Avsnitt
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It started in medical school, when I witnessed the stark reality of the hidden curriculum: a transgender patient referred to as "it" by an attending physician. Over the years, I saw more subtle but no less harmful behaviors—snickers, misused pronouns, quiet biases. I often felt lost in how to respond.
Today, transgender identity feels more politically charged than ever. But beyond the politics, what’s it like simply to be transgender? What challenges do transgender patients face—physically, medically, socially, and emotionally? And how do you navigate a world that sees you differently after transitioning?
In this episode, Dr. Jailyn Avila shares her story. We cover the deeply personal aspects of transition, from conversations with her wife and kids to navigating professional dynamics as an internationally recognized expert. Dr. Avila offers candid insights into her experience as a physician presenting as both male and female, practical advice for providing better care for transgender patients, and strategies for addressing pronouns and mistakes with grace.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest bio: Jailyn Avila is a board-certified emergency medicine physician, transgender woman, wife, and mother of three. She has been heavily involved in medical education with an emphasis on bedside ultrasound and runs Core Ultrasound, delivering online educational content. In 2021, Jailyn began her gender transition and “completed” said transition in 2023. Jailyn is currently Core Faculty for the UHS SoCal MEC Emergency Medicine Residency in Temecula, California where she also functions as the Associate Ultrasound Director and the Director of Faculty Development.
Coming Out to Her WifeNavigating External Frictions and Gender IdentityBalancing Personal and Professional IdentityThe Gradual Process of TransitionWork and Social DynamicsExperiences as Both a Male and Female PhysicianManaging Emotions: The RAIN MethodCaring for Transgender Patients in the Emergency DepartmentImpact of Jailyn's Transition on Her Family and ChildrenUnderstanding Gender and Biological VariationsMentioned in this episode:
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.🎓 P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
Never Lame. Never Spammy. Always Fresh.
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5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
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Why do our minds seek explanations for everyday patterns, even attributing a cause where none may exist? "Regression to the mean" offers a statistical lens on why extreme experiences naturally revert to the norm. In medicine, this concept reveals why critical observations and repeated assessments are essential to avoid overreactions to abnormal results.
In this episode, we explore the nuances of regression to the mean, breaking down its impact on medical decision-making, patient assessments, and even how we view high-stakes scenarios in healthcare. Finally, we delve into how understanding this principle can enhance clinical judgment and reduce unnecessary interventions.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest bio: Josh Russel, MD, is the editor-in-chief of the Journal of Urgent Care Medicine and is double board-certified in Palliative Care and Emergency Medicine. Apart from his clinical practice, he is a writer, educator, entrepreneur, and trivia enthusiast.
We Discuss:Superstitions in the Emergency DepartmentUnderstanding Regression to the MeanIs It a Good Idea to Chastise Fighter Pilots?Blood Pressure Lives on a Bell CurveThe Importance of Control GroupsPediatric Visits For FeverNatural History of Disease Processes: Some Are OutliersThe Test of TimeBalancing Urgency with Thoughtful Testing ThresholdsMentioned in this episode:
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
Never Lame. Never Spammy. Always Fresh.
If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our Newsletter
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.🎓 P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
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Saknas det avsnitt?
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Being a patient can feel like a lonely experience, especially when you sense your doctor is disconnected. A rushed or disengaged interaction can leave patients feeling unheard and uncared for, no matter how clinically skilled the physician is. At the same time, doctors struggle with overwhelming workloads, which can lead to unintentional detachment from those they treat.
In this episode, we explore five ways to build connection in the exam room quickly, why small gestures matter, and how intentional preparation can change the entire dynamic. Finally, we dive into the emotional complexities of patient care and the essential role of listening and presence in preventing burnout. Our conversation centers around the ‘Presence 5 Practices’ from this article.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bio: Clay Smith, MD, is an Associate Professor of Emergency Medicine at Vanderbilt University. He is triple board-certified in Internal Medicine, Emergency Medicine, and Pediatrics and the founder of JournalFeed, which provides concise, daily summaries of top medical journal articles.
We Discuss:The Disconnect Between Patients and PhysiciansWhy Genuine Doctor-Patient Connections Matter More Than You ThinkEasing Patient Anxiety and ShameThe Impact of Preparation and Focus on Patient CareListening Intently and CompletelyAligning Care with Patient PrioritiesBuilding Trust by Connecting with the Patient's StoryUnderstanding Emotional CuesThe Delicate Balance of Antibiotic StewardshipUnderstanding Fear Behind Patient AngerMentioned in this episode:
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.🎓 P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
Never Lame. Never Spammy. Always Fresh.
If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our Newsletter
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It's often not the big power moves that change our lives; it's the small, intentional actions. By focusing on micro-skills, even the most ambitious goals become achievable.
In this episode, we talk with Drs. Adaira Landry and Resa E. Lewiss about their new book, MicroSkills: Small Actions, Big Impact. We explore how financial literacy, self-presentation, concise communication, and allyship can be developed as essential micro-skills for a successful career. We also navigate workplace dynamics, including recognizing and addressing issues like mansplaining and bropropriating. Finally, we discuss the nuances of learning when to say “yes” or “no,” and the art of timely, respectful communication.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bios: ADAIRA LANDRY, MD, MEd, is an assistant professor at Harvard Medical School who studied and trained at University of California, Berkeley; University of California, Los Angeles; New York University; and Harvard with almost a decade of experience mentoring students and early-career professionals. She is an entrepreneur, keynote speaker, and award winning mentor. She co-founded Writing in Color, a nonprofit that teaches the craft of writing.
RESA E LEWISS MD is a professor of emergency medicine, TEDMED speaker, TimesUp Healthcare founder, designer, entrepreneur, and award winning educator, mentor, and point-of-care ultrasound specialist. She studied at Brown University, the University of Pennsylvania School of Medicine, the NIH Howard Hughes Research Scholars Program, Harvard Emergency Medicine, and Mount Sinai St. Luke’s Roosevelt. She hosts the Visible Voices Podcast, amplifying content in the healthcare, equity, and current trends spaces.
They have written for CNBC, Fast Company, Forbes, Harvard Business Review, Nature, the Philadelphia Inquirer, Science, Slate, STAT News, Teen Vogue, VOGUE, and USA Today.
We Discuss:
The Concept of Micro-SkillsFinancial Literacy and Debt ManagementPerforming a Debt Inventory to Understand the Landscape of Your DebtAppearance Matters and Personal Hygiene is a Skill That Doesn't Always Come NaturallyTiming and Context are Critical When Checking In or Providing FeedbackWe’re Trained to be Cumbersome in Communication When What We Need is to be SuccinctDon't Bury The LeadRole-Playing to Improve CommunicationLearning from Experience and Modeling. Do we Leave Too Much Up to Chance?Micro-Skills for Self-Care and Burnout Prevention: The Art of Saying NoResponding to Emails Promptly and Respecting Deadlines are Force MultipliersAddressing Mansplaining and BropropriatingThe Power of AllyshipRecommended BooksMentioned in this episode:
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.🎓 P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
Never Lame. Never Spammy. Always Fresh.
If you’d like...
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Ready to reset, recharge, and level up?
Join us at our live event - Awake + Aware, 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!
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How do you handle your authority being challenged under stress? Even minor communication missteps in high-pressure environments like medicine can create lasting rifts and missed details. While the instinct to push back is strong, it's rarely the best response.
We share a story of miscommunication between a resident and a nurse, highlighting the importance of humility and inquiry in clinical settings. We examine why leading with curiosity instead of ego can save time, build trust, and improve patient care.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
We Discuss:
Because I Said SoCherubic Buddha vs Grumpy GravelYou May Feel Frustrated, That's OKPushing vs PullingTell Me What You're ThinkingThe Three Reasons Why a Nurse Might Question a Doctor's OrderWhy Inquiry Saves Time and Improves CareThe Other Person's Special Knowledge
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It’s hard to be a good boss and even harder to work under a bad one. This episode breaks down how to begin as a new leader with little to no experience, the critical errors leaders often make, and what to do when your boss is suboptimal. We explore how quick fixes, lack of empathy, and poor communication can alienate teams and stifle growth. Leaders who ignore the importance of relationships, skip proper onboarding, or impose their own agendas without collaboration set themselves up for failure. We also discuss how future writing can help leaders clarify their vision and avoid these pitfalls. Finally, we offer strategies to recognize and correct these missteps, creating a more effective and cohesive leadership style.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bio: Karl Pister is president and founder of The Coaching Group, with over 34 years of experience in executive coaching, conflict management, and leadership development. He’s also the host of the Healthcare Leadership Podcast, which focuses on leadership, conflict resolution, and emotional intelligence.
We Discuss:
The Practice of Future WritingThe Logic Behind Future WritingDaily Writing Routine and Its ImpactPremeditation Malorum | Best vs. Worst Case Scenario VisualizationMaladaptive vs. Adaptive PerfectionismWhat Daily Future Writing Looks Like—Doesn’t It Get Repetitive?Write for the Future in the Present TenseHow to Be a Successful New Leader With an Underperforming TeamTom Peters' Top 5 of Excellent LeadershipYour Team Knows What Action Needs To HappenHow Do You Know When You Have Enough Information To Start Taking Action?Identify Your InfluencersHandling Someone Else’s Emergencies as a New LeaderDay One as a New Physician Leader, You’re Prodded From Multiple Sides About a Pressing Issue. What Do You Do?Dealing with Difficult BossesBuilding Positive Relationships With a Bad LeaderA Bad Leader Is Often Insecure. Becoming an Asset to Them Rather Than an Opponent Can Make Your Job a Lot BetterBooks mentioned in this episode:
The Inner Game of Tennis by Tim GallowayAtomic Habits by James ClearThe Leadership Challenge by James Kouzes and Barry PosnerWhat Got You Here Won’t Get You There by Marshall GoldsmithGetting to Yes by Roger Fisher and William UryPossible by William UryNegotiating the Non-Negotiable by Daniel ShapiroThe First 90 Days: Proven Strategies for Getting Up to Speed Faster and Smarter, Updated and Expanded by Michael D. WatkinsMentioned in this episode:
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.🎓 P.S. Yes, this is a CME event!
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Navigating the complexities of taxes can be daunting, especially for medical professionals with unique financial situations. From maximizing retirement contributions to understanding the benefits of Health Savings Accounts (HSAs), strategic tax planning is essential. In this episode, we explore various tax strategies that physicians can leverage to optimize their financial outcomes. Finally, we delve into practical tips for managing multiple income streams and setting up your business on the right side of the IRS.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bio: Alexis E. Gallati is the founder and Lead Tax Strategist at Cerebral Tax Advisors, Cerebral Wealth Academy, and the author of the book Advanced Tax Planning for Medical Professionals. She has over 20 years of experience in high-level strategic tax planning and multi-state tax preparation and has trained at the highest level, holding two master’s degrees. Alexis grew up in a family of physicians and is married to a private practice physician. That’s why she understands how hard medical professionals work to get where they are and why she provides simple and accessible tax solutions tailored to busy physicians.
We Discuss:
Maximizing Retirement ContributionsUnderstanding 403b and 457b PlansWhy Health Savings Accounts (HSAs) are Tax Advantageous Compared with Flexible Spending Accounts (FSAs)Immediate vs. Deferred Medical Expense PaymentsHow to Make Smart HSA ChoicesTurboTax: When to DIY and When to Go ProA Primer on LLCs and S-Corps for PhysiciansBalancing Multiple Income StreamsThe Benefits of 1099 IncomeRetirement Plans for 1099 IncomeSEP IRA vs. Backdoor RothRenting Your House to Your BusinessCan I Write Off My Vacation?Starting a Business on the Right Side of the IRSMentioned in this episode:
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.🎓 P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
Never Lame. Never Spammy. Always Fresh.
If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our Newsletter
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
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Psychological safety is a crucial factor in creating a healthy and effective workplace. It involves a shared belief that the team is safe for interpersonal risk-taking. This episode delves into the intricacies of psychological safety, particularly in high-stakes environments like medicine. We explore how rigid hierarchies, cultural biases, incivility, and unrealistic expectations can hinder psychological safety and how fostering a culture of openness and vulnerability can lead to better team performance and resilience. We explore various strategies to enhance psychological safety, including setting clear expectations, modeling vulnerability, and showing gratitude. Finally, we provide actionable tools for leaders to create a psychologically safe team environment.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bio: Kim Bambach, MD is an Assistant Professor of Emergency Medicine at The Ohio State University and Assistant Director of the Kiehl Resident Wellness Endowment
We Discuss:
What is “psychological safety”?Google's Project AristotleWhy psychological safety is important, even on a SWAT teamThreats to psychological safetyThe Korean Air Crash of 1997Contributors to trainees feeling psychologically unsafeCollegiality between specialties and its impact on psychological safetyThe Psychological Safety ScaleSix key leadership behaviors to create a culture of psychological safetyMentioned in this episode:
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.🎓 P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
Never Lame. Never Spammy. Always Fresh.
If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our Newsletter
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
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What would you do if your job ended tomorrow? Even though you might want to say, “Take this job and shove it,” that won’t help build stepping stones to your next job.
In this episode, we discuss: what it’s like for physician coaches who regularly work with docs in this situation, getting fired, dealing with unexpected events that shake up professional stability, planning for career disruption, the importance of networking, and finding your clinical practice N plus one.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bio: Health Joliff, DO, is dual-boarded in Emergency Medicine and Medical Toxicology. He is a certified executive coach and can be found at Physician Coaching Solutions.
We Discuss:
We plan for what happens at the bedside. Why don't we plan for what might happen to our careers?What happens to the majority of docs who come to coaching wanting to get out of medicineThe importance of clinical medicine + 1Networking doesn't have to be a massive labor. Small steps can make a big difference.Great doctors getting firedFirst steps after losing employment: be humble and don't burn bridgesStrategies for bringing up having been fired in an interviewThe therapeutic power of venting (versus dumping)Should you accept your group's director position?The distinction between imposter syndrome and inexperienceYour contract has not been renewedYou are a new resident, and your health system suddenly closesAn older physician plans to retire in a year and is uncertain what to do nextYour first job out of training will likely not be your lastMentioned in this episode:
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.🎓 P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
Never Lame. Never Spammy. Always Fresh.
If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our Newsletter
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Many of us have ideas that could make a great business. Most of the ideas, however, never see the light of day. It can feel like a big leap from physician to entrepreneur. So how do you do it? We speak with Dr. Jason Hine, the founder of SimKit, and see how he went from community emergency medicine doctor to successful business owner.
In this episode, we cover how Jason started his business, accounting for the knowledge gap between clinician and entrepreneur, setting boundaries, why saying hell yes has a critical proviso, the inevitable oscillation between passion and money, and a marketing exercise that’s critical to walk through before you even consider jumping in on a new product or business.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bio: Jason Hine, MD, is an emergency physician in southern Maine, where he is the Director of Education for his community hospital. He is a graduate of Tufts University School of Medicine and completed his residency at Temple University Hospital, where he served as chief resident. His interests include procedural skillset decay and the role of academics in improving the recruitment, retention, and satisfaction of community physicians. He is the founder of SimKit, a medical education company focusing on delivering convenient and effective hands on procedural skills practice.
We Discuss:
Sharks and bouldersBuild a business plan earlyEffective resources and dead-end rabbit holesThe first thing to consider before starting a business: the pain point and value propositionGetting out of the Lone Wolf mindset and forming an advisory committeeWhat challenge surprised Jason as he got the business rollingHow do you pay your advisory committee before your business makes money?What it means money-wise to give someone equity in your companyNegotiating equity stake and why contracts are by nature adversarialThe tipping point from dreamer to doerA self-reflective prompt that puts endeavors in proper perspectiveIt might be a hell yes for you but a no for your familyProtecting immutable bouldersLogistics of setting and keeping boundariesNothing super cool happened because someone just wanted to make a bunch of moneyFinding your ideal customer before the product even existsA marketing exercise to do when a product is still an ideaMentioned in this episode:
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.🎓 P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.🎓 P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
Never Lame. Never Spammy. Always Fresh.
If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our Newsletter
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Success and happiness are often determined by where we place our focus: within ourselves or on external factors. Mastery lies in asking the right questions, and understanding the locus of control is a key part of this. Those who focus on what they can influence are generally happier and more successful. In this episode, we explore the philosophy behind the locus of control, its impact on burnout, the importance of small bets in making significant changes, and state vs. trait gratitude. Finally, we delve into practical strategies to cultivate a more resilient mindset
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bio: Dan Mccollum, MD is an emergency physician and Director of Teaching and Learning at the Medical College of Georgia. Hear more of Dan on Stimulus episodes #1 Verbal Judo #14 Stoic With A Capital S, #25 Digital Minimalism, and #59 Aim to Be A Zero.
We Discuss:
Waiting room medicine has become the norm. It's not ideal. So what do you do about it?The power of placing small betsStoicism and the philosophy behind locus of controlSome things in the world are up to us; others are notSextus, "The crowd is irrelevant."What is the locus of control?Shades of gray in the locus of controlThe Stoic approach to patient complaintsTaming the blame ogreDomains of control and the paradox of varied strengthThe Stoic approach to patient complaintsHow a mishandled aspirin overdose led to a major recalibration of control locusA tactical approach to developing an internal locus of controlThe 'Good' reframeThe five slices of gift exerciseThe jar of awesomePower of an end-of-day debriefTrait vs. state of gratitudeNot every approach is for everybodyBook recommendations for operationalizing an internal locus of controlMentioned in this episode:
5 Free Tools To Make Medical Practice Easier
Scripts for your least favorite conversations.The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.
Free Resources Link
Awake + Aware Bend May 5-7, 2025 | Our in person live event
Ready to reset, recharge, and level up?Awake + Aware is a game-changing 3-day workshop where you will learn how to stay cool when the pressure’s on and lock in the mindset you need to flourish. Space is limited.🎓 P.S. Yes, this is a CME event!
Awake + Aware Bend 2025
Never Lame. Never Spammy. Always Fresh.
If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our Newsletter
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Medical debt has a strange and storied history in America. Stretching back to colonial times, physicians and patients alike have grappled with its harsh realities. In recent years, hospitals have resorted to selling medical debt to third parties, who then aggressively pursue patients. In today’s episode, medical historian Luke Messac, MD, PhD, guides us through the past and present landscape of medical debt, examining perspectives from patients, providers, hospitals, and governments. We delve into a form of indentured servitude in the name of debt clearance, the birth of nonprofit hospitals, a pivotal shift in the 1980s, feasibility of operating healthcare under free market principles, medical economics in the 1600s, hospitals suing patients, and the emergence of medical debt as its own thriving industry.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bio: Luke Messac MD, PHD emergency physician and medical historian whose research focuses on health care's history and political economy. Luke is an attending physician at Brigham and Women’s Hospital, an Instructor in Emergency Medicine at Harvard Medical School, and the author of two books, No More to Spend: Neglect and the Construction of Scarcity in Malawi's History of Health Care and most recently, Your Money or Your Life: Debt Collection in American Medicine.
We Discuss:
Hospitals suing patients over debtThe Service Credit Program | Indentured servitude in the name of debt clearanceNonprofit hospitals were born out of the almshouse tradition, where charity care was part of the missionThe 1980s were a turning point for medical debt in the United StatesWith cuts in government medical spending, hospitals cut costs by limiting charity care and aggressively pursuing unpaid debtsWhy healthcare cannot operate in a pure free marketHospitals used to refuse care to patients and the courts supported itPatient dumping and the rise of EMTALACollecting money from patients has been an issue for hundreds of yearsIn the 1600s, doctors could be arrested for charging too muchDebtor's prisonDoes suing patients to recover medical debt improve a hospital's bottom line?In the early 2000s, Yale New Haven Hospital put liens and foreclosing on patients' homes as part of a debt collection strategyMedical debt collection has now become a thriving industryHow third-party medical debt collectors operateRIP Medical Debt buys and forgives medical debtIs buying and forgiving medical debt better or just forgiving it upfront?Dollar For is a nonprofit focused on helping patients navigate financial assistance programsSome hospitals are making financial assistance easier to accessState legislation is starting to address medical debt collectionNational approaches to medical debtMedical debt is prevalent around the world, but the US stands apart among wealthy countriesThe consequence of copaysPaul Farmer and caring for the destitute sick. The jungle hospital that's carrying out Paul Farmer's vision in GuatemalaRudolf Virchow - Physicians are the natural attorneys for the poorMentioned in this episode:
Awake +...
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It's natural to feel guilt or shame when living in abundance while much of the world faces hardship. In this episode, Dr. Barry Kerzin, the Dalai Lama's personal physician and a Buddhist monk, shares his approach to managing these emotions with a simple yet powerful tool. He also discusses his journey to becoming a monk, life within the Dalai Lama's compound, as well as anger management, self-compassion, and impatience strategies.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bio: Barry Kerzin, MD is a US born and trained family physician who for the past several decades has resided as a monk in Dharamshala, India — home of the Tibetan community in exile. In addition to serving as H.H. the Dalai Lama’s personal physician, Dr. Kerzin is the founder of the Altruism in Medicine Institute, whose mission is to increase compassion and resilience among healthcare professionals and extended professional groups, such as police officers, first responders, teachers and leaders.
Self described as “…a doctor, a monk, a teacher, a lazy man. All of these things, yet none of these things,” you can follow Dr. Kerzin on Facebook, Youtube, Instagram or learn more about his story here.
He's also got a new app that you might be interested in -- AIMIcare. This app is crafted to counteract the distressing prevalence of burnout, depression, and frustration among those facing the brunt of human suffering by instilling the virtues of compassion, mindfulness, and self-care
Download AIMIcare: here
AIMIcare Mobile App Website: https://aimicare.altruismmedicine.org/
We Discuss:
How Dr. Kerzin made the trade from US-based family doctor to Buddhist monk and the Dalai Lama's personal physicianStudying Tibetan medicine for the treatment of high blood pressureA day in the life of the Dalai Lama’s doctorWhat the food is like in the Dalai Lama's compoundHow Barry feels about being referred to as 'The Dalai Lama's Doctor'Two experiences in younger life that sparked Barry's spiritual questThe guilt of living in abundanceThe importance of generositySelf-compassionAn approach to imposter syndromeAnger managementHealthy self-confidenceUsing purpose as an antidote for impatienceHaving patience in the time-compressed reality of medical practiceMentioned in this episode:
Never Lame. Never Spammy. Always Fresh.
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4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling...
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Non-compete clauses have plagued contracts for decades. It’s been analogous to asymmetric warfare, with employers holding the upper hand.
All of that may soon be a thing of the past.
In this episode, we explore the Federal Trade Commission's recent ruling to ban these clauses and its implications for doctors and the healthcare industry. We'll also discuss the unexpected ways non-competes can protect smaller groups, the rise of independent contractor models, and the critical staffing issues in emergency medicine. A highlight of our discussion includes the lure and the trap of signing bonuses—what seems like a generous offer can sometimes come with subtle strings attached. Finally, we'll touch on the U.S. Senate's investigation into major staffing companies and the innovative emergence of empath units for mental health patients.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bio: Leon Adelman, MD, MBA, FACEP, FAAEM is an emergency physician and co-founder of Ivy Clinicians, a software company that simplifies the emergency medicine job search through transparency. Dr. Adelman is the author and publisher of the Emergency Medicine Workforce Newsletter, which explores the business of emergency medicine.
We Discuss:
What is a non-compete clause?The Federal Trade Commission's ruling making non-complete clauses null and voidWhy employers and private equity are unhappy with the non-compete rulingThe emergency medicine-specific burn point of the non-compete ruling: contract retentionThe unexpected way that individual non-compete contract clauses can protect a group from being replacedWhy small groups like to use non-compete clausesHow larger groups have moved away from non-competes and favored a 1099 independent contractor modelWhy the non-compete ruling is a massive win for independent physician practicesThe lure and the trap of physician signing bonusesA signing bonus is a loan, not a check. It's a loan you are paying back with time.What is the chance of someone not paying back the time attached to a signing bonus?There's a reason that some jobs offer a signing bonus and others don't.The US Senate Committee on Homeland Security and Governmental Affairs is investigating the staffing models of USACS, Team Health, Envision, and Life PointWhen private equity owns a hospital, it tries to lower expenses by decreasing staffing48 states and the federal government don't require a physician in the emergency departmentIndiana and Virginia are the only two states that require a physician to be on duty in emergency departmentsAre Empath Units the solution to helping emergency department mental health patients?Mentioned in this episode:
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I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. It’s free, low-pressure, and will give you clarity on your next steps.
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4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations. The Driveway...
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Understanding cultural context in healthcare can seem overwhelming, especially when time and resources are limited. Why should clinicians invest energy in learning about different cultures? In this pod, we break down the differences between cultural competence and cultural safety, explaining why the latter is essential for patient care. We share practical examples of how understanding cultural context can improve interactions, strategies for making patients feel seen and heard, and the pitfalls of the term ‘non-compliant’. We also touch on how these practices can make your job more rewarding and prevent burnout.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bio: Raj Sundar, MD, is a family physician and community organizer in Washington state. His podcast, Healthcare for Humans, “is dedicated to educating you on how to care for culturally diverse communities so we can be better healers.”
For full show notes of this episode and all sorts of other goodies, visit our podcast website
The Flameproof Course
The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets
We Discuss
What does it mean to care for diverse communities effectively?An argument for why it’s not the patient’s job to teach clinicians about their cultureUnderstanding the cultural context of frustrating behaviorsShifting from 'why me' to 'of course'How to create a framework for cultural knowledgeWhat happened to Raj's practice when he started interviewing local Pacific Islander community leadersHow to have patients feel seen, heard, and known in the point of careCultural competence vs cultural safetyWhat does cultural safety look like?Why should I spend my energy on learning another's culture? If they've moved here, shouldn't they be the ones to assimilate into this culture?The language of noncompliance vs nonadherence vs nonjudgmentalWhy social determinants of health in documentation might be a good thingRumi's The Great WagonMentioned in this episode:
1 on 1 Physician Coaching
I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. It’s free, low-pressure, and will give you clarity on your next steps.
Physician Coaching FAQ
Never Lame. Never Spammy. Always Fresh.
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4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling consults.
Free Resources Link
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"Kicking the can down the road" is a common behavior that manifests in various ways, from delaying difficult patient decisions to avoiding complex tasks. We explore the reasons behind on-shift procrastination and strategies for overcoming it. Our discussion includes practical steps to recognize and address decision deferral, techniques for managing aversion to some decisions, and pre-loading accountability. We also highlight the importance of building decision-making resilience and creating systematic pathways to streamline the decisional process.
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
We Discuss:
What does it mean to kick the can down the road?How procrastination shows up on a clinical shiftWhy does procrastination happen?It doesn't take much dread for can-kicking to occurAvoidance AwarenessDecisional InterrogationKicking the can because deciding will set off a cascade of more workAvoiding the infinite test of timeIdentify how, when, and where you’ll make high-level decisionsLong term guests | How is it that decisions can finally be made when the shift is over?ChunkingZero in on your critical decision pointsKicking the can at work: pick one thing and identify YOUR decision pointsPreloading accountabilityPerfectionists get caught in a tree when they're actually in a tunnelMentioned in this episode:
1 on 1 Physician Coaching
I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. It’s free, low-pressure, and will give you clarity on your next steps.
Physician Coaching FAQ
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling consults.
Free Resources Link
Never Lame. Never Spammy. Always Fresh.
If you’d like a few minutes of career-elevating curated kickassery delivered to your inbox, sign up for our newsletter.
Sign up for our Newsletter
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How do you build a team in the critical first moments of a crisis? The balance between rapid response and thoughtful planning is delicate, especially when understanding what defines a crisis and acknowledging when you're in the midst of one. This conversation delves into the complexity of emergency team dynamics, emphasizing that the composition and organization of these teams are deeply influenced by their members' specific skills and contexts, with lasting implications long after the crisis has passed.
We introduce 'Name, Claim, Aim'—a straightforward, three-step framework designed to streamline team organization under pressure. It's about rapid situational assessment, clear role delegation, and setting concise objectives. The discussion extends to effective leadership in high-stakes situations, including establishing command, ensuring effective communication from the start, and striking the right balance to encourage team input without compromising decisiveness.
Exploring the subtleties of crisis leadership, we'll discuss the strategic balance needed for effective oversight and the practicality of 'Name, Claim, Aim' as a distilled version of more complex crisis management theories tailored for the immediacy of emergency care. The conversation will also cover the practical implementation of this framework, from team huddles to understanding the profound impact of the first few seconds on the trajectory of team success.
This episode builds on episode 115 - Zero Warning | Frameworks for no notice critical patients
💡 Check out our Free Resources specifically designed to address pain points in medical practice💡
Guest Bio:
Lon Setnik, MD, is an emergency physician practicing in New Hampshire and the associate director of clinical programs at the Center for Medical Simulation. Lon is a Stimulus fan favorite. Here are some of his most popular episodes:
Listening to Understand versus Listening to WinFeedback can be hard to give and harder to receive. Here are techniques to do both betterTake the Suck out of Documentation | Making the most of scribes, documenting in the room (and in front of the patient), efficient workflowsWe discuss:
The tension between planning and actionWhat defines a crisis?How do you know when you're in a crisis?Teams are contextual in their skill setsHow you organize a team in a crisis has ripples after the event has endedThe three steps to organizing teams in a crisis: Name, Claim, AimHow to declare yourself as a team leaderModeling closed-loop communication from the first moments of team formationThe balance between being a tyrant vs an effective leader and how to avoid suppressing speaking-up behaviorsThe two pillars of Aiming what we want to achieve and who is going to do what to get us thereName, Claim, Aim needs to be fast and efficient; otherwise, people will just start getting to work without organizingBalancing the balcony and the dance floor | The impulse in crisis is to do. The leader does not have to be the primary operator, but it's hard to hold back!As a team leader, it's ideal to keep your hands -
Will you have enough money to retire? What does that even mean? In this pod, our guest physician financial coach, Elisa Chiang, M.D. Ph.D. breaks down
Trading time for money and money for timeWorking harder vs creating valueThe FIRE (Financial Independence Retire Early) movement and why it doesn't always mean living by austerity rulesThe risk of relying solely on retirement accounts to fund your post-career lifeHer biggest financial mistakeHow identity influences spending habitsIncorporating real estate into an investment portfolioGuest Bio: Elizabeth ‘Elisa’ Chiang, M.D. Ph.D. is a board-certified ophthalmologist and fellowship-trained oculoplastic surgeon who found her way into personal finance and real estate investing during her MSTP program, aspiring for FIRE long before it became mainstream. Battling burnout from her work in a hospital system, she turned to real estate as her avenue to financial independence, complemented by her newfound passion for life coaching. With active involvement in rental properties and passive investments in syndications and real estate funds, Elisa now helps others achieve financial independence while embracing life's journey. Learn more at https://www.growyourwealthymindset.com/
For full show notes of this episode and all sorts of other goodies, visit our podcast website
We discuss:
Why a high income does not equate to wealthWorking harder vs creating valueOnce debt is gone, attention to money can dwindle Finding a place to start investing can be overwhelming and lead to inertiaHow to navigate a scarcity mindsetHow identity influences spending habitsMoney can buy time, but there's a catchElisa's biggest financial mistakesHow to decide if a real estate investment is a good (or bad) dealElisa’s big-picture financial strategyReal estate investing for positive cash flowIf you only think about maxing out your retirement account, you probably won't retain the same lifestyle when you stop workingBeyond real estate investing, what are other areas for investment to produce cash flow?F.I.R.E Financial Independence Retire Early | Survival, Regular, and Fat FIREHow to figure out how much FIRE money you'll need to stop workingWill my retirement funds actually last? Rate of withdrawal and sequence of returns risk Fat FIRE | Spending more in retirement than you did while workingMentioned in this episode:
4 Free Resources specifically designed to address pain points in medical practice
Scripting your least favorite conversations. The Driveway Debrief. My 4 favorite documentation templates. The quick and dirty guide to calling consults.
Free Resources Link
1 on 1 Physician Coaching
I work with physicians to help them flourish in medical practice. If you're feeling stuck, burned out, or in trouble at work because of communication or conflict, check out our FAQ page for more info. Ready for real change? Book a discovery call. It’s free, low-pressure, and will give you clarity on your next steps.
Physician Coaching FAQ
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