Osler’s desk

Posted on October 29, 2010 by marylbrandt

Sir William Osler was probably one of the most prolific, most loved and most respected physicians in American history. Osler is credited with the concept of journal clubs, with being responsible for bringing medical students onto the wards for “clinical clerkships” and for the structure of the modern medical residency. Osler is also famous for quotes about medicine and teaching medicine. But, for this post, I want to focus on something that recently caught my eye … his desk. Osler wrote the first definitive textbook of Internal Medicine in the United States, The Principles and Practice of Medicine. I can only assume that a lot of his writing took place at this desk:

Which made me look at my desk and think about desks in general. There are many of us, particularly in the era of the laptop computer, who use our desks as storage space. But maybe we are missing an opportunity. What if, instead of stacking things on our desks, we actually created a space that made it easy to study, read, think and be creative? Organizing your desk will unquestionably lead to being more productive. But being productive isn’t the only goal. It’s also important to create a space that makes you look forward to spending “non-productive” time thinking, dreaming and being creative.

Organizing a desk.

Keep pens, highlighters, etc that you use in a holder – but only the ones you use. Get rid of the pens that don’t really work, and the ones you don’t like.
Declutter the surface of the desk by hiding electronic wires, filing stacks of papers, etc
Keep a scratch notebook on the desk to replace scraps of paper. Use it for phone messages, ideas, etc.
Keep the surface clear of everything except what you are working on (and put it away when you are done)
Position your computer screen so it’s ergonomic

Personalizing a desk (and the space it lives in)

Make sure you have a great (and very comfortable) chair.
Get a really good light.
Make sure the area is quiet
Keep the area decluttered to decrease visual “stress”
If you listen to music when you work, get good speakers for your computer (or a good sound system)
Put things in the space that motivate you – art, photos, quotes, etc

Tips for an organized desk from Productivity501.com

Increasing Energy Levels at Work

Posted on October 24, 2010 by marylbrandt

Eating regularly can really help with energy levels during the day. Based on this interesting study from Canada, it’s also better for your patients. Not only does this study show that the docs felt better when they ate regularly, they also did better on objective tests of cognition.

If you want to feel good at work start the day with a good breakfast. Once you get to work, eat balanced snacks or small meals every 3-4 hours. Energy bars are a great solution if you are really on the run – just put one or two in your white coat pocket. My favorites are kind bars, mojo bars and clif bars but there are a lot of good choices. What is important is to choose healthy energy bars not bars that are candy in disguise.

Physician nutrition and cognition during work hours: effect of a nutrition based intervention. BMC Health Serv Res. 2010 Aug 17;10:241. Lemaire JB, Wallace JE, Dinsmore K, Lewin AM, Ghali WA, Roberts D.

Department of Medicine University of Calgary Health Sciences Center 3330 University Drive NW Calgary, Alberta T2N4N1, Canada. lemaire@ucalgary.ca

Abstract

BACKGROUND: Physicians are often unable to eat and drink properly during their work day. Nutrition has been linked to cognition. We aimed to examine the effect of a nutrition based intervention, that of scheduled nutrition breaks during the work day, upon physician cognition, glucose, and hypoglycemic symptoms.

METHODS: A volunteer sample of twenty staff physicians from a large urban teaching hospital were recruited from the doctors’ lounge. During both the baseline and the intervention day, we measured subjects’ cognitive function, capillary blood glucose, “hypoglycemic” nutrition-related symptoms, fluid and nutrient intake, level of physical activity, weight, and urinary output.

RESULTS: Cognition scores as measured by a composite score of speed and accuracy (Tput statistic) were superior on the intervention day on simple (220 vs. 209, p = 0.01) and complex (92 vs. 85, p < 0.001) reaction time tests. Group mean glucose was 0.3 mmol/L lower (p = 0.03) and less variable (coefficient of variation 12.2% vs. 18.0%) on the intervention day. Although not statistically significant, there was also a trend toward the reporting of fewer hypoglycemic type symptoms. There was higher nutrient intake on intervention versus baseline days as measured by mean caloric intake (1345 vs. 935 kilocalories, p = 0.008), and improved hydration as measured by mean change in body mass (+352 vs. -364 grams, p < 0.001).

CONCLUSIONS: Our study provides evidence in support of adequate workplace nutrition as a contributor to improved physician cognition, adding to the body of research suggesting that physician wellness may ultimately benefit not only the physicians themselves but also their patients and the health care systems in which they work.

Easy Ways to Increase Activity at Work

Posted on October 22, 2010 by marylbrandt

The Institute of Medicine recommends 60 minutes of vigorous exercise everyday to maintain optimal health. The scientific evidence is clear – we would all be healthier if we did real exercise for an hour a day. But – as Dr. Richard Forgos says in his commentary on the subject – “An hour a day? You’ve got to be kidding!” I agree – It’s next to impossible for most physicians, students and residents to find an hour to exercise every day. (Which is really more like 1½ or 2 hours if you plan to go somewhere like a gym).

That being said, any amount of exercise you can add to what you are (or aren’t) doing now will improve your health, help you control your weight, and improve your mood. When you can, try to schedule a real workout. When you can’t, focus on easy ways to add small amounts of activity into your normal day:

Take the stairs. For one week, make yourself take the stairs every time you change floors. You’ll see an improvement in your huffing and puffing by the end of the week, and you’ll be convinced that this is real exercise! When I was a resident, one of our legendary attendings climbed a new mountain every summer during his vacation. The only training he ever did was to take the stairs in the hospital. (He looked great after 10 flights of stairs… the interns were suffering.) At a minimum make a 2 or 3 floor rule i.e. take the stairs if you are going up 2 or 3 floors. You should always take the stairs if you are going down!

Commute on your feet. If you live close enough (and it’s safe), walk or bike to work. If you have to drive, park farther away than you usually do so you have to walk a little farther.

Wear a pedometer. Find out how many steps is an “average” day for you and set a new goal. Shoot for a minimum of 10,000 steps a day.

Don’t stroll on rounds. A lot of people who give advice about increasing activity talk about “walk meetings”. We have walk meetings all the time! (We call them rounds.) If you are in charge of rounds, set the standard by walking quickly between areas and taking the stairs.

Drink a lot of water and then use restrooms on a different floor. No one drinks enough water at work, so this helps meet that need. The obvious consequence of drinking enough water can lead to more walking!

Stand when you are talking on the telephone or writing in a chart. This sounds trivial, but it actually adds a lot to overall activity. If you are somewhere you won’t be embarrassed, add some squats or lunges while you are talking.

Have active post-call “team meetings”. Instead of meeting for a “beverage” at a restaurant (or other establishment), go play Frisbee in the park (beverages allowed). (Picture from http://en.wikipedia.org/wiki/Flying_disc)

10 simple ways to increase your physical activity – obesitypanacea.com

Increasing daily activity – American Heart Association

Exercise at work – about.com

Easy Fast Recipes: Cheap, Healthy, Good

Posted on October 17, 2010 by marylbrandt

Medical students and residents don’t have a lot of money to spend on food. I was happy to find a new site for easy and healthy recipes that also addressed the cost of the food. Cheap, Healthy, Good is a website maintained by Kristen Swensson Sturt and some guest writers. They describe their recipes as “mostly simple, delicious dishes made of whole foods. And love. But mostly whole foods.” There are a lot of recipes that meet my “pizza rule” (i.e. <30 minute rule) and would be great for busy students, residents and practicing docs.

Baked Eggplant with MushroomTomato Sauce

Pasta Puttanesca

Make Your Day Better Lentil Soup

How to Use RSS

Posted on October 16, 2010 by marylbrandt

I consider myself relatively tech savy (at least not embarrassingly illiterate). I recently learned how to use RSS – which just seems like something I should have known about for a long time. So, forgive me if this is ridiculously simple for you, but in case you don’t know how to use RSS, here goes…

Bottom line:

1. If you want to follow a blog or website you can subscribe with RSS

2. Anytime the site posts new information it will be automatically sent to you

3. The new posts are listed by title – you click on the ones you want to read

4. This saves a lot of time

Here’s more details:

RSS stands for Really Simple Syndication
When you find a website you want to follow, find either the RSS symbol or something like “to subscribe” and pick RSS

Pick which RSS reader you want to use. I use Google reader but there are a lot of other readers out there to choose from. Using a reader like Google, Yahoo, MSN, etc lets you access the reader from any computer, unlike some of the other readers listed here
Open your reader when you want to see what’s new on the websites you follow – the “headlines” of all the new posts will be listed. Clicking on any headline takes you to the full story

Here are a few more sites if you need more information:

http://www.problogger.net/what-is-rss/

http://paulstamatiou.com/how-to-getting-started-with-rss

Physician Suicide

Posted on October 11, 2010 by marylbrandt

What a hard topic to write about.

Like most physicians, I knew a colleague who committed suicide. Also, like most physicians, I didn’t see any warning signals. I recently came across a review article on the subject of physician suicide on emedicine that made me decide to post some information.

Every year in the United States, we lose the equivalent of at least an entire medical school class to physician suicide. It happens during medical school, residency and once doctors are in practice. It’s nearly always related to depression – a clinical problem we all learn about, but have trouble recognizing in ourselves or our colleagues.

Depression is a disease, not a personal failing. It affects 12-18% of practicing physicians and – it’s treatable. It’s often associated with alcohol or substance abuse, which are also treatable. The good news is that depression, substance abuse and alcoholism are more successfully treated in physicians (and trainees) than the general public – probably because of the personality traits that lead us to become physicians in the first place.

All medical schools have confidential and free support for students and residents. If you are worried about the effect on your career – don’t. Seeking treatment is a sign of strength, not weakness. If you are struggling, please know that there is help and you are not alone.

Here are some important resources (you don’t have to be suicidal to ask any of these sites for information or help)

National Suicide Prevention Hotline 1-800-273-TALK (8255).

http://www.doctorswithdepression.org/ an outreach program from The American Foundation for Suicide Prevention

Farmer’s Markets

Posted on October 9, 2010 by marylbrandt

I just got back from the farmer’s market and decided to add to my previous thoughts about buying your food locally.

Houston is a little bizarre when it comes to produce. Our growing season has a real lull in the summer when it gets so hot. As the weather cools in October, the plants perk up again and we start seeing great produce reappear.

I’ve become convinced that food bought from local farmers usually has less contaminants, more nutrients and just tastes better. It’s also clear that you are doing a good deed for the environment if you buy food that doesn’t have to be shipped to you. But there is another intangible benefit of shopping at the farmer’s market for people who spend their days in intense work – it’s a social event that is very grounding (no pun intended). It’s outside, it’s beautiful and – at least in Houston – there is good music, good coffee and a crowd of smiling people.

Take care of yourself by buying food that’s good for you. If you are trying to follow Michael Pollan’s advice on how to eat well (“Eat food. Not too much. Mostly plants.” ) you can’t do better than buying your food at the farmer’s market.

Portion Distortion

Posted on October 5, 2010 by marylbrandt

Most operating room lounges provide food for the surgeons, residents and medical students. In our operating room it’s usually bagels and muffins. The muffins don’t seem that big… until you realize they are at least 2 servings each! Check out this picture from fooducate.com.

Knowledge is power when it comes to your diet – particularly if you are trying to lose weight (or at least not gain weight). One of the biggest eye openers for people struggling with weight is to learn about the “portion distortion” that has occurred over the last decade or two. This information will not only help you counsel patients, it will help you “walk the walk” by taking care of your own nutrition. Weight gain is extremely common during clinical rotations and residency. If you are interested in losing weight, or at least preventing weight gain during residency, one of the first steps is getting a grasp on normal serving sizes, food groups and how many servings of each food group you should eat.

Here’s a good list of how to “eyeball” what constitutes a single serving (from Webmd.com)

Vegetables or fruit is about the size of your fist.
Pasta is about the size of one scoop of ice cream.
Meat, fish, or poultry is the size of a deck of cards or the size of your palm (minus the fingers).
Snacks such as pretzels and chips is about the size of a cupped handful.
Apple is the size of a baseball.
Potato is the size of a computer mouse.
Bagel is the size of a hockey puck.
Pancake is the size of a CD.
Steamed rice is the size of a cupcake wrapper.
Cheese is the size of a pair of dice or the size of your whole thumb (from the tip to the base).

As a guide, a healthy diet should have (roughly) 8-10 servings of fruits and vegetable, 6 servings of grains or starches, 2-3 servings of milk or milk products and 1-2 servings of meat or other vegetable protein in a day.

Photo credit

Which Medical Shows Do Medical Students Watch?

Posted on October 1, 2010 by marylbrandt

The 5th annual survey of the Future Physicians of America just came out. This is a survey of 710 students who use Epocrates (funded by the company). Epocrates is a mobile medical reference I previously mentioned in a post about iphone apps for docs.

The link to the entire survey can be found on www.medgadget.com.

I’ve had a clear message from classes in recent years that they have different reasons for being in medicine than some of their predecessors. This survey, even with the limitations it has, reinforced my feeling that current medical students have an strong focus on being good physicians and good people.

There are some other interesting details about why they chose their medical schools, how they find information, which portable devices they use to find medical information etc … and which medical shows they watch on TV!