New Year Resolutions

The “clean slate” of a new year almost always leads us to think of resolutions … things we could change to make our lives better.  This is a great time for reflection to realize what you have accomplished, where you’d like to be in a year, and what changes you need to arrive at that goal.  I just finished reading Making Habits, Breaking Habits: Why We Do Things, Why We Don’t, and How to Make Any Change Stick by Jeremy Dean which provided some useful ideas about making resolutions.

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Know why you want to make the change

“There has to be an ultimate goal that is really worth achieving or the habit will be almost impossible to ingrain.”  Jeremy Dean

Let’s take one example – losing weight.  It’s fine to say you want to lose weight… but why?  Wanting to fit into your clothes is not a trivial reason, but will it really motivate you when it gets tough as much as these?

  • Being able to “walk the walk” when you talk to patients about losing weight
  • Reduction in your risk for diabetes, heart disease, cancer and a variety of other health problems
  • More energy, better mood, less pain…

What’s important is that you find reasons that resonate for you.  Do a little research and write down why you want to make the change.  Plan to review this, and revise it when needed, on a regular basis.

 

Make the resolution then make a plan.

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To continue the losing weight example, what are the specific new habits you want to develop?  Are they “SMART” changes?   (Specific, Measurable, Attainable, Realistic and Time-Based).  For example…

  • I will eat 8 servings of fruits and vegetables every day.
  • I will set the alarm clock 15 minutes early to do push-ups, crunches and squats before I go to the hospital.
  • I will plan my meals and shop once a week so I can take healthy food with me to work.
  • I will schedule my workouts every weekend so I can attend at least two spin classes a week.
  • I will cook one healthy dish on the weekend that I can eat for at least 4 meals during the week

 

Develop the “what if” plan.

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The next step is to imagine all the things that might derail you and write down a specific plan for each of them.  This will be an ongoing process… as you come up with new excuses to not follow through with your new habit, add it to the list.

Back to the example of losing weight….

  • If I forget to bring fruit/veggies with me to work, I will go to the cafeteria or lounge to get at least 2 servings to eat at work.
  • If I walk by MacDonald’s and feel drawn in by the smell of the fries, I will remember that I’m trying to set a good example for my patients
  • If I hit snooze on my alarm clock, I will move it across the room.
  • If I think I’m too tired to go shopping for the week, I will remember that this is the key to having healthy food at work.

“Making healthy habits should be a voyage of discovery.” Jeremy Dean

 

Keep track.

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Self-monitoring is critically important to maintaining a new habit.   It doesn’t matter if you use an app like My Fitness Pal, a calendar, a spreadsheet or a system like the Bullet Journal… stay accountable by keeping track.

 

As the habit becomes engrained, change it a little to keep it interesting.

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Working out with exactly the same routine quickly becomes boring. It’s one of the reasons people love group classes like spin classes  – the instructors are always changing the routine.  Be mindful and creative… but stay out of ruts!

“Making or breaking a habit is really just the start. To develop a truly fulfilling and satisfying happy habit, it’s about more than just repetition and maintenance; it’s about finding ways to continually adjust and tweak habits to keep them new; to avoid mind wandering and the less pleasurable emotional states that accompany it. There is great enjoyment to be had in these small changes to routines. When life is the same every day, it gets boring.”  Jeremy Deans

 

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Looking for inspiration?  Here’s a list of New Year’s Resolutions for medical students, residents and busy docs.  Pick 1 or 2 and start working on your plan, your what-ifs and how you will monitor them!

  1. Learn to meditate and spend at least 10 minutes every day meditating with HeadSpace. (Here’s the TED talk that introduced me to this great app.)
  2. Eat fruits and veggies with every meal.
  3. Walk 10,000 steps per day.
  4. Take the stairs instead of the elevators.
  5. Learn the names of all the people you work with… the guy who mops the floor, the clerk at the desk, the person who works in the blood bank.
  6. Write down three things you are grateful for every night before you go to bed.
  7. Log all cases (if this applies to you) the same day and finish medical records within 24 hours.
  8. Use a system like the Bullet Journal or Remember The Milk to become more organized and never miss a deadline (including the birthdays of your family and friends)
  9. Cook your own meals at home (take a class if you need to).
  10. Be on time to conferences, rounding, meetings, classes, etc.
  11. Spend at least half a day a week “unplugged” and use it to play.
  12. Keep a journal to remember the important events of the day, vent about things that upset you, and make plans for the future.
  13. Read something that is not medical every day.
  14. Stop eating fast food.
  15. Drink less alcohol or stop all together.
  16. Get at least 7 hours of sleep any night you are not on call. (and have a plan post call to sleep more)
  17. Cut out all added sugar.
  18. Drink more water.
  19. Keep your house neater… or at least a part of your house!
  20. Stop texting while driving.
  21. Learn about motivational interviewing to help your patients.
  22. Read a major textbook in your field in one year.
  23. Learn something new from every patient you see
  24. Try a new way to exercise every month
  25. Set your intention for the day every morning.
  26. Eat breakfast every morning.
  27. Set limits on checking email, Facebook, Twitter, Instagram and other social media sites.
  28. Practice mindfulness.
  29. Plan your meals for the week on the weekend to make sure you have great food on call and at work.
  30. If you have to sit a lot at work, come up with a plan to not be so sedentary.

 

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Advice physicians should follow. But don’t.

This is a truly wonderful piece from Emily Gibson, re-posted here with her permission from her beautiful blog, Barnstorming.  Enjoy!

octevening298As we drown in the overwhelm of modern day health care duties, most physicians I know, including myself, fail to follow their own advice. Far too many of us have become overly tired, irritable and resentful about our workload.  It is difficult to look forward to the dawn of the next work day.

Medical journals and blogs label this as “physician burnout” but the reality is very few of us are so fried we want to abandon practicing medicine. Instead, we are weary of being distracted by irrelevant busy work from what we spent long years training to do: helping people get well, stay well and be well, and when the time comes, die well.

Instead, we are busy documenting-documenting-documenting for the benefit of insurance companies and to satisfy state and federal government regulations. Very little of this has anything to do with the well-being of the patient and only serves to lengthen our work days — interminably.

Today I decided to take a rare mid-week day off at home to consider the advice we physicians all know but don’t always allow ourselves to follow:

Sleep. Plenty. Weekend and days-off naps are not only permitted but required. It’s one thing you can’t delegate someone else to do for you. It’s restorative, and it’s necessary.

Don’t skip meals because you are too busy to chew. Ever. Especially if there is family involved.

Drink water throughout the work day.

Go to the bathroom when it is time to go and not four or even eight hours later.

Nurture the people (and other breathing beings) who love and care for you because you will need them when things get rough.

Exercise whenever possible. Take the stairs. Park on the far side of the lot. Dance on the way to the next exam room.

Believe in something more infinite than you are as you are absolutely finite and need to remember your limits.

Weep if you need to, even in front of others. Holding it in hurts more.

Time off is sacred. When not on call, don’t take calls except from family and friends. No exceptions.

Learn how to say no gracefully and gratefully — try “not now but maybe sometime in the future and thanks for thinking of me.”

Celebrate being unscheduled and unplanned when not scheduled and planned.

Get away. Far away. Whenever possible. The backyard counts.

Connect regularly with people and activities that have absolutely nothing to do with medicine and health care.

Cherish co-workers, mentors, coaches and teachers that can help you grow and refine your profession and your person.

Start your work day on time. End your work day a little before you think you ought to.

Smile at people who are not expecting it, especially your co-workers. Smile at people who you don’t think warrant it. If you can’t get your lips to smile, smile with your eyes.

Take a day off from caring for others to care for yourself.  Even a hug from yourself counts as a hug.

Practice gratitude daily. Doctoring is the best work there is anywhere and be blessed by it even on the days you prefer to forget.

 

Top 10 Holiday Gifts for Physicians and Physicians in Training

The holiday season is rapidly approaching.   Here’s my top ten gifts for medical students, residents and physicians…. or any busy friend!

  1. Mark Bittman’s new book How To Cook Everything Fast.

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This is an amazing cookbook and it is perfect for busy people. The recipes are interesting, delicious and healthy. The instructions are easy for a novice without being simplistic and the layout of the book in innovative and makes it really easy to use.

 

  1. An electric pressure cooker.

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Slow cookers are often suggested for medical students and residents but I don’t think they are as good as a pressure cooker.   You have to be there when slow cookers are (slowly) cooking, which is usually your rare day off. Also, it’s hard to cook vegetables in a slow cooker. Pressure cookers on the other hand cook broccoli in 2 minutes (perfectly!).  I’ve been told that the electric pressure cookers take a little longer to come up to pressure, but it seems a small downside for a device that also lets you slow cook, steam, sauté, and cook rice.

 

  1. Coffee or Tea

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There are several options to consider if they are a serious coffee or tea drinker. A Starbucks or Teavana gift card in a cute “medical” coffee mug? A Starbucks Verismo coffee brewer? Nespresso? Keurig?

 

  1. A FitBit

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Anyone in medicine loves gadgets and loves data. The fitbit has become a socially acceptable piece of “jewelry” in the hospital and it unquestionably changes behavior to increase activity. Having washed three of the “clip on” Fitbits with my scrubs, I would recommend one of the wristband Fitbits!

 

  1. A maid or housecleaning service

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Doing housework has to be on everyone’s lowest list of fun things to do on your day off, but it’s especially true for people who are studying extensively or taking call in the hospital. My parents helped finance someone to come occasionally to help clean my apartment when I was an intern. It was without a doubt the best present I’ve ever received.

 

  1. Anything that helps make it easy to get more exercise

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Another great gift is anything that will promote more exercise… a bicycle to commute to school or work? Yoga classes? Spin classes? A gift certificate for new running shoes? Resistance bands for the call room? A membership to a YMCA or a gym close to where they live? Certificates for post workout massages?

 

  1. “Date night” packages

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Whether they are single or have a significant other, being able to socialize is an important part of stress reduction for busy people.   Create combinations of gift cards to movie theaters and restaurants to support “date nights”. If they love art, music, or sports think of season tickets (or ticket packages) to museums, music venues or professional sport teams.

 

  1. An “over the top” alarm clock

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It’s not easy getting up at “dark thirty” to make it to rounds, but being on time is important.   The snooze button is not a good idea… but it’s so easy to hit. This alarm clock is my personal favorite to make sure you get out of bed. After a few hits of the snooze button, it rolls off the table and around the room until you turn it off!

 

  1. Great books by, for and about doctors.  

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If they are a serious reader, think about a Kindle (or other eReader). The Kindle paperwhite is small, lightweight, back lit and has a great battery life – which makes it great for the occasional times on call that you can find 30 minutes to escape into a good book. You can also read it outside in bright sunlight (unlike tablets like the iPad) On my list of great reads for doctors (in no particular order)…

Cutting for Stone by Abrahan Verghese

How Doctors Think by Jerome Groopman

House of God by Samuel Shem

The Immortal Life of Henrietta Lacks by Rebecca Skloot

The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukheries

Being Mortal: Medicine and What Matters in the End by Atul Guwande

William Osler: A Life in Medicine by Michael Bliss

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman

 

  1. The always appropriate gift of money

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If you are going to give gift certificates or money,  “package” it with some humor (in a pill bottle with a “prescription”) or a context (this is to help you buy good food for times you are too busy).

Please let me know (comment or email) anything else to add to this list!  Happy Holidays to all!

 

 

What happened to my workouts?

I’m just went through a particularly busy time and, once again, I didn’t find/make time for exercise.  I could give you the list of tasks, travel, call nights, etc that led to blowing off my workouts, but it wouldn’t be different from yours.

I know better.

If you haven’t seen it, this is a remarkably persuasive “lecture” (with very cool animation) on why we should make time to exercise.

 

Here’s what I’m going to do, based on previous experience and a lot of good advice from people who know more than I do:

1.  Put exercise on a calendar.

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Schedule exercise as an appointment – every day.  I personally think call days and post-call days should be exempt (if you are up most of the night).  Sleep trumps exercise if you are really sleep deprived.  It’s understandable there will be a day, maybe even two, when something comes up that you can’t control …and you miss your workout.  But the end result of having a plan for everyday is that you’ll work out 4-5 days a week (instead of 0-2)

2.    Put your shoes on.

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For most of us, it’s not doing the exercise that’s so hard, it’s getting started.  I think the “10 minute rule” is key.  Put your shoes on and start your workout no matter how bad you feel or how much you don’t want to do it.  If, after 10 minutes, you still feel that way – stop.

3.    Just do it.

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Self explanatory.  Sometimes you just have to make up your mind that the benefits outweigh your desire to sit on the couch.   If you don’t like to work out – talk yourself into it.

4.    Keep track

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Watching yourself improve is a great incentive to keep going.  Set up goals for slow and steady improvement and then log what happens.  We’re all good at science – think about approaching this as one big “experiment”.  When things don’t work out the way you expect, log it.  Buy a notebook or find an app you like.  Use your log to figure out what works and what doesn’t.

I’m in.  For the next month I’m going to set and meet a goal for 150 minutes/ week of real exercise.  Join me?

Why you should run (even if you hate it) – and how to stay safe when it’s hot outside.

Running is one of the most efficient ways for busy students, resident and physicians to stay in shape.  If you are looking for the best way to meet your “MED” (Minimal Exercise Dose) to stay fit, you really can’t do better than running. It’s cheap (but don’t skimp too much on the shoes and clothes you need), easy (we are born to do it) and incredibly time efficient. You don’t have to plan to run a marathon to gain amazing benefits from a running program.  20-30 minutes, 3-4 times a week, will keep you fit, reduce stress, and prevent the weight gain associated with residency.  If you are a beginner, check out Runner’s World 8 week to start running.

I work with a remarkable runner, Carlos Campos MD, who wrote the following for the Texas Children’s Hospital Department of Surgery wellness newsletter.  Given how hot it is in most of the country right now, I thought the following advice was important to pass on!

Training in hot weather can be challenging, and without the proper precautions it can be dangerous. But a few easy guidelines can help you beat the heat.

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Get the Data

Before stepping out on a hot day, make sure to check the heat index. The heat index combines air temperature and relative humidity to determine how hot it feels. The National Weather Service offers heat index alerts when it becomes dangerous to exercise outdoors.

Your body cools itself with perspiration which evaporates and carries heat away. When the relative humidity is high, the evaporation rate is reduced and heat is removed from the body at a slower rate.

One way to get through those hot and humid days is to avoid them. When the heat index reaches dangerous levels consider taking that well deserved day off.

If avoidance is not an option for you, try running in the early morning or early evening when the heat index is typically lower.

Another option is to do your workout indoors. A climate-controlled indoor track or treadmill can serve as an alternative to running under the scorching sun. However, not everyone has the luxury of an indoor facility so you need to plan accordingly.

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Wear the Right Clothes

You’ve probably heard the saying “there’s no bad weather just bad clothing.” Whether or not it’s true, you should always wear temperature-appropriate gear, especially when running in the heat.

Avoid dark colors since they tend to absorb heat rather then reflect it. Find clothing that is made of high performance technical materials. These materials wick or pull moisture away from your body while allowing air to flow through the material. Wicking materials are a great improvement over cotton, which tends to absorb moisture and can contribute to chaffing.

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Find a Cool Course

Temperatures tend to be a few degrees cooler in the shade, so look for a running route that offers lots of it. It’s also a great excuse to get off-road and do a little cross-country training.

If you are lucky enough to live near the coast, you may want to consider a beach run. Temperatures are cooler along coastal areas, and you can always go for a quick dip to cool down.

Consider looking for an athletic facility that waters their fields with sprinklers. Running through sprinklers serves a dual purpose: It helps keep you cool and makes you feel like you’re 12 again.

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Protect Your Skin From the Sun

Wearing sun block is a must. The occurrence of skin cancer is on the rise and without protection, you increase your risk. The higher the sun protection factor or SPF, the more effective the sun block is in protecting your skin against harmful rays. For example, sun block rated at SPF 30 filters out about 96 percent of ultra violet rays.

The sun’s rays are strongest between 10:00 a.m. and 4:00 p.m., so avoid training during these hours. It is recommended that sun block be applied about 30 minutes before going outdoors and every hour after.

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Wear a Cap With a Wide Brim

The first women’s marathon was introduced at the 1984 Summer Olympics in Los Angeles. As you can imagine, summers in LA are hot, and the morning of the marathon was no exception. To make matters worse, most of the course was on freeways that offered no escape from the sun.

To compensate for the conditions, Joan Benoit Samuelson wore a white cap with a wide brim. The cap served the dual purpose of shielding her from the harmful rays of the sun and acting as a cooling device. Periodically she would pour water on the cap. She finished a minute ahead of her rivals to win the first women’s Olympic gold medal in the marathon.

Today’s running caps are made of high-tech materials that are both light and vented. Just add a little water to help keep cool.

If you don’t like wearing hats or want additional protection for your eyes, wear sunglasses. Make sure you find sunglasses that come with UV coating.

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Stay Hydrated

Runner’s World has a great summary of how to stay hydrated in the heat.  To summarize, drink something before you go out and replace what you are losing.  For 20-30 minute runs a good drink of water before you go should be plenty.  It’s important not to go overboard by drinking too much or adding salt.

 

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Running in the heat can be a challenge, but when met with a few common sense rules you can beat the heat!

Starting Internship (I know what you are worried about)

I sat at the table this week with our new interns and the outgoing chief residents. Listening to our new interns as they asked questions, I realized everyone starting their internship has the same fears, whether or not they express them:  Will I kill or hurt someone?  Will I look stupid?  What if they find out I’m not as smart as everyone else?  Will I get divorced/separated/alienated from my friends?  Will I gain weight?  How am I going to find time to take care of myself?

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What you are feeling is normal. Every doctor who ever started an internship felt exactly the same way.  The best way to manage your (healthy) fear is to have a strategy.   I’ve written in the past about how to succeed as an intern.  But if I were going to condense that advice into three easy rules (for every day except your day off)  it would be these:

1.    Read at least one section from a textbook in your field every day

2.    Learn something (in detail) from at least one patient every day

3.    Do something to take care of yourself every day

Read at least one section from a textbook in your field every day.

Your goal for the year should be to read a major textbook in your field cover to cover.  You don’t have to buy the physical book.  It’s fine if it’s on line or downloaded onto your iPad.

Once you have the book, make a list or spreadsheet of all the sections in all the chapters.  For most textbooks, it’s probably going to be a list somewhere between 150 and 200 topics.  When you look at the 48-50 weeks you will be working this year, it works out to basically a topic a day (with some days for review).

The real goal is not just to read these topics, but to really learn them.  So, when you read, don’t just skim.  Read to learn.  That means taking notes – and reviewing them.

Put a chart on the wall with the list and give yourself a gold star when you finish a topic if you have to, but find a way to make sure you cover all the topics (at a steady pace) during the year.

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Learn something (in detail) from at least one patient every day.

It’s really easy, as an intern, to get caught up in the work and forget that you are fundamentally here to learn – not to provide service.  Make it a daily habit to learn in detail about one patient in your care.  It will overlap nicely with your goal to read a complete textbook.  When you admit a patient with pneumonia, read the section (and make notes) on pneumonia and then check it off your list.

One other important point (that none of us like to hear) – You will make mistakes. Be humble, be honest, and learn from your mistakes. The mistakes you make (and maybe more importantly your “near misses”) are absolutely your most valuable teacher.  When you do make a mistake, use it as the topic you will review for the day. You are going to be really upset but be easy on yourself.  Being upset is the mark of someone who cares, but don’t let it escalate beyond a healthy response. Talk to your mentors and senior residents.  They’ve been there.

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Do at least one thing to take care of yourself every day.

This may sound trivial, but it’s not. If you can, try to eat well, get some exercise and be social every day.  At a minimum, though, pick one specific thing you are going to do for yourself and then do it.

Eat well

Get Some Exercise

Be social

Sitting is bad for you – Even if you exercise.

New findings about sedentary behavior have real implications for medical students, who spend a lot of time sitting during the first year or two of medical school. This is also an important issue for residents and practicing physicians, particularly those in the more sedentary fields of medicine like pathology, psychiatry and radiology.   However, this problem affects us all, regardless of specialty.  All physicians have become more sedentary due to the time we spend at our computers.

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The goal is to move on this continuum from less activity to more… in other words, to become less sedentary.  Here’s some ways to accomplish that goal:

  1. Make sure you move at least every hour.   Breaking up sedentary time is important. Although just moving (even a short stroll) is good, if you have time and the inclination do something a little more strenuous.  Walk up several flights of stairs, do 10 squats and 10 pushups, or whatever catches your fancy.  Try to find ways to incorporate more activity into your day on a regular basis.
  2. Stand when you can.  Stand when you are reading, working on the computer (with an adjustable desk), or just hanging out.
  3. Walk instead of looking up data on the computer on rounds.  I’ve recently discovered I can access our EMR (Epic) on my iPad by installing the Citrix app.  I’ve started taking my iPad with me on rounds, rather than sitting to look up notes, images and lab values.  I’m still not to the point where I write my notes on the iPad, but I’m going to work on it.
  4. Walk to meet instead of sitting around a table. Rounds are obvious, but we have lots of other meetings as well.  There are even physicians who have started doing a part of patient visits as a walk.
  5. Consider ways to move while you do your “sedentary” work:


Adjustable desks. Although there are a lot of these on the market that are really expensive, there are some that are more affordable, including desks marketed for kids in school.  Or be creative and make your own adjustable desk.

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Under the desk pedals are inexpensive, and are particularly effective if you are reading and studying.
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Put a desk on your stationary bicycle. Work while pedaling on your stationary bike.  If you have a bicycle, you’ll need to by a trainer to convert it to a stationary bike.  I recently bought  a desk (FitDesk Pro) for my spin bike and it really works.  If you don’t want to spend the money, there are other ways to use your laptop or read while you are on a stationary bike like using an ironing board, or putting your bike under an adjustable desk. I particularly liked this idea of a bicycle rack that doubles as a desk.

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Fit Desk.  If you don’t own a stationary bike, and don’t mind spending $200, look into the Fit Desk.  Friends who have tried this say it is very stable while pedaling.

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Treadmill desk.  This is the most expensive option, but for practicing physicians is not at all a reach.  For students and residents, if you can find an old treadmill, you can build this for $39.

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