Stimulus – Learn Tools to Crush It in Your Medical Career

Do you work in medicine and love patient care but feel like parts of the job don’t measure up? Stimulus equips you with tools, mindset shifts, and strategies they didn’t teach you in training—so you can practice medicine like a boss, flourish in your career, and not let it crush your soul. Emergency physician and executive coach Rob Orman, MD, goes in-depth with thought leaders on how to avoid burnout, improve communication, lead without drama, and stay calm amidst the storm. Don’t just suck it up, think differently.

Latest Episodes:

14. Stoic With a Capital S Jul 27, 2020

Show notes

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 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

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 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.

12. How to Achieve Flow State Jul 09, 2020

Show notes

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 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

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:

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]; and
More.

11. ZDoggMD | Race, Star Wars, virtue signaling, and prepping for a live show Jun 29, 2020

Show notes

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 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

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 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].

10. The Space Between Stimulus and Response Jun 11, 2020

Show notes

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 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

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:

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];

What ECMO Does (and doesn't) Do. ERcast Lite Final Episode Jun 08, 2020

Show notes

In the swan song of ERcast Lite, we speak with Scott Weingart about the truths, misunderstandings, and physiology of ECMO.

To subscribe to ERcast and get 2.5 hours of high yield monthly content, CME, and all sorts of goodies, use the code 'bacon' for a 3 month free trial. https://www.hippoed.com/em/ercast/

Pearls:

VV ECMO takes over lung function and is used for those with severe lung disease (ie. ARDS, pneumonia, severe asthma).
VA ECMO takes over the heart and lung. Ideal candidates are patients with massive PE or cardiogenic shock.
Intubated patients who you can’t oxygenate despite rapidly escalating PEEP and a high FiO2 should be considered for VV ECMO.

There are 2 primary types of extracorporeal membrane oxygenation (ECMO): veno-venous (VV) and veno-arterial (VA).

- VV ECMO takes over lung function.
  - It drains blood from the IVC or SVC, sends it through a pump which delivers it to an oxygenator (a membrane which allows the influx of oxygen and removes CO2), and then pumps the oxygenated blood back into the right heart system (returning it to the IVC or SVC).

Useful for those with severe lung disease but decent heart function.

Examples: pneumonia, ARDS, severe asthma with CO2 retention, immunologic lung diseases, cystic fibrosis awaiting lung transplant

- Limited by its complications, cost, and logistical catastrophes.
VA ECMO takes over lung AND heart function.
- It drains blood from the IVC/SVC, pumps it out and sends it to an oxygenator, and then returns the blood retrograde up the aorta so it can perfuse the abdominal viscera, brain, and possibly even the heart.

For patients with cardiogenic shock or massive PE.

Does not yield as much benefit for patients with septic shock or other vasodilatory states (unless they had a sepsis-induced cardiomyopathy).
Shares the same limitations as VV ECMO, with the addition that the physiology induced by the VA ECMO itself can be deleterious.

Which patients might benefit from transfer to an ECMO center?

- The threshold for transfer depends in part on the capabilities at your institution for advanced ventilatory modalities (ie. airway pressure release ventilation, proning patients, nitric oxide).
- A large percentage of patients transferred for ECMO never end up receiving or needing it. However, they still greatly benefit from moving to a facility that has the ability to provide other nuanced critical care options.
- In general, transfer young patients who are on very high vent settings and not getting better.
  - At a community hospital with few vent resources, these patients should be transferred within hours.
  - At bigger institutions, transfer within 48 hours. Often people wait too long (5-7 days) to initiate the transfer.

Use the ARDSnet Mechanical Ventilation Protocol and Murray Score to help decide if a patient would be a good VV ECMO candidate.

- The ARDSnet protocol is evidence-based and communicates where the patient is on their vent settings. It gives receiving centers a clean way to evaluate patients for potential transfer.
- Patients should be

Amal Mattu on COVID Cardiology Jun 02, 2020

Show notes

COVID-19 causes STEMI’s, arrhythmias and myocarditis?!? Emergency medicine and cardiology guru Amal Mattu, MD chats with Mizuho Morrison, DO on the cardiovascular effects of COVID-19. They discuss: the known pathophysiology of how viral infections affect the heart; Review the new consensus statement from the Society of Cardiovascular Angiography and interventions (SCAI), American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP) on how to manage STEMIs; and lastly discuss how cardiac arrest management differs in this COVID era.

Promo code for 3 month trial of ERcast in intro segment
Hippo education COVID resource site: Link

References:

Mahjid, M. Payam, S. et al. Potential Effects of Coronaviruses on the Cardiovascular System: A Review [published online ahead of print, 2020 Mar 27]. JAMA Cardiol. PMID 32219363
Mahmud E, Dauerman HL, et al. Management of Acute Myocardial Infarction During the COVID-19 Pandemic,CONSENSUS STATEMENT from the Society of cardiovascular angiography and interventions (SCAI), American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP). Journal of the American College of Cardiology (2020), doi https://doi.org/10.1016/j.jacc.2020.04.039. PMID:32330544
Edelson D, Sasson C. et al. Interim Guidance for Basic and Advanced Life support in Adults, Children and Neonates with suspected or confirmed COVID-19. Circulation AHA April 2020. PMID: 32270695
Stefanini GG, Azzolini E, et al. Critical Organizational Issues for Cardiologists in the COVID-19 Outbreak: A Frontline Experience From Milan, Italy [published online ahead of print, 2020 Mar 24]. Circulation 2020. PMID: 32207994

9. The Master Skill of Taking Breaks May 25, 2020

Show notes

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 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

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 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.

Verbal Judo May 18, 2020

Show notes

The good news is that 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’, has a specific sequence to this approach, which he’s going to walk us through, step by step. We are also joined by Dan McCollum, emergency physician at Augusta University, to talk about conflict resolution that evolved from the martial arts principal of using your opponent's energy to resolve conflict, rather than simply butting heads. The name for this method? Verbal Judo.

For complete shownotes: Use this link

To learn more: https://www.stimuluspodcast.com/

We discuss:

Ways to de-escalate and defuse people who are belligerent or intoxicated [00:50];
The origin of “Verbal Judo”, a term coined by George Thompson, PhD and the title of his book [03:31];
McCollum’s de-escalation sequence which is a graduated response to agitated patients based on the military system of DEFCON 1-5 [06:35];
How crucial it is to be nice, have empathy, speak quietly, know when you can bend (while still keeping things safe), and offer anxiolytics as needed [08:10];
The notion that empathy can absorb tension and be a strategic tool for conflict de-escalation [14:18];
The 6 steps of Dike Drummond’s Universal Upset Patient Protocol [22:30];
The importance of being organized and having a plan before starting a difficult conversation [29:43];
How your response to confrontation says just as much about you as it does about the other person [32:52];
How the stoic idea of the dichotomy of control applies in these situations [34:43];
The value of seeing a situation from the other person’s eyes [35:40];
The “Sword of Insertion” technique [36:58];
The importance of active listening in conflict resolution [38:38];
Jose Pacheco’s tips for interacting with difficult patients in the ED [41:15];
Non-verbal cues and why they are the majority of our communication [51:46]; and
More.

8. The Bob Ross School of Trauma | Don't rush but don't linger, full chill, talk the process May 14, 2020

Show notes

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 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

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:

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].

7. The White Coat Investor | Bear markets, investing plans, income loss, and cushion cash May 07, 2020

Show notes

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 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

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 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 [54:20
The best financial mindset in an economic downturn is to take a long-term perspective and know that this too shall pass. [58:20].