Stimulus - Learn Tools to Crush It in Your Medical Career

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 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 Flameproof CourseThe 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 websiteWe 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.

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 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 Flameproof CourseThe 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 websiteWe 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.

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 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 Flameproof CourseThe 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 websiteWe 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].

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 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 Flameproof CourseThe 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 websiteWe 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 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 Flameproof CourseThe 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 websiteWe 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 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 Flameproof CourseThe 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 websiteWe 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 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 Flameproof CourseThe 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 websiteWe 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]; andEsther’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 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 Flameproof CourseThe 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 websiteWe 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.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 Flameproof CourseThe 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 websiteWe 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.