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:

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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. 

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 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

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 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

What: Awake and Aware. Our 3-day live event

When: May 1-3 2024

Where: Bend, Oregon. USA

Website: Awakeandawarebend.com

Early bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024

CME: Yes! Category 1 AMA continuing medical education credit

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

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

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

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

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

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

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.

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 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 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 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.

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:

• 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 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 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.  

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 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