Stimulus | Helping Doctors overcome burnout, excel in leadership, and unlock their most fulfilling careers
Stimulus | Helping Doctors overcome burnout, excel in leadership, and unlock their most fulfilling careers
Rob Orman, MD
We break down ideas, strategies, and tactics to help you improve your mindset, overcome burnout, excel in leadership, prioritize your well-being, get unstuck, de-stress, and thrive in your career. If you are a doctor, nurse, paramedic, medical student, physician assistant, nurse practitioner, administrator, or even tangentially related to healthcare, this show is made for you. Hosted by emergency physician and executive coach Rob Orman, MD. Don't just suck it up, think differently.
Phantasia Kataleptike | The secret skill of Stoicism
Phantasia Kataleptike, a lesser-known gem from Stoic philosophy, offers a transformative approach to life's challenges. This practice of 'objective representation' strips away the layers of subjective judgment that often cloud our perceptions. Imagine the power of viewing a setback not as a disaster but simply as a fact of life, a moment ripe with potential for growth. How does this shift affect our inner turmoil? The Stoics had insights that might surprise you, blending ancient wisdom with actionable strategies for modern living. In this pod, we break down the essence of Phantasia Kataleptike and multiple methods for employing it as a tool for equanimity and de-catastrophization. Love medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.For full show notes of this episode and all sorts of other goodies, visit our podcast websiteThe Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time! We Discuss:Defining Phantasia KataptikeAcceptance of what isA dog and a cart | Epictetus’ classic simileWhy the words we use impact us as much as (or more than) they impact othersThe lost shipThe A-hole in a JaguarOperationalziing Phantasia KataleptikeValence | Awareness of emotion and narrative The Dichotomy of ControlHow to Think Like a Roman EmperorActively de-catastrophizing Shifting from ‘what if’ to ‘why did’ to ‘so what?’ to ‘what’s next’The threat-challenge seesawWhat to do when the emperor banishes youThe counterarguments to Phantasia KataleptikeMentioned in this episode:4 Free Resources specifically designed to address pain points in medical practiceScripting your least favorite conversations The Driveway Debrief My 4 favorite documentation templates The quick and dirty guide to calling consultsFree Resources LinkOur Live Event. May 1-3, 2024 | Bend, ORAwake and Aware An in-person live workshop to help you put into practice the tools you hear on this show. Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work. CME? Yes! This is a CME event. Unplug, slow down, and dig in.Awake and Aware
Mar 11
31 min
Making the trade | How to know when it's time to change careers
Have you ever found yourself deep in “The Pit” where the mere thought of going back to work triggers an existential crisis? You wonder if your current job is the right choice. Sometimes, all it takes are a few adjustments to the current job and you'll feel fully refreshed and stoked to tackle that next shift. It may also, however, be time for The Trade.In this episode, we delve into the critical juncture many professionals, particularly physicians, find themselves in when their once-aspired career paths no longer bring fulfillment. We tackle:Whether to deepen commitments to your current role or brave the uncertainty of switching careersWhat it means to tolerate another yesterdayThe silent tax paid by grinding it outThe emotional and practical implications of making significant life changesHow a well-cultivated professional identity can become an albatrossA step-by-step guide on how to transition towards a more satisfying careerSo, whether you're a physician on the brink, a professional in a pickle, or just someone who enjoys a good existential quandary with their morning coffee, tune in. Let's laugh in the face of the status quo and ponder if the grass is greener, or if it's just astroturf.Guest bio: Lon Stroschein is the purveyor of the Normal 40 podcast and author of The Trade. In past career interactions, he was an aide to a US senator and brokered billion-dollar deals in the aerospace industry. He now guides professionals in finding their second-half stories. The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time! Love medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.For full show notes of this episode and all sorts of other goodies, visit our podcast websiteWe Discuss: Do I double down on what I'm doing right now or consider making a career change?Tolerating another yesterdayThe Pit: A Signal for ChangeRecognizing and Overcoming the Tax of DiscontentWorking yourself into The Box | We strive for years to get into it, but then it can feel like a trap. The two things that keep high-level professionals stuck in a career or positionWork identity takes a long time to build. It gives amazing opportunities but also takes some awayThe Trade: Step by StepThe mindset to thwart inertia #JFDSHas this job given me all it has to give and have I gotten all I have to get?A lifetime is a long time, but it doesn't take long to live itMentioned in this episode:Awake and AwareOur Live Event. May 1-3, 2024 | Bend, OR Awake and Aware An in-person live workshop to help you put into practice the tools you hear...
Feb 26
53 min
Default Mode Network vs. Task Positive Network | How our brains balance mind wandering and focused attention
The interplay between the Default Mode Network (DMN) and the Task Positive Network (TPN) is crucial for our cognitive and emotional health. The DMN, active during restful states and wandering mind, facilitates introspection, memory recall, and creativity, serving as a foundational element in our mental processes. On the other hand, the TPN takes charge during focused, goal-oriented tasks, enabling attention, decision-making, and problem-solving. They operate in balance - when one is active, the other quiescent and this dynamic is essential for optimal mental functioning.However, imbalances in these networks can lead to mental health challenges. For instance, excessive DMN activity is linked to conditions like depression and anxiety, where rumination and negative self-referential thoughts prevail. In contrast, overreliance on the TPN without adequate rest can lead to burnout and stress.Mindfulness meditation offers a practical approach to equilibrating the DMN and TPN, promoting mental well-being by fostering a state of alert relaxation and enhancing self-awareness. Moreover, incorporating regular breaks into the workday, particularly those that allow for mental disengagement from task-focused activities, is vital for sustaining cognitive performance and preventing decision fatigue. Engaging in activities that stimulate the DMN, such as spending time in nature or practicing mindfulness, during these breaks can further enhance cognitive restoration and emotional balance.Awake and Aware | Our 2024 Live EventJoin us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.Website: Awakeandawarebend.com16.25 Hours Category 1 AMA CMELove medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.For full show notes of this episode and all sorts of other goodies, visit our podcast websiteWe DiscussWhat is the Default Mode Network?What is the Task Positive Network?Interplay of the TPN and DMNDefault Mode Network out of Balance | Mental IllnessThe Neurophysiology Behind How Taking a Small Step of Action Can Decrease Rumination and AnxietyThe Default Mode Network and InsomniaWhat Happens with the DMN in Meditation?The Task Positive Network's Role in MeditationWhy Your Task Positive Network is Begging You to Take a Break in the WorkdayHow to Take a Break That Effectively Recharges Your Task Positive NetworkMentioned in this episode:Our Live Event. May 1-3, 2024 | Bend, ORAwake and Aware An in-person live workshop to help you put into practice the tools you hear on this show. Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work. CME? Yes! This is a CME event. Unplug, slow down, and dig in.Awake and Aware4 Free Resources specifically designed to address pain points in medical practiceScripting your least favorite conversations The Driveway Debrief My 4 favorite documentation templates The quick and dirty guide to calling consultsFree Resources Link
Feb 6
32 min
Moral Injury | The crossroads of conscience
Moral injury, a term initially used in the military context during the Vietnam War to describe the psychological trauma soldiers experienced, has become increasingly relevant in medicine. In this episode, we discuss how moral injury manifests as psychological distress when healthcare professionals' actions, or inactions, contradict their moral or ethical codes, leading to feelings of guilt, inadequacy, and a sense of betrayal.Our conversation will navigate through the history of this term, its definition, relationship with burnout, PTSD, and moral distress. We'll examine real-life scenarios where healthcare workers face moral dilemmas, feeling trapped in a system that often works contrary to their values. Moreover, we’ll explore individual and systemic actions that may help mitigate the impact of moral injury.Guest Bio: Kim Baumbach, MD  is an Assistant Professor of Emergency Medicine at The Ohio State University and Assistant Director of the Kiehl Resident Wellness Endowment Awake and Aware | Our 2024 Live EventJoin us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.Website: Awakeandawarebend.com16.25 Hours Category 1 AMA CMELove medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.For full show notes of this episode and all sorts of other goodies, visit our podcast websiteMentioned in this episode:Our Live Event. May 1-3, 2024 | Bend, ORAwake and Aware An in-person live workshop to help you put into practice the tools you hear on this show. Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work. CME? Yes! This is a CME event. Unplug, slow down, and dig in.Awake and AwareThe Driveway DebriefA free resource to help you transition from work to home life. Developed from extensive experience with one-on-one physician clients, The Driveway Debrief is a structured exercise for decompression and processing the day's events. *Release work tension *Establish a boundary between professional and personal life *Be more present with your loved ones after a day's workThe Driveway Debrief
Jan 22
50 min
117. From Chaos to Control | Taming the tempest of task saturation
There’s no getting around the surges and potential chaos of an emergency department. The good news is that these events are predictable, you know they’re going to happen, just not when. So how do you prepare and then navigate the storm once you’re in the thick of it?In today’s episode, we start with a discussion with Thom Mayer, MD exploring strategies to steel yourself for the inevitable chaos, underscoring the importance of maintaining a positive, agentic, proactive mindset. Drawing parallels to General Theodore Roosevelt Jr.'s decisive leadership on D-Day, the discussion highlights the critical need for quick, confident decision-making. A key focus is on the concept of "energy packets," a methodical approach to managing the cognitive overload in the ED by strategically allocating mental resources to specific tasks. We also delve into understanding individual stress thresholds and how to manage stress without succumbing to a sense of helplessness. In the second half of the episode, Chris Hicks, MD gives his approach to managing high patient volumes, communication while managing critical patients, and how to address a direct challenge in the resus bay. Guest Bios:Chris Hicks, MDChris is an emergency physician and trauma team leader at St. Michael's Hospital in Toronto.  He has innovated in several areas of resuscitation and psychological skills, including mental practice, stress inoculation training.  These days he enjoys a quieter life, free from the problematic corporate jib-jab of academic deliverables.  In 2018, as a partial rebuke of the status quo, Chris co-created and chaired resusTO, an inter-professional simulation-based resuscitation conference in Toronto with international acclaim.  In 2020, he co-founded Advanced Performance Healthcare Design, consulting with hospitals and industry using simulation to inform the design of systems, spaces and teams.  Chris is an avid speaker and lecturer, staunch #FOAMed supporter, occasional runner and cyclist, fledgling boxer, semi-retired pianist, and proud father of three lunatic boys.Thom Mayer, MDDr. Mayer is the Medical Director for the NFL Players Association, Clinical Professor of Emergency Medicine at George Washington University and a Senior Lecturing Fellow at Duke University. Dr. Mayer was named the ACEP Outstanding Speaker of the Year in the second year the award was given and has twice been named ACEP’s “Over-the-Top” award winner. On September 11, 2001 Dr. Mayer served as one of the Command Physicians at the Pentagon Rescue Operation, coordinating medical assets at the site.  Dr. Mayer has served on the Department of Defense on Defense Science Board Task Forces on Bioterrorism, Homeland Security and Consequences of Weapons of Mass Destruction. Dr. Mayer also serves as a Medical Director for the Studer Group.Awake and Aware | Our 2024 Live EventJoin us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.Website: Awakeandawarebend.com16.25 Hours Category 1 AMA CMELove medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.For full show notes of this episode and all sorts of other goodies, visit our podcast websiteWe Discuss:Setting Yourself Up for Success at the...
Jan 8
53 min
116. Resistance | How to crack inertia
We all have an internal drive that propels us forward, inspiring us to achieve and create. Yet, there's also an innate anti-drive, a subtle yet powerful force that holds us back. This episode delves deeply into the nature of this anti-drive. We explore the foundations of resistance, drawing insights from Stephen Pressfield's 'The War of Art' and linking it to entropy and the Second Law of Thermodynamics. We'll examine why resistance occurs, how it manifests in both our personal and professional lives, and the various ways it can be hidden, even under the guise of positivity. We'll discuss practical strategies to overcome this resistance, ranging from the psychological tools developed by Phil Stutz to Stephen Pressfield’s adopting a professional mindset.Awake and Aware | Our 2024 Live EventJoin us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.Website: Awakeandawarebend.com16.25 Hours Category 1 AMA CMEThe Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time! Love medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.For full show notes of this episode and all sorts of other goodies, visit our podcast websiteWe Discuss:What is Resistance?The link between resistance and entropy Resistance is always on patrol and ready to thwart creativityWhere does resistance come from, and how does it work? The pain of leaving the comfort zoneResistance can be hidden in positive actionHow to overcome resistance. Strategy 1 – Phil Stutz’s The ToolsEven the best feel fear, it can rarely be overcome How to overcome resistance. Strategy 2 – Going ProWhy being process vs goal-oriented is a key to overcoming resistance but nearly impossible to execute fully How criticism can be a manifestation of resistanceOvercoming resistance in documentation habitsMaking your bed and small acts that squeeze resistance out of the pictureMentioned in this episode:Our Live Event. May 1-3, 2024 | Bend, ORAwake and Aware An in-person live workshop to help you put into practice the tools you hear on this show. Learn to keep cool under pressure, better manage stress, and thrive in what's an incredibly challenging line of work. CME? Yes! This is a CME event. Unplug, slow down, and dig in.Awake and Aware
Dec 25, 2023
29 min
115. Zero Warning | Scott Weingart on frameworks for no-notice critical patients
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.Awake and Aware | Our 2024 Live EventJoin us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.Website: Awakeandawarebend.com16.25 Hours Category 1 AMA CMEThe Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time! Love medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.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 CountThe Emergency Action DrillGet Off the Spot: Taking Action to Get Out of the White NoiseBeat The Stress Fool: Breathe, Self Talk, See (Mental Rehearsal), Focus with a Trigger WordUsing Operant Conditioning to Train a De-escalating Trigger WordYou Don't Need to Be Everything, Everywhere, All at Once: The Critical Steps to Start UnfreezingThe transition from temporizing to definitive care in a trauma arrestWhy ACLS Fails as an Emergency Action Drill: Strategy vs LogisticsThe Reason Why Cognitive Freeze Happens in a Zero Warning Critical SituationHow to Craft Your Own Emergency Action Drills: The Difference Between Thinky Time and Pure ActionBuilding an Emergency Action Drill from the Ground Up for a New DiseaseA Hospital's Resuscitation Readiness Contributes to an Individual Clinician Freezing in a Zero Warning SituationMaking an Emergency Department Resuscitation Ready on an Individual LevelEmergency Department Resuscitation Readiness on a Systems Level: The Four Steps to Become a Resus World ChampionPotential Objections to Becoming Resuscitation ReadyHow to Communicate Uncertainty in a Critical SituationMentioned in this episode:The Driveway DebriefA free resource to help you transition from work to home life. Developed from extensive experience with one-on-one physician clients, The Driveway Debrief is a structured exercise for decompression and processing the day's events....
Dec 11, 2023
44 min
114. An Insider’s Guide to Medical Malpractice | Why the US system is so peculiar and how to navigate the morass
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 and Aware | Our 2024 Live EventJoin us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.Website: Awakeandawarebend.com16.25 Hours Category 1 AMA CMEThe Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time! Love medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.For full show notes of this episode and all sorts of other goodies, visit our podcast websiteWe Discuss: The Fundamental Difference Between Law and MedicineShould you be worried about the National Practitioner Data Bank?Can Getting Sued Lead to Getting Sanctioned by the Medical Board?The Odds of Getting SuedThree Reasons Why The US Has So Many Malpractice SuitsShould You Push For Settling a Lawsuit?The Plaintiff's Attorney Is Not Your Friend, Even If They Act Like ItWhen the Doctor's Med Mal Fear Supersedes the Patient's Risk ToleranceWhat's Really Happening in a DepositionHigh Yield and Low-Cost Ways to Reduce Med Mal Risk and AnxietyThere's a Big Ticket Item That Your Documentation Doesn't CaptureWhat to do About Hindsight Bias
Nov 27, 2023
53 min
113. Understanding Healthy (and Unhealthy) Relationship Dynamics
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 compromiseGuest 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 HereAwake and Aware | Our 2024 Live EventJoin us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots.Website: Awakeandawarebend.com16.25 Hours Category 1 AMA CMEThe Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets Coming soon: Out on TimeStay out of chart debt. Document like a legend. Get home on time! Love medicine, but the job itself leaves a lot to be desired?I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.For full show notes of this episode and all sorts of other goodies, visit our podcast website We Discuss: The Campfire Metaphor for RelationshipsInteracting with Others' CampfiresThe Difference Between Healthy Interdependence and Codependency The Dynamics of Healthy RelationshipsIdentifying Healthy vs. Unhealthy RelationshipsBlaming Never Helps, But It Sure Happens A LotUnderstanding Resistance in Personal Growth and RelationshipsResistance is a Struggle Against AcceptanceConfronting and Recovering from PerfectionismThe Impact of Attunement on Personal and Professional InteractionsThe Importance of Boundaries in Healthy RelationshipsThe Distinction Between Appeasement and Compromise
Nov 13, 2023
48 min
Our 2024 Live Event | May 1-3. Bend, OR
What: Awake and Aware. Our 3-day live eventWhen: May 1-3 2024Where: Bend, Oregon. USAWebsite: Awakeandawarebend.comEarly bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024CME: Yes! Category 1 AMA continuing medical education credit
Nov 10, 2023
5 min
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