Advertise on podcast: EMplify by EB Medicine

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the Januray 2026 Emergency Medicine Practice article, Emergency Department Diagnosis and Management of Patients With Syphilis Syphilis cases have surged 42% in the US, making it critical for emergency physicians to recognize and treat this "great masquerader." In this episode, hosts Sam Ashoo and Dr. T.R. Eckler break down the January 2026 Emergency Medicine Practice article on syphilis diagnosis and management. They cover the rising prevalence in high-risk populations, the four clinical stages (primary, secondary, latent, and tertiary), special presentations like neurosyphilis and congenital syphilis, and practical diagnostic approaches. With a national penicillin shortage, they discuss alternative treatment options including doxycycline and post-exposure prophylaxis. The conversation also addresses the dark history of the Tuskegee Study and its lasting impact on medical ethics. Whether you're seeing more cases in your ED or want to sharpen your diagnostic skills, this episode provides actionable insights for frontline providers. Timestamps[0:00] Opening/Introduction [0:11] Host Welcome & Resources [0:50] Episode Introduction [1:30] Epidemiology & Rising Cases [4:30] Risk Factors & Screening [6:30] Pathophysiology & Transmission [9:30] Primary Syphilis [12:30] Secondary Syphilis [15:30] Tertiary & Latent Syphilis [18:30] Neurosyphilis [22:30] Congenital Syphilis [25:30] Ocular & Otic Syphilis [28:30] Differential Diagnosis & Pre-hospital Care [31:30] History & Physical Examination [34:30] Diagnostic Testing Overview [38:30] Testing Details & Titers [41:30] Treatment: Penicillin & Alternatives [43:30] Closing Subscribers, take the CME test here.Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the December 2025 Emergency Medicine Practice article, Diagnosis and Management of Cannabis-Related Emergencies Episode Outline: [0:00] IntroductionWelcome and show overview by Sam AshooMention of resources at ebmedicine.net[0:46] Episode StartHosts introduce themselves: Sam Ashoo and Dr. T.R. EcklerDr. Eckler’s background and experience with cannabis cases in Colorado[1:16] Topic IntroductionFocus on diagnosis and management of cannabis-related emergenciesPrevalence and importance in emergency medicine[1:34] Legal LandscapeOverview of cannabis legality across statesMedicinal vs. non-medicinal use[3:03] Increase in ED VisitsStatistics: ~1 million cannabis-related ED visits annuallyDemographics: younger population most affected[3:52] Synthetics and ChallengesDiscussion of synthetic cannabinoids and their risksIssues with detection and legality[4:50] Clinical SpectrumRange of presentations: from nausea/vomiting to psychosis and seizuresImpact on different age groups[6:34] FDA-Approved UsesCannabis-derived products approved for specific medical conditions[7:20] Physiology and PathophysiologyCannabinoid receptors (CB1 and CB2) and their effectsDifferences between plant-derived and synthetic cannabinoids[9:10] Chronic Use and WithdrawalDownregulation of receptors, withdrawal symptoms, and persistent nausea[10:20] Product Forms and Delivery MethodsSmoking, edibles, oils, tinctures, suppositories, topicals, etc.Risks associated with concentrated forms (e.g., wax, oils)[12:00] Clinical Effects by SystemPsychiatric: anxiety, psychosis, paranoiaCardiovascular: tachycardia, MI risk, QT prolongationPulmonary, renal, metabolic, dental, and ocular effects[13:50] Cannabinoid Hyperemesis Syndrome (CHS)Phases: prodrome, hyperemesis, recoveryHot showers as a diagnostic clue[16:00] Withdrawal SyndromeSymptoms and timelineExacerbation with synthetic cannabinoids[18:15] Counseling and ManagementImportance of cessation and patient educationTimeline for symptom improvement[18:42] Differential DiagnosisBroad differential for persistent nausea/vomiting and abdominal painImportance of considering other causes[20:55] Diagnostics and TestingLimitations of drug screens (false positives/negatives)Importance of EKG, labs, and imaging as indicated[23:10] Treatment ApproachesFirst-line: benzodiazepines, antiemetics (ondansetron, metoclopramide)Second-line: butyrophenones (haloperidol, droperidol), olanzapineCapsaicin as adjunct therapy[29:50] Complications and Special ConsiderationsRisks of undertreatment (e.g., Boerhaave syndrome, aspiration)Pediatric and pregnant populations: unique risks and reporting requirements[36:00] Five Practice-Changing TakeawaysElicit cannabis use historyKnow testing limitationsConsider ECG and appropriate labsUse butyrophenones when indicatedAdmit if symptoms are refractory[39:00] Conclusion Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and Tim Horeczko, MD discuss the November 2025 Pediatric Emergency Medicine Practice article, Emergency Department Management of Measles, Mumps, Rubella, and Varicella in Pediatric Patients 00:00 Introduction to Emergency Medicine 00:21 Welcome and Holiday Greetings 01:16 Special Guest Introduction 01:41 Discussion on Pediatric Emergency Medicine 04:55 Epidemiology of Measles 08:16 Challenges in Diagnosing Measles 14:27 Mumps: Symptoms and Complications 27:36 Rubella: Risks and Symptoms 29:28 Varicella: Symptoms and Precautions 33:12 Differential Diagnosis and Conclusion 35:14 Using Inductive Reasoning in Medical Diagnosis 35:40 Recognizing Purpuric Rash and Its Implications 36:22 Guidance for EMS Colleagues on Handling Fever and Rash 37:14 Importance of Communication and Relationships with EMS 39:12 Decontamination and PPE Protocols for EMS 42:34 Detailed Patient Assessment in the ED 46:06 Diagnostic Testing and Clinical Diagnosis 49:20 Reporting Responsibilities and Treatment Protocols 01:01:19 Addressing Vaccine Controversies and Public Trust 01:06:25 Conclusion and Additional Resources Check out Dr Horeczko's podcast - Pediatric Emergency Playbook Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the November 2025 Emergency Medicine Practice article, Diagnosis and Management of Emergency Department Patients With Alcohol Withdrawal Syndrome Epidemiology & Background Rising ED visits related to alcohol use. Mortality rates and spectrum of patient presentations. Importance of high suspicion and complexity of cases.Pathophysiology & Mechanisms Alcohol metabolism and neurochemical changes. Differential diagnosis: Conditions that mimic alcohol withdrawal.Prehospital & EMS Considerations Role of EMS in triage and initial management. Use of sobering centers vs. ED transport. Prehospital administration of benzodiazepines (IM midazolam).History & Risk Assessment Key questions to assess risk for alcohol withdrawal syndrome. Importance of patient history, medication use, and comorbidities. Discussion on patient honesty and rapport.Physical Exam & Scoring Systems DSM-5 criteria for alcohol withdrawal. Use of CIWA-AR, BAWS, and PAWSS scoring systems. Importance of objective measurement for monitoring and disposition.Complications & Special PresentationsComplicated alcohol withdrawal: Hallucinosis, seizures, delirium tremens. Diagnostic workup: Labs, imaging, and co-ingestions. Special populations: End-stage liver disease, pregnancy, intubated patients.Treatment Strategies Mainstay: Benzodiazepines (types, dosing, and protocols). Phenobarbital: Indications, dosing, and evidence. Adjunctive therapies: Thiamine, glucose, magnesium. Alternative/adjunct medications: Gabapentin, ketamine, dexmedetomidine, baclofen.Clinical Pearls & Practice Changes Early, aggressive therapy to prevent complications. Symptom-based vs. fixed-schedule treatment. Gabapentin as an alternative or adjunct. Anti-craving medications for relapse prevention.Disposition & Protocols Use of scoring systems for safe discharge, observation, or admission. Importance of protocolized approaches and community resources.Summary & Take-Home Points Five key practice-changing points. Clinical pathway. Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and Lara Zibners, MD discuss the August 2025 Pediatric Emergency Medicine Practice article, Diphtheria, Pertussis, and Tetanus: An Update of Evidence-Based Management of Pediatric Patients in the Emergency Department Introduction and guest backgroundHost welcome, show contextDr. Lara Zibners’ credentialsEB Medicine involvementPersonal stories and clinical experienceMemorable tetanus and pertussis casesVaccine advocacyRare disease encountersDiphtheria: overview, presentation, treatmentToxigenic vs. non-toxigenic, “bull neck”Cardiac, neurologic complicationsAntitoxin, antibiotics, public healthPertussis: symptoms, vaccine, treatment“100-day cough,” apnea in infantsWaning immunity, boostersAzithromycin, treat contactsTetanus: risk, presentation, managementClostridium ubiquity, no outbreaksMuscle spasms, autonomic instabilityAirway, sedation, antibioticsKey ED takeaways and pearlsEarly suspicion, isolationICU admission for severe casesVaccination, reportingResources and article summaryAppendix, clinical pathwayebmedicine.net referenceCME, further readingGuest’s podcast plug and closing remarks“Unstable Vitals” podcastWhere to listenThank you, sign-off Check out Dr Zibner's podcast Unstable Vitals Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the October 2025 Emergency Medicine Practice article, Emergency Department Evaluation and Management of Patients With Adrenal Insufficiency Introduction Welcome and host introductionsBrief overview of the episode’s topicResources and CME reminderArticle Overview Source: Emergency Medicine Practice, October 2025Authors: The SimcoesImportance of evidence-based reviewClinical Context & Epidemiology Frequency and rarity of adrenal insufficiencyDiagnostic challenges and statisticsImportance of recognizing adrenal crisisPathophysiology Primary, secondary, and tertiary adrenal insufficiencyCauses and mechanismsKey anatomical and physiological conceptsDifferential Diagnosis Overlap with other diseases (infections, autoimmune, endocrine, psychiatric, cardiac, GI, etc.)Importance of considering adrenal crisis in complex casesPrehospital Care EMS recognition and limitationsImportance of medication history and emergency kitsLegal and logistical barriers to prehospital hydrocortisoneEmergency Department Evaluation Recognizing symptoms and prioritizing careRole of EMR and clinical decision supportKey history and risk factors (medications, steroid use, opioid use, comorbidities)Physical Examination Specific and nonspecific findingsCushingoid features vs. primary adrenal insufficiency signsDiagnostic Workup Laboratory studies (cortisol, ACTH, renin, aldosterone, TSH, etc.)Imaging considerationsGold standard tests and their limitations in the EDTreatment Immediate administration of hydrocortisoneDosing for adults and pediatricsSupportive care (fluids, glucose, treating underlying cause)Sick day dosing and home managementSpecial Populations Pregnancy considerationsSeptic shock and adrenal crisisCommon Pitfalls & Takeaways Delaying steroids for labs/diagnosisImportance of high suspicion and early treatmentKey trivia and learning pointsClosingSummary and final thoughts Reminders for further reading and CMEFarewell and next episode teaser Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD interviews Evan Dvorin, MD about the dangers of short term steroid use. Background & Regional Differences Dr. Dvorin’s clinical journey from New England to New Orleans. Noticing increased use of corticosteroids for common conditions in the Southeast. Discussion of how steroid prescribing practices vary by region and setting.Inappropriate Steroid Use Common conditions where steroids are often inappropriately prescribed (sinus infections, bronchitis, sciatica, rashes, plantar fasciitis, etc.). Trends showing increased steroid prescribing over time. Similar patterns observed in emergency, urgent care, and primary care settings.Risks and Side Effects of Short-Term Steroid Use Short-term steroids can cause significant side effects: infection, sepsis, bone fractures, thromboembolism, psychiatric effects, hyperglycemia. Dose-response relationship: higher doses and repeated use increase risks. Some side effects (e.g., bone loss) may persist beyond two months.Patient Communication & Shared Decision-Making Importance of discussing risks with patients, tailored to individual risk factors (e.g., diabetes, psychiatric history, age). Strategies for educating patients and managing expectations. The role of patient education videos and resources.Impact of Provider Education & Quality Metrics Ochsner Health’s initiatives to reduce inappropriate steroid use. Use of CME, quality dashboards, and feedback to clinicians. Evidence that education and reporting can reduce unnecessary prescriptions.Special Populations & Scenarios Considerations for pediatric patients and repeated dosing. Challenges when specialists recommend steroids for certain conditions (e.g., sciatica, neurosurgery cases). The need for evidence-based practice and inter-provider communication.Medical-Legal Considerations Lawsuits related to steroid side effects (e.g., fat atrophy, infection). Importance of documentation and informed consent.Alternatives & Symptom Management Focusing on treating the patient’s most bothersome symptoms. Non-steroid options and the value of patient education about illness duration and expectations.Resources Mention of Dr. Dvorin’s educational video on corticosteroid side effects (available on YouTube). Reminder of EB Medicine’s journals and resources for further learning.Conclusion Key takeaway: “Do no harm” and practice evidence-based medicine. Encouragement for clinicians to review their prescribing habits and educate patients. Ochsner "Side effects from corticosteroids" Video: https://www.youtube.com/watch?v=PdMJ9HYxkck

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Status Epilepticus   Topic Introduction Focus: Status Epilepticus in AdultsReference to recent pediatric episodeArticle authors: Dr. Marquez, Dr. Kaur, Dr. LayWhy Status Epilepticus Matters Teaching value and clinical challengeTeam-based care and multidisciplinary involvementGuidelines and Evidence Review of major guidelines (International League Against Epilepsy, Neurocritical Care Society, American Epilepsy Society)Key trials: EcLiPSE, ConSEPT, ESETTUpdated definition of status epilepticusClassification and Diagnosis Convulsive vs. non-convulsive statusImportance of repeated neurologic examsDiagnostic challenges and mimics (e.g., syncope, psychogenic seizures)Etiology and Workup Acute vs. non-acute causesCommon triggers: medication noncompliance, metabolic issues, infections, traumaImportance of sleep patterns and ammonia levelsThe NORSE acronym (new onset refractory status epilepticus)Prehospital and ED Management Airway, breathing, circulation prioritiesEarly pharmacologic intervention (IM midazolam preferred in prehospital)Gathering history and medication informationPositioning and airway protectionDiagnostics Laboratory workup: glucose, CBC, metabolic panel, drug levels, pregnancy testImaging: non-contrast CT, MRI, ultrasound, lumbar punctureEEG: spot vs. continuous monitoringTreatment Approach First-line: Benzodiazepines (lorazepam, midazolam)Second-line: Levetiracetam, valproate, fosphenytoin, phenobarbital, lacosamideThird-line: Continuous infusions (midazolam, propofol, pentobarbital, thiopental, ketamine)Dosing pearls and importance of rapid escalationSpecial Populations Pregnancy (eclampsia: magnesium as first-line)Substance-induced status epilepticus (e.g., isoniazid toxicity and pyridoxine)Brief mention of pediatric management and the PD stat appRisk Management Pitfalls Non-convulsive status is common and easily missedImportance of weight-based dosingNeed for formal EEG in ambiguous casesDon’t assume non-adherence is the only cause in known epilepticsAlways consider higher level of care for status patientsClinical Pathway Stepwise approach to medication and escalationEmphasis on having a pathway/checklist for these high-stress casesConclusion Recap of key pointsThanks to authors and listenersReminder to visit ebmedicine.net for CME and resources Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD interviews Ali Chaudhary, MD about the benefits of working Locum Tenens in Emergency Medicine. 00:00 Introduction and Welcome 00:54 Meet Dr. Ali Chaudhary 01:41 The State of Emergency Medicine 03:29 Understanding Locum Tenens 05:45 Financial Benefits of Locum Work 08:40 Balancing Family Life with Locum Work 12:54 Locum Work Logistics and Misconceptions 17:34 Maximizing Travel Perks as a Contractor 18:07 Adjusting to New Hospitals and EMRs 19:32 The Hassles of Credentialing 20:48 Navigating Locum Staffing Companies 22:27 Understanding Your Worth and Negotiation 25:14 The Importance of Organization 27:41 About Our Locum Staffing Company 29:59 Practical Tips for Malpractice Insurance 31:09 Final Thoughts and Contact Information For more about Dr. Ali Chaudhary: https://thelocums.com/

In this episode, Sam Ashoo, MD interviews Lauren Black, MD about the August 2025 Emergency Medicine Practice article, Updates and Controversies in the Early Management of Sepsis and Septic Shock 00:00 Introduction and Welcome 01:09 Meet Dr. Lauren Page Black: Sepsis Expert 01:56 Sepsis Statistics and Impact 04:16 Understanding Sepsis Definitions 09:56 Screening Tools for Sepsis 13:57 Pre-Hospital Sepsis Recognition 19:33 Clinical Examination and Diagnostics 24:03 The Role of Lactate and Procalcitonin 27:40 Clinical Gestalt and Imaging in Diagnosis 29:21 CMS Bundle Requirements and Updates 34:02 Fluid Type Preferences in Sepsis 36:49 Antibiotic Timing and Selection 43:43 Vasopressors and Steroids in Sepsis Management 50:18 Special Populations and Future Directions 53:44 Conclusion and Resources Emergency Medicine Residents, get your free subscription by writing [email protected] 

In this episode, Sam Ashoo, MD interviews Christina Shenvi, MD, PhD, MBA about ways to manage your day and keep distraction at bay. Introduction to Dr. Christina ShenviWhy Focus and Time Management MatterExperiences coaching medical students and professionalsThe importance of managing mind, time, and attentionApplicability to both career and personal lifeFramework for FocusThree-step framework: Prioritize, Strategize, FocusExplanation of prioritizationMapping personal and professional activities to prioritiesDeep Work vs. Shallow WorkDefining deep work and shallow workStrategies for categorizing and scheduling tasksTime-blocking and protecting focus timeOvercoming DistractionThe psychology of distraction and procrastinationThe impact of digital devices and social media on attentionThe variable reward system of social media and its addictive natureStrategies to Improve FocusClearing mental, physical, and digital environmentsThe importance of a distraction-free workspaceSystems for capturing and organizing tasksThe Pomodoro method and using time pressureBuilding a Personal SystemExperimenting with different task management toolsAdapting systems to personal needs and preferencesDaily Practice and Training FocusReviewing and updating task lists dailyChunking email and shallow work to specific timesTraining the brain to focus like a muscleSpecial considerations for people with ADHDResources and ContactDr. Shenvi’s website and online course (timeforyourlife.org)Invitation to connect for coaching or further learning For more about Christina Shenvi : https://timeforyourlife.org/

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the July 2025 Emergency Medicine Practice article, Emergency Department Management of Status Epilepticus in Pediatric Patients IntroductionWelcome and brief overview of the episodePromotion of EB Medicine’s $1 for 7-day trial offerWhy Pediatric Status Epilepticus MattersSeizures make up ~1% of ED visits and ~3% of EMS callsHigh-risk and high-stakes condition requiring rapid actionStatus epilepticus now defined as ≥5 minutes of seizure activityILAE’s T1 and T2 timelines help define when to treat and when damage beginsCommon CausesTop contributors:Fever/infectionStructural CNS abnormalitiesToxic ingestionsGenetic/metabolic disordersAdditional factors by age:Infants: febrile seizures, chromosomal issues, traumaSchool-age: autoimmune disordersAdolescents: eclampsia, hypertension, functional disordersAlways consider non-accidental traumaPrehospital CareIM midazolam is effective and recommended (RAMPART trial)Other options: intranasal, rectal, or IV benzodiazepinesEarly benzodiazepine administration improves outcomesImportance of airway support, glucose check, and EMS flexibilityParent-administered home meds (e.g. rectal diazepam) can be helpfulED Evaluation and Initial ManagementPrioritize ABCs: Airway, Breathing, Circulation, ConsciousnessUse end-tidal CO₂ to monitor ventilation if availablePoint-of-care glucose is essentialLabs: CMP, Mg, Phos, lactate, drug levels, pregnancy test (when indicated)Imaging: Head CT if concern for trauma, shunt malfunction, or focal signsCase examples highlight pitfalls and diagnostic delaysFirst-Line TreatmentBenzodiazepines remain the cornerstoneLorazepam preferred IV agent (0.1 mg/kg)Midazolam preferred if no IV access (IN, IM, or IO)Diazepam is also effective, especially rectallyBe mindful of respiratory depression and the need for airway controlSecond- and Third-Line TherapiesBased on ESETT trial:Levetiracetam, fosphenytoin, and valproate have similar efficacyLevetiracetam favored for safety and ease of useFosphenytoin may be avoided in trauma or toxicityValproate not recommended in mitochondrial diseasePhenobarbital reserved for refractory cases onlyRefractory Status EpilepticusDefinition: persistent seizures despite first- and second-line agentsRequires sedation and likely intubationInfusion options:Midazolam (preferred for flexibility)Propofol (short-term use only due to risk of infusion syndrome)Pentobarbital (rare, ICU-level care)Need for continuous EEG to assess seizure activitySpecial ScenariosNeonates:Watch for subtle signs (lip smacking, bicycling, tongue thrusting)Broad differential includes asphyxia, infection, metabolic errorsFebrile Status Epilepticus:Higher risk of CNS infections, especially if unvaccinatedConsider lumbar puncture if indicatedElectrolyte/Metabolic Triggers:Treat hypoglycemia, hyponatremia, and hypocalcemia directlyUse 3% saline or dextrose as appropriateDisposition and Discharge ConsiderationsMany children will require ICU-level careSome known epilepsy patients may go home if back to baselineEnsure rescue medications are up to date (rectal/intranasal benzos)Consider “clonazepam bridge” for short-term seizure preventionCollaborate with neurology for medication adjustment and follow-upFinal ThoughtsKeep treatment tables and dosing references accessibleEarly, aggressive treatment can prevent long-term harmEpisode closes with gratitude to article authors and a reminder to visit EBMedicine.netEmergency Medicine Residents, get your free subscription by writing [email protected]

Special Offer - EB Medicine is 26 years old! Get 26% off all purchases at ebmedicine.net! In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the June 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Thyroid Emergencies Introduction to Thyroid EmergenciesUnderstanding Decompensated HypothyroidismThyroid Storm: The Other ExtremeDifferential Diagnosis and ComplicationsMedication Triggers and Patient HistoryPhysical Examination FindingsLaboratory Analysis Scoring Systems and Risk AssessmentIntroduction to Treatment ApproachesManaging Decompensated HypothyroidismTreating Thyroid StormSpecial Considerations and PopulationsRisk Management Pitfalls Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the May 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Complications of Chronic Neurologic Disease: Parkinson Disease, Myasthenia Gravis, and Multiple Sclerosis   Parkinson's DiseaseImportance of maintaining medication schedule for Parkinson's patients Strategies for ensuring patients receive their medications promptly Overview of Carbidopa Levodopa's mechanism of actionMyasthenia GravisDescription of the disease mechanism Importance of assessing respiratory function Diagnostic alternatives like the negative inspiratory force test and counting test Discussion on appropriate emergency department actions and treatments including steroids, plasmapheresis, and IVIGMultiple SclerosisDescription of the disease mechanism Description of the typical patient demographic Discussion on the varied presentation of MS Treatment strategies including high-dose steroids and Baclofen Emergency Medicine Residents, get your free subscription by writing [email protected] 

In this episode, Sam Ashoo, MD interviews Rob Orman, MD about ways to manage the trauma inflicted by the ER. Discussing Trauma in Emergency MedicinePersonal Experiences with TraumaThe Impact of SuppressionDefining Trauma and Its EffectsIntegration vs. DisintegrationDebriefing and Coping MechanismsThe Driveway DebriefNurse and Physician DynamicsReflective Solitude vs. IsolationCreating Narratives During TraumaDropping Anchor TechniqueBody-Oriented ResetsPost-Incident RitualsAddressing Lowercase t TraumasTherapy and Trauma Pathways For more about Rob Orman and physician coaching: https://roborman.com/