Jason Hine: Hello. Hello everybody. Welcome back. Welcome back to the Sim Kit podcast today, and our podcast topic Right now I’m calling it The Good Vice, the Good Vice podcast, where we’ll be talking about kind of the positive ideas or maybe the effects that vices, things that are generally obviously thought of as negative can have in someone’s life.

And kinda looking at that balance between indulgence and health and I, I guess you’d even say like [00:01:00] resiliency, certainly if you’re thinking about a emergency medicine professional trying to get through a long career. So, so, you know, whenever I start to think about the balance of work in life, considering the pros and cons, the benefits and drawbacks that happen, there’s one person who particularly comes to mind for me, who has been particularly influential for me.

And that individual is the person you see on the screen opposite here with me today. This is Dr. Rob Orman. He has been influential in so many spaces, uh, as a medical educator, learning from him in that way, and then now as a coach, working with physicians, finding, meaning, resiliency, purpose in the careers that they have.

And so Rob, you’re a perfect person. You have helped countless people in this space, in generality. Obviously, I’m not saying specifically talking about good vices, [00:02:00] but you have been a former guest on the podcast. You’re a well-known vo voice to many, and so I decided to have you come back to sort of pick your brain, get your thoughts, and kind of have a conversation about this idea of the balance between indulgence, reward, and the potential idea of a good vice.

So Rob, thank you so much for joining us today.

Rob Orman, MD: I, oh, Jay, it’s always a treat to get to chat with you, whether on the pod or informally, and is a topic that I can say I have never discussed or heard discussed on a podcast that I’m just, I’m stoked. I’m stoked to dig in. I’m curious to see where we’re going here.

Jason Hine: Yeah, I like having, you know, sometimes we have a pretty well cut. This is, we’re gonna talk about positive pressure ventilation and you know, when you adjust things or other topic matter, you know, we talked about burnout, brass tacks, and work-life balance. Those are pretty regimented. This is [00:03:00] more conversational.

So I too am excited to see, you know, the track as we build it and where the conversation goes, but.

Rob Orman, MD: I love that. That’s, that’s how our train’s going. We’re building the track as we go. Take it away, baby.

Jason Hine: Let’s do it. Right. And so the idea, you know, the idea for this podcast came from just a general recognition and notion that many of us, and I guess the US here, emergency medicine, but I’m, I’m obviously coming with my emergency medicine hat on, and I know you work with clinicians in high stakes, high functioning professionals in a lot of space, but we work in a high stress, high acuity, high performance space, or we have that type of job.

And within that, you know, there’s this sense I feel anyway, and I’m sure this is a universal. There’s a sense of relief almost of survivorship when you get through a crazy busy shift like I am alive. My time has come to end. You know, the, the old all bleeding [00:04:00] stops. My shift will eventually end. I will sign out and I get to go home.

Um, which is nice. And within that, sometimes I feel the need to reward myself to unwind, uh, in some capacity when that end comes. So I’m sure I’m not alone in this area, that there’s oftentimes this maybe celebratory ritual or as I said, reward that comes with a degree of an indulgence, right? For us. And I recently kind of, you know, I asked myself an important question of, is this a bad thing?

Is my celebratory ritual or my indulgence, is it a bad thing for me as a human being, as a professional? Am I affecting my bo my body? In a negative way. So from that, there’s some science about self reward treats, indulgences, and vices and so, Rob, I, you know, I, I dove into that and I’m [00:05:00] curious, you wanna hear what I found?

Rob Orman, MD: Oh, I, only that, I have so many questions for you about the stuff you’re talking about. I wanna know, what is this indulgence that you have in your mo? What is this thing that has triggered this podcast? Yes. First science and then the reveal.

Jason Hine: Sure, sure. I will, I will, I will give you my reveal of my indulgence at the end. So, um, you know, looking into the idea when I was like, man, are these things that we’re doing or that I’m doing, is it good or bad for me? This is really gonna be psychology data, right? That seems to be where most of this.

Information lives in the sphere of psychology. And you know, this data in it suggests that people who do allow themselves small indulgences, and, you know, the definition of that is where we’re gonna kind of get into our, into the weeds here. But they give themselves these small indulgences, they’re gonna cope better with stress.

Um, and they’re gonna be able to pursue these, you know, [00:06:00] long-term goals better than people who are really rigid and kind of uncompromising with themselves, if that makes sense. Right? So, you know, examples here, there’s a weight loss goal and you may just be a hard hitter. I’m not gonna, you know, get anything sweet.

Or you might be someone who, okay, I’m on track, you know, seven, six of the seven days. I’m doing fantastic. I wanna have a very small indulgence on Sunday with a cookie, you know, as an example. So people that actually allow that small, I don’t know if you the right term, is cheat day or cheat activity. The reward.

Rob Orman, MD: on that. I, I don’t like that term. I just, I realize I never even thought about

Jason Hine: Yeah,

Rob Orman, MD: because

Jason Hine: yeah,

Rob Orman, MD: shame that’s associated with it with, oh, it’s a cheat day. It’s kind of, you know what it is, baby. It’s a bonus day.

Jason Hine: yeah.

Rob Orman, MD: I.

Jason Hine: A reward day, right?

Rob Orman, MD: we’re changing nomenclature right now. It’s, uh, there’s no cheat, there’s no shame. Oh, enjoy.

Jason Hine: If you earn it, right. Yeah. That’s [00:07:00] the idea. And then that’s that back and forth that comes with that. But yeah, when you have achieved certain degrees of milestones, you give yourself a reward rather than you’re cheating or you’re indulging those again, I agree. That negative connotation. But, so yeah, the, the psychology literature suggests those people are actually going to achieve their end goal more readily or more, you know, a higher percentage of the time, which is great.

Rob Orman, MD: That brings to mind for me some of the literature on perfectionism that perfectionists are less likely complete their goals. Or even start projects than people who have more self-compassion or kind self-talk, because the perfectionist is much more rigid the person who says, Hey, you know what?

I’m not perfect, but it’s okay. Let’s just roll with the punches and keep going.

Jason Hine: Yeah, I, I could see that as true. And I think, you know, we’ve talked in the [00:08:00] past about. I could see a perfectionist man, you, as we, we talked about sim kit and starting in, in all the barriers and hurdles, like diving in and then seeing if there’s water. That’s an approach that is sometimes necessary. Um, but a perfectionist may not be able to start a project like that without all of the unknowns being known.

And that becomes a challenge in ever being able to begin right in its own way.

Rob Orman, MD: Yeah. Yeah. It’s, I I think it goes back to that term you used before of rigidity. When, speaking to this audience, when does that serve you? Now there’s definitely, I’m going to follow a protocol or a pathway, but inherent to any mastery is flexibility. And I think that because if you’re rigid, rigid and you can’t adapt any, anything that you’re gonna face, say in emergency medicine, is gonna have some variable to it. I know we’re, [00:09:00] we’re talking about talking about vices, but I think that this is all connected to loosening up a little bit and surfing with the wave rather than trying to the wave and break it.

Jason Hine: Yeah, sure. I like that. I like that analogy. And like, you’re not gonna control the nature of that. You can’t control the nature of your work environment, those things that, that rigidity you. You can’t win. You’re, you’re going against forces, uh, you know, it’s certainly an emergency medicine and in many high performance professions where you’re just fighting against a force much greater than yourself.

Rob Orman, MD: All right. Back,

Jason Hine: Yeah.

Rob Orman, MD: back to the back to the science my friend.

Jason Hine: Yeah, the science is psychology, science, so, um, you know, other areas I think we were just kind of talking about where this can come to the fore, that indulgence of cookie, we’re gonna get away with indulgence. We’re gonna give that reward of cookie as we reach our, you know, our weight loss targets, our exercise targets, whatever it be.

Um, you know, you continue in another project or path and [00:10:00] you indulge or you give yourself a purchase toward a hobby, uh, that, you know, it’s a item that’s more expensive than you might normally, typically buy. But you know, you, I’ve completed x, y, or Z elements of this really dogged task and I’m gonna buy that wonderful driver.

I’m not a golfer that, that, that wonderful driver that I’ve been eyeing for six months, you know, as examples. And so that generally comes to the idea that people who allow themselves. To have these nuggets of joy. They actually have collectively better emotional regulation. They’re more likely to stop that maybe binge behavior that led to the excessive, you know, weight gain or things along those lines.

And very importantly in emergency medicine, they’re less likely to burn out in their career. So the permission of joy for yourself is a, I think, a really important takeaway and language I don’t typically think about, [00:11:00] uh, in this space, but it, it’s supported in the psychology literature. Hmm.

Rob Orman, MD: Yeah. What we do focus on so much. What is the thing that drags you down? What is the thing you drag you down and then how do you correct for that? Versus what is it that brings you joy in your job and how do you double down on that? And for some it’s, I have many friends who would begin, or who do their shift with like a, a cup of Pete’s coffee or Phil’s coffee.

And it just, it’s a ritual. It gets him in that

Jason Hine: Yeah,

Rob Orman, MD: it’s, it’s a, it’s a pre reward. And some who do a coffee the end of their shift now, not too close to sleep, we don’t wanna condone that the end of the shift of, ah, here it is, here’s my reward. And I just kind of, it just feels good.

I’ve got a little dopamine and serotonin rather than some sort of antagonistic neurotransmitter. My limbic system firing right, different part, different part of the brain. And we, we thrive on [00:12:00] reward.

Jason Hine: we do. Yeah. Yeah, I, that, that’s right down the, the fairway for me. I usually halfway through shift have that, and I’m trying to do, like you said, maybe half decaf, half regular, whatever it be, depending on what time of day it is. Um, if I’m going home to my kids, you know, it’s, it’s a shot of espresso in there too.

Um, just kidding. We don’t have an espresso machine, but halfway through the shift, I, I reward myself for that milestone with an additional, you know, beverage of a, you know, enjoyment, variety, whether it be caffeinated or not. I’m very interested in, and it’s almost a, a conversation for a future podcast ’cause we’re talking about how we reward ourselves end of shift.

But that psychology of coming into shift rewarded with a right mindset is one I’ve never thought about before. So you’re telling me that you have many clients or people that you’re coaching that are giving themselves a reward as they prepare their mind for the busyness of emergency medicine?

Rob Orman, MD: Yeah, I mean, [00:13:00] you’ve got. You operate in such a demanding area, if you don’t pregame, you are leaving a lot of scraps on the table. I mean, athletes, pregame musicians, well, some pregame to get themselves in the right mindset, the right physiology. sometimes that has to do with a reward ritual.

Sometimes it’s just creating a certain mindset, and you have 100% control, hundred percent over your mindset when you enter that ed. You might start off the day on the wrong side of bed, but you can shift it. And sometimes that involves, all right, I know that this is going to be a bit of a trial. How do I account for that? I mean, you and I know that the physiology of one of those shifts is, is just hard. So, you know, I know it’s gonna be hard. Let me, uh, give myself a little bit of a, a, a pre trophy jumping in there.[00:14:00]

Jason Hine: I like that, that like, you know, brings me back to middle school. You get your participation award. We need your participation trophy. Just ’cause you’re in the parking lot of the er.

Rob Orman, MD: You get your park,

Jason Hine: Um,

Rob Orman, MD: trophy I love. As soon as

Jason Hine: yeah,

Rob Orman, MD: deck, you get yourself a little ribbon.

Jason Hine: I made it. I’m physically here. Yeah. Um, I, I liked how you brought up the, the dopamine, um, pathways and how we’re sort of, we’re not tricking our brain, but we’re using our inherent.

You know, neurotransmitters, um, for our benefit, which I think is smart, and that’s what I found in some of this research about the dopaminergic rewards that are associated. Our brain starts to associate these with small anticipated pleasures, right? So these bit of, you know, small to moderate vices can actually increase our motivation, make these difficult routines like a, a Monday shift in the emergency department, make them more sustainable and actually improve our adherence to [00:15:00] things like healthy habits.

So it’s interesting how we can use little bits of what might be thought of as a negative, as a positive collectively.

Rob Orman, MD: Could you imagine associating the start of your workday with a dopaminergic surge, maybe even little serotonin and oxytocin? I mean, like, that’s just so contrary to what we generally envision, how, how that’s gonna play out.

Jason Hine: Yeah. Right. That is the antithesis of what you think about how people are, uh, oftentimes, especially, you know, we’re recording in cold and flu season right now. Many of our, my part, you know, partners in, in, uh, the trenches are in the surge, the thick of it and your drive in is the opposite, uh, of those, those receptors being activated.

And so tricking or using a little bit of a reward on the PO on the front side, I love that idea. Not even one that I really thought, um, about coming into this podcast. So.

Rob Orman, MD: And I’ll honestly tell [00:16:00] you, I hadn’t thought about it either till you said it in this context. And mean, gosh, uh, what, because what is the, what is the term that is so often used for a shift? It is another day in the salt mines, right? I mean, it’s kind of, you are all ready setting a, um, I don’t know. You’re setting the context. be a very unpleasant labor.

Jason Hine: Yes. Yeah, you’re right. And, and even the way you, the way you talk about those types of things and all of that, that’s getting pretty meta, that’s getting high level stuff for me. But I think that those are important things that I, maybe we, we record a, a pre-shift ritual or, uh, conversation for the future.

But

Rob Orman, MD: devices. Let’s, let’s,

Jason Hine: let’s talk about, let’s talk about what’s bad for us and how it might be good for us. Um, so, you know, the psychology data is helpful, informative, but it doesn’t answer the question for me. Here’s your reveal. By the [00:17:00] way. The question for me that came forward was I was sitting after shift and I’m wondering, you know, are the two fingers of whiskey that I have sitting on the couch after a shift, are they helping or harming me?

So there you go. Little bit of alcohol.

Rob Orman, MD: Okay?

Jason Hine: I love whiskey, I like scotch. You know, I’m not putting a forefinger pour. It was that. That’s two ounces. Depends on it depends on your glass size, you know, so, but um, you know, that’s, that was my area of question is rewarding yourself for having that element of a glass of wine, you know, a little bit of whiskey.

Um, those types of things that are commonplace. And, and I’d love to get a little further into the weeds and really start to delineate when that razor’s edge starts getting a little sharp, you know? Nicotine, other substances, all that stuff. But areas, so with coming back to my indulgence, you know, alcohol, a little bit of alcohol to reward oneself after studies are [00:18:00] showing that these, you know, the regular positive emotions, even little ones like, ah, I love to just sit down with my, you know, my little bit of alcohol and, and decompress.

Think about the shift that I had and, and sip on that small quantity. Those little positive emotions help improve our stress hormone regulation and help, I can feel it that sort of amp at, you know, 10 or 11, you can feel your cardiovascular, norepinephrine, and epinephrine response just sort of starting to melt away and, you know, sitting on a couch.

And, and we’ve actually talked in the past how sometimes after late shift you could sit on the couch and try to numb your mind with a movie. And find that four hours later when you, you know, should have gone to bed, you basically turned an evening shift into a night shift. But just getting on the couch, getting outta that environment in and of itself is obviously going to, you know, parasympathetic you to a, to a degree.

But there [00:19:00] seems to be in that psychology literature that that bit of reward is helpful too. That’s further decreasing the high adrenergic tone that comes with working the shift that you do. So it’s gonna improve your sort of calm down rate. It’s gonna get those stress hormones down, get the cardiovascular system down, and there’s actually some data that your emotional resilience might improve with this, which is a huge one.

Yep. This is apparently the, uh, broaden and build effect in positive psychology if people are interested in looking into it more, the broaden and build so. Basically what they’re saying is that this daily, you know, treat, it gives a genuine pleasure response that physiologically can counterbalance the stressors of our work.

And you know, of course stress reduction itself has many downstream health benefits, et cetera, et cetera. So [00:20:00] with all that and the kind of domino effect that comes from it, it seems like these small indulgences have a, you know, if you’re, if you were a scale, it looks like it might weigh in the positive, but I’m curious, Rob, what do you think about that?

I, yeah.

Rob Orman, MD: I have a couple questions for you about your. Is it, it’s two fingers of whiskey that we’re talking about. Okay.

Jason Hine: Two fingers whiskey.

Rob Orman, MD: How, far from the end of your shift, and you can even throw an outlier in here, do you start thinking about those two fingers of whiskey? I,

Jason Hine: Oh, um, no, that’s a great, you know, it’s a. Straight area. Uh, it is not, I’m not very anticipatory.

Rob Orman, MD: okay.

Jason Hine: not like halfway through shift, like, okay, I’ll call. That’s good. Yeah, that’s good.

Rob Orman, MD: about the th the thirst for it, you know, the, all the, all the questions of do you drink it when you wake up? All these things. I just, just kind of, just kinda, oh, yeah, I can, I can see, I can see the off ramp. I can see the, the decompression.

Jason Hine: Yeah. Yeah. I’d say [00:21:00] probably once I’m in my driveway maybe would be the space where that comes up. Yeah.

Rob Orman, MD: And when you think about it, what do you think about?

Jason Hine: Hmm. I, I find that it’s actually very, um, sensory. Like, you know, I have used, um, the little. Not, I don’t like actually using ice. I like using, um, whiskey stones, so like the clink of the, the whiskey stone into the glass and cold, actually cold whiskey being poured in, and then a very cold taste with, obviously whiskey has a bit of a burn to it, so I, I find that to be the most pleasant part of the ritual or experience.

Rob Orman, MD: And it’s, it’s almost like a boundary ritual that you’re using with

Jason Hine: Mm-hmm.

Rob Orman, MD: that, that that century experience and that burn is making a clear demarcation of what just happened. And now my off ramping is it, does that, does that land with [00:22:00] you?

Jason Hine: Yeah, no, that holds true, I’d say. Yep.

Rob Orman, MD: So I, I, I, I, there’s so many ways to, to look at all of this, and when you first mentioned vices a while ago, what popped into my mind was the dose makes the poison. And I think I would add that the intention also determines whether, ah, this is a, a dose of joy or a little dose of joy, or this is something becoming detrimental. And

Jason Hine: Mm-hmm.

Rob Orman, MD: to an interview with Dave Grohl from the Foo Fighters and Nirvana, and

Jason Hine: Absolutely. Love that guy.

Rob Orman, MD: yeah,

Jason Hine: first, first band I ever saw, foo Fighters, red Hot Chili Peppers.

Rob Orman, MD: That guy is so cool. And I.

Jason Hine: Yeah, it’s.

Rob Orman, MD: this was years ago, I don’t know how many years ago, and the interviewer asked him, he says, do you have any guilty pleasures? Any guilty musical pleasures? Any, any, any [00:23:00] musicians as you listen to that would be that. And he said, well, you know what? love listening to Britney Spears and i’s not a guilty pleasure. It’s just a, it’s just a pleasure. There’s no guilty pleasure. Why? Why would I feel guilty about that? Where, where, where would that shame come from? That I’m listening to Britney Spears. It’s just pleasure, pleasures. And, you know, we think, well, what, what would outside viewers think about what I’m doing?

And it’s ashamed. Do I need to hide it? When you look at habit research, adding a little bit of joy the end of a habit you’re trying to form, and BJ Fog, I, I think it’s his name, is the author of Tiny Habits. He calls this The Shine. the shine on the end of the new habit, that you do the reward, and that helps that habit stickier, right?

As, as you were,

Jason Hine: Yeah, sure.

Rob Orman, MD: about that habit, get the thing that you do starts to [00:24:00] get associated with the dopamine. And, you know, and we’ve all got things that we enjoy that we inherently, that we naturally enjoy, that we seek out, that we’d even pay to do. The downside is when it starts to become a detriment.

You were alluding to this, such as, you know, if I’m starting to drink to excess, to grief or pain

Jason Hine: Right.

Rob Orman, MD: or stress, or am I going to, you know, try to eat my emotions and binge eat or watching tv? You know, so let’s talk about that. That’s my advice tv, uh, if you wanna call it a vice. I love, I, I love, love watching a good TV show.

My wife and I watch TV together. I love it. Watching TV can be such a delight until it’s not. I may have talked about this on the show, on, on this show before. I’m not sure. And then I’m not exaggerating when I say this, that I used to watch four to six hours of TV after a late shift. You, you were talking about [00:25:00] that you turn a swing shift into night shift.

So

Jason Hine: Yeah.

Rob Orman, MD: between 11:00 PM and 3:00 AM nobody’s up. There’s no accountability for going to bed. I’d sit down and I would begin veg marathon, and the next thing I knew is just hours had gone by because my brain couldn’t shut down. And the longer I stayed up, I just felt more and more and more scrambled. Most physicians have version of this, or many, let’s say not most many

Jason Hine: Yeah,

Rob Orman, MD: version of this. So it could be tv, it could be alcohol, could be, could be something else that we would think of as a vice. Now lot exercise. Oh, well, is that a vice? Hmm. Dunno.

Jason Hine: to bring that one up. Yeah. That one double edged sword.

Rob Orman, MD: it’s right, it’s a double edged sword.

And so I, I realized I needed a better off ramp

Jason Hine: Mm-hmm.

Rob Orman, MD: you know, so basically what I, I was, [00:26:00] I like tv, but I had this unending stream of digital comfort food you could say.

Jason Hine: Yeah.

Rob Orman, MD: I want, so you’ve been talking about research. I want to, I wanna talk about a little bit of German research for me. So this was 2007 and this was a, um, uh, a workforce study and they looked to see how do people effectively recover from job stress, which is somewhat of, we’re talking about you’re sitting there with your two fingers of whiskey, you’re drinking.

It’s

Jason Hine: Yeah.

Rob Orman, MD: now I’m processing the day I’m slowing things down. I’m dealing with this job. Stress recovery from that on four factors. There’s detachment, which is mentally switching off from work. There is relaxation, so detachment, relaxation, is restorative activity. So just doing some activity you really enjoy.

[00:27:00] And then there’s mastery. That’s kind of a big picture thing, which is having challenging non-work pursuits. You know, I can, I can really get into a flow state in something else. And also, and, and in the big picture there’s autonomy over your free time. But when we’re talking about this moment, this, this

Jason Hine: Mm-hmm.

Rob Orman, MD: work or the moment when the vice would come in, detachment the strongest link to both recovery better mood as you were talking about before.

You know, kind of the resilience and feeling happier. So get back to that digital marathon, to that TV marathon

Jason Hine: Yeah. Yeah.

Rob Orman, MD: were talking about before. So from a clinical standpoint. I was dealing with, or I was experiencing boundary erosion where my physical body left work, but my mind was still there.

You know, it’s still on and it’s still processing that, you know, that boundary erosion that I, I I, I didn’t fully leave [00:28:00] work that prevented or, you know, or, or full detachment, or at least

Jason Hine: Yeah.

Rob Orman, MD: substantive, substantial detachment. And so the, the ability to mentally disengage and the TV watching shifted from something I enjoyed to maladaptive coping, which I think you were getting at before.

Maladaptive a behavior that feels like it helps in the moment. But it really makes things worse. I mean, that it was escape behavior and

Jason Hine: Yeah.

Rob Orman, MD: it did is it allowed me to avoid dealing the fact that I couldn’t wind down. Right. It was just like this cycle that wouldn’t end. I was, I mean, TV’s not you tech like a me technically medicine, but I was self-medicating with the screen trying

Jason Hine: Yeah. Yeah.

Rob Orman, MD: yeah, trying to numb that residual activation instead of addressing it.

And I, I think we’ve talked about the, the driveway debrief, right? This thing that,

Jason Hine: Yep.

Rob Orman, MD: this exercise I’ve got on my [00:29:00] side of how to down regulate, how to detach, how to process. And it was born out of those four to six hours

Jason Hine: that need. Yeah. Yeah.

Rob Orman, MD: Yeah. And, and so when something you enjoy becomes something you use compulsively to regulate your distress, then that becomes problematic use

Jason Hine: Mm-hmm.

Rob Orman, MD: You know, without true detachment, your stress system stays on and the spillover just keeps going. And so it’s like, okay, I, I’m looking for a tool to do it. But then when you, I’m not sure what the term was that you, you used before, but there’s kind of an inflection point when it becomes, oh, this is actually little dose of reward versus this is escapist problematic use.

Jason Hine: Yeah, and I, I, I like that description and that sort of differentiation. And [00:30:00] the line between detachment and escapism is actually pretty blurry, right? You could say, okay, yeah, you get home at 11. You could, you should maybe watch an hour or tv, go to bed at midnight, get up at whatever your time, you know, seven 30, you, that’s normal behavior.

An hour of TV helps you detach, go to bed, and then. Five hours of tv, that’s, that’s escapism. That’s, you know, that becomes clear. But the line between detachment and escapism is, is blurry and interesting for me. And it’s obviously gonna, I also be variable by the person, their home environment and their needs outside of the work that they do.

Rob Orman, MD: I will say that, you know, for the most part, the, there, there’s a problem with escapism, but sometimes it’s okay, so you are gonna work. of hours at this job, and there’s just these little bits of accumulated stress and [00:31:00] sometimes trauma that we want to continually escape from and not face. And I, I, I heard one, uh, ed doc say this recently says, I take all of the stress of the shift and I put it in a dark closet in my soul that is filled with cobwebs and has no light, and I slam the door shut so that it never comes out.

And I hope, I hope that that door doesn’t burst. Like, hey, you know, we kind of need to really process what happens in these days and face it

Jason Hine: Yeah. Yeah.

Rob Orman, MD: towards it and think about, all right, you know, what, what went well this day? What, what even just happened? Because I mean, we’re getting far away from vices, but we are coming at, you know, to, to processing and escapism

Jason Hine: Mm-hmm.

Rob Orman, MD: these memories of the day. back as fragments. They come back as ruminative fragments, not as, oh, here’s kind of this cohesive narrative that happened for the day. It’s kind of this, oh, this, this intrusive fragment. And when you process the day and you know, and, and, and [00:32:00] consider what happened, and look for the lessons learned where I could have been better and what I did well, in whatever way you do it, you’re putting it into a coherent narrative that helps you to process and also even more so integrate what happened in that day. the opposite is where it becomes something that, uh, you know, becomes an intrusive thought or becomes even, you know, at its extreme PTSD versus, oh, I’m integrating those experience into who I am. I actually, weird. I’m integrating those experiences into my psyche. Versus the o the other side of this.

So escape. Sometimes things are so bad, so freaking horrendous or heinous, you need to go watch two movies or just, you know, go drink a beer and play pool. And do you just

Jason Hine: Yeah.

Rob Orman, MD: to sublimate or you [00:33:00] need to, um, give it some fricking time and space. I’m not saying you

Jason Hine: I,

Rob Orman, MD: hammered, but there

Jason Hine: no,

Rob Orman, MD: events.

Where’s I’m,

Jason Hine: where you’re like, I gotta do something different. Yeah.

Rob Orman, MD: that also, like it can only be this reward here also becomes rigidity

Jason Hine: Mm-hmm.

Rob Orman, MD: think, oh, this can only be at this dose with this reward at this time, and if I don’t do it that way, then I’m not doing it right and then it’s

Jason Hine: I’m bad.

Rob Orman, MD: It’s,

Jason Hine: Yep. Yep.

Rob Orman, MD: it also benefits from some flexibility.

Jason Hine: I appreciate that. That’s interesting when you start getting into that space of like, the really, really bad, um, for me, um, I don’t know what the, the physical need comes out where like, I don’t have many shifts where I’m like, I’m gonna get, go home and I’m just gonna run until my legs are burning and my lungs are burning.

Rob Orman, MD: Yeah.

Jason Hine: like there’s like that physical release that happens, whereas opposed to the typical shift I’ve taken from you, that idea of sitting in the garage, [00:34:00] taking all the elements of the day, that bad interaction with a nurse, that mother who didn’t appreciate the caregiving, put it in the balloon, cut the balloon, watch it, float away, enter the house.

And there’s obviously different layers and different rituals that we all can do. Um, but then for me that, you know, that little, that two fingers of whiskey is kind of the, the next phase as I kind of incrementally go back into my regular life. Um, yeah.

Rob Orman, MD: And that, well, I, I wanna ask you about that balloon. When, when we talk about boundary erosion, you ha that is a, a beautiful boundary ritual of. Two, you know, two fingers of whiskey. I’m sitting on my couch, I’m processing the day this is, I was there, I am now here. And you and I both know, is some of your brain still at work?

Of course it is. It’s not perfect. I mean, it, it’d be amazing if it was like walking through some sort of dimensional portal where it would completely squeegee off all the crap from the day. But alas, it’s [00:35:00] not. So the boundary ritual to account for the, the, the very likely boundary erosion, which is what’s happening when you just continually escape, is it’s very hard to outrun that, that boundary.

You know, you really, you just gotta consider how do I create it? So it a vice or is it, Ooh. Oh, this is, this is so, this is so bad. I’m, uh, you know what, this is almost a dad joke. Is it a vice or is it a device?

Jason Hine: That is a dad joke. It is. Yeah. Yeah.

Rob Orman, MD: Dad jokes are actually, are actually just jokes and, and, and of late, they’ve really gotten a lot of social, uh, ostracism. But I think, um, I think that they’re okay.

Jason Hine: Thumbs up on dad jokes. All right. I agree. I do ’em all the time. Yeah,

Rob Orman, MD: Wait,

Jason Hine: all day long.

Rob Orman, MD: tell a dad joke, do you say, was that a dad joke? And then

Jason Hine: No, no. That my kids all know that every joke I make to them is a dad joke, but I almost made one. [00:36:00] ’cause you were talking about integrating and then you’re disintegrating and I’m like, if you do too much disintegration, you’ll just completely erode away. Disintegration.

Rob Orman, MD: And now there are two listeners to the podcast and it’s actually

Jason Hine: Yeah.

Rob Orman, MD: just listening

Jason Hine: Sorry, everybody.

Rob Orman, MD: has left the

Jason Hine: I’m gonna keep telling bad jokes. No.

Rob Orman, MD: So I want, let, I wanna bring up, I wanna bring up a vice question. I wanna get back to this issue of vices. ’cause my wife and I were talking about this be before the pod, and we were thinking, okay, what, what are my, my Rob Orman?

What are my vices? And it’s definitely

Jason Hine: Yeah.

Rob Orman, MD: sometimes will just kind of veg out, kind of, oh gosh, I need to go to sleep. But I’m just kind of, you know, stuck in this TV loop. when I was in residency. And I’m even including when I was on rotations where I was doing every other night calls. So you basically never sleep or leave the hospital throughout the entirety of residency.

Four years. I did not have one sip caffeine,[00:37:00]

Jason Hine: Wow,

Rob Orman, MD: a single sip, because I thought it was a vice and that if I had caffeine, I was lesser as like, I don’t need

Jason Hine: interesting.

Rob Orman, MD: That is a vice. That’s not good for me. Well, now I know the opposite. I don’t, I don’t drink coffee. I don’t drink caffeinated tea. I don’t drink any caffeine. And now. love green tea. My son and I just went to Japan. We went to UJI where matcha was invented. We were watching matcha be made. We had it. It is just wonderful. I love it. I love the effect of caffeine. I love drinking it as a treat, you know, cup, cup maybe cup two a day. And I think about that rigidity that view of that, that inner dialogue of a little bit of self-judgment and shame over this thing that I had put up.

I guess, I don’t [00:38:00] know if it was put up on a pedestal, but I had put a certain light on it that if I do that thing, which isn’t gonna freaking harm me, probably gonna help me.

Jason Hine: Yeah,

Rob Orman, MD: somehow I am, I am either cheating as we were talking about before, or I’ve, I’ve, I’ve lost something. I’ve, I’ve lost some, some battle.

So I’m curious your thoughts on that.

Jason Hine: I’m surprised by the, the Rob Orman of before being such a very, that’s a very rigid way of thinking and being. Incredibly So, um, I wonder if in your psyche there’s also, was there any degree of superior to, for lack of a better term, and like everybody else around you is drinking coffee and you’re like, I don’t need that

Rob Orman, MD: my

Jason Hine: and survive residency?

Rob Orman, MD: I, I hadn’t thought about that. I’ll bet

Jason Hine: Yeah.

Rob Orman, MD: that there was, I’ll bet

Jason Hine: Yeah. Some [00:39:00] supremacy.

Rob Orman, MD: that kind of, I am, I’m better than all y’all. ’cause I don’t need

Jason Hine: Yeah. I don’t drink coffee. Yeah. Oh, maybe.

Rob Orman, MD: I’m army crawling on the floor of a night shift at three eight because I’m so freaking tired.

Jason Hine: Yeah. Right, right.

Rob Orman, MD: are weak.

Jason Hine: That’s funny. Yeah, it’s interesting, um, getting in that space and we talked a lot about how you. How you think about the activity and because of how you think about the activity, its benefit or lack thereof. And I, you know, bringing us back, I, you know, we’re building a crazy train track as we drive, uh, bring us back to the, the vice topic.

Um, I find it really interesting and valuable in the positive psychological benefit and physiologic benefit that I talked about earlier. Is there, if you see it as such, and what a crazy meta idea, right? You have to recognize that this is a small thing that may have a very minimal and negative impact on your body.

But if you. [00:40:00] Are able to treat yourself, to reward yourself to amplify that positive emotional factor you make that stronger, makes the negative physiologic impact even lower or lesser. Like your, your scale starts to tip even more in your favor, which is really interesting, you know, guilt and that the psychological stressfulness of that, that’s going to compound the, the scale to tip in the other direction.

And so there’s a high degree of, of how you approach and how you think about your indulgences, your good vices, your rewards, all the different terms we’ve used for this activity post shift. But if you see it as a benefit to yourself, it truly is, which is fa fantastic and fascinating to me.

Rob Orman, MD: And we think that, you know, we, you know, we, we, you and I together and in our. our own silos. We talk a lot about mindset, [00:41:00] and mindset can seem like kind of this nicety and you think a little bit differently, and I think you’re, what you’re getting at is that mindset has a physiologic component and there’s research done by Ari Crumb and,

Jason Hine: Yeah.

Rob Orman, MD: of, I think she’s out of Stanford.

And I, I’ll say actually, I, um, I was, I was listening to, uh, a, a book where she, she was discussed. I was like, wait, I, I know her. I actually, I, I, I went to school with her brother and like her, her dad was a Aikido teacher in my town. And I knew I learned a lot from this awesome thing. But anyway, I was like, wow, she really, she’s really pretty amazing.

But Eric Cru did this seminal research on mindset with, I think it was hotel housekeepers. it was, they. Told them the housekeepers that the work that they were doing was exercise [00:42:00] the harder they worked, the more it would benefit them. And, and for, I’m probably getting this study wrong, but the, the housekeepers that they told this to had substantial improvements in fitness because of how they viewed what they were doing. And this is, and I have, I have talked about this on my show before, maybe your show too. This is my favorite mindset study in the history of humanity. It is the counterclockwise study have, have you heard of this, this

Jason Hine: Counter? No. No.

Rob Orman, MD: is, and I’ve, it’s in a, um, it’s in a book and I believe the book is called Mindset. Um, It was done in 1979 with a group of men who were in their seventies, and they took these guys and they built a retreat center. I mean, it was a retreat center, but then they built it up so that it would look like it was 20 years before. And when they

Jason Hine: Okay.[00:43:00]

Rob Orman, MD: they were watching TV from 20 years before they were dressing.

They had to do the activities like, I don’t know, flag football. I don’t know what, 50-year-old, well, actually I do since I am, but.

Jason Hine: You are? Yeah, sure.

Rob Orman, MD: they had to talk as if, and they had to talk about the

Jason Hine: Going.

Rob Orman, MD: were happening then. So they were living, they truly had to basically method act as if they were 20 years younger and some

Jason Hine: Yeah,

Rob Orman, MD: guys by, by report.

It’s, um, you know, I’ve never been able to find the details on this. I’ve only heard it, I

Jason Hine: I know.

Rob Orman, MD: the study author, is that some of them actually had to be helped up the stairs when they were going into the, the retreat center. By the

Jason Hine: Got it.

Rob Orman, MD: by the end of this, this is one week mindset, how they’re thinking, strength, flexibility, hearing vision all improved, and when pictures of them at the end of the week were shown [00:44:00] to independent reviewers. They identified those pictures the younger selves, and

Jason Hine: Oh wow.

Rob Orman, MD: mindset. So you’re thinking, oh, how I think about something, how I think about the saying of here I go for my two fingers of Richie of whiskey. Ah, I so look forward to this. This is my boundary ritual. I worked hard and now here is where I get to come home. Or I’m gonna go do a hundred burpees and I love this. This is just how I get that out and I’m gonna become a civilian and a human being again versus I am drinking these two fingers of whiskey because it is just an utter freaking dumpster fire and nobody this, that, and this is, I just need this to numb my pain. imagine that is going to be a very different neurochemical response between those two, even though the action is the same.

Jason Hine: Oh, totally, totally. That’s going back. That’s a un You call that the, the rewind clock [00:45:00] or

Rob Orman, MD: study.

Jason Hine: counter clockwise study. I gotta find that. ’cause

Rob Orman, MD: Langer

Jason Hine: God.

Rob Orman, MD: study author.

Jason Hine: That’s fascinating and mind blowing in its own way. Um, and yeah, I mean mindset, I think that that’s gonna, in it, in collectively, that almost sums up the entire Good Vice podcast, right?

It depends on your mindset. Um, but it really, I think it in, in totality for me, as we kind of chew on these ideas, it’s gonna come down to moderation, control and response, right? So moderation control, I guess those are almost the same. We have to be able to indulge or enjoy or reward and feel like we are the ones who are pressing the gas and pressing the brake.

And as you mentioned. I mean, for many and for, for people in my life, in the throughout, any LI listener is gonna recognize alcohol. That’s one that you have to be very conscious and very [00:46:00] careful of because you can quickly become not the person on the gas or brake, not the one controlling the consumption at all those parts.

And so having that ability to maintain that moderation, maintain your control on the gas and brake, and then like we said, that mindset, that recognition that this is a small reward for a difficult task completed, that is where the physiologic benefit, the psychologic benefit comes in and outweighs any potential detriment in that space.

Rob Orman, MD: In addition that, I, I, I think that some. Intellectual, or at least just honesty with self is in order because you, you can game this anyway, say, oh, my intent is that this is a boundary ritual and I, I was speaking with a client, uh, about this once and that, you know, you know, I, I, I have some tequila when I, when I get [00:47:00] home and And, but I sure have a hard time sleeping after that. Okay, well, how much tequila do you have? I don’t know, seven or eight shots. And, okay, so what do, what, what do you think that’s doing? Well, I’m getting hammered. Okay, so

Jason Hine: Yeah.

Rob Orman, MD: can be this kind of, well, those guys said that the intent is all that matters.

And you say, okay, it’s the moderation. Well, what’s moderation? You know, you know, how’s it impacting my life? How’s it impacting my sleep? How’s it impacting my physiology?

Jason Hine: Mm-hmm. Yeah. And I, and there’s, depends on your, you know, the fabric from what, which you’re cut, but there’s a subconsciousness that is in there, and like you said, you can. Attempt to trick yourself, I think, into saying, oh yeah, this indulgence is good. But if you’re trying to have an internal monologue about how that is, every time you engage in it, or routinely you’re checking your quantity of consumption of movies or [00:48:00] alcohol or nicotine or any substance, then that’s probably an indication that, you know, you’re, you might not be fully in control of that moderation side of things.

And you start real, realistically, you start to lose your physical and psychological benefit because deep down inside you recognizing, okay, this is going beyond what is reward based, what is healthy. And so I, I don’t know how true that holds for everyone. I’m curious in your coaching experience, how you might talk people through this if they are in that space, but, um, when you start to second guess the.

Activity itself might be a time for a a stop point in recognition. Is this truly a reward for good behavior? Am I seeing it as such, so maintaining that benefit, et cetera, et cetera.

Rob Orman, MD: Yeah, well, I mean, just so perfectly there. I have anything to add. And it’s, you know, and, and I, I, sometimes there are those conversations on that level, but sometimes it’s [00:49:00] also, you know, I, I can’t stop and then it’s time

Jason Hine: Mm-hmm.

Rob Orman, MD: have some chemical dependency counseling or work, and it’s kind of okay.

That’s all right. I mean, some, sometimes, I mean, I know we’ve, we’ve really kind of focused in on alcohol. I mean, there’s a lot, there’s a lot of different, quote unquote vices, but when it’s having a negative impact on your life and it’s hard to pump the brakes on it, sometimes that just happens. And that might be genetic, that might be psychosocial, might be a combination of all of those.

I mean, that, ha, that happens. Okay. get, get a little help.

Jason Hine: Yeah, and I mean if you’re gonna play the play, the odds alcohol is probably the one worth most worth talking about from a societal standpoint. Nicotine maybe, maybe in comparison. But, uh, yeah, those are things that are balanced. Um, you know, is there a physiologic benefit to nicotine? Maybe in an alertness, but you’re not gonna do it on a shift.

We talked about some of the physiologic benefits of the unwind process associated with alcohol, which is the sphere in which I live. [00:50:00] So, um, they’re both work worth taking on if you’re a listener and thinking about in this space that we are, obviously., All right, so we kind of talked about what a, you know, the, the term good vice and we threw a lot of different ways to describe that in cheat and cheat day. We kind of threw that one out the window, the indulgence, the reward. Those are kind of more in the, in the framework where we might want to think, you know, indulgence itself actually has a, you know, has that negative connotation in some regards that we, as we talked later in the podcast about.

We wanted to move away from and in these high performance professions like emergency medicine, like many other that, that, uh, Rob worked with, we come out of shift, come out of the work with the need to Correct me on your terms here, Rob. You want to not dissociate, you want to separate detach. Thank you.

Rob Orman, MD: [00:51:00] I guess you

Jason Hine: I know it’s not dissociate.

You could dissociate, but then we have another problem, ketamine. Um, yeah. So you wanted to be able to detach, you want to be able to keep the two spaces separate. We actually even went into like a pre-shift ritual and pre prepping your mind and your neurotransmitters and receptors in a positive way going into the work that you do.

And then on the other side, being able to stop. Create some sort of physical, physical or psychological barrier. We talked about for me, the helium balloon full of all the activities, cutting the string, letting that fly away, and then some degree of reward is not necessarily bad, even if the activity itself might have some small physiologic negatives that could happen, like alcohol consumption.

And so if you’re in the space of recognizing that you are in control of the quantity consumed, whether it be exercise, tv, alcohol, nicotine, we talked about all those areas in [00:52:00] control and in moderation, recognize and reward yourself in that way and see this as a positive for a job well done. Your pros of that in terms of psychological, uh, stress management, cardiovascular deescalation, the ability to get to sleep on time as the ER doc and the evening shift, all those benefits greatly outweigh the potential.

Harms that, small harms that could come when you get in the space of recognizing that you may no longer be in control of those quantities and you can’t necessarily not do it related to that ritual or end of shift or what it be, that might be a time to look in the mirror, recognize a common potential problem of, you know, substance dependency, addiction, et cetera.

So how we think about it, how we allow ourselves to do that, and our mindset globally is the most important part of what could be a good vice.[00:53:00]

Rob Orman, MD: The question that comes up for me as I hear you walk through that how does this serve me what does this cost me? And I think those are the two fundamental questions.

Jason Hine: Yeah.

Rob Orman, MD: a, a little bit of dark chocolate at the end of a meal, how does it serve me? Well, you know, it’s, it’s just delightful If you’re a dark chocolate lover and it’s, um, you know, maybe there’s some positive physiologic effect.

Maybe, maybe not. What does it cost me? Well, you know, there’s a little bit of sugar in here and a little bit of this and that, but probably not a huge cost. So, alright, net positive.

Jason Hine: Yeah.

Rob Orman, MD: I eat 15 chocolate bars. I mean, know, we’re kind of getting into food and there’s a lot, a lot, a lot associated with that. It’s kind of, okay, how does that serve me?

Well, I mean, I do like chocolate bars, but the cost of that is, is, is very high. And

Jason Hine: Mm-hmm.

Rob Orman, MD: I, I mean that’s, that’s [00:54:00] kind of a, uh, outlandish example, but that’s the question for any of these things. And oftentimes the things that bring us joy, serve us massively. ’cause as, as you were saying in the beginning of this, before we even started recording, how you spend your time and where you put your thought is how you spend your life. And so if you enjoy these things, I mean, as far as we know, we just get one shot at this thing. And am I going to be rigid or am I going to have flexibility and allow these things at least someplace in my life?

Jason Hine: I like it. I love that conclusion. Yeah. We didn’t dive into the, uh, spiritual element of that in, in its own right, but like enjoyment of life, you know, having a life that may be a little bit shorter, but one that you really indulge in and or you live fully is valuable. And yeah, I think that’s a topic for another time, for sure.

Rob Orman, MD: say, I will say that if renunciation brings you [00:55:00] joy, that’s fine too. It doesn’t have to be, well, you know, you gotta have a little treat here and there. It’s kind of, I freaking love being an aesthetic so much and I get so much joy out of it a okay. No judgment.

Jason Hine: Fair enough. I like that too. Um, all right, well, Dr. Orman, thank you so much for coming back on the podcast, for just talking back and forth with me about a pretty, uh, robust space. You know, uh, uncovering all the nuances of how we manage the stressful lives we live and how we can reward ourselves in that space and, and be conscious of, you know, where, where the, uh, the processes could get a little slippery, where the, the problems can develop.

Uh, it was really informative for me to walk through and I appreciate all of your insights and coming on the podcast once again.

Rob Orman, MD: Always a treat, my friend.