Dirty White Coat

Send a textWhat 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 a textWe 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 a textDr. 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 a textMel 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 a textThis 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

Send a textDr Gillian Schmitz former ACEP president and current vice chair of education at Naval Medical Center San Diego, examines emergency medicine's financial crisis and its consequences. She identifies the fundamental contradiction in how America treats emergency care as a universal right while funding it as a privilege, creating an unsustainable system where nearly 70% of ED patients don't cover their care costs.• Former ACEP president with extensive experience in civilian and military emergency medicine• Healthcare in America faces a fundamental conflict between right vs privilege approaches• Nearly 70% of emergency department patients don't pay the full cost of care• Insurance companies making billions while avoiding fair payment for emergency services• Boarding and overcrowding have reached dangerous levels affecting patient safety• Physician groups facing consolidation as independent practice becomes financially nonviable• Potential solutions include better insurance accountability and reconsidering funding models• Some physicians consider unionization and collective action as necessary steps• Media portrayal through shows like "The Pit" helps public understand emergency medicine challengesWe need the public to understand how emergency care is funded – or not funded – and the impact of this unfunded mandate on the entire healthcare system. Without addressing the root cause, boarding, violence, and consolidation will continue to worsen.Support the show

Send a textThe ACEP and RAND StudyInterview with David Schriger, Peter Viccellio, and Al Sacchetti, MD'sFour decades of emergency medicine experience reveals how the specialty continues to normalize dysfunction while failing to articulate what emergency care should look like. Veterans explore solutions to the systemic problems that have kept emergency departments "at the breaking point" for over 30 years.• Emergency physician compensation ranks around 16th among medical specialties—not the financial crisis some portray• Working conditions, not compensation, represent the true crisis in emergency medicine today• Emergency departments generate 33-50% of hospital revenue, but this value is rarely recognized by administration • Physicians have accepted and normalized dysfunctional practices like hallway medicine instead of demanding change• Simple solutions like elective scheduling smoothing and enhanced discharge programs work but aren't widely adopted• Emergency medicine needs to define and demand what optimal practice should look like• The healthcare system tries to solve 7-day-a-week problems with 5-day-a-week solutions• Hospitals contain chaos in emergency departments to maintain predictability on inpatient floors• Emergency physicians increasingly moving into hospital leadership roles where they can implement systemic improvementsListen to our next episode where we'll explore how new emergency physicians can advocate for better workplace conditions despite institutional resistance.Support the show

Send a textThe Dr. Lorna Breen Heroes Foundation works to eliminate barriers to mental health access and improve work environments for healthcare workers, following the tragic suicide of Dr. Lorna Breen during the first COVID wave.A interview with CEO Stephanie SimmonsLinks:ALL IN for Mental Health: https://drlornabreen.org/allinformentalhealth/Specifically the ALL IN for Mental Health resource page: https://drlornabreen.org/allinformentalhealth/six-actions/accessible-affordable-mental-health-care/ACEP wellbeing resource page: https://www.acep.org/life-as-a-physician/wellnessDr. Lorna Breen Heroes' Foundation Licensing/Credentialing toolkit: https://drlornabreen.org/removebarriers/Write your Representative to support Reauthorization of the Dr. Lorna Breen Healthcare Provider Protection act: https://drlornabreen.org/reauthorizelba/Become an Ambassador: https://drlornabreen.org/become-an-ambassador/Donate (and thank you!):  https://drlornabreen.org/donate/Summary:• Founded by Lorna's sister and brother-in-law after thousands of healthcare workers reached out following her death• Three main areas of work: advocacy at federal and state levels, advanced collaboration, and accelerating solutions• Successfully helped pass the Dr. Lorna Breen Health Care Provider Protection Act in 2022, establishing grants for healthcare provider mental health programs• Working to remove stigmatizing questions about mental health from licensing and credentialing applications• 35 state medical boards and over 600 hospitals have removed invasive mental health questions• Many healthcare workers avoid seeking mental health care fearing professional consequences• Anonymous resources available include the Emotional PPE Project and Physician Support Line• Healthcare workers compartmentalize trauma like "putting it in a backpack" that eventually becomes too heavy• The foundation is committed to being "completionist" in changing all state licensing boards• Physicians and healthcare workers have unique power to advocate for these changesVisit the All In for Mental Health website for resources and use the legislative call to action tool to support reauthorization of the Dr. Lorna Breen Healthcare Provider Protection Act.Support the show

Send a textThe Nocturnists Podcast with Emily Silverman, MDThe HBO Max series "The Pit" has struck a chord with healthcare professionals unlike any medical drama before it. What makes this show so different? Why are doctors and nurses messaging each other saying, "You have to watch this—they finally got it right"?In this special bonus episode, I sit down with the brilliant creative team behind the show that's capturing the true essence of emergency medicine: R. Scott Gemmel (creator and showrunner), Joe Sachs (emergency physician and writer), and Mel Herbert (renowned ER educator and consultant).Our conversation reveals how "The Pit" breaks new ground through its revolutionary real-time storytelling format—each episode covers just one hour of a 15-hour shift, immersing viewers in the relentless pace experienced by healthcare workers. We explore how the team meticulously crafts authentic medical scenarios, using actual cases as jumping-off points for character development while ensuring perfect technical accuracy.The show's commitment to authenticity extends beyond medicine to address systemic healthcare challenges—the boarding crisis, corporate pressure over satisfaction scores, staff shortages, and the alarming rise in violence against healthcare workers. As Joe reveals, "56% of nurses reported experiencing physical assault in the last month." By tackling these realities head-on, "The Pit" serves as both entertainment and powerful advocacy.We also get fascinating behind-the-scenes insights into the production process, from the incredibly detailed set design (complete with sometimes-too-convincing fake toilets) to the custom-built anatomical models created for intubation scenes. The team's dedication to getting every detail right explains why healthcare workers are feeling so seen by this groundbreaking show.The conversation concludes on a hopeful note as the creators share their ultimate mission—to celebrate the extraordinary dedication of emergency medicine professionals while inspiring a new generation to enter healthcare despite today's challenges. As Scott beautifully puts it, the show is fundamentally "a love letter to a profession that is sometimes just taken for granted."Listen now to discover how storytelling can bridge the gap between healthcare realities and public understanding in ways that might just change how we all see the emergency department and those who work there.Support the show

Send a textLink 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 careerCall us or visit our website to learn more about physician executive coaching and register for upcoming sessions.Support the show

Send a textWe're exploring the integration of AI search within Corpendium and discussing the delicate balance between powerful search capabilities and maintaining medical accuracy. Our team dives deep into the technical challenges and ethical considerations of implementing AI in a trusted medical reference platform.• AI search struggles with staying confined to just Corpendium's content despite explicit instructions• RAG (Retrieval Augmented Generation) allows AI to search internal databases while maintaining natural language understanding• The tension between sensitivity and specificity mirrors clinical decision-making in emergency medicine• Vector space embeddings help AI understand semantic relationships between medical terms beyond simple keyword matching• Citations and references are crucial for verifying AI-generated information against human-authored content• Traditional search still has value, especially in offline modes where large language models aren't available• Expert human judgment remains essential as AI can make dangerous mistakes despite sounding authoritative• Editorial teams benefit from AI by automating formatting tasks while focusing human expertise on clinical content• The system will launch in beta with user feedback mechanisms to continuously improve accuracy• AI is most valuable as a tool for experts rather than a replacement for medical education and trainingAI doesn't replace the learning that medical professionals go through. It's exceptionally helpful in the hands of experts, but always scrutinize what it tells you.Support the show

Send a textMel will be on a trip to Kenya doing some teaching. Show will reboot in mid March. Lts of great interviews coming up!Support the show

Send a textMel interviews Graham Walk of "MD Calc" fame. This episode explores the evolving role of AI in healthcare, focusing on a study that compares ChatGPT's performance to that of human doctors in managing complex medical cases. We discuss the implications of these findings, the potential for misinformation, and the future of AI integration in clinical practice.• Examination of the BMJ study on AI vs. doctors • Real-world application of AI in patient care • Concerns around AI misdiagnosis and misinformation • Future prospects of AI in healthcare settings • Impacts of AI integration on workforce and private equity • Human-AI collaboration as a path forwardSupport the show

Send a textThis episode unravels the complexities of using Ozempic, a GLP-1 receptor agonist, for weight loss—especially among people without diabetes. Dr. Anne Peters highlights the health implications, individual responses to the drug, and the broader context of weight management.• Examination of Ozempic’s functions and benefits • Discussion on who should consider using Ozempic • Clarifying misconceptions about weight loss and obesity • Insight into the body’s set point and its impact on weight • Risks associated with using medications for non-diabetic individuals • Emphasizing the need for a multifaceted approach to health • Historical context of obesity and diabetes in society • Conclusion on prioritizing health over aesthetic standardsSupport the show

Send a textMel Interviews Sam Ko for an enlightening episode where we explore the extraordinary journey of an ER doctor who switched gears from the chaotic world of emergency medicine to the innovative realm of ketamine therapy. Gain insights into how medical podcasts influenced his path, ultimately leading to the first ER doctor-led ketamine clinic in California. This episode promises a deep dive into the transformative impact of ketamine clinics, the challenges of leaving traditional ER careers, and the successful expansion across the nation through online education.Our guest shares the meticulous approach taken in his clinic, which blends medical precision with holistic elements for an optimal therapeutic experience. Hear about the importance of setting intentions, the safety measures during administration, and the unique process of integrating music and aromatherapy. We discuss the nuances of different ketamine administration routes, with a special focus on the benefits of intravenous therapy, offering listeners a comprehensive understanding of this emerging treatment and its emotional breakthroughs.Venturing beyond ketamine, we tackle broader topics such as the necessity of personal experience in psychedelic therapy and the historical and legal landscapes that shape it. Delve into the psychological underpinnings that draw some to high-adrenaline careers like emergency medicine, with reflections on how childhood trauma might influence such career paths. This episode is packed with compelling narratives and expert knowledge, offering a fresh perspective on the evolving world of mental health treatment.Support the show

Send a textMel interviews Karina Sergi, MS, MFT Director, Psychedelic Therapy Training; Director, Diversity, Equity & Inclusion and  Keith Heinzerling, MD Director, Treatment & Research In Psychedelics (TRIP) Center; Addiction Medicine.We discuss psychedelic associated therapy, ketamine, DMT, Psilocybin,  Hallucinogen persisting perception disorder (HPPD, Ontological shock, Psychnaughts and so much more as we continue our series on mental health treatment optionsThe Treatment and Research in Psychedelics clinic (TRIP) located at Pacific Neuroscience Institute. Their website: https://www.pacificneuroscienceinstitute.org/treatment-research-in-psychedelics/Support the show

Send a textMel interviews and is himself interviewed by Sandy Newes, PhD who co-founded the Living Medicine Institute, an online community offering content and training for clinical and medical professionals interested in the legal use of ketamine to address mental health issues. She can be found on LinkedIn here.Together they discuss Ketamine for depression and PTSD, dosing, Mels personal experience and how to get trained to safely and ethically provide and use this type of treatment. There is discussion of mental health diseases and suicidality so please be aware of this particular content.Support the show

Send a textMel interviews the author's of the GPT Vs. Residents NEJM study. How did they do it, why did they do the study and what does it all mean for the future of medical education.  Support the show

Send a textMel interviews ER doc and AI expert Justin Schrager whose company vital.io makes patient facing AI for Emergency medicine and inpatient departments. We talk models, hallucinations, the singularity and more. Support the show

Send a textMel Herbert, MD, and the creators of EM:RAP, UCMAX, CorePendium, and many of the most influential medical education series present a new free podcast: “Dirty White Coat.” Join us twice a month as we dive into all things medicine—from AI to venture capital, long COVID to ketamine, RFK Jr. to Ozempic, and so much more. Created by doctors for clinicians of all levels and anyone interested in medicine, this show delivers expert insights, engaging discussions, and the humor we all desperately need more of!Support the show