Effective (and ineffective) leadership comes in many flavors, but there is an underlying quality to any good leadership that you know when you see it. In this episode, Colonel Jim Czarnik, MD and Josh Bucher, MD break down the lessons they’ve learned leading in both the military and civilian worlds of medicine and crisis situations. My favorite quote from this episode: “Purpose is embraced, not imposed.”  

Guest Bios:

Colonel Jim Czarnik, MD  is the Deputy Chief Of Staff, Surgeon United States Army Special Operations Command. He has previously served as Command Surgeon for US Army Africa and was instrumental in coordinating the multinational response to the recent western Africa Ebola outbreak.

Josh Bucher, MD.is an assistant professor of emergency medicine at Rutgers- RWJMS. He is EMS-fellowship trained and currently holds the position of associate EMS Medical Director for RWJ-Barnabas MHS. An expert in tactical emergency medicine, he is medical director of the Middlesex and Somerset County SWAT team. 

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 be a leader and why leadership is a state of mind [03:15];
• The culture that you want to create in your professional environment [04:10];
• The ERO relationship (Event + Response= Outcome) [06:20];
• Why self-motivation is so important for success in the emergency department [09:00];
• How teamwork is directly related to your mission: a good patient outcome [10:40]; 
• Keys to success when you transition to a position of leadership [13:40]; 
• Mistakes young leaders or people newly in leadership positions commonly make [20:15];
• The right mix of being respected and being liked [22:30];
• Czarnik’s special skill for being able to start conversations with anybody, no matter who they are [27:25];
• How Czarnik manages email [31:15];
• Czarnik’s personal philosophy and approach to life [33:00];  
• Czarnik’s ask for the world of medicine and something he’d like to see change [34:10]; 
• And more.

In this Stimulus Thump: Should we be worried about COVID on surfaces? Tools to manage the third wave. A new study suggests there might be benefits from aspirin.  Having flu and COVID at the same time increases odds of mortality. 

Listen on:

• iTunes
• Spotify
• Stitcher

This episode is sponsored by Wild Health.  Wild Health provides personalized medicine that takes into account your DNA, biometrics, microbiome, and lifestyle factors to come up with your ideal diet, supplements, and lifestyle to optimize health and maximize healthspan. Use the code "Stimulus” for  10% off any Wild Health care plan.

We Discuss:

• Two tools to mitigate mental health impacts of the third COVID surge [01:48];
• Influenza and COVID co-infection increases mortality compared to COVD infection alone [06:40];
• An association between aspirin use and decreased in-hospital mortality, ICU days, and need for a ventilator [10:00];
• How long COVID exists on surfaces and does it remain infectious [14:57]
• More. 

For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/

If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!

Interested in sponsoring this podcast? Connect with us here

Follow Rob:
Twitter: https://twitter.com/emergencypdx

Facebook: https://www.facebook.com/stimuluswithrobormanmd

Youtube: https://www.youtube.com/c/emergencypdx

When things are going well, you may not notice how your mind is working. But sometimes, you are overtaken by events and it can feel like the gears are grinding in the worst possible way in both life and work.  In this episode, physician coach Gail Gazelle, MD,  walks us through the mental processes that happen in those gear grinding moments and how to not only work through them, but also come out the other side with resilience and a better understanding of ourselves.

Guest Bio: Gail Gazelle, MD, MCC is a former hospice physician, part-time Harvard Medical School Assistant Professor, and Master Certified Coach for physicians. One of the leading pioneers in physician coaching, Dr. Gazelle has coached over 500 physicians and physician leaders on leadership development, mindfulness, emotional intelligence, resilience, and moving from burnout to balance. She is the author of Everyday Resilience. A Practical Guide to Build Inner Strength and Weather Life’s Challenges, (Free chapter here). You can contact Gail through her website and, if so inclined, schedule a complimentary coaching consultation.

Today’s episode is sponsored by Wild Health.  Wild Health provides personalized medicine that takes into account DNA, biometrics, microbiome, and lifestyle factors to come up with the perfect diet, supplements, and lifestyle to optimize health and maximize healthspan. They also have a fellowship program to teach physicians, providers, and health coaches how to practice this new paradigm of medicine. Use the code "Stimulus” for  10% off any Wild Health care plan.

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 fundamentals of mindfulness [02:55];
• What burnout looked like for Dr. Gazelle before she embarked on a new career path as a physician coach [05:45];
• The impact COVID-19 has had on her conversations with physician clients [07:15];
• The response of front-line providers when referred to as a “hero” [10:10];
• What it’s been like for physicians, trained to be the captain of the ship, when put in the position of managing COVID patients with little guidance from science [12:40];
• How Gazelle helps physicians manage uncertainty and weather difficulty [17:30];
• Tips for ensuring that the “daily dose of goodness” becomes a defined habit [21:30];
• How accepting what is/isn’t in your control can help mitigate stress, frustration, and anger [29:50];
• Different ways of handling a bad leader [33:00];
• The importance of regulating your emotional temperature [38:00];
• The problem with either/or thinking [42:00];
• The STOP tool for applying mindfulness practice in the heat of an intense moment [45:50];
• Anticipatory dread and catastrophic thinking in medicine [49:40];
• The crossroads of imposter syndrome and perfectionism which makes for a cycle of perceived inadequacy [55:30];
• An affirmation Gazelle created for her clients who struggle with perfectionism:  “I am good. I do my best. I cannot control all the rest.” [59:40];
• And more.

In this Thursday Thump: Is there a role for aspirin in COVID? Does vitamin D reduce the chance of getting COVID or being sicker once you have it?  Association between going to a restaurant and testing positive. Cardiac injury in athletes after mild and asymptomatic infection.

Listen on:

• iTunes
• Spotify
• Stitcher

We Discuss:

• Is there a role for aspirin in COVID infection? [01:42] ;
• The evidence for and against vitamin D in COVID infection [03:15];
• COVID positive patients have increased odds of having been to a restaurant compared to COVID negative [09:57];
• Understanding odds ratio [11:00];
• Exercise with active covid infection isn’t a good idea [13:00];
• Potential risks of exercise after COVID infection [14:00];
• Ohio State University is going to get cardiac MRI on athletes to screen them for return to play [17:00];
• Gadolinium Deposition Disease might or might not be a thing [17:54];
• More.

For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/

If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!

Interested in sponsoring this podcast? Connect with us here

Follow Rob:
Twitter: https://twitter.com/emergencypdx

Facebook: https://www.facebook.com/stimuluswithrobormanmd

Youtube: https://www.youtube.com/c/emergencypdx

Our digital lives have become cluttered, scattered, and reflexive rather than intentional. Is it time for a change? In this episode, Rob and Dan McCollum, review the principles and exercises laid out in the book Digital Minimalism: Choosing a Focused Life in a Noisy World. Taking it a step further, they share what happened when they went full on guinea pig and dove deep into the process.

Guest Bio: Dan McCollum, MD is an emergency physician, associate professor, and associate residency director at the Medical College of Georgia. Here more of Dan from Stimulus Episode #1 Verbal Judo. 

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

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 digital minimalism is something we might want to consider doing [03:07];
• Most of the interactions that we have with social media are of low value [05:40];
• The truth about why most people participate in social media [06:15];
• The core principles of digital minimalism [07:20];
• Cal Newport’s method for using phones, computers, and apps in a way that they are net positive [11:00];
• Tips and observations from Rob’s and Dan’s 30-day breaks from technology [13:10];
• The process for reintroducing technology after the 30 day declutter [19:00];
• Strategies Rob and Dan have employed for using technology differently, months after a declutter [21:00];
• Dan’s bottom line about digital minimalism [27:25].

World-renowned vaccine expert Paul Offit discusses where we stand with the development of a COVID-19 vaccine, challenges ahead, and how clinicians can best focus our efforts in vaccine education and advocacy.

This podcast is produced in partnership with Hippo Education

• How the COVID vaccine is being made and where it targets the virus
• Different variations of the vaccine
• The normal path to vaccine development and how it's different with this one
• Why Paul Offit would opt for wearing a mask vs getting a vaccine if he had to choose between the two
• How to balance the urgency for the need for a vaccine with safety concerns
• What happens in Phase 1, 2, and 3 trials
• Likelihood the vaccine will be rushed to market

Guest Bio: Paul Offit is a pediatrician specializing in infectious diseases and an expert on vaccines, immunology, and virology. He is the co-inventor of a rotavirus vaccine that has been credited with saving hundreds of lives every day. Offit is the Maurice R. Hilleman professor of vaccinology, professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania and director of The Vaccine Education Center at  Children's Hospital of Philadelphia (CHOP). Offit is currently a member of National Institutes of Health (NIH) working group on vaccines, a subgroup of the "Accelerating COVID-19 Therapeutic Interventions and Vaccines" (ACTIV) comprised of experts to combat COVID-19. He is also a member of the FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC). Previously, he was a member of the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices. Offit is a board member of Vaccinate Your Family and Autism Science Foundation.  "Overkill" is his 11th book. 

For show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/

If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!

Interested in sponsoring this podcast? Connect with us here

Follow Rob:
Twitter: https://twitter.com/emergencypdx

Facebook: https://www.facebook.com/stimuluswithrobormanmd

Youtube: https://www.youtube.com/c/emergencypdx

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

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

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

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 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. 

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 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.

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:

[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.

Convalescent plasma has been a hot button news story over the past few weeks since the FDA approved its use in COVID patients. In this episode, hematologist Tom DeLoughery (@Bloodman) breaks down what it is, what it purportedly does, the evidence (or lack thereof) supporting its use, at what point in disease it might work, and potential dangers of indiscriminate use. 

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

We Discuss

• What is convalescent plasma (CP)? [04:06];
• How plasmapheresis can collect large volumes of donor plasma [4:53];
• If donating plasma (and losing antibodies) can make one more susceptible to infection [5:32];
• The potential folly of using CP in only the sickest patients and why it might be better used at the beginning of illness [06:25];
• How much immunity a single unit of plasma might provide [10:51];
• Adverse consequences of plasma use [12:00];
• Does CP actually work? [14:16];
• Would Tom want CP if he got COVID? [21:35];
• What we’ve learned from the massive effort to accelerate CP collection [23:02];
• And More.

****

For Show Notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/

If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance!

Interested in sponsoring this podcast? Connect with us here

Follow Rob:

Twitter: https://twitter.com/emergencypdx

Facebook: https://www.facebook.com/stimuluswithrobormanmd

Youtube: https://www.youtube.com/c/emergencypdx