When you have a patient who requests a Z-pack for what is almost certainly an acute viral respiratory infection, you probably respond internally or externally (possibly both) that antibiotics do not treat viruses. But could there be some effect on their symptoms, or the viral infection itself, that is not part of the common discussion when it comes to such things? We know that azithromycin is an antibiotic, but it turns out that azithromycin actually has some activity in the viral arena. This absolutely shocked me. The question is, does it matter?  ﻿Awake and Aware | Our 2024 Live Event Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots. Website: Awakeandawarebend.com 16.25 Hours Category 1 AMA CME The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets Out on TimeStay out of chart debt. Document like a legend. Get home on time! Begins August 15, 2024. Learn more here  For full show notes of this episode and all sorts of other goodies, visit our podcast website We Discuss:In vitro studies show azithromycin reduces rhinovirus replication and release.  Another in vitro study on respiratory cells from lung transplant patients found azithromycin reduces rhinovirus-associated cellular inflammation.Kids with coronavirus (the pre-COVID, old-school coronavirus)  had reduced viral load with azithromycin. In enterovirus-infected mice, azithromycin improved survival. Patients infected with influenza a who were given azithromycin had reduced interleukins 6, 8, 17, tumor necrosis factor, and CRP, indicating anti-inflammatory properties in flu patients.This study, however, did not show improved clinical outcomes with azithromycin.Another study using a similar methodology did not see any change in inflammatory markers but had a slight improvement in sore throat and fever resolution in the azithromycin group. A 2009 paper found that azithromycin did not improve disease course in hospitalized infants with a respiratory synovial virus. There has been signal of clarithromycin decreasing hospitalization in patients with severe RSV, but the preponderance of data are fairly consistent that there is no benefit in hospital stay, length of illness, or oxygen utilization. 


96.5 The curious case of Zithromax and viral respiratory infections

We break down ideas, strategies, and tactics to help you improve your mindset, overcome burnout, excel in leadership, prioritize your well-being, get unstuck, de-stress, and thrive in your career. If you are a doctor, nurse, paramedic, medical student, physician assistant, nurse practitioner, administrator, or even tangentially related to healthcare, this show is made for you. Hosted by emergency physician and executive coach Rob Orman, MD. 

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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 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 workflows
For full show notes of this episode and all sorts of other goodies, visit our podcast website We 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...

How to Create a Team in 10 Seconds | Why time is not linear and every second not worth the same

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 portfolio
Guest 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 working
Mentioned 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 The Flameproof Course. Sept 10, 2024 Real-time instruction with Rob Orman, MD, and Scott Weingart, MD. 
Specific tools and strategies for anti-burnout, career longevity, and self-mastery.
From a recent Flameproof graduate, "I went from constantly dreading work and thinking of quitting to being able to enjoy shifts on a regular basis." Flameproof Course

Thinking Outside Your Retirement Account | working harder vs creating value

Phantasia Kataleptike, a lesser-known gem from Stoic philosophy, offers a transformative approach to life's challenges. This practice of 'objective representation' strips away the layers of subjective judgment that often cloud our perceptions. Imagine the power of viewing a setback not as a disaster but simply as a fact of life, a moment ripe with potential for growth. How does this shift affect our inner turmoil? The Stoics had insights that might surprise you, blending ancient wisdom with actionable strategies for modern living.  In this pod, we break down the essence of Phantasia Kataleptike and multiple methods for employing it as a tool for equanimity and de-catastrophization.  For full show notes of this episode and all sorts of other goodies, visit our podcast website The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets Out on TimeStay out of chart debt. Document like a legend. Get home on time! Begins August 15, 2024. Learn more here  We Discuss:Defining Phantasia KataptikeAcceptance of what isA dog and a cart | Epictetus’ classic simileWhy the words we use impact us as much as (or more than) they impact othersThe lost shipThe A-hole in a JaguarOperationalziing Phantasia KataleptikeValence | Awareness of emotion and narrative The Dichotomy of ControlHow to Think Like a Roman EmperorActively de-catastrophizing Shifting from ‘what if’ to ‘why did’ to ‘so what?’ to ‘what’s next’The threat-challenge seesawWhat to do when the emperor banishes youThe counterarguments to Phantasia Kataleptike
Mentioned 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 Out On Time Course Finishing shifts with a stack of charts to complete gets old fast. It also contributes to burnout.
Join us for 'Out on Time,' a comprehensive 10-week six-session course where you'll learn how to walk out the door unencumbered.

This is the only Out On Time that will be fully live, so don't miss out!

The course begins on August 15, 2024. Out On Time Course

Phantasia Kataleptike | The secret skill of Stoicism

Have you ever found yourself deep in “The Pit” where the mere thought of going back to work triggers an existential crisis? You wonder if your current job is the right choice. Sometimes, all it takes are a few adjustments to the current job and you'll feel fully refreshed and stoked to tackle that next shift. It may also, however, be time for The Trade. In this episode, we delve into the critical juncture many professionals, particularly physicians, find themselves in when their once-aspired career paths no longer bring fulfillment. We tackle:Whether to deepen commitments to your current role or brave the uncertainty of switching careersWhat it means to tolerate another yesterdayThe silent tax paid by grinding it outThe emotional and practical implications of making significant life changesHow a well-cultivated professional identity can become an albatrossA step-by-step guide on how to transition towards a more satisfying career
So, whether you're a physician on the brink, a professional in a pickle, or just someone who enjoys a good existential quandary with their morning coffee, tune in. Let's laugh in the face of the status quo and ponder if the grass is greener, or if it's just astroturf. Guest bio: Lon Stroschein is the purveyor of the Normal 40 podcast and author of The Trade. In past career interactions, he was an aide to a US senator and brokered billion-dollar deals in the aerospace industry. He now guides professionals in finding their second-half stories.  The Flameproof CourseCohorts 1 and 2 sold out. Cohort 3 begins Sept 10, 2024. This is the hidden anti-burnout curriculum we all should have learned in training. Get the deets Out on TimeStay out of chart debt. Document like a legend. Get home on time! Begins August 15, 2024. Learn more here  For full show notes of this episode and all sorts of other goodies, visit our podcast website We Discuss: Do I double down on what I'm doing right now or consider making a career change?Tolerating another yesterdayThe Pit: A Signal for ChangeRecognizing and Overcoming the Tax of DiscontentWorking yourself into The Box | We strive for years to get into it, but then it can feel like a trap. The two things that keep high-level professionals stuck in a career or positionWork identity takes a long time to build. It gives amazing opportunities but also takes some awayThe Trade: Step by StepThe mindset to thwart inertia #JFDSHas this job given me all it has to give and have I gotten all I have to get?A lifetime is a long time, but it doesn't take long to live it
Mentioned in this episode: Out On Time Course Finishing shifts with a stack of charts to complete gets old fast. It also contributes to burnout.
Join us for 'Out on Time,' a comprehensive 10-week six-session course where you'll learn how to walk out the door unencumbered.

This is the only Out On Time that...

Making the trade | How to know when it's time to change careers

The interplay between the Default Mode Network (DMN) and the Task Positive Network (TPN) is crucial for our cognitive and emotional health. The DMN, active during restful states and wandering mind, facilitates introspection, memory recall, and creativity, serving as a foundational element in our mental processes. On the other hand, the TPN takes charge during focused, goal-oriented tasks, enabling attention, decision-making, and problem-solving. They operate in balance - when one is active, the other quiescent and this dynamic is essential for optimal mental functioning. However, imbalances in these networks can lead to mental health challenges. For instance, excessive DMN activity is linked to conditions like depression and anxiety, where rumination and negative self-referential thoughts prevail. In contrast, overreliance on the TPN without adequate rest can lead to burnout and stress. Mindfulness meditation offers a practical approach to equilibrating the DMN and TPN, promoting mental well-being by fostering a state of alert relaxation and enhancing self-awareness. Moreover, incorporating regular breaks into the workday, particularly those that allow for mental disengagement from task-focused activities, is vital for sustaining cognitive performance and preventing decision fatigue. Engaging in activities that stimulate the DMN, such as spending time in nature or practicing mindfulness, during these breaks can further enhance cognitive restoration and emotional balance. ﻿Awake and Aware | Our 2024 Live Event Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots. Website: Awakeandawarebend.com 16.25 Hours Category 1 AMA CME For full show notes of this episode and all sorts of other goodies, visit our podcast websiteWe DiscussWhat is the Default Mode Network?What is the Task Positive Network?Interplay of the TPN and DMNDefault Mode Network out of Balance | Mental IllnessThe Neurophysiology Behind How Taking a Small Step of Action Can Decrease Rumination and AnxietyThe Default Mode Network and InsomniaWhat Happens with the DMN in Meditation?The Task Positive Network's Role in MeditationWhy Your Task Positive Network is Begging You to Take a Break in the WorkdayHow to Take a Break That Effectively Recharges Your Task Positive Network
Mentioned in this episode: Out On Time Course Finishing shifts with a stack of charts to complete gets old fast. It also contributes to burnout.
Join us for 'Out on Time,' a comprehensive 10-week six-session course where you'll learn how to walk out the door unencumbered.

This is the only Out On Time that will be fully live, so don't miss out!

The course begins on August 15, 2024. Out On Time Course 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

96.5 The curious case of Zithromax and viral respiratory infections

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