August Updates and Book Suggestion!

Send us Fan MailWe talk with Professor Dave Schriger (UCLA) and Dr. Al Sacchetti (New Jersey ER doc and academic) about why emergency departments feel permanently overwhelmed and how emergency medicine loses its identity when profit and protocols replace clinical judgment. We wrestle with administrator-driven incentives, shrinking alternatives to hospitalization, and what it would take to make the system match patients to the right level of care. • the original role of emergency physicians as decision-makers who prevent unnecessary tests and admissions • how hallway care and boarding reflect incentives more than capacity • why hospitals undervalue ED work by ignoring admitted-patient revenue and downstream impact • the explosion of non-clinical administration and how payment complexity fuels it • what happens when leaders stop practicing clinically and policies lose bedside realism • why some quaternary hospitals avoid emergency departments to control admissions • the need for multiple ED exit paths including community hospitals and hospital-at-home • concierge models as a pressure release for the few that weakens incentives to fix access for everyone • unionization, specialty societies, and whether emergency medicine failed to draw a line • a generational shift toward protocol-driven care and the erosion of ownership • paying physicians for thinking instead of testing and how AI might simplify billing Support the show

Send us Fan MailWe talk with ER doctor Matt Clark about why he believes medical aid in dying crosses a moral line for clinicians and for society. We test his claims against autonomy, real-world suffering, and a personal story of a friend who chose a planned death. • dignity as inherent rather than earned through independence or control • why redefining dignity can undermine equal treatment for disabled and dependent patients • the risk to vulnerable people through normalization and eligibility expansion over time • “slippery slope” and indication creep examples from Canada and the Netherlands • how medical ethics changes when intent shifts from relief to killing • doctrine of double effect and why intention matters in end-of-life pain control • the case for better goals-of-care talks plus stronger hospice and palliative care funding Support the show

Send us Fan MailThe most uncomfortable end-of-life questions are often the most practical ones: Is medical aid in dying legal, who qualifies, and what does it mean for the people who have to live with the aftermath? We bring on Bob Ooslander, an emergency physician turned palliative care specialist, to walk through what “death with dignity” looks like in real homes with real families, not just in headlines.We get specific about the core facts, including why medical aid in dying is treated as a legal process and why it’s typically limited to terminal illness with an expected life expectancy of less than six months. Bob explains two patterns he sees again and again: patients declining quickly who are likely to use the medication, and patients who want the prescription as an option they may never take because having control reduces fear. We also connect this to hospice and palliative care, where good support can sometimes ease suffering enough that people choose a natural death without ever using the medication.Then we go where the tension usually lives: family dynamics, religious objections, and the fear of “indication creep.” Bob shares how patients often have to convince loved ones to accept their choice, why neutral counseling matters, and how safeguards are meant to prevent misuse while preserving access for those who qualify. We close on a message that applies no matter where you stand on physician-assisted dying: clarity is a gift. If this brought up feelings or questions, subscribe, share with someone you trust, and leave a review with your take.Link to How Doctors Die Essayhttps://empoweredendings.com/Support the show

Send us Fan MailWe talk with Tyler Jorgensen and Katie Masters about River Therapy, a new film that follows emergency clinicians stepping outside the hospital to face burnout, grief, and the grind of a broken system. We trade real-world ways to reset an overworked nervous system and build resilience through community and time in nature. • The origin of River Therapy and why the ER community needs it • Burnout in emergency medicine as isolation grief and chronic stress • Filming on the Pecos River in far west Texas as a deliberate reset • Prescribing nature as “microdoses” and “macrodoses” that fit real lives • The sensory contrast between ER noise and quiet that helps the body recover • Why “work hard, party hard” is not a sustainable recovery plan • Screening plans and a post-film Q&A to keep the conversation going I hope that everybody comes and we can have some nice discussions about um how to build our teams up and build resiliency and getting outside together.Support the show

Send us Fan MailWe talk with Navy-trained emergency physician and author Andrea Austin about what war zone medicine taught her and why so many clinicians feel broken after years of high-stakes care. We name what sits underneath “burnout” and lay out practical ways to protect the people who are the safety net on everyone’s worst day.The BookThe PITT• Andrea’s path from 9-11 to military emergency medicine• How the Health Professions Scholarship Program creates a long service commitment• What changes when you practice resuscitation in a deployed war zone• Why Andrea wrote Revitalized after a 2021 existential crash and sabbatical• Moral injury vs burnout and how compassion fatigue shows up at work• Complex PTSD in emergency medicine and why triggers can be unclear• Why trauma often surfaces when stress finally drops• The case for embedded therapists in the emergency department• Debriefs, peer support, and how trauma can spread through team dynamics• Boundaries, and how childhood patterns can reactivate in clinical work• The “backpack” problem of unprocessed grief and the Body Keeps The Score• Why The Pit matters for telling the story of emergency care and its costSupport the show

Send us Fan MailWhat happens when a trusted EM education brand hands the day-to-day to a leader who grew up on County shifts, built startups, and still believes teaching should feel human? We open up about a big leadership change, why credibility beats polish, and how we’re rebuilding medical education to match the realities of modern emergency medicine.First, we trace Mizuho’s path from Santa Barbara to County, through early EM:RAP projects and entrepreneurial swings, to a CEO role focused on protecting the core—reliable, relatable, high-yield teaching—while pushing formats forward. That means cinematic fundamentals filmed in a new studio, graphic overlays that mirror real resuscitation thinking, and modules that work whether you’re printing PDFs or binging 90-second pearls between patients. If you haven’t tackled pediatric resuscitation or trauma in years, you’ll see why visual refreshers can be safer than skimming dense text after a long shift.Then we get serious about boards. With written pass rates shrinking and a revamped oral exam adding simulation and hands-on elements, the Invictus suite aims to turn board prep into lifelong learning. Expect emphasis-driven videos, short companion podcasts for daily reps, practice cases built for the new format, and study guides mapped to PGY levels. Program directors get roadmaps that cut through noise. Attendings gain a path to rebuild rusty domains without losing time.Threaded through it all is the weight of burnout and moral injury. We talk candidly about the gap between what clinicians know to do and what systems allow, and why storytelling matters in repairing that fracture. Our collaboration with The Pit helps families see the strain behind the badge, and it feeds back into education that respects your time, your attention, and your reality on the floor.If you care about EM education that earns your trust and meets you where you work, this conversation lays out the why and the how. Subscribe, share with your team, and leave a review with the one topic you want us to build next—we’re reading every word.Support the show

Send us Fan MailWe examine how clinician-built AI can safely support emergency care, where consumer tools fall short, and why planning, context, and evaluation matter more than model hype. We also share a patient-facing approach to unify records and recordings for safer, clearer answers.• differences between consumer and medical‑grade AI, HIPAA and BAAs• model regressions, sycophancy, and hallucinations• context engineering and planned prompting for safety• ambient clinical decision support at the bedside• evaluations, benchmarks, and model selection• medico‑legal uncertainty and state regulations• education risks of over‑reliance on AI• human oversight, prioritization, and tactile care• patient empowerment via unified records and encounter recordings• interoperability gaps and practical workaroundsSupport the show

Send us Fan MailDr. Rob Rodriguez, MD Professor of MedicineAssociate Dean of Clinical & Population Health ResearchUniversity of California Riverside School of MedicineThe MMWR ArticleDiscusses his groundbreaking study examining vaccination screening in emergency departments across America. The research reveals a critical public health opportunity as 86% of ED patients aren't up-to-date on their vaccinations, yet nearly half would accept them if offered during their visit.• Vaccination has saved more lives than any other public health intervention• For 25-30% of Americans, emergency departments are their only healthcare access point• Study conducted across 10 EDs in 8 cities focused on non-critically ill adult patients• About half of patients were unaware of vaccines recommended for their age group• Implementation could increase vaccination rates from 14% to potentially 48%• Automating the screening process is the next step to avoid burdening ED staff• Government funding for vaccines significantly increases uptake rates• Recent political shifts have reduced emphasis and funding for vaccination researchIf you're interested in joining this public health mission or have thoughts to share, please contact Dr. Rodriguez through the link in our show notes.Support the show

Send us Fan MailMel give some updates and his book selection for this summer!Everything is Tuberculosis by John GreenInvictus.Reviews landing Page is live.Support the show

Send us Fan MailThis is a reproduction of the Caring Greatly Podcast. The 100th episode and the interviewer Liz Boehm.Dr. Mel Herbert, emergency physician, educator and medical consultant for the hit TV drama "The Pit," shares how the show portrays the realities of emergency medicine and healthcare's biggest challenges. The conversation reveals how healthcare professionals are pushing for system-wide change, especially in addressing clinician mental health needs.• Emergency departments serve as society's 24/7 safety net but are facing unprecedented staffing and capacity challenges• Wait times at prestigious hospitals now routinely reach 12-24 hours due to system-wide issues and patient boarding• "The Pit" accurately portrays healthcare challenges including workplace violence, administrative pressures, and resource constraints• Clinicians carry an "emotional backpack" of trauma from witnessing death and suffering without adequate mental health support• Dr. Herbert advocates for mandatory mental health support for all healthcare workers to eliminate stigma• Emergency medicine consistently ranks highest in burnout and suicide rates among medical specialties• The profit-driven healthcare system contributes to systemic problems that harm both patients and providers• The show helps patients and families understand what really happens in emergency departments• Media portrayal of healthcare challenges can drive public understanding and potentially influence policy changeWatch "The Pit" to support continued storytelling about healthcare's frontline workers and the challenges they face.Support the show