing techniques that calm the nervous system
• Self-talk under pressure
• Mental rehearsal that ends in success
• Trigger words for fast de-escalation
• Gratitudinal flooding as a shield during emotional overload
• Real-time tools for grief resilience
• The quiet strength of negative visualization
• Teaching stress tools to trainees without pushback

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UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course

As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.

The UnBurnable Course

5 Free Tools To Make Medical Practice Easier

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No one enters medicine expecting to land on a performance improvement plan, yet for many physicians, it becomes a disorienting reality. A PIP can feel like both a warning and a test, raising existential fears about career, reputation, and future. Behind the formal language is often a complex mix of organizational risk management and legitimate behavioral concerns. In this episode, we explore what it really means to be placed on a PIP, how to navigate the process effectively, and why resistance is rarely a successful strategy. Finally, we share a structured approach to coaching through a PIP that can turn even the most fraught situation into meaningful professional growth.

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

We Discuss:

• Understanding the Purpose and Structure of a Performance Improvement Plan (PIP)
• Variability and Pitfalls in PIPs
• Why Coaching Matters During a PIP
• Common Reactions and Emotional Toll
• Structural Flaws That Undermine PIPs
• Negotiating and Responding to a PIP
• The Myth of Performance Immunity
• A Coaching Framework for Navigating PIPs
• Collaborating With Leadership
• Success and Long-Term Impact

Mentioned in this episode:

UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course

As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.

The UnBurnable Course

5 Free Tools To Make Medical Practice Easier

Scripts for your least favorite conversations.

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What if addiction isn’t about drugs, but about pain? Beneath compulsive behaviors often lie histories of trauma, anxiety, and unmet emotional needs, hidden behind layers of stigma and misunderstanding. In medicine, addiction is still often mischaracterized as a moral failing rather than a treatable illness with deep psychological roots. In this episode, we explore the personal and professional evolution of Dr. Casey Grover, an addiction medicine physician who reframed both his own struggles and the way he cares for patients. Finally, we uncover how shifting mindset and language can transform both clinical outcomes and clinician well-being.

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

Guest bio:  Dr. Casey Grover is a board-certified physician in Addiction Medicine and Emergency Medicine at Montage Health, where he also serves as Chief of Staff. He is the Physician Champion for the Monterey County Prescribe Safe Initiative, a program focused on reducing opioid misuse through education, safe prescribing, and improved treatment access. In addition to his clinical and leadership roles, Dr. Grover hosts the podcast Addiction Medicine Made Easy, where he breaks down complex topics to make addiction care more approachable for both providers and the public.

We Discuss:

• What is Addiction?
• When Food Becomes a Coping Mechanism
• The Stigma of Addiction
• The Neurology of Addiction
• Divided Views on Sobriety
• Why Some People Recover and Others Relapse
• The Reason Some Brains Get Hooked
• Addiction vs. Dependence — and Why Stigma Makes It Worse
• Building Trust with Patients
• From Frustration to Compassion: Reframing Patient Encounters
• Trauma, PTSD, and Personal Reckoning
• The Practice of Addiction Medicine

Mentioned in this episode:

UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course

As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.

The UnBurnable Course

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5 Free Tools To Make Medical Practice Easier

Scripts for your least favorite conversations.

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What is it about your work that still lights you up inside? At the center of every profession is a core - the reason we chose it in the first place, the part that feels meaningful no matter the chaos around it. When we reconnect with that core, even amid challenge, fulfillment often follows. Sometimes, though, that spark fades. Sometimes the core of what we love evolves, shifts direction, or gets buried under layers of stress and routine. In this episode, we explore how to evaluate your relationship with the essence of your work and how small (or big) recalibrations can realign your day-to-day with what matters most. Finally, we share strategies to clear out the noise, fuel the flame, and shape a career that energizes rather than drains.

🧭 UnBurnable | Our Cohort-Based Burnout Prevention and Cure Course

As physician coaches, my partner, Scott Weingart, and I have noticed a clear pattern: some doctors are thoroughly burned out, and many others are on the path toward it. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.

This course will teach you the hidden anti-burnout curriculum.

Learn more at unburnablecourse.com 🚀

• Starting with the central question: How do you feel about the core of your work?
• Using the stories you tell about your job as diagnostic tools. What tone are you bringing to those tales?
• What is a micro recalibration, and how can it reshape your workday from within your current job?
• How do you recognize when overwhelm is a sign of a broken approach, not a broken you?
• Exploring macro recalibrations. What if you love the work, but the environment is eating you alive?
• Running the “look-around test” to evaluate other institutions.
• Identifying “gravity problems.” Which issues can't be solved within your current system?
• Considering a mega recalibration. What does it mean to step away from the work entirely?
• How identity and sunk costs keep us rooted in roles we may have outgrown.
• Visualizing the flame and smoke of your career. What’s burning bright, and what’s clouding the view?
• Defining what a fulfilling day looks like. Is that kind of day even possible where you are now?
• Use a five-year future vision to clarify whether your current job fits into your ideal life.
• Why walking away doesn’t have to mean burning it down. What might rediscovery look like instead?
• You don’t have to burn it all down to rediscover what lights you up.

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

Burnout isn’t just emotional, it’s financial. Many doctors put off financial planning until they’re deep in debt, stuck in lifestyle inflation, and too burned out to pivot. In this episode, The White Coat Investor Jim Dahle lays out how to build a burnout-resistant career by making smart, intentional money decisions, whether you’re a student or a seasoned physician.

We delve into frugality (the useful and the absurd), how burnout can quietly become your biggest financial threat, what makes a solid investment plan, the waterfall method of managing your money, and why many doctors end up wealthy on paper but broke in practice. Plus: when hiring a financial advisor is the smartest move you can make—and when it’s the worst.

Guest bio:  Jim Dahle, MD, FACEP is a practicing emergency physician and the founder of The White Coat Investor. After early experiences with predatory financial advisors, he taught himself personal finance and saw firsthand how financial literacy transformed his life. Motivated to help colleagues avoid similar pitfalls, he launched The White Coat Investor—then the only unbiased financial education resource for physicians. More than a decade later, Dr. Dahle continues to lead the organization as CEO, columnist, and podcast host, staying true to its mission: “help those who wear the white coat get a fair shake on Wall Street.”

• Financial goals as the “game,” not competition with others
• Embracing frugality (and where it can go too far)
• Burnout as a major financial risk
• Strategies to reduce burnout, including working less and managing spending
• Understanding your financial “basement” (minimum monthly needs)
• Lifestyle creep and how to monitor it
• The “live like a resident” strategy post-training
• Net worth versus income, and why physicians sometimes retire broke
• The financial “waterfall” (how to prioritize where your money goes)
• Why trying to beat the market usually backfires
• Whole life insurance: the hype versus reality
• Creating an Investment Policy Statement (IPS)
• Real estate investing: REITs versus hands-on ownership
• Designing your life and shifts as a financially independent physician
• The "night shift marketplace" model
• When to work with, or fire, a financial advisor
• Case study: mid-career physician financial planning

Making a major career shift is never easy, especially when you've dedicated decades to a profession that has become part of your identity. The decision to leave clinical medicine can be fraught with self-doubt, financial considerations, and the lingering question - what comes next? But at some point, the balance shifts, and the cost of staying outweighs the fear of leaving. In this episode, we explore what it takes to walk away from a stable medical career, redefine success, and craft a life that aligns with evolving priorities. Finally, we dig into strategies for managing stress, investing in personal growth, and finding fulfillment beyond the bedside.

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

Guest bio:  Dr. Patrick O’Malley is an emergency physician with nearly two decades of experience in community emergency departments and high-acuity urgent care. Based in Columbia, South Carolina, he has recently expanded into entrepreneurial ventures, including The Laceration Course, in partnership with EB Medicine. He helps moderate the EM Docs Side Hustle Facebook group, a community of over 3,000 emergency physicians exploring side gigs and alternative careers. Dr. O’Malley is dedicated to helping physicians explore new opportunities beyond the walls of the emergency department.

We discuss:

• The Decision to Resign
• Financial Readiness and the Role of Family Support
• Looking Back on a Career in Emergency Medicine
• Redefining Work-Life Balance
• Transitioning to a New Identity
• Investing in Yourself
• Burnout, Coaching, and the Road to Change
• Finding Joy in Medicine: Small Moments, Big Impact
• Living Another Yesterday
• Crafting Your Own Path: Empowering Clinicians
• Newman and John Marks: Managing Stress and Calm

Mentioned in this episode:

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Just dropped: a brand-new video + PDF on how to recalibrate your career based on our sold-out webinar, now re-recorded with the best audience questions and tactical takeaways.

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Recalibrate Your Career

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.

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UnBurnable - Our Cohort-Based Burnout Prevention and Cure Course

As physician coaches, my partner, Scott Weingart, and I have noticed a pattern: some doctors are thoroughly burned out, and some are on the path to burnout. Almost all were shortchanged in their medical training, having been molded into excellent clinicians but given virtually no tools for retaining joy and equanimity throughout their careers.

The UnBurnable Course

Delivering the news of death is one of the hardest yet most overlooked skills in emergency medicine. Many learn by watching others or through trial and error rather than structured training (or just make it up as they go). This lack of preparation can lead to discomfort, stress, avoidance, and even systemic failures in how death notifications are handled. In this episode, we explore the critical components of death communication, how to navigate these difficult conversations with clarity and compassion, and why avoiding or mishandling these moments can have lasting consequences for both providers and families. Finally, we discuss the emotional toll of secondhand grief and the importance of proactive mental health care for those on the front lines of healthcare.

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

Guest bio:  Alexandra Jabr, PhD, EMT-P, is the founder of Emergency Resilience and a leading voice in the overlooked aspects of first responder training. With nearly 15 years of experience as an EMT, paramedic, cardiac tech, EMS coordinator, and educator, she saw firsthand the emotional toll of the job—especially when it came to death communication. She went on to earn a Master’s in Death, Grief, and Bereavement, followed by a Ph.D. in Depth Psychology, focusing on how first responders can maintain their mental health while supporting grieving families and colleagues. Through her work, she’s redefining continuing education, ensuring first responders get the training they truly need—not just another CPR recert.

We discuss:

• Why On-Scene Death Notifications Are So Difficult
• Challenges in Death Communication Training
• Practical Steps for Delivering the News of Death
• A Structured and Compassionate Framework
• Handling Determination of Death
• Common Mistakes
• Secondhand Grief and Provider Well-being
• Proactive Mental Health for Providers

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Awake + Aware | May 5–7, 2025

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

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