Stimulus - Learn Tools to Crush It in Your Medical Career

What is a flow state? When you feel it, you know it. It’s an almost effortless ease of action. To define it, you could say it's a feeling of being in control without making any conscious effort to do so, or being completely immersed in an activity with energized focus. In this episode, performance coach Jason Brooks, PhD breaks down the steps to achieving flow and how to get it back when it slips away. 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:How achieving a flow state is as much about knowing yourself as it is knowing the skill [02:00];Michael Jordan’s superpower -- being 100% present in every moment of every game [06:00];The nuanced distinction between a flow state and being “in the zone” [07:50];The TED talk by Mihaly Csikszentmihalyi and how a state of “flow” promotes lasting satisfaction [09:20];Why training and skill are prerequisites to a flow state [10:50];Tools to bring yourself back into an optimal state when distractions hijack your attention [14:45];Why having joy in what you do is essential to achieving flow [17:30];Self-distraction theory and how that contributes to performance [25:30];Ways we can set ourselves up for success to be in a flow state [32:40];How practicing basic techniques will give you something to fall back on when you’re lost [44:00];Whether it’s better to capitalize on your strengths, or shore up your weaknesses [51:40]; andMore. 

Our guest today is Dr. Zubin Damania (aka ZDoggMD), an internist, hospitalist, and healthcare evangelist. ZDogg is dedicated to turning the practice of medicine into the healing art that it should be, rather than the leviathan of bureaucracy, roadblocks, and nonsense that it sometimes seems to be. In this episode we cover:  the morality of masks and not wearing them in public, racism, suspension of the scientific method in the early phases of the pandemic, Star Wars, and much more.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 RECOVERY Trial which found that steroids reduced mortality in certain COVID patients [02:10];The optimal way to introduce Star Wars to someone who has never seen an episode [07:50];How ZDogg prepares for the flow state of an unscripted live show or polemic [12:30];Why wearing a mask in public during the COVID pandemic is like paying taxes [17:50];Virtue signalling [23:00];The time when Rob was most proud to be ZDogg’s friend [23:55];Pandemic & Protest: Racism As A Social Determinant Of Health [23:55];The fundamental unfairness when judged on something that you cannot control [28:30];The challenge of being both authentic to yourself but also using your large social media platform to spread important messages [34:40];Things that surprised ZDogg about COVID-19 [37:25];The danger (and benefits) of dissemination of anecdotes [40:15];How distancing has disrupted the fabric of society [41:35];The importance of recognizing your emotional response and biases [44:25];Victims of misinformation and how they’re influenced by FLICC [46:20];How infrequent hand-washing demonstrates that quality in healthcare is equated with what’s financially incentivized rather than what really makes a difference [51:20].

Sometimes it feels like we’re buffeted by the winds of life and have little control over what happens to us. The more this cycle recurs, the more helplessness embeds itself into our psyche. Chances are that some of the decisions you make (or don’t make) come from a place of internally throwing your hands up and feeling like you have no say in the matter. The opposite of this mind-frame is called 'agency', or acting with agency. When you act with agency, you own your decisions and act with specific intent. It’s not always easy to get there, however.In this episode of Stimulus, we speak with Christina Shenvi MD, PhD about acting with agency - what it means, actionable skills, and how to apply it. We also talk about: the importance of being specific and deliberate about your philosophy of life, how remembering your mortality puts the rest of life in perspective, Stoic philosophy, Viktor Frankl, and whether or not we have free will.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:Corporate vs. personal mission statements and how codifying your life philosophy can help you live with intent [03:00];Rob and Christina’s personal mission statements [06:15];The fact that even when we try our best to act in accordance with our values, it sometimes feels like there are magnetic forces pulling us away [08:30];Martin Luther, the famous theologian, said that there are two days that matter, this day and judgement day [10:35];The concept of Memento Mori [12:00];The psychologist and Holocaust survivor, Viktor Frankl, whose writing about stimulus and response is like a look into the human soul [16:27];Whether we have free will [18:10];Stephen Covey’s book Seven Habits of Highly Effective People and what the word responsibility means from a Stoic perspective [19:45];What it means to have agency and the way it relates to how you see yourself making decisions [22:55];The importance of knowing that you are the author of your own story [26:10];Learned helplessness and how it stifles creativity [28:00];Barriers to acting with agency [29:50];Different approaches to managing your emotions when criticized by a colleague or consultant [31:40];How Shenvi skillfully manages negative swirls of emotion [41:10];

The thought of taking a break during a busy work day can sound impossible if not contrary to the ethos of our job. The reality, however, is that taking a break is not only possible, but will likely make you clinically sharper, more efficient, and possibly even happier. In this episode, Dr. Joshua Russell walks us through how to take a break within the constraints of our clinical responsibilities as well as pitfalls to avoid when taking a pause from patient care.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 breaks and how they can positively impact your affective state and ability to care for patients;The abundant evidence that says that breaks are helpful;How mental vigilance naturally wanes and decision fatigue sets in as the day progresses. Nobody functions with the same efficiency throughout an entire day; System 1 vs. system 2 thinking, and how when we’re in a negative affective state (ie. a “bad mood”), our ability to be deliberate in our decision-making is compromised;What a healthy break looks like;The notion that finding the time for a break takes intention.

Bob Ross is best known as the mellifluous host of The Joy of Painting, yet there are things he can teach about how to effectively care for trauma patients. In this episode, we cover: how Bob Ross can help invoke calm during crisis, the Chuck Norris mode of trauma resuscitation, why Bob Ross is your trauma room spirit animal, finding your feet, the power of acknowledging mistakes.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:Who Bob Ross was and how he can help us remain calm in a crisis [00:24];The tendency for trauma team leaders to stay in full-on warrior mode, even when that mode not only is no longer necessary, but also may be deleterious [02:30];Why Bob Ross (not Chuck Norris or Wonder Woman) should be our spirit animal in the secondary survey [05:00];Specific ways to be more like Bob Ross in the resus bay [05:50];How “finding your feet” can help you when mistakes are made [07:44];The value of acknowledging a mistake[09:35].

Jim Dahle is an emergency physician who is widely known by his moniker, the White Coat Investor. He's become one of the leading voices for financial literacy and intelligent planning for those who 'wear the white coat'. In this conversation, Jim gives perspectives and strategies on managing finances during a bear market. We address the dangers of market timing, the value of a written investment plan, how Jim invests his money, and why a good financial advisor can sometimes be the best couple's therapist.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 definition of a bear market [02:00];How bonds differ from stocks and why some believe bonds are safer in a bear market [03:10];Why cashing out your whole portfolio when the market tanks may not be the best strategy [06:15];The value of having a written investment plan which tells you what you’re going to do if and when the market changes [10:00];Stock investments, and why it’s better to invest in a low-cost, broadly diversified index funds rather than individual stocks [12:15];Different ways for coming up with your individualized written investment plan [14:15];The importance of having an emergency fund in the event that your income drops dramatically, and how this money should be invested with the goal of having the best return OF the principal, not the return ON the principal [16:40];Ideas for alternate sources of income for physicians that can serve as another buffer in an economic downturn [25:00];Advantages and disadvantages of federal student loans [29:30];What we should do with leftover money, once we’ve fully funded our emergency cushion, 401k and Backdoor Roth IRA and contributed to our 529 [34:10];How to handle discretionary spending and the conflict that can arise when there’s spousal income inequality [36:00];Why having a no-questions-asked allowance can help your marriage [39:50];The wisdom of this advice: “Be generally frugal, but selectively extravagant” [42:15];What physicians should do if they’ve lost their job, but are still several years away from retirement [46:00];How we can help our retired parents who may have lost their nest egg in the stock market [48:50];The cost of health insurance and how it might be far more expensive than you think [52:50];Why renting your home to your business might be more than hoodwinkery [54:20The best financial mindset in an economic downturn is to take a long-term perspective and know that this too shall pass. [58:20].

We've been breathing since our first moments of life, but does that mean we are truly experts? In this episode of Stimulus, therapist and breathwork coach Ryan Cheney walks us through how we can make breath work for us, not just with us.Despite breathing being an automatic process since birth, most of us have yet to harness breath's potential to consciously improve our well-being. The discussion covers various aspects of breathing techniques and their effects, including influence on mental and physiological states, visual field expansion for psychological adjustment, and the three pillars of breath physiology. Cheney also delves into specific breath patterns for nervous system regulation, the advantages of nose versus mouth breathing, and the significance of intentional breathwork in managing stress.  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: How breathing can be used to create different mental and physiologic states [02:40];Expanding your visual field to quickly adjust your psychological state [03:15];The mechanics of breathing [07:00]; Chest breathingDiaphragmatic breathingVolume controlThe physiology of breathing [10:40];The psychology of breathing [15:30];3 categories of breath exercises[16:05]; Apnea breath patternsCadence protocolsSuper VentilationMouth vs. Nose Breathing [18:00];Why stress can be a good thing, but we need to learn how to come down-regulate from it [26:00];Specific breathing exercises and how they can change your mental state [28:45],The calming effect of ocean breathing and elongating the exhale [33:20].

Jason Brooks, PhD is a performance coach who works with physicians, athletes, and the military, helping them develop the cognitive skills not only to operate at the highest level, but to thrive no matter what the task. During the COVID-19 pandemic, Jason has been working with frontline clinicians, helping and guiding them through the cognitive and emotional aspects of what’s happening. This episode will give us strategies to mentally prepare for each day. It will show us how to find an anchor to ground us so that rather than feeling like we’re constantly running defense, we’re actually on offense. 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:How pandemic medicine may be more dangerous to the healthcare provider than battlefield medicine, from the Happy MD blog [02:24];Two big emotions experienced by people on the frontline of the COVID-19 pandemic:  the fear of uncertainty and the lack of control [05:42];How we should keep our focus small and put our attention on the things that we feel some degree of certainty about [07:25];Ways people have created leadership and command centers to handle information overload [09:40];Strategies for managing the stress, anxiety, and fear that comes with working in the COVID-19 environment [11:55];The 2 things fear needs to know:  that you hear it and that you have a plan to keep yourself safe [14:35];The tipping point between being scared and feeling panic [15:35];The importance of flipping your perspective from being on the defense to being on the offense [17:45];The value of adding purpose where there is uncertainty and fear [19:00];Tools for handling moments of stress, panic or fear [22:30];Anti-fragility and how it compares with resilience [23:52];How some people perform better as the favorite, but others prefer being the underdog [29:00];Ways to “pregame” before entering the COVID-19 environment, and how your pre-performance plan can be thought of as a prayer [31:30];Why showing compassion to your fear and embracing it as a part of you is far better than resisting it [42:00];How the aftermath of COVID-19 will need space for healing, processing, and recovery [44:10].

At the end of the day, have you made the world a little better? My guess is that you have, even if only in a small way. That’s certainly true of today’s guest, Dan Bissell, MD. Dan is co-founder of Portland Street Medicine, a medically focused non-profit dedicated to caring for the homeless. What’s unique about the care delivered is that it happens in the austere environment of homeless camps, underpasses, and street corners. In this episode, Dan and I cover what a day of the street medicine team looks like, how his group started, and how street care has impacted his everyday medical practice. 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 follow your bliss [00:45];The best medicine is tangerines and socks. . [04:45]The goal of Portland Street Medicine [07:15]Working in an environment with constrained resources. [11:55]Design thinking [12:44]Portland Street Medicine origin story.[14:45]Homeless communities are complex, heterogeneous, vibrant, and cohesive.  [23:15]The secret sauce to success of Portland Street Medicine.[28:18]Portland Street Medicine serves three populations [29:00]Utility of the stethoscope.  [34:00]The case of Susannah [37:00]The homeless are at a minimum ignored and at a maximum shunned. [40:50]Getting to know the homeless has reformed Dan's thinking about how we structure health care. [42:20]Ask some honest questions.   [46:55]Slow down, find joy. [50:38]

We can't immediately change the process of medicine, the stuff that is kind of a drag and wears us down. What we can change, however, is our mindset. In this episode, we dissect several practices for shift preparation with a common goal of operating at a peak level of performance and experiencing more joy in what we do. Today we learn how to pregame, like a pro.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 system will not adjust to what you need right now.  You have to adjust yourself. [1:45]How accepting gratitude, and other small changes in mindset, can have a logarithmic return on investment. [4:50]The ways that many elite-level performers pregame.  They rely on their rituals for peak performance. [07:15]Physicians are elite-level performers who rarely have the time to mentally prepare for each day. [8:40]How some doctors pregame (or not)....Mike Weinstock doesn't pregame [12:06]Clay Smith's pregame distraction [13:20]Joshua Russell's sequence of physical, emotional and mental prep [15:10]Sabrina Adams the BAFERD [18:00]Jaime Hope thinks of her 4 professional identities [19:10];Mizuho Morrison's 3 steps of self talk [21:40]Ran Ran biking to work. [24:20]Joe Dubois walks to workChris Nickson walks to workRoss Fisher calms during his commute.Haney Mallemat uses mental visualization.Luz Silverio's pregame ritual is to arrive to work 15 minutes early to “chit-chat” with members of her team.[28:40]Alan Sielaff allows sufficient time before the shift to get prepared. [29:30]: Dan McCollum starts the day mentally preparing with the 5 Minute Journal.[31:00] Reuben Strayer mentally prepare for a shift by practicing mindfulness [32:50] Salim Rezaie isolates himself from social media and email for at least 1-2 hours prior to each shift.[35:30] Mike Mallin uses intermittent fasting to improve his focus, attitude, and endurance at work. [37:15]  Rich Hamilton treats a shift like it’s a competitive sport. [38:30] Rob's 2 pregame exercises. [41:10] Jocko Willink’s “Good” [44:06]