April 14, 2025 • 35 mins
Link to scott course: https://guidewirecoaching.com/unburnable/
Scott Weingart shares his experiences developing physician executive coaching to help emergency physicians find meaning and purpose despite a broken healthcare system.
• Burnout often stems from negative inner voice rather than external circumstances
• Cognitive distancing helps physicians separate themselves from unhelpful thoughts
• Stoic acceptance allows doctors to focus energy on what they can control
• Nonviolent communication techniques transform interactions with difficult consultants
• Maintaining fundamentals during shifts (eating, drinking, bathroom breaks) is essential
• Optimal performance pace prioritizes patient safety and career longevity
• Sleep optimization receives special focus, with warnings about alcohol and caffeine
• Lifelong learning reignites the curiosity and satisfaction many found in residency
• Executive coaching costs approximately $3,000 for twelve sessions over 24 weeks
• Regular meditation practice can be transformative for emergency physicians
• Every emergency physician should consider therapy from the beginning of their career
Call us or visit our website to learn more about physician executive coaching and register for upcoming sessions.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 2 (00:13):
now I have my audio mal, but I don't have a clean
copy of your audio.
Speaker 3 (00:17):
Okay, good, all right and then, of course, ladies and
germs, is scott weart.
Now Scott is one of the mostfamous emergency physicians
critical care people in theworld.
But he's not just a doc.
He is now doing some coaching.
He is now helping docs withburnout with Rob Orman, and I
got him on the phone here andtalked to him about what are
(00:40):
they doing, what are some of theprinciples, because this really
means a lot to me right now.
Are they doing?
What are some of the principles, because this really means a
lot to me right now.
What can we do?
Really do more than the yogapants for a group of clinicians
that are really suffering?
So this is not a CME piece.
Scott is the owner of a companythat does this with Rob, so
just understand that.
But I think there's so muchuseful information here you
(01:03):
should hear it and then youshould act on it.
So on the coat that is quitefilthy here is Scott Weingart.
Maybe, I'll throw this onInvictus as well.
What the heck.
Speaker 2 (01:14):
Yeah.
So I started doing physicianexecutive coaching like five
years ago and it was just to befor high performers, people
already at the top of their game, helping them get that 1% more.
And that was fine, that was fun.
But then people started comingand saying could you coach me,
cause I'm miserable in emergencymedicine and I'm like how is
(01:36):
that possible?
It's the best job in the world.
And I started taking on a fewof these clients and they really
were not happy with their livesand they weren't being abused.
You know the system's totallybroken.
You know that, mel.
But when they described theirjob it was like just like
everyone else's job, you know ithad its ups and downs, but at
(01:57):
the heart of it it wasfundamentally an amazing job.
And yet people were miserableand I started thinking, well,
why is this?
And so I started working withburnout clients, started putting
together a mental model of howthis was working, why it was
ramifying on these physiciansthe way it was.
And then I got together with myprofessional coaching partner,
(02:21):
a man you know very well, robOrman, and we decided to go from
individual coaching to groupcoaching.
And we've run through probablylike 200 doctors at this point
through this group coachingmodel.
And it was even more potentbecause now they were talking to
each other and saying it's notany better in my neck of the
woods.
You're not going to, by changingjobs, escape all the things
(02:43):
that you're dealing with andwhat people come to the
realization of is that it'sreally an issue of mindset and
fundamentals, and not an issueof which job they're working at.
For the most part, now, there'sabusive jobs out there.
I don't want to pretend thatpeople aren't having true misery
in the field, and if that's thecase, then they got to switch,
(03:04):
but most of the time the grassis not greener.
It's just a question of havinglost a meaning and purpose and
not going about things in a waythat's setting you up for
long-term life.
In emergency medicine, peopleare very much using short-term
strategies.
Speaker 3 (03:21):
Oh, and I should just be clear that I have nothing to
do with their company.
No kickbacks, nothing.
Because they are going to talkor I'm going to talk a lot about
what they're doing.
So just for the records.
So I said to Scott this soundslike horseshit, this sounds like
you're dreaming, because thesystem is so broken.
(03:42):
You're being asked to do morewith less, doing rectal exams in
waiting rooms, and just it's sobad.
How can you make this better?
What's your magic?
Because it doesn't seem like achange in mindset.
It's really going to help.
So I'm going to call bullshiton Scott Weingart right up the
front.
Speaker 2 (04:03):
They're absolutely right.
There are enormous systemissues, but they can absolutely
work around that system andstill find the things that are
meaningful and important in thejob.
They just have to change one,the way they think about it.
And two, to your point, theyhave to change whether or not
(04:25):
they're going to take theburdens that the system is
trying to place on them andactually accept them and now try
to strive to achieve them, orthey're going to play around the
system and get back to thethings they care about.
Speaker 3 (04:37):
So, scott, you don't have to reveal all the special
sauce of what you do, but tellus some of the key things that
you're doing in this new line ofbusiness.
And the reason that this is nota back and forth is because I
screwed up the timing and I wason my phone, so I cut that audio
out and I'm VOing it right herefor you.
Speaker 2 (04:55):
No, I'll tell you all the special sauce.
I got no problem with it, justrevealing it all.
And it's not rose coloredglasses.
If we were telling people, ohno, you have a great job, just
go back to it and just realizehow good it is, then people
would obviously not have anybenefit from it at all and
they'd probably you know,pillory us.
No, well, I'll tell you thesequence, mel, and then you tell
(05:17):
me if any of it's of anyinterest.
To go into more depth, thefirst thing we deal with is
inner voice, and this is thefundamental foundation of the
course, because this is therealization that docs come to
when they work in this coachingformat that a lot of their
(05:38):
misery comes from their ownbrain, their thoughts, the
negativity, the this sucks, the.
I can't take it anymore.
If I have one more psychpatient that should be upstairs,
come in, I'm just going to loseit.
And they have this litany, thisconstant stream of negative
vocalization that people don'trealize is not them, don't
(06:11):
realize is not them.
It is a separate set of piecesof your brain.
It was very well built to keepus alive, you know, 8,000 years
ago.
It's not well suited to ourcurrent time, but this constant
negative litany is actuallyfused with the core identity of
the docs, and so they are having, in essence, a demon on their
back whispering in their earthis constant stream of
(06:33):
negativity that they think isthem.
And so this inner voice.
We explain what's going on andwe start working on techniques
of cognitive distancing, whichis just a fancy way of saying
you are not your thoughts, youare not your feelings.
Those thoughts and feelings aregoing to pop up into your
awareness and then it's up toyou to decide whether you want
(06:55):
to listen to them or not.
Now, if you had a drunkenfriend, it's a buddy, it's
someone you care about, it'ssomeone you've known for years,
and they're telling you how tosolve your life.
There's an excellent chanceyou're going to be very kind to
them because it's a buddy, butyou're not going to really
listen to their advice.
Does that sound like itresonates with you?
Speaker 3 (07:11):
No, absolutely not.
I'll do exactly what they say.
Yeah, that resonates.
Okay, keep going.
Speaker 2 (07:16):
So that's how we want you to start treating these
thoughts that pop up.
This litany of negativity is asif they're coming from a
drunken buddy.
So you're kind, you say oh,thank you.
And then you evaluate all right, is this helpful to me?
Right, like the thoughts of Ishould probably just burn this
ED down, right, if I have todeal with one more shift of this
(07:38):
, if they put that triage nurseon, that's it, I'm just walking
out.
That's probably not helpful toyou.
So we teach how to separate outthose thoughts and ask yourself
you know, have a moment ofawareness that they're there and
ask yourself okay, is thishelping me or not?
And if it is great, you couldact on them, you could use them,
you could put them in a placewhere they're being given
(08:00):
prominence.
And if they're not helpful, ifthey're just making your day
worse, then you thank your brain.
You say thank you, brain, forbringing that up.
But I'm going to go a differentdirection right now.
And it seems stupid.
Every single person we tell itto they're like that's
ridiculous, I'm not going to dothat.
And we tell them up front it'sgoing to seem stupid.
And it starts to work.
And it starts to work not justin the work setting, it starts
(08:22):
to work in your home setting,because that's really where
burnout lives is.
You have tension at work.
You perceive it as stress, youperceive it as threat and you
know that just makes the shiftsa little tougher at first.
But then you start bringing ithome and now, all of a sudden,
your loved ones are not likingyou too much and that breeds
discontent.
You stop doing the fundamentalsat home and then all of a
(08:43):
sudden you know all the miseryof your job has come to roost in
the environment that's supposedto be restorative, rejuvenating
, and that's where burnoutreally sets in.
So we need the inner voicerecognized at home and at work
and we need to distanceourselves and we need to
actually ask ourselves is thishelpful or not?
So that's the start.
That would be.
Session one is inner voice work.
(09:04):
No-transcript.
(09:53):
Then don't worry about it, letit fade away, let it be less
prominent in your thoughts.
So if you come in and theentire waiting room is full and
you have, you know, no space andyou look at the residents and
they're you know the crew thatyou're like this is going to be
a really tough shift and you'relike start spending five, 10
(10:14):
minutes just locked on to howhorrible the shift's going to be
.
It's going to affect the entiretenor of your time.
If you say, all right, well,this is what I got to work with,
let's get to it, then that'sgoing to be a different mindset.
Does that make sense?
Speaker 3 (10:30):
Mel.
This reminds me of the serenityprayer that I think we're all
pretty aware of.
Speaker 2 (10:36):
Yeah, that's exactly the one.
And the serenity prayer wasbased wholly on stoicism, which
is where this comes from.
Right, god, grant me theserenity to change those things
I can, to accept those things Ican't, and the wisdom to tell
the difference between the two.
That's it exactly, and that'sacceptance.
We'd love the docks to go onestep further, and Nietzsche
(10:56):
coined it as amor fati love yourfate which is, instead of just
accepting it, we'd love them toget there.
That's already going to make ahuge difference, but it would be
even better if they could applyamor fati, which is all right.
So waiting room is totally full.
I'm going to be operating withjust two beds the entire time,
because the rest are filled withborders.
All right, what job can I dowith just those two beds?
How can I make this likeabsolutely the best possible
(11:22):
situation with those two beds?
Let's do it.
You look at which surgeons areon and it's just the meanest,
most horrible surgeons in thehospital.
All right, beautiful.
This is now a challenge.
When I interact with them, I'mgoing to make them smile in the
course of my interaction.
That's my game I'm going toplay.
It's called the stoic challenge, right, I'm going to challenge
myself to actually have themlaughing in my interactions with
(11:43):
them.
May succeed, may not, but it'sgoing to be fun, because now
it's actually a trainingexercise, you know.
So that mindset shift, it seemsminimal, it changes your entire
demeanor.
Everything is the lens you'relooking through when you
perceive your situation and wedon't realize that that lens,
(12:03):
that negative lens, is fused toour face when we're in the midst
of burnout, and so we have totake off those glasses for a
second, find that we can havefun with the situation.
Speaker 3 (12:15):
This all sounds like a bit of a mind trick and not
too long ago I would have saidyou're out of your mind, you
can't control this stuff, itjust happens.
But in my journey I've realizedthat is actually not true.
But it's sort of like being amonk it requires work and
exercise and it's really amuscle.
And I know that many of you arevery skeptical still.
(12:37):
But let's go on.
Speaker 2 (12:40):
All right.
Next we do communication andit's an entire walk through a
technique called nonviolentcommunication, and I can't go
into it here, mel, because itwould take the entirety.
I mean, maybe that's an entiredifferent discussion.
But we teach people how tocommunicate nonviolently because
we are exposed to violentcommunication constantly from
(13:01):
the people around us, from thepatients, and we actually put it
out there to the world.
We communicate violently, notviolently in the sense of like
raising our fists, violently inthe sense of trying to exert our
will onto others.
And once we start talking aboutit, we realize how often we are
interacting with staff, withpatients, with ourselves.
We speak to ourselves withviolent inner voice.
(13:22):
So we walk people through howto go about being nonviolent
with communication.
And then that leads into thenext segment, which is dealing
with a difficult consultant,because when we did surveys we
found this was a big source ofmisery in emergency medicine.
It's just we're at the whims ofthese children who have been
(13:43):
given the imprimatur of, youknow, top-notch positions in the
hospital and now we have todeal with the fact that they
have an advanced past-toddlerstage.
Well, we've walked throughtechniques to actually do that
in a way that's not just safefor us not just safe for our
patient and gets them what theyneed, but also potentially could
be, like I mentioned before,viewed as a communication
(14:04):
challenge that we now are goingto see if we could live up to or
not, and it becomes kind of agame.
Speaker 3 (14:10):
For me, this is one of the most difficult things
during my practicing career.
Yes, like you, I have theimages of the dead and dying
children that are really hard toget out of your head decades
later.
I have that.
I have it bad, but on theday-to-day, the thing that
really stressed me was having totalk to all surgeons and
consultants that would just talkdown to you, didn't know as
(14:32):
much as you did and just madeyour life miserable.
Speaker 2 (14:36):
Mel, you have a kindred spirit.
I mean, dealing with surgeonswas the bane of my existence and
it made me absolutely miserable.
Mel, you have a kindred spirit.
I mean, dealing with surgeonswas the bane of my existence and
I just.
It made me absolutely miserable.
In fact, it was one of the onlythings in emergency medicine
that made me miserable is justdealing with these people who
had never learned how tocommunicate with other human
beings.
But there are ways, and thatnonviolent communication just
changes the game.
Speaker 3 (14:57):
That is not to say that all surgeons are the same.
I've worked with someincredible surgeons, like Kenji
Inaba, for example.
You could not find a nicerhuman being and a better surgeon
and somebody that you wanted topick up the phone when you
needed help.
Always professional, always sonice, and actually that makes it
worse because, like, this ishow we could talk to each other.
(15:19):
Wouldn't that be awesome if wedid that all the time?
Speaker 2 (15:23):
we then, uh, we moved to shift efficiency and now
this.
You know, we go from the verytheoretical mindset stuff to
what really you could sink yourteeth into and the first thing
we teach is what I call thefundies, the fundamentals, which
is you're on shift, you'regoing to eat when you need to
eat.
You're going to drink whenyou're thirsty.
Shift, you're going to eat whenyou need to eat.
You're going to drink whenyou're thirsty.
You're probably going to bedrinking when you're not thirsty
(15:44):
because your thirst responselags behind.
Every time you need to urinate.
Unless you have a critically illpatient, you're going to go and
do it.
You're going to, when you makephone calls, go out onto the
ambulance bay ramp and look atthe sky, whether it's nighttime
or daytime, and then your paceis not going to be motivated by
how full the waiting room is.
(16:05):
Your pace is going to bemotivated by what has you in
optimal performance for thesafety of your patients and your
longevity.
And obviously, if sick patientscome in, then you got to up
your game and change your pace.
But if they're not criticallyill patients, then you go at a
pace that allows you to worksafely and most potently for
(16:28):
your patients and your careerlongevity.
Speaker 3 (16:30):
Now this is a really, really hard one as well,
because we have basically toldresidents if you're a good
resident, you are going to lookin the waiting room, see how
busy it is and go as fast as youcan to make the waiting times
as short as possible, and wejust pounded into each other's
heads that that's what you haveto do.
But now we find ourselves in asituation where we can't we
(16:55):
can't clear the waiting room, wecan't get it all done, we can't
do it ourselves, we just can'tdo it, and people are driving
themselves crazy trying to do it.
But again, this mindset thatI've been responsible for as
well, that this is what you areIf you're a real doctor, if
you're a real ER doc, you can goat full speed all the time, no
(17:16):
problem, and the truth isparticularly in this environment
.
You cannot You've put yourfinger on it, mel problem.
And the truth is particularlyin this environment you cannot.
Speaker 2 (17:22):
You've put your finger on it, mel.
What you've said is embodyingthe voice of so many of the
doctors that come to us, andeven the ones that don't say it
consciously.
That's their subconsciousfeeling, because it was beaten
into all of us by our chiefresidents and our attendings
when we were training is whatthe hell are you doing sitting
there?
You know, drinking some water,there's patients to be seen?
(17:44):
Get your ass off the chair.
And we started just bringingthat into our core, and, as a
result, now we're the ones doingit to ourselves.
And I'm not saying sandbag, I'mnot saying go slow.
I'm not saying make patientswait unnecessarily.
I'm saying that I know that Ihave a level of performance that
leads me to be making gooddecisions for my patients and
(18:06):
leaves me with some gas in thetank for when a sick patient
does show up, and that's theoptimal place.
Now we'll have attendings comein who are at the very bottom of
their pack in terms ofefficiency, and telling them to
slow down more is going to bedeleterious to their job
security.
So, then, what we have to doand we usually have to work with
them separately, not in thegroup is we have to increase
(18:29):
their efficiency, because almostall of those doctors are upping
their pace, but they'respinning their wheels.
They're not actually movingvery quickly, but they just are
doing it frantically.
And instead we want to teachthem charting techniques, we
want to teach them flowtechniques and we want to teach
them ways of getting to themiddle of the pack.
And once you're at the middleof the pack, then you pick your
(18:50):
optimal pace and the only timeyou change it is when patients
are dying, not when patients arewaiting.
And we have to accept this as agroup in emergency medicine,
because then we could startbreaking the perpetuation of
this idea that we're superhuman.
You'll be able to do that for ayear or two.
You'll be miserable, you'll beburnt out, but that's not the
way to make it to a 20 or30-year career in emergency
(19:13):
medicine.
The optimal pace is the onethat allows you to be running as
if you're a marathoner, not asprinter.
Speaker 3 (19:20):
I know that many of you are feeling very
uncomfortable about that.
This is such a part of who wethink we are and what we should
be doing and I've got to say Ithink it's wrong.
I think Scott's right here.
We can't take on all thisburden ourselves.
We can't empty the waiting room.
We need to get some resources.
We need to go at a pace that wecan sustain, not for a shift,
(19:42):
not for a week of shifts, butfor a lifetime of shifts.
Speaker 2 (19:45):
We do some life management stuff on how to
manage calendars, to-do lists,hiring people to do
non-essential tasks, actuallyreserving time for your family,
for your partner, and locking itin, having that ironclad on the
schedule.
The same way you have yourshifts.
I'm not going to go into thatany further because it just you
know, everyone knows it, theyjust don't do it, so we teach
(20:07):
them good methods for that.
Then the next one is we talkedabout work fundamentals, what to
do on shift, eating, drinking,peeing, et cetera.
Then we talk about thefundamentals at home and these
get ignored as people get burntout, because the nice thing to
do if you're starting to feelburnout would be to do all of
these restorative things.
But instead what you do is youdrink beer, you watch Netflix
(20:29):
for five hours and you don'tsleep, and then you wonder why
the burnout is perpetuating athome.
So we teach movement, lightexposure, nutrition, meditation,
optimizing restorativerelationship, time, nature, flow
and mindfulness practices andplay and laughter, and then the
one that we spend the lion'sshare of the time like 90% of
(20:50):
the time on, is sleep, and wetalk about sleep from the
perspective of restorative sleepwhen you're on a regular shift
schedule.
And then we deal with circadiandisruption from night shifts.
Which is the real bugbear ofemergency medicine is this
circadian disruption.
So sleep gets big primetimebilling.
Because when you look at thesleep habits of emergency
(21:10):
medicine they're horrible andtheir caffeine intake just
destroys their capability ofdeep, restorative sleep.
And then we talk about alcoholMel.
Talk about alcohol Mel.
And it's really a rudeawakening when we show the
studies and we discuss the factthat if you're drinking past 5
pm you are really messing upyour sleep.
And that is a big sea changefor emergency medicine.
(21:33):
Because there is nothing I lovebetter than working a night
shift and then having breakfast,steak, eggs and a few beers and
then going to sleep andthinking that I'm falling asleep
so easily.
But you're just destroying yoursleep architecture with alcohol
so that people don't like tohear.
But when we have them track itbecause that's what we do for
the ones that are doubters weactually have them put on sleep
(21:57):
tracking rings and they prove itto themselves every single time
that you can't drink at nightand have restorative sleep.
Speaker 3 (22:04):
Prove it to themselves every single time
that you can't drink at nightand have restorative sleep.
I've been pretty skeptical ofall these sleep tracking things
and just strapping yourself upand making yourself more anxious
about what's going on.
But in this context, to proveto yourself what works and what
doesn't work for your good sleep, and that's not just the stuff
that you're ingesting but theway you set up your room and
then you can check hey, was Igetting enough REM sleep and
stuff, I think for those veryspecific purposes that actually
(22:27):
might be useful.
Speaker 2 (22:28):
Oh yeah, the self-experimentation is huge
because we don't ask people totake anything we say on faith.
We'll show them the studies.
People don't believe thestudies when it comes to
themselves.
If you're a doctor, we knowbetter.
We have them do it and say,okay, give me a week where of
alcohol at night and then a weekwithout, and show me the
numbers.
And they don't show thembecause they're too embarrassed.
And then caffeine is justbrutal.
(22:50):
Even the people that are like,no, I could drink a cup of
coffee right before bed, I'mfine.
Yeah, I believe you that you'll.
You'll fall asleep, but show methe numbers on your deep and
REM sleep and then you coulddecide whether it's great to be
drinking caffeine later in theday.
But yeah, so we go through anentire unit on sleep.
Then we move on to lifelongmastery.
This is what a lot of theattending level, the consultant
(23:13):
level, docs, lose is they lovedresidency and now they're not
really liking their job anymoreand they wonder why.
And it's like oh, maybe I'mjaded, maybe I'm bored, maybe
it's just gotten worse, but no,what it is is during residency,
every day they were discoveringsomething new and so they had
this innate flow state, thisinnate purpose for showing up
(23:34):
and they lose that.
They've kind of gotten to thepoint where they're not learning
new things.
But the reason they're notlearning new things is not
because they're not exposed toit.
It's because learning outsideof shift primes you to now see
and recognize things you didn'tperceive.
And all of a sudden you arelearning.
So you read a new paper on anew technique for doing the
(23:55):
Valsalva maneuver and now all ofa sudden that AFib, that's just
like yeah, yeah, give them theDeltiazem.
Like you're excited, because,like I want to try it.
I want to see if this uh revert.
What is it?
Oh, mel, you probably rememberbetter than me the maneuver
where you lift their legs in theair.
Speaker 3 (24:07):
Yeah, that's right.
The revert trial you get themto sit up, blow on, uh, do a
bell salver and then lift theirlegs up and convert a lot more
people than this standard waysof fixing an SVT.
Speaker 2 (24:18):
Yeah, there we go.
So it was revert, great,lifelong mastery.
But we wanted to take a stepfurther, mel.
We want them to listen or read,but then actually write it down
and fit it into a framework oflearning such that because it's
so much more potent if you'retaking notes and using that to
build a tree of knowledge forthemselves.
(24:38):
So we teach them the ways to dothat, the techniques and the
best apps and such for that, ofthe ways to do that, the
techniques and the best apps andsuch for that.
And we try to invigorate theirlearning, because a lot of docs
they go to ASEP once every threeyears and that's their learning
and it's not enough, not enough.
And then the last piece, mel, iswe talk about burnout on a
systemic level.
We talk about what goes into it.
(24:59):
I show them the MCRIT burnoutmodel and then we talk about if
they are in a position to lobbyor actually create system change
, what those would be.
But that's a very small part,because we go back to the agency
piece.
The things the docs haveimmediate agency on is their own
behavior and their own mindset.
(25:19):
The things they have verylittle agency on is making these
systems changes.
So it's not that I don't thinkthey should happen.
It's just that to spin ourwheels talking about the fact
that the hospital shouldradically shift the way they
treat us a lot of times is a bigdream.
Speaker 3 (25:34):
Now we have to be careful with this one, because
I've heard some very smartpeople.
Actually, one of the residentscalled Chris Chris, I don't
remember your last name at UCLA,we're saying the same thing we
should not be blaming doctorsfor systemic functional problems
that are above their pay grade,that they can't do anything
about, that.
They're asked to do more withless this whole thing.
But what I think we're sayinghere is that we should be trying
(25:55):
to do both.
The system needs to get better,but if you're going to survive
this right now, for however longit takes to fix it, then you're
going to have to do some ofthese tricks, these mind tricks
and these really important lifehacks in order to get through,
and you're also going to have tovery much accept that stuff
isn't going to change veryquickly.
So it's not that we shouldn'tfix these things or it's the
(26:17):
doctor's fault.
That is not what this is about.
This is about the system isbroken and if we're going to
continue to function in thissystem, we have to hack it, and
that's what this is abouthacking ourselves to try and you
know survive a broken system.
So tell us a bit more about howthis functionally works.
Uh, do you go up to an ashramand you're there for a month or
(26:38):
a year, or do you do it via zoom?
How does this work?
Speaker 2 (26:42):
We do.
It's 12 sessions is the courseand we do that every other week,
so it's 24 weeks and that givespeople time to talk amongst
themselves in group and toreally let the stuff sink in.
And we at the end of it it'snot just listening, because that
doesn't do anything.
They have to go and experimentand they're given homework and
(27:04):
you have to try it out and letus know what worked, what didn't
work, in order to be able toadjust for the individuals.
And I don't even know whatwe're charging right now.
It's probably somewhere around$3,000 is what the course costs.
Individual coaching it'sexpensive and it's going to vary
by coach.
(27:24):
I used to be charging $500 anhour, now it's $750 an hour.
It's a lot of money and anyonewho says to me I shouldn't be
paying this, I'm not going to doit.
I'm like, yeah, I'm with you,man, it's a lot.
And the thing we found that isa saving grace is most of the
time the hospitals will pay forthis out of your CME money.
Even though it's not CME, theydo consider it a better use of
(27:47):
funds than most of the peoplegoing to Aruba for those
conferences where we knowthey're not learning anything.
But that's what physicianexecutive coaching that's really
the ballpark for everyone who'sdoing it.
That's what it's coming out to.
Speaker 3 (28:00):
That's expensive, real expensive.
Why is it so expensive?
Speaker 2 (28:11):
I hear it.
Yeah, you know I thought theywere ridiculous rates at first
too, and you know this is allyou know self-justification.
But I don't know how therapistsdo it, mel, because they're
doing 40 hours a week For medoing you know, a few hours of
executive coaching, which is allI could really handle.
Each hour takes so much out ofme, like I'm pretty much done
for the day and maybe atherapist would tell me like
(28:31):
you're not supposed to beputting that much of yourself
into it, scott, you're supposedto just be kind of oh yeah, yeah
, Tell me, tell me more aboutthat.
But that's not how it is for,uh, for me or for the people I
know.
And like, after an hour ofdoing executive coaching with a
physician, I'm like I'm spentbecause the active listening and
the amount of attention you'reputting into this, it's just
(28:53):
give me an ED shift.
That's going to be a lot morerelaxing.
Speaker 3 (28:57):
I looked at executive coaching just for the business
part of my life and the peoplewho do this who are a bit more
famous, they're chargingthousands of dollars per hour
and I'm just I can't bringmyself to pay that.
That's ridiculous.
So this is not an outrageousnumber that they're talking
about there.
Nobody wants to talk aboutmoney.
(29:17):
It's one of those topics wedon't talk about.
But it is funny that ER docs inparticular will ask each other
how much do you make an hour?
It's sort of a thing that wejust do in a mincemeat.
But other people do not talkabout this stuff.
So in person or via Zoom,because that would raise the
expense a lot.
It's one thing to go to aconference that's $1,000 or
(29:37):
$2,000 or $3,000, but thenthere's the hotel and then
there's the plane and all thatstuff.
That's where it really startsto add up.
Speaker 2 (29:44):
No, it's over Zoom and we were worried like would
the group dynamic be there?
But I don't know about you, mel, but I've found like I've done
meditation over Zoom, I've donetherapy work over Zoom and, for
whatever reason, I don't thinkyou lose that much.
I mean, with the degree ofresolution of the cameras now,
the capability of seeingpeople's facial expressions, I
(30:07):
just don't feel it's a big lossand in fact now most of my grand
rounds are done virtually,because to have that carbon
footprint and all of that moneybeing wasted to just go there
and speak for an hour, I'd muchrather just do it on Zoom in
almost every case, and I don'tthink you lose that much.
So, yeah, it's virtual.
Speaker 3 (30:25):
So I'll have to also agree with that.
I have found although we gotsick of Zoom during the pandemic
, the cameras, the mics reallyhave improved so much.
I do therapy every week forpart of my restoration, trying
to get healthy again, and I findthat it's fantastic and I don't
have to drive and I'm notstressed and I'm not trying to
get healthy again and I findthat it's fantastic and I don't
have to drive and I'm notstressed and I'm not trying to
(30:46):
get parking, and you can do alittle meditation beforehand and
then do the session.
I really find that it worksjust fine.
Probably the first few timesyou want to meet the person and
get to know them have a bit of arapport, but I find that it
works just fine.
Thank you very much.
And I got to tell you I justbought this thing called an owl
and this is a bit of a sidething and again I have no
(31:08):
association with the company butthis thing called an owl, which
is a array of cameras andmicrophones that if you're doing
groups like you, put it in themiddle of the table and it'll
pick out who's talking and itwill focus the camera on that
person and it'll focus the audioon that person and it has been
just so good when you've got agroup of people in one place and
(31:30):
you're emoting in somebody else, so really helpful.
Anyway, that was an aside, so Iwas wrapping it up saying you
know scott, thanks for the time,and the reason that I'm talking
to him about this is becauseI've known him for 25 years or
more.
He has been at the top of hisgame and now he's doing this to
help other physicians.
I just think that's reallyimportant and he's a no bullshit
(31:52):
guy.
He's absolutely a no bullshitguy and you can go to one of his
sessions, no doubt, and callbullshit on him and have the
discussion.
That's what I really like aboutScott.
Speaker 2 (32:02):
Yeah, you're so kind, mel and have the discussion.
That's what I really like aboutScott.
Yeah, you're so kind, mel.
You know what you just said aminute ago brought up some I
forgot like a key session we do,mel, and I can't believe I
forgot it because it's one thatmay be the most important to me
and that's we do an entiresession on meditation for
physicians, and that one is soclose to my heart and I think
every doctor should have ameditation practice.
(32:24):
So when before you said, beforetherapy, you do meditation, I'm
like, oh my God, how did I missmentioning that?
Because it is the game changer,I think, for emergency medicine
in particular, to have ameditative practice.
Speaker 3 (32:38):
And then, as we're cleaning up here, I was saying
you know I've said on multiplepodcasts across the world,
cleaning up here.
I was saying you know I've saidon multiple podcasts across the
world, but I think every ER,doc, nurse should have therapy
from basically the day theybegin.
It is such an abnormal job.
It is just you need to have aplace where you can try and work
through those feelings and thatemotion and that maybe now I'm
(32:58):
thinking we should all haveexecutive coaches.
I don't know.
What do you think, scott?
Speaker 2 (33:02):
No, I think your suggestion was right, mel.
I think every doc should be intherapy.
I've heard you say that.
It resonated so strongly withme.
I think you go to a coach whenyou have a true issue you want
to work through and you know, Ithink I would reserve it for
that.
I mean, I'm sure there arecoaches out there that would
just salivate over having aclient that's going to come to
(33:23):
them on a regular basis withoutany true problems.
But executive coaching at leastas opposed to life coaching,
executive coaching really isproblem-oriented.
So I would think every docwould benefit from having one
number or contact information intheir back pocket for when
something comes up.
But I think, incontradistinction to clinical
(33:43):
coaching Now that's, that'ssomething very different.
That, maybe, is anotherdiscussion.
But you know Atul Gawande'sidea that every doc should have
a coach that could come in on ashift and actually watch them
perform and give advice andfeedback.
I'm not doing that yet, butthat, I think, would be the true
(34:04):
game changer for our specialtyin terms of upping performance.
Speaker 3 (34:07):
So thanks to Scott for giving us a bit of the
inside scoop of what they do.
I'm not suggesting that you goand use Scott and Rob, but I am
suggesting that you think aboutthis and maybe there's somebody
in your area or check them out.
I don't care.
I'm just here to tell you thatthere are people that do this
and there are things and ways ofthinking about our job that
might be helpful, and that'swhat this whole thing has been
(34:29):
about and continues to be aboutin my brain.
How do we help the people whoare out there doing the work?
Because the work matters and weneed to keep people in it in
the game, and if we can't fixthe system yet, how do we stay
in the game?
And Scott has got some greatideas about that.
So thanks, scott, and we shallindeed talk more about this and
(34:49):
some other stuff in the monthsahead.
Speaker 2 (34:52):
I would love that.
Thank you, mel, and thank youfor everything you do.
now I have my audio mal, but I don't have a clean
copy of your audio.
Speaker 3 (00:17):
Okay, good, all right and then, of course, ladies and
germs, is scott weart.
Now Scott is one of the mostfamous emergency physicians
critical care people in theworld.
But he's not just a doc.
He is now doing some coaching.
He is now helping docs withburnout with Rob Orman, and I
got him on the phone here andtalked to him about what are
(00:40):
they doing, what are some of theprinciples, because this really
means a lot to me right now.
Are they doing?
What are some of the principles, because this really means a
lot to me right now.
What can we do?
Really do more than the yogapants for a group of clinicians
that are really suffering?
So this is not a CME piece.
Scott is the owner of a companythat does this with Rob, so
just understand that.
But I think there's so muchuseful information here you
(01:03):
should hear it and then youshould act on it.
So on the coat that is quitefilthy here is Scott Weingart.
Maybe, I'll throw this onInvictus as well.
What the heck.
Speaker 2 (01:14):
Yeah.
So I started doing physicianexecutive coaching like five
years ago and it was just to befor high performers, people
already at the top of their game, helping them get that 1% more.
And that was fine, that was fun.
But then people started comingand saying could you coach me,
cause I'm miserable in emergencymedicine and I'm like how is
(01:36):
that possible?
It's the best job in the world.
And I started taking on a fewof these clients and they really
were not happy with their livesand they weren't being abused.
You know the system's totallybroken.
You know that, mel.
But when they described theirjob it was like just like
everyone else's job, you know ithad its ups and downs, but at
(01:57):
the heart of it it wasfundamentally an amazing job.
And yet people were miserableand I started thinking, well,
why is this?
And so I started working withburnout clients, started putting
together a mental model of howthis was working, why it was
ramifying on these physiciansthe way it was.
And then I got together with myprofessional coaching partner,
(02:21):
a man you know very well, robOrman, and we decided to go from
individual coaching to groupcoaching.
And we've run through probablylike 200 doctors at this point
through this group coachingmodel.
And it was even more potentbecause now they were talking to
each other and saying it's notany better in my neck of the
woods.
You're not going to, by changingjobs, escape all the things
(02:43):
that you're dealing with andwhat people come to the
realization of is that it'sreally an issue of mindset and
fundamentals, and not an issueof which job they're working at.
For the most part, now, there'sabusive jobs out there.
I don't want to pretend thatpeople aren't having true misery
in the field, and if that's thecase, then they got to switch,
(03:04):
but most of the time the grassis not greener.
It's just a question of havinglost a meaning and purpose and
not going about things in a waythat's setting you up for
long-term life.
In emergency medicine, peopleare very much using short-term
strategies.
Speaker 3 (03:21):
Oh, and I should just be clear that I have nothing to
do with their company.
No kickbacks, nothing.
Because they are going to talkor I'm going to talk a lot about
what they're doing.
So just for the records.
So I said to Scott this soundslike horseshit, this sounds like
you're dreaming, because thesystem is so broken.
(03:42):
You're being asked to do morewith less, doing rectal exams in
waiting rooms, and just it's sobad.
How can you make this better?
What's your magic?
Because it doesn't seem like achange in mindset.
It's really going to help.
So I'm going to call bullshiton Scott Weingart right up the
front.
Speaker 2 (04:03):
They're absolutely right.
There are enormous systemissues, but they can absolutely
work around that system andstill find the things that are
meaningful and important in thejob.
They just have to change one,the way they think about it.
And two, to your point, theyhave to change whether or not
(04:25):
they're going to take theburdens that the system is
trying to place on them andactually accept them and now try
to strive to achieve them, orthey're going to play around the
system and get back to thethings they care about.
Speaker 3 (04:37):
So, scott, you don't have to reveal all the special
sauce of what you do, but tellus some of the key things that
you're doing in this new line ofbusiness.
And the reason that this is nota back and forth is because I
screwed up the timing and I wason my phone, so I cut that audio
out and I'm VOing it right herefor you.
Speaker 2 (04:55):
No, I'll tell you all the special sauce.
I got no problem with it, justrevealing it all.
And it's not rose coloredglasses.
If we were telling people, ohno, you have a great job, just
go back to it and just realizehow good it is, then people
would obviously not have anybenefit from it at all and
they'd probably you know,pillory us.
No, well, I'll tell you thesequence, mel, and then you tell
(05:17):
me if any of it's of anyinterest.
To go into more depth, thefirst thing we deal with is
inner voice, and this is thefundamental foundation of the
course, because this is therealization that docs come to
when they work in this coachingformat that a lot of their
(05:38):
misery comes from their ownbrain, their thoughts, the
negativity, the this sucks, the.
I can't take it anymore.
If I have one more psychpatient that should be upstairs,
come in, I'm just going to loseit.
And they have this litany, thisconstant stream of negative
vocalization that people don'trealize is not them, don't
(06:11):
realize is not them.
It is a separate set of piecesof your brain.
It was very well built to keepus alive, you know, 8,000 years
ago.
It's not well suited to ourcurrent time, but this constant
negative litany is actuallyfused with the core identity of
the docs, and so they are having, in essence, a demon on their
back whispering in their earthis constant stream of
(06:33):
negativity that they think isthem.
And so this inner voice.
We explain what's going on andwe start working on techniques
of cognitive distancing, whichis just a fancy way of saying
you are not your thoughts, youare not your feelings.
Those thoughts and feelings aregoing to pop up into your
awareness and then it's up toyou to decide whether you want
(06:55):
to listen to them or not.
Now, if you had a drunkenfriend, it's a buddy, it's
someone you care about, it'ssomeone you've known for years,
and they're telling you how tosolve your life.
There's an excellent chanceyou're going to be very kind to
them because it's a buddy, butyou're not going to really
listen to their advice.
Does that sound like itresonates with you?
Speaker 3 (07:11):
No, absolutely not.
I'll do exactly what they say.
Yeah, that resonates.
Okay, keep going.
Speaker 2 (07:16):
So that's how we want you to start treating these
thoughts that pop up.
This litany of negativity is asif they're coming from a
drunken buddy.
So you're kind, you say oh,thank you.
And then you evaluate all right, is this helpful to me?
Right, like the thoughts of Ishould probably just burn this
ED down, right, if I have todeal with one more shift of this
(07:38):
, if they put that triage nurseon, that's it, I'm just walking
out.
That's probably not helpful toyou.
So we teach how to separate outthose thoughts and ask yourself
you know, have a moment ofawareness that they're there and
ask yourself okay, is thishelping me or not?
And if it is great, you couldact on them, you could use them,
you could put them in a placewhere they're being given
(08:00):
prominence.
And if they're not helpful, ifthey're just making your day
worse, then you thank your brain.
You say thank you, brain, forbringing that up.
But I'm going to go a differentdirection right now.
And it seems stupid.
Every single person we tell itto they're like that's
ridiculous, I'm not going to dothat.
And we tell them up front it'sgoing to seem stupid.
And it starts to work.
And it starts to work not justin the work setting, it starts
(08:22):
to work in your home setting,because that's really where
burnout lives is.
You have tension at work.
You perceive it as stress, youperceive it as threat and you
know that just makes the shiftsa little tougher at first.
But then you start bringing ithome and now, all of a sudden,
your loved ones are not likingyou too much and that breeds
discontent.
You stop doing the fundamentalsat home and then all of a
(08:43):
sudden you know all the miseryof your job has come to roost in
the environment that's supposedto be restorative, rejuvenating
, and that's where burnoutreally sets in.
So we need the inner voicerecognized at home and at work
and we need to distanceourselves and we need to
actually ask ourselves is thishelpful or not?
So that's the start.
That would be.
Session one is inner voice work.
(09:04):
No-transcript.
(09:53):
Then don't worry about it, letit fade away, let it be less
prominent in your thoughts.
So if you come in and theentire waiting room is full and
you have, you know, no space andyou look at the residents and
they're you know the crew thatyou're like this is going to be
a really tough shift and you'relike start spending five, 10
(10:14):
minutes just locked on to howhorrible the shift's going to be
.
It's going to affect the entiretenor of your time.
If you say, all right, well,this is what I got to work with,
let's get to it, then that'sgoing to be a different mindset.
Does that make sense?
Speaker 3 (10:30):
Mel.
This reminds me of the serenityprayer that I think we're all
pretty aware of.
Speaker 2 (10:36):
Yeah, that's exactly the one.
And the serenity prayer wasbased wholly on stoicism, which
is where this comes from.
Right, god, grant me theserenity to change those things
I can, to accept those things Ican't, and the wisdom to tell
the difference between the two.
That's it exactly, and that'sacceptance.
We'd love the docks to go onestep further, and Nietzsche
(10:56):
coined it as amor fati love yourfate which is, instead of just
accepting it, we'd love them toget there.
That's already going to make ahuge difference, but it would be
even better if they could applyamor fati, which is all right.
So waiting room is totally full.
I'm going to be operating withjust two beds the entire time,
because the rest are filled withborders.
All right, what job can I dowith just those two beds?
How can I make this likeabsolutely the best possible
(11:22):
situation with those two beds?
Let's do it.
You look at which surgeons areon and it's just the meanest,
most horrible surgeons in thehospital.
All right, beautiful.
This is now a challenge.
When I interact with them, I'mgoing to make them smile in the
course of my interaction.
That's my game I'm going toplay.
It's called the stoic challenge, right, I'm going to challenge
myself to actually have themlaughing in my interactions with
(11:43):
them.
May succeed, may not, but it'sgoing to be fun, because now
it's actually a trainingexercise, you know.
So that mindset shift, it seemsminimal, it changes your entire
demeanor.
Everything is the lens you'relooking through when you
perceive your situation and wedon't realize that that lens,
(12:03):
that negative lens, is fused toour face when we're in the midst
of burnout, and so we have totake off those glasses for a
second, find that we can havefun with the situation.
Speaker 3 (12:15):
This all sounds like a bit of a mind trick and not
too long ago I would have saidyou're out of your mind, you
can't control this stuff, itjust happens.
But in my journey I've realizedthat is actually not true.
But it's sort of like being amonk it requires work and
exercise and it's really amuscle.
And I know that many of you arevery skeptical still.
(12:37):
But let's go on.
Speaker 2 (12:40):
All right.
Next we do communication andit's an entire walk through a
technique called nonviolentcommunication, and I can't go
into it here, mel, because itwould take the entirety.
I mean, maybe that's an entiredifferent discussion.
But we teach people how tocommunicate nonviolently because
we are exposed to violentcommunication constantly from
(13:01):
the people around us, from thepatients, and we actually put it
out there to the world.
We communicate violently, notviolently in the sense of like
raising our fists, violently inthe sense of trying to exert our
will onto others.
And once we start talking aboutit, we realize how often we are
interacting with staff, withpatients, with ourselves.
We speak to ourselves withviolent inner voice.
(13:22):
So we walk people through howto go about being nonviolent
with communication.
And then that leads into thenext segment, which is dealing
with a difficult consultant,because when we did surveys we
found this was a big source ofmisery in emergency medicine.
It's just we're at the whims ofthese children who have been
(13:43):
given the imprimatur of, youknow, top-notch positions in the
hospital and now we have todeal with the fact that they
have an advanced past-toddlerstage.
Well, we've walked throughtechniques to actually do that
in a way that's not just safefor us not just safe for our
patient and gets them what theyneed, but also potentially could
be, like I mentioned before,viewed as a communication
(14:04):
challenge that we now are goingto see if we could live up to or
not, and it becomes kind of agame.
Speaker 3 (14:10):
For me, this is one of the most difficult things
during my practicing career.
Yes, like you, I have theimages of the dead and dying
children that are really hard toget out of your head decades
later.
I have that.
I have it bad, but on theday-to-day, the thing that
really stressed me was having totalk to all surgeons and
consultants that would just talkdown to you, didn't know as
(14:32):
much as you did and just madeyour life miserable.
Speaker 2 (14:36):
Mel, you have a kindred spirit.
I mean, dealing with surgeonswas the bane of my existence and
it made me absolutely miserable.
Mel, you have a kindred spirit.
I mean, dealing with surgeonswas the bane of my existence and
I just.
It made me absolutely miserable.
In fact, it was one of the onlythings in emergency medicine
that made me miserable is justdealing with these people who
had never learned how tocommunicate with other human
beings.
But there are ways, and thatnonviolent communication just
changes the game.
Speaker 3 (14:57):
That is not to say that all surgeons are the same.
I've worked with someincredible surgeons, like Kenji
Inaba, for example.
You could not find a nicerhuman being and a better surgeon
and somebody that you wanted topick up the phone when you
needed help.
Always professional, always sonice, and actually that makes it
worse because, like, this ishow we could talk to each other.
(15:19):
Wouldn't that be awesome if wedid that all the time?
Speaker 2 (15:23):
we then, uh, we moved to shift efficiency and now
this.
You know, we go from the verytheoretical mindset stuff to
what really you could sink yourteeth into and the first thing
we teach is what I call thefundies, the fundamentals, which
is you're on shift, you'regoing to eat when you need to
eat.
You're going to drink whenyou're thirsty.
Shift, you're going to eat whenyou need to eat.
You're going to drink whenyou're thirsty.
You're probably going to bedrinking when you're not thirsty
(15:44):
because your thirst responselags behind.
Every time you need to urinate.
Unless you have a critically illpatient, you're going to go and
do it.
You're going to, when you makephone calls, go out onto the
ambulance bay ramp and look atthe sky, whether it's nighttime
or daytime, and then your paceis not going to be motivated by
how full the waiting room is.
(16:05):
Your pace is going to bemotivated by what has you in
optimal performance for thesafety of your patients and your
longevity.
And obviously, if sick patientscome in, then you got to up
your game and change your pace.
But if they're not criticallyill patients, then you go at a
pace that allows you to worksafely and most potently for
(16:28):
your patients and your careerlongevity.
Speaker 3 (16:30):
Now this is a really, really hard one as well,
because we have basically toldresidents if you're a good
resident, you are going to lookin the waiting room, see how
busy it is and go as fast as youcan to make the waiting times
as short as possible, and wejust pounded into each other's
heads that that's what you haveto do.
But now we find ourselves in asituation where we can't we
(16:55):
can't clear the waiting room, wecan't get it all done, we can't
do it ourselves, we just can'tdo it, and people are driving
themselves crazy trying to do it.
But again, this mindset thatI've been responsible for as
well, that this is what you areIf you're a real doctor, if
you're a real ER doc, you can goat full speed all the time, no
(17:16):
problem, and the truth isparticularly in this environment
.
You cannot You've put yourfinger on it, mel problem.
And the truth is particularlyin this environment you cannot.
Speaker 2 (17:22):
You've put your finger on it, mel.
What you've said is embodyingthe voice of so many of the
doctors that come to us, andeven the ones that don't say it
consciously.
That's their subconsciousfeeling, because it was beaten
into all of us by our chiefresidents and our attendings
when we were training is whatthe hell are you doing sitting
there?
You know, drinking some water,there's patients to be seen?
(17:44):
Get your ass off the chair.
And we started just bringingthat into our core, and, as a
result, now we're the ones doingit to ourselves.
And I'm not saying sandbag, I'mnot saying go slow.
I'm not saying make patientswait unnecessarily.
I'm saying that I know that Ihave a level of performance that
leads me to be making gooddecisions for my patients and
(18:06):
leaves me with some gas in thetank for when a sick patient
does show up, and that's theoptimal place.
Now we'll have attendings comein who are at the very bottom of
their pack in terms ofefficiency, and telling them to
slow down more is going to bedeleterious to their job
security.
So, then, what we have to doand we usually have to work with
them separately, not in thegroup is we have to increase
(18:29):
their efficiency, because almostall of those doctors are upping
their pace, but they'respinning their wheels.
They're not actually movingvery quickly, but they just are
doing it frantically.
And instead we want to teachthem charting techniques, we
want to teach them flowtechniques and we want to teach
them ways of getting to themiddle of the pack.
And once you're at the middleof the pack, then you pick your
(18:50):
optimal pace and the only timeyou change it is when patients
are dying, not when patients arewaiting.
And we have to accept this as agroup in emergency medicine,
because then we could startbreaking the perpetuation of
this idea that we're superhuman.
You'll be able to do that for ayear or two.
You'll be miserable, you'll beburnt out, but that's not the
way to make it to a 20 or30-year career in emergency
(19:13):
medicine.
The optimal pace is the onethat allows you to be running as
if you're a marathoner, not asprinter.
Speaker 3 (19:20):
I know that many of you are feeling very
uncomfortable about that.
This is such a part of who wethink we are and what we should
be doing and I've got to say Ithink it's wrong.
I think Scott's right here.
We can't take on all thisburden ourselves.
We can't empty the waiting room.
We need to get some resources.
We need to go at a pace that wecan sustain, not for a shift,
(19:42):
not for a week of shifts, butfor a lifetime of shifts.
Speaker 2 (19:45):
We do some life management stuff on how to
manage calendars, to-do lists,hiring people to do
non-essential tasks, actuallyreserving time for your family,
for your partner, and locking itin, having that ironclad on the
schedule.
The same way you have yourshifts.
I'm not going to go into thatany further because it just you
know, everyone knows it, theyjust don't do it, so we teach
(20:07):
them good methods for that.
Then the next one is we talkedabout work fundamentals, what to
do on shift, eating, drinking,peeing, et cetera.
Then we talk about thefundamentals at home and these
get ignored as people get burntout, because the nice thing to
do if you're starting to feelburnout would be to do all of
these restorative things.
But instead what you do is youdrink beer, you watch Netflix
(20:29):
for five hours and you don'tsleep, and then you wonder why
the burnout is perpetuating athome.
So we teach movement, lightexposure, nutrition, meditation,
optimizing restorativerelationship, time, nature, flow
and mindfulness practices andplay and laughter, and then the
one that we spend the lion'sshare of the time like 90% of
(20:50):
the time on, is sleep, and wetalk about sleep from the
perspective of restorative sleepwhen you're on a regular shift
schedule.
And then we deal with circadiandisruption from night shifts.
Which is the real bugbear ofemergency medicine is this
circadian disruption.
So sleep gets big primetimebilling.
Because when you look at thesleep habits of emergency
(21:10):
medicine they're horrible andtheir caffeine intake just
destroys their capability ofdeep, restorative sleep.
And then we talk about alcoholMel.
Talk about alcohol Mel.
And it's really a rudeawakening when we show the
studies and we discuss the factthat if you're drinking past 5
pm you are really messing upyour sleep.
And that is a big sea changefor emergency medicine.
(21:33):
Because there is nothing I lovebetter than working a night
shift and then having breakfast,steak, eggs and a few beers and
then going to sleep andthinking that I'm falling asleep
so easily.
But you're just destroying yoursleep architecture with alcohol
so that people don't like tohear.
But when we have them track itbecause that's what we do for
the ones that are doubters weactually have them put on sleep
(21:57):
tracking rings and they prove itto themselves every single time
that you can't drink at nightand have restorative sleep.
Speaker 3 (22:04):
Prove it to themselves every single time
that you can't drink at nightand have restorative sleep.
I've been pretty skeptical ofall these sleep tracking things
and just strapping yourself upand making yourself more anxious
about what's going on.
But in this context, to proveto yourself what works and what
doesn't work for your good sleep, and that's not just the stuff
that you're ingesting but theway you set up your room and
then you can check hey, was Igetting enough REM sleep and
stuff, I think for those veryspecific purposes that actually
(22:27):
might be useful.
Speaker 2 (22:28):
Oh yeah, the self-experimentation is huge
because we don't ask people totake anything we say on faith.
We'll show them the studies.
People don't believe thestudies when it comes to
themselves.
If you're a doctor, we knowbetter.
We have them do it and say,okay, give me a week where of
alcohol at night and then a weekwithout, and show me the
numbers.
And they don't show thembecause they're too embarrassed.
And then caffeine is justbrutal.
(22:50):
Even the people that are like,no, I could drink a cup of
coffee right before bed, I'mfine.
Yeah, I believe you that you'll.
You'll fall asleep, but show methe numbers on your deep and
REM sleep and then you coulddecide whether it's great to be
drinking caffeine later in theday.
But yeah, so we go through anentire unit on sleep.
Then we move on to lifelongmastery.
This is what a lot of theattending level, the consultant
(23:13):
level, docs, lose is they lovedresidency and now they're not
really liking their job anymoreand they wonder why.
And it's like oh, maybe I'mjaded, maybe I'm bored, maybe
it's just gotten worse, but no,what it is is during residency,
every day they were discoveringsomething new and so they had
this innate flow state, thisinnate purpose for showing up
(23:34):
and they lose that.
They've kind of gotten to thepoint where they're not learning
new things.
But the reason they're notlearning new things is not
because they're not exposed toit.
It's because learning outsideof shift primes you to now see
and recognize things you didn'tperceive.
And all of a sudden you arelearning.
So you read a new paper on anew technique for doing the
(23:55):
Valsalva maneuver and now all ofa sudden that AFib, that's just
like yeah, yeah, give them theDeltiazem.
Like you're excited, because,like I want to try it.
I want to see if this uh revert.
What is it?
Oh, mel, you probably rememberbetter than me the maneuver
where you lift their legs in theair.
Speaker 3 (24:07):
Yeah, that's right.
The revert trial you get themto sit up, blow on, uh, do a
bell salver and then lift theirlegs up and convert a lot more
people than this standard waysof fixing an SVT.
Speaker 2 (24:18):
Yeah, there we go.
So it was revert, great,lifelong mastery.
But we wanted to take a stepfurther, mel.
We want them to listen or read,but then actually write it down
and fit it into a framework oflearning such that because it's
so much more potent if you'retaking notes and using that to
build a tree of knowledge forthemselves.
(24:38):
So we teach them the ways to dothat, the techniques and the
best apps and such for that, ofthe ways to do that, the
techniques and the best apps andsuch for that.
And we try to invigorate theirlearning, because a lot of docs
they go to ASEP once every threeyears and that's their learning
and it's not enough, not enough.
And then the last piece, mel, iswe talk about burnout on a
systemic level.
We talk about what goes into it.
(24:59):
I show them the MCRIT burnoutmodel and then we talk about if
they are in a position to lobbyor actually create system change
, what those would be.
But that's a very small part,because we go back to the agency
piece.
The things the docs haveimmediate agency on is their own
behavior and their own mindset.
(25:19):
The things they have verylittle agency on is making these
systems changes.
So it's not that I don't thinkthey should happen.
It's just that to spin ourwheels talking about the fact
that the hospital shouldradically shift the way they
treat us a lot of times is a bigdream.
Speaker 3 (25:34):
Now we have to be careful with this one, because
I've heard some very smartpeople.
Actually, one of the residentscalled Chris Chris, I don't
remember your last name at UCLA,we're saying the same thing we
should not be blaming doctorsfor systemic functional problems
that are above their pay grade,that they can't do anything
about, that.
They're asked to do more withless this whole thing.
But what I think we're sayinghere is that we should be trying
(25:55):
to do both.
The system needs to get better,but if you're going to survive
this right now, for however longit takes to fix it, then you're
going to have to do some ofthese tricks, these mind tricks
and these really important lifehacks in order to get through,
and you're also going to have tovery much accept that stuff
isn't going to change veryquickly.
So it's not that we shouldn'tfix these things or it's the
(26:17):
doctor's fault.
That is not what this is about.
This is about the system isbroken and if we're going to
continue to function in thissystem, we have to hack it, and
that's what this is abouthacking ourselves to try and you
know survive a broken system.
So tell us a bit more about howthis functionally works.
Uh, do you go up to an ashramand you're there for a month or
(26:38):
a year, or do you do it via zoom?
How does this work?
Speaker 2 (26:42):
We do.
It's 12 sessions is the courseand we do that every other week,
so it's 24 weeks and that givespeople time to talk amongst
themselves in group and toreally let the stuff sink in.
And we at the end of it it'snot just listening, because that
doesn't do anything.
They have to go and experimentand they're given homework and
(27:04):
you have to try it out and letus know what worked, what didn't
work, in order to be able toadjust for the individuals.
And I don't even know whatwe're charging right now.
It's probably somewhere around$3,000 is what the course costs.
Individual coaching it'sexpensive and it's going to vary
by coach.
(27:24):
I used to be charging $500 anhour, now it's $750 an hour.
It's a lot of money and anyonewho says to me I shouldn't be
paying this, I'm not going to doit.
I'm like, yeah, I'm with you,man, it's a lot.
And the thing we found that isa saving grace is most of the
time the hospitals will pay forthis out of your CME money.
Even though it's not CME, theydo consider it a better use of
(27:47):
funds than most of the peoplegoing to Aruba for those
conferences where we knowthey're not learning anything.
But that's what physicianexecutive coaching that's really
the ballpark for everyone who'sdoing it.
That's what it's coming out to.
Speaker 3 (28:00):
That's expensive, real expensive.
Why is it so expensive?
Speaker 2 (28:11):
I hear it.
Yeah, you know I thought theywere ridiculous rates at first
too, and you know this is allyou know self-justification.
But I don't know how therapistsdo it, mel, because they're
doing 40 hours a week For medoing you know, a few hours of
executive coaching, which is allI could really handle.
Each hour takes so much out ofme, like I'm pretty much done
for the day and maybe atherapist would tell me like
(28:31):
you're not supposed to beputting that much of yourself
into it, scott, you're supposedto just be kind of oh yeah, yeah
, Tell me, tell me more aboutthat.
But that's not how it is for,uh, for me or for the people I
know.
And like, after an hour ofdoing executive coaching with a
physician, I'm like I'm spentbecause the active listening and
the amount of attention you'reputting into this, it's just
(28:53):
give me an ED shift.
That's going to be a lot morerelaxing.
Speaker 3 (28:57):
I looked at executive coaching just for the business
part of my life and the peoplewho do this who are a bit more
famous, they're chargingthousands of dollars per hour
and I'm just I can't bringmyself to pay that.
That's ridiculous.
So this is not an outrageousnumber that they're talking
about there.
Nobody wants to talk aboutmoney.
(29:17):
It's one of those topics wedon't talk about.
But it is funny that ER docs inparticular will ask each other
how much do you make an hour?
It's sort of a thing that wejust do in a mincemeat.
But other people do not talkabout this stuff.
So in person or via Zoom,because that would raise the
expense a lot.
It's one thing to go to aconference that's $1,000 or
(29:37):
$2,000 or $3,000, but thenthere's the hotel and then
there's the plane and all thatstuff.
That's where it really startsto add up.
Speaker 2 (29:44):
No, it's over Zoom and we were worried like would
the group dynamic be there?
But I don't know about you, mel, but I've found like I've done
meditation over Zoom, I've donetherapy work over Zoom and, for
whatever reason, I don't thinkyou lose that much.
I mean, with the degree ofresolution of the cameras now,
the capability of seeingpeople's facial expressions, I
(30:07):
just don't feel it's a big lossand in fact now most of my grand
rounds are done virtually,because to have that carbon
footprint and all of that moneybeing wasted to just go there
and speak for an hour, I'd muchrather just do it on Zoom in
almost every case, and I don'tthink you lose that much.
So, yeah, it's virtual.
Speaker 3 (30:25):
So I'll have to also agree with that.
I have found although we gotsick of Zoom during the pandemic
, the cameras, the mics reallyhave improved so much.
I do therapy every week forpart of my restoration, trying
to get healthy again, and I findthat it's fantastic and I don't
have to drive and I'm notstressed and I'm not trying to
get healthy again and I findthat it's fantastic and I don't
have to drive and I'm notstressed and I'm not trying to
(30:46):
get parking, and you can do alittle meditation beforehand and
then do the session.
I really find that it worksjust fine.
Probably the first few timesyou want to meet the person and
get to know them have a bit of arapport, but I find that it
works just fine.
Thank you very much.
And I got to tell you I justbought this thing called an owl
and this is a bit of a sidething and again I have no
(31:08):
association with the company butthis thing called an owl, which
is a array of cameras andmicrophones that if you're doing
groups like you, put it in themiddle of the table and it'll
pick out who's talking and itwill focus the camera on that
person and it'll focus the audioon that person and it has been
just so good when you've got agroup of people in one place and
(31:30):
you're emoting in somebody else, so really helpful.
Anyway, that was an aside, so Iwas wrapping it up saying you
know scott, thanks for the time,and the reason that I'm talking
to him about this is becauseI've known him for 25 years or
more.
He has been at the top of hisgame and now he's doing this to
help other physicians.
I just think that's reallyimportant and he's a no bullshit
(31:52):
guy.
He's absolutely a no bullshitguy and you can go to one of his
sessions, no doubt, and callbullshit on him and have the
discussion.
That's what I really like aboutScott.
Speaker 2 (32:02):
Yeah, you're so kind, mel and have the discussion.
That's what I really like aboutScott.
Yeah, you're so kind, mel.
You know what you just said aminute ago brought up some I
forgot like a key session we do,mel, and I can't believe I
forgot it because it's one thatmay be the most important to me
and that's we do an entiresession on meditation for
physicians, and that one is soclose to my heart and I think
every doctor should have ameditation practice.
(32:24):
So when before you said, beforetherapy, you do meditation, I'm
like, oh my God, how did I missmentioning that?
Because it is the game changer,I think, for emergency medicine
in particular, to have ameditative practice.
Speaker 3 (32:38):
And then, as we're cleaning up here, I was saying
you know I've said on multiplepodcasts across the world,
cleaning up here.
I was saying you know I've saidon multiple podcasts across the
world, but I think every ER,doc, nurse should have therapy
from basically the day theybegin.
It is such an abnormal job.
It is just you need to have aplace where you can try and work
through those feelings and thatemotion and that maybe now I'm
(32:58):
thinking we should all haveexecutive coaches.
I don't know.
What do you think, scott?
Speaker 2 (33:02):
No, I think your suggestion was right, mel.
I think every doc should be intherapy.
I've heard you say that.
It resonated so strongly withme.
I think you go to a coach whenyou have a true issue you want
to work through and you know, Ithink I would reserve it for
that.
I mean, I'm sure there arecoaches out there that would
just salivate over having aclient that's going to come to
(33:23):
them on a regular basis withoutany true problems.
But executive coaching at leastas opposed to life coaching,
executive coaching really isproblem-oriented.
So I would think every docwould benefit from having one
number or contact information intheir back pocket for when
something comes up.
But I think, incontradistinction to clinical
(33:43):
coaching Now that's, that'ssomething very different.
That, maybe, is anotherdiscussion.
But you know Atul Gawande'sidea that every doc should have
a coach that could come in on ashift and actually watch them
perform and give advice andfeedback.
I'm not doing that yet, butthat, I think, would be the true
(34:04):
game changer for our specialtyin terms of upping performance.
Speaker 3 (34:07):
So thanks to Scott for giving us a bit of the
inside scoop of what they do.
I'm not suggesting that you goand use Scott and Rob, but I am
suggesting that you think aboutthis and maybe there's somebody
in your area or check them out.
I don't care.
I'm just here to tell you thatthere are people that do this
and there are things and ways ofthinking about our job that
might be helpful, and that'swhat this whole thing has been
(34:29):
about and continues to be aboutin my brain.
How do we help the people whoare out there doing the work?
Because the work matters and weneed to keep people in it in
the game, and if we can't fixthe system yet, how do we stay
in the game?
And Scott has got some greatideas about that.
So thanks, scott, and we shallindeed talk more about this and
(34:49):
some other stuff in the monthsahead.
Speaker 2 (34:52):
I would love that.
Thank you, mel, and thank youfor everything you do.
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