Stimulus - Learn Tools to Crush It in Your Medical Career

Verbal de-escalation is a tool that can be learned by almost anyone. In this episode, we learn from two masters in the art of de-escalating those who are agitated and upset:  Jose Pacheco, RN, known affectionately to his co-workers as ‘The Drunk Whisperer’,  and Dan McCollum, MD,  emergency physician at Augusta University. The core of this conversation hinges around an approach to conflict resolution that evolved from the martial arts principle of using your opponent’s energy to resolve conflict, rather than simply butting heads. The name for this method? Verbal Judo.A proviso to all of this is that if the room/scene needs to be safe. Your top priority is to keep yourself and your team safe. Do not put yourself at risk. That doesn’t always mean physical escalation (though sometimes it does), it can simply mean removing yourself from the physical space of the escalating situation. 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:Jose Pacheco's tactics to de-escalate and defuse agitated patients in the emergency department [03:13];Dan McCollum’s de-escalation sequence based on needs of the situation [09:30];The unifying principle of verbal judo: Empathy absorbs tension [15:50];Present the professional image [22:50];The Universal Upset Patient Protocol [24:20];“We treat people as ladies and gentlemen not because they are, but because we are.” [35:50];You can’t control how an upset person is going to respond to conflict, you can only control how you respond. [36:40];Seeing a situation from the other person’s eyes. [37:50];Sword of Insertion technique aka How to politely interrupt [38:20];Active listening [40:50];Tips for interacting with difficult patients in the ED. [42:30];Non-verbal cues [53:30].

What happens at the end of an event can disproportionately impact our perception and memory of it. In this episode, we investigate the research behind the peak end pattern and how you can use this phenomenon to improve your own experience at work (and life).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:Research identifying a peculiar aspect of how memories and impressions are formed;The peak end phenomenon is often portrayed as a bug in our operating system, but it can also be used as a feature;Michael Jordan was a master of finishing time;Focusing on a peak end can not only lead to a better memory of events, but possibly better patient care;Is there evidence that focusing on the peak end will improve job satisfaction and lessen burnout?Two types of peak endings.

In this episode with guest Justin Morgenstern, the concept of availability bias and its impact on decision making is explored. They discuss the challenges of diagnosing rare, life-threatening conditions and the struggles with understanding low probabilities. The importance of mindful decision-making and the role of cognitive biases in medicine are also discussed.

Specific strategies to improve workflow and manage overwhelm during an emergency department shift.Guest Bio: Landon Mueller, MD is an emergency physician and fellowship trained sports medicine specialist who gave the best talk I’ve ever seen on managing workflow in the emergency department. Now he's our guest on the show. 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:3 phases of an emergency department visitWhy disposition is king, until it isn’Hierarchy of tasksBlocking timeLinear vs parallel processingSwarmingBatchingThe quick hit charting nidusTask switchingRunning the boardManaging interruptions

What does it mean to act like a true professional? I’m not sure it’s been fully fleshed out in medicine but I’ve met those who are exemplars of it. This pod is a conversation with my partner in hundreds of critical resuscitations, Ben Peery, MD. We talk about wins, losses, lessons learned and, even more than that, I get to introduce you to someone who, for me, was a role model in how to carry oneself as a physician. Guest Bio: Ben Peery, MD is a 20-year veteran of the emergency department, spending the bulk of that time working in a rural hospital. A former SWAT team member and tactical medicine expert, he is now the host of The Grit Podcast with Ben Peery which you can find on Spotify, iTunes, and all the rest. Ben’s show is conversations “with colleagues in medicine, law enforcement, EMS, and anyone else who has been in the sh*t. By sharing stories and insights we hope to offload mental trauma.”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 website

An inside look at what it takes to launch a ketamine clinic including first steps, navigating hurdles, potential pitfalls, which patients benefit from ketamine, and an exhortation about why you should (and shouldn’t) go into this type of business. Guest Bio: Dr. Samuel Ko is a Board Certified Emergency Physician and medical director of Reset Ketamine in Palm Springs, California. In addition to his medical practice, Dr. Ko is Co-Creator of an online course - Ketamine StartUp - which teaches other physicians how to start their own ketamine clinic.  During his free time, he practices yoga, meditation, reads voraciously, and relaxes with his amazing wife, daughter, and four-legged son. Find Sam on the Insta and Facebook.Here is the link mentioned in this episode with some ketamine clinic startup SWAG (the ultimate checklist and business plan template) from Sam Ko for Stimulus listeners. 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 Sam started a ketamine clinic [04:45];What patients report after awakening from a ketamine procedural sedation in the ED [09:30];What it takes to open a ketamine clinic [11:45];How ketamine is administered [17:30];Adverse events during the infusion are rare [20:55];What happens when the patient enters the clinic [23:05]; Mental preparation prior to the ketamine session [25:50];The 4 stages of ketamine therapy [28:10];Monitoring the patient during the experience [28:50];Liability, price, insurance coverage, and intranasal ketamine [30:10];Online telemedicine ketamine prescribing and therapy [35:30];What people get wrong when they start a ketamine clinic [40:40]; Indications for ketamine therapy [43:20];Ketamine for neuropathic pain [44:50];Ketamine vs. antidepressants for mood disorders [49:15];

Pediatric hospitalist shares his experience of recovering and recalibrating after a devastating case, turning tragedy into growth. The importance of journaling, reflecting on impermanence, and making purposeful choices. Preparing for difficult events and earning forgiveness by removing self-doubt and honoring learning opportunities.

Have you ever had a situation where afterward you repeatedly questioned the choice you made at the time? You chewed on it, perseverated on it, kept coming back to it? If you are a clinician, there is an amplifier to this because someone else’s life is also involved - the patient’s. You worry about their health, you worry about whether they or their family may sue you - you worry worry worry. I think most of us have been there to varying degrees. In this episode, we will discuss one strategy to manage these fears:  the letter to your future self.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 website

Medical Ethicist Abbott, MD walks us through her perspectives on myriad ethical quandaries including:  How to approach discordance between a patient's written wishes and a family member who says do the opposite, the ethics of operating on demented patients who have an acute life threatening critical illness, a case of a young man with an unsurvivable brain bleed and whether or not to extubate him before the family enters the resus room, strategies to skillfully guide families through withdrawal of life support, and the real consequences of restrictive hospital visitation policies.Guest Bio: Dr. Jean Abbott is a medical ethicist and faculty at the Center for Bioethics and Humanities and Core Faculty, Master of Science in Palliative Care, University of Colorado Health Sciences Center. She is also Professor Emerita University of Colorado School of Medicine, and 30 year veteran of the emergency department.  Not part of her CV but germane to this show...she was my attending when I was a resident in the 1990s and had a profound impact on who I became as a physician. Irreverent, quick witted, and a tireless patient advocate, she is one of the finest physicians I have ever known. 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:Visitor policy– one of the enduring tragedies of the COVID-19 pandemic;A case of a 45 year old with an unsurvivable brain bleed – Do you remove the endotracheal tube before the family enters the room to say goodbye or do you await their permission to extubate?;The struggle that society has with brain death;Withdrawing and withholding care in the emergency department;One way to approach death disclosure;Accommodating requests to delay death so family members can arrive to say their goodbyes;The case of a minimally communicative, demented (but happy) patient with a subdural hemorrhage who was unable to provide consent to surgery and has no POLST;Reasons why we tend to over treat in the ED;The scenario where the patient’s POLST form (eg. comfort measures only) and the desires of the power of attorney (do everything) do not align;Priming families in the ED;The ethical thing to do when you can’t get informed consent from a patient;Navigating the “Daughter from California”;When does the medical Power of Attorney kick in?

There’s no denying that mistakes happen in medicine. When they do, what’s the next step? Business as usual is to deny and defend. Not only is this an adversarial and destructive process, it is also a lost opportunity to learn (and for the patient/family to fully understand what happened). In this episode, we explore a novel approach that shifts thinking from ‘risk management’ to ‘patient management’, which some argue is profoundly better for all parties involved in a medical error- clinicians, patients, and systems. Guest Bio: Peter Smulowitz MD is an expert in health policy and author of Disclosure, apology, and offer programs: stakeholders' views of barriers to and strategies for broad implementation.  He currently serves as Chief Medical Officer, Milford Regional Medical Center and is an Associate Professor of emergency medicine, University of Massachusetts Medical School.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 status quo for the way we handle mistakes creates multiple victims, but no winners.  [03:30]It was the aftermath of an unfortunate case that sparked Smulowitz’ interest in this subject. It motivated him to try to make systems better so that others did not have to go through the same trauma. [06:30]We are taught not to apologize after an adverse event. But is this good advice? [13:50]Communication, Apology, and Resolution (CARe) programs have been developed to bring providers out of the shadows, encouraging them to talk about adverse events and encouraging a transparent process with the patients and families. [15:55]How would you apply the CARe process to this hypothetical scenario:  a young woman with a viable pregnancy is mistakenly given methotrexate (which was ordered for the patient with an ectopic in the room next to her)?What is the best way to deliver bad news and apologize effectively? [24:10]The University of Michigan made the CARe program an institutional process. What happened after they started using it?  [22:05]What are the barriers and strategies for the implementation of CARe programs? [28:45]