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.

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.

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.

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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The Best of Wellness Rounds 2011

HAPPY NEW YEAR TO EVERYONE!

Advice for interns

Why I hardly ever drink diet drinks

How to choose your specialty

What to do on your day off

Studying basic sciences – strategies for success

Studying clinical medicine

Getting (and staying) motivated to exercise

How to succeed on clinical rotations

Gifts for medical students and residents

Why I’m spending more time on Twitter

How not to have sore feet after a day in the hospital

How to Succeed in Clinical Rotations

Next week will be the start of clinical rotations for students at Baylor College of Medicine.  It’s an exciting time, but a big transition!  After seeing this a few times, I thought the following advice on how to approach clinical rotations might help.

 

Don’t sit in the back of the plane.

The basic sciences are important to learn the vocabulary and grammar of medicine.  Clinical rotations are different – it’s where you learn to speak the language.  There are tricks for learning clinical medicine but fundamentally it’s about realizing you are still in school and not just observing.

If you use the analogy of learning to fly, there’s a simple concept that summarizes learning on the wards: You cannot learn to fly a plane by sitting in the back.  In basic sciences you are studying the book on how to fly the plane.  In your clinical rotations you are in the plane, watching and learning from the pilot.  Which means you have to be in the cockpit.

In every situation you encounter in the hospital, imagine that you are “flying the plane.”  When the resident starts to write the admission orders say “Do you mind if I write them and you show me how?”  On your surgery rotation, get to the holding area early and ask the anesthesia resident if he/she will explain how to intubate, show you how to intubate, or even let you try.  When you are writing an admission H&P on a baby in the ER, imagine you are the only doctor who will be seeing that patient.  Let the adrenaline of that thought guide you to the computer to look up more about the condition, how to treat it and what you would do if you were the only person making the decisions.

Yes, you need to be pushy and, yes, sometimes it will backfire.  Be reasonable, but stay engaged. If it’s not an appropriate time to be assertive, stay in the game mentally by asking yourself what they will do next, what you would do if you were making the decisions, or what complication might occur from the decisions being made.  Write down questions you will ask after the smoke clears if it’s not appropriate to ask during a stressful situation.

 

Know what you are expected to learn before you start.

If learning objectives for the rotation are done well, they are very helpful, but many people don’t take the time to do them well (or don’t know how to do them).  For the rest of your professional life, you are going to have to define your own learning objectives.  So, in a way, learning how to do this early – during your core rotations – is also part of the skill set you need to know.  (Word of advice, though – even if they are very poorly written, you need to read any objectives you are given and make sure you accomplish them.)

To define your learning objectives for the rotation, start with a basic textbook.  Textbooks are written for residents and practicing physicians so don’t get overwhelmed – You will NOT be responsible for learning all the details in the textbook!

The strategy:

1.     Make a list of the topics covered in a general textbook for the field.  There are usually 2-3 good textbooks for every specialty.  Ask other students or residents which one(s) they recommend.  You will probably rotate on sub-specialty services during your core rotation, but don’t get bogged down in looking in sub-specialty textbooks.  Stay with the general textbook.

2.     Plan to skim and make notes on every major topic.  These should be “big picture” notes, not every detail.  If there are 60 chapters in the book and your rotation is 2 months long, you should be shooting for one chapter a day.  Keep track and make sure you get them all covered during the rotation (not after).  When you are done with the rotation, these notes should be all you will need to review for the shelf exam. These notes will also be incredibly helpful when you are studying for your Step 2 exam.

3.     Don’t read the chapters in order – read them as you see patients (see below). But, make sure that all the chapters are covered since it’s unlikely you will see patients with every disease in the book.

 

Practice being professional.

It’s really important to be professional and to be seen as professional in all your interactions.  First of all, it’s the right thing to do.  Secondly, a bad interaction with a nurse on the floor can lead to a poor evaluation by your attending.  Make learning how to behave as a professional one of your learning objectives.  Learn from those around you.  Which residents and attendings are the most professional?  Why?  When you see bad behavior (and you will), think about it – what would you have done differently?

 

Learn from every single patient you see.

Use every patient to learn about their specific disease.  Even if it’s the 30th patient with hypertenion you’ve seen you’ll still learn something new.  (or use it to learn about a different problem they have instead)

The strategy:

1.     Keep a notebook with an entry for every patient you see.  You can use 3×5 cards, if you prefer.  In fact, many hospitals have 3×5 cards with the patient info available in the patient’s chart for docs to take. (don’t lose them or leave them lying around though – which is a violation of HIPPA!)

2.     Make yourself read something about every patient you see.  If you haven’t read the textbook chapter on the subject, that’s where you start.  If you have read the textbook, review your notes and read something new (UpToDate, PubMed, or a journal article for example)

3.     Make yourself write down a minimum of 3 things you learned from the patient in your notebook (or on your 3×5 card).

 

Be the doctor for patients that are assigned to you.

You will be assigned patients to follow during your rotations.  When this happens, make up your mind that you are going to “wear the white coat”.   What if you were the only doctor taking care of Mr. Smith after his surgery?  In addition to reading (see above), ask the residents to help you write all the orders.  Write a daily note and make sure your notes are at the level of the residents (ask them to review and critique your notes).  When a drug is prescribed, know the dose you are giving, the effects of the drug and the potential side effects.  When a x-ray is ordered, be the first person to actually see the image and know the result (and make sure you call the resident as soon as you do!).  Don’t get any information second hand – make sure you see the results and the images yourself.  At any point in time, if the attending asks, you should be able to present your patient as though you are his/her only doctor, which means how they presented, their past history, social issues, test results, procedures performed and how they are doing now.

 

Prepare for conferences.

Every service has at least one or two weekly teaching conferences.  In most cases, the topic (or cases) are known before the conference.  Ask your residents or attendings the day before the conference for the topics and/or cases that are going to be discussed.  Use the strategy outlined above to prepare e.g. consider these “vicarious” patients and learn from them as if they were a patient assigned to you.

 

Come early, stay late and keep moving.

Taking care of patients in the hospital is a team sport.  The best medical students become part of the team early and are taught more just because of the relationships that are developed.  It’s human nature and it’s just the way it works.  Don’t brown nose, don’t show off…. just show up.   If there are labs to look up before morning rounds, be there 10 minutes early and look them up for the residents. If you don’t know the answer to a question the best response is “I don’t know, but I’ll find out!” If there is scut work to be done that you can help with, volunteer to help before you go home. Trying to show off on rounds will backfire. It’s particularly important not to try to one-up your residents.  You will have more time to read than the residents, so you may actually know more than they do about a specific topic.  But, if the attending asks a question and the resident gets it wrong, don’t correct them in front of the attending.  (Unless it’s a critical issue and you think the patient might suffer in which case you have to speak up!)  Whenever you can, set up the resident to succeed.  “A rising tide floats all boats” – if you help them look good, you will look good and the team will look good. Take breaks when you are tired but don’t sit in the lounge waiting for someone to come tell you what to do.  There are patients to see, conferences to attend, rounds to do, labs to look up… the hospital never sleeps!

 

Practice having a balanced life.

Compassion fatigue is a constant threat to practicing physicians.  Taking care of yourself, staying connected to family, friends and the outside work are all critical components of preventing compassion fatigue.  This, too, is a skill you need to learn during your rotations so you can carry it with you into your residency and your practice.  Use this time to develop strategies for how you will eat a healthy diet, including when you are on call, and find time to develop an exercise habit.

 

Wear the Right Shoes

Dressing correctly is part of professionalism, but shoes deserve a special note of their own.  The hospital is not a place to worry about how your feet look.  At the end of a long day, you’ll appreciate picking the right shoes to wear in the hospital.

 

Enjoy!  You are finally a “real” doctor!’’

Your experiences on your clinical rotations will be among the most special of your life. Buy a new journal and take time to jot down the funny and not-so funny occurrences of daily life in the hospital.  You will see some extraordinarily beautiful moments of human life. and some horrendous examples of what people can do to other people. We all learn to deal with these extremes by telling stories.  Make sure you find the right people and the right setting, but realize that this is an important way to cope with the transition you are making.

It’s a special world you are entering.   You’ll want to remember it by taking notes, recording stories and with pictures of your team and unique sights around the hospital. (No patients, though – remember HIPPA!)  Don’t forget to record your “firsts”… the first time you set a fracture or hear a murmur of aortic stenosis will be the only “first time” you have.

Congratulations! You are well on your way to the privilege and joy of practicing medicine. Enjoy the journey!

 

Starting Medical School: Rules of the Road

In the next few weeks 17,000 college graduates will start the process of becoming lifelong students of medicine.   Medical school is a wonderful, but at times difficult experience.  Here are five “rules” that I hope will help with this exciting transition.

 

1. You can drink from a fire hydrant, but you’ll need to learn how.

The amount of information you are going to be exposed to in medical school is logarithmically more than you had to learn in college.  At Baylor (where I teach) we calculate that the first year of medical school is the undergraduate equivalent of 22 hours of course work per semester.  It really is like being asked to drink from a fire hydrant.   You are going to have to study more, study better and actually use the time in class to learn.  The first year or two of medical school may, at times, seem like an obstacle course you have to “get through” to get to the “real stuff”.  But these first two years are important; You are learning a new vocabulary… a new language.  If you don’t learn the breadth and depth of this new language, when it comes time to apply it to patient care you won’t be “fluent”.   By the way, sometime during the first month or two of medical school you will think that a) everyone here is smarter than I am, b) the admissions committee must have made a mistake and I’m not really supposed to be here and c) there is absolutely no way to read all of this material.  But, like everyone who has done this before you, will discover that a) you are just as smart as everyone else (sometimes in different ways, but equally effective) b) nobody made a mistake – you really are supposed to be here and c) you have to change the way you study, but you really can learn this much material.

 

2. Make your bed.

You wanted to become a doctor for a myriad of reasons, but one of them was surely because service to others is important for you.   Therefore, you are already primed to sacrifice a lot of your needs for other people.  Sacrifice is part of the culture of medicine.  But, it’s like a Starling curve… a little sacrifice makes you better, but too much makes you ineffective.  “Make your bed” is a simple rule (and action) which helps you remember that you need to take care of your environment, your fitness, your nutrition and your spiritual wellbeing as you are learning how to become a physician.

 

3. Act like a doctor – starting now.

We (all practicing physicians) see you as a doctor already.  I know this is a really hard concept for first year medical students, but it’s absolutely true.  You have started your apprenticeship and, unless you are one of the very, very few who change their mind, you will have an MD after your name in 4 years.  With all of the joys and privileges that come with this role, there are a few responsibilities to start thinking about as well.  Start thinking about your decisions, words and actions and how they might be interpreted by patients or colleagues.  It’s no longer acceptable to put anything you want on YouTube, Facebook, Twitter or other social media.  How you dress and act when you are in professional settings will be important.  You’ll learn more specific details about professional behavior from your professors and colleagues as your training progresses, but the core values of medical professionalism start when you enter the profession, which is now.

 

4. Kindness matters.

It is remarkable how our paths in medicine cross over and over again.  The person sitting next to you on the first day of medical school may be someone who will be an intern with you in 4 years or who will refer you patients 10 years from now.  You and your classmates will be going through classes together (like you did in college), but this is different.  You are starting your professional life together as well.  The camaraderie that results is a gift and is also very important personally and professionally.  Don’t blow off the class events.  Don’t stay home to study instead of going to class.  Go out of your way to meet everyone in your class and really get to know them.  Cultivate and nurture these important friendships.

 

5. Enjoy the journey

You are about to embark on a life changing (and fulfilling) journey.  This journey is a privilege and it is very, very special.  Take a few minutes everyday to write down the events of the day.  The first time you hear a murmur in a heart will be just that – the first time.  Take a minute to record what that was like.  You are going to have a lot to process as you start studying anatomy – more than just the names of the structure.  “Talking” about it in a journal is a great way to make the transition we all make in the anatomy lab.   There are also going to be some hilarious stories and events that you’ll forget if you don’t write them down.  When you look at them later, you’ll be glad you recorded them with words, photos, or drawings.

 

“Our study is man, as the subject of accidents or disease. Were he always, inside and outside, cast in the same mould, instead of differing from his fellow man as much in constitution and in his reaction to stimulus as in feature, we should ere this have reached some settled principles in our art.”

William Osler, from Teacher and Student, in Aequanimitas.

 

 

 

Motivation to Exercise

For several weeks my schedule has gotten the best of me and all efforts at working out have fallen by the wayside.  So, I decided to think about fitness, motivation and the “MED” (minimum exercise dose) to maintain fitness.  Here’s what I came up with:

1. Consistency, not quantity is essential.

  • 10-20 minutes “every” day (i.e. 5 or 6 days a week) is really better than 60 minutes once a week.  Google “ten minute workouts” and you’ll find a huge number of workouts to do (or buy).
  • Concentrate on just increasing the time you move. Consider using a pedometer (cheap) or one of the more expensive monitors, like the Apple Watch.

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2. Planning helps.

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3. Having a goal works better than not having a goal.

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4. At some point you just have to decide it’s important.

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Advice for New Interns

This is the week that the roughly 16,000 new doctors in the United States will start their residency training.  Even though it doesn’t feel like it, you are ready!  The first year of medical school gave you the “vocabulary” you needed for this new language.  The second year gave you the “grammar.”  Your rotations in the clinics taught you the “language”.  Now you get to actually use it every day!

This year will be one of the most profound transitions you will ever make…. and it will also be a year of intense and fabulous memories.  Take some time to write down the stories, or take some photos (but not of patients unless you have their permission!).  These notes and images will be precious memories in the future.

In talking to other physicians and thinking about my own experiences, here are a few words of advice for you as you start your internship this week:

Learn from every patient.

As an intern, you will need to know a lot of detailed information on your patients.  You’ll need to use a system to keep track of all this information so that when you are asked, you know the last potassium level, which antibiotics were ordered and what the ID consultant said.  If you have a system you developed as a 4th year medical student, great!  If not, start with 3×5 cards. Keep one card per patient, clipped together or held together with a metal ring.   There are electronic systems available like iScut and My scut list.  I haven’t found one that I think is adequate –  but I’d love to hear from anyone who has found good software that works!  Also (very important) – if you are going to have any patient information stored electronically, please make sure it is HIPAA compliant.

That covers the information, but not the learning.  Learning is something that should be actively integrated into your day, not something you do at night when you are falling asleep.   Work on a system that lets you record what you are learning during your daily tasks in a way you can review later.  3×5 cards are a simple, cheap and very effective system for studying medicine, which I’ve described in a previous post. Make a separate card (or use the back of your rounding card) to list something (anything) you learned from every patient you see.

Don’t confuse gathering information with studying information.  Taking notes is a critical part of learning. Don’t just make files of chapters and articles… summarize them to review later by taking notes.

Be the doctor for your patients.

This may sound obvious, but in the everyday world of the hospital, it is really easy as an intern to get lost in the details of patient care… and forget about caring for the patient.  Stop every once in a while and remember that you really are their doctor.  Take a few deep breaths and put yourself in their shoes for a minute to ask something about their family, hold their hand, or just sit with them for a minute.

It’s very easy to get swept away by the velocity of the work most interns experience and lose the “big picture”.  When you are confronted with something you haven’t seen before, push yourself to make a plan before you call your upper level resident or the attending.  What if you were really the only doctor around?  What would you do?  Spend 2 minutes on UpToDate if you have to, but don’t just be a clerical worker – be their doctor.

Part of being a good doctor to your patients is to recognize your own limitations.  You should never feel bad about calling someone with more experience, no matter how “dumb” you think the question is.  It’s the right thing to do for the patient.

Be deliberate about learning your field.

From day one, commit to an organized plan of study to cover everything you need to learn in your field.  Your goal should be to learn (not just read) everything in the primary textbook for your field.

Make a plan to read (and then study to learn) a textbook every year.  Make notes that are easy to review, so you don’t have to go back to the textbook to review the material.    Whatever system you use, make it easy to integrate the notes you are making in the hospital (i.e. the 3×5 card on each patient) with your organized study system.  Adding articles into the mix is fine – but only after you have mastered the basics.  Don’t let reading the latest finding take the place of really learning the material in the textbook.

Be kind and be part of the team.

Hard work is made easier when it’s done with your friends.  You will all be tired, you will all be stressed, but be kind to each other.  Staying 5 minutes more to help out a fellow intern is an investment that will help both of you.  Look for ways to apply the golden rule of internship:  “Help others the way you would liked to be helped”.

Make your bed.

Do this simple act every morning to remind yourself to take care of yourself.  Find time to consciously take care of your emotional, physical and spiritual health. Take good food to the hospital for your nights on call.   Find ways to get stress reducing exercise into your weekly schedule, or at least find ways to increase your activity while you are at work. Watch your weight – if you are losing or gaining, it’s a sign that you need to focus on your own wellbeing by improving your nutrition and working on your fitness.   Nurture your relationships – make your family and friends a priority.  Take care of your spiritual needs in whatever way is best for you, but don’t ignore this important aspect of self-care.

Smile!

You have the enormous privilege of caring for other people and learning the art of medicine.   Take a little time every day to notice the moments of joy in this work and, if you can, write them down to look at on the days you are tired.

Congratulations to you for all you’ve accomplished thus far!  Enjoy this incredible journey!

Fast Easy Exercise: The Daily Fitness Solution

I went in search of an exercise equivalent for “fast easy recipes” and came up with a good find.   The Daily Fitness Solution provides 20 minute workouts that don’t require a gym or equipment.  It’s written by Reinhard Engels, who works in bioinformatics visualization at MIT.  So, as you might expect, his program is logical, simple and without hype.

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The workout program is more than reasonable, with rest days built in (which could be swapped with a workout day if you are on call)  No matter how busy you are, you can probably find 20 minutes!

I also liked his approach to weight loss – the  The No “S” diet:

The No S Diet, also known as the “Grandma Diet,” the “Why Didn’t I Think of that Diet,” and the “No $ Diet” is a program of systematic moderation I invented for myself that I imagine might work for similarly minded people.

No funny science or calorie accounting involved, just a few simple and mnemonic tricks for giving your willpower the upper hand.

There are just three rules and one exception:

  • No Snacks
  • No Sweets
  • No Seconds

Except (sometimes) on days that start with “S”

That’s it.

How could something this simple possibly work? Precisely because it’s simple — or rather, following the Einsteinian dictum, “as simple as possible, but not simpler.”

June’s Healthy Habit – Get Stronger

One of my New Year’s resolutions was to come up with monthly “resolutions” for myself and for anyone who follows this blog.  Cooking Light magazine (which is one of my favorite sources of recipes and ideas for healthy living) had the same idea, so I am shamelessly borrowing their healthy habits!

Cooking Light’s 12 Healthy Habits

It’s a lot easier to commit to 30 days of a new habit than a full year.  So this month’s goal is to get stronger.  How to get stronger is something that is taught in medical school.  Whether it’s strengthening cardiac muscle to improve cardiac function or building striated muscle to improve strength it’s the same concept – Getting stronger requires a progressive and repetitive load on the muscle that forces it to adapt.

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Why it’s important to lift weights

  1. Weight control.  If you are interested in losing weight or controlling your weight, you probably have been told to do more cardio.  Although cardio is important, adding weight training will greatly improve your odds of losing or maintaining weight.  The math is simple.  Fat doesn’t burn very many calories but muscle does.  If you build muscle, you increase your lean mass and, therefore, you burn more calories just sitting around (and a lot more if you are working).   In addition, strength training has an “after burn” that helps; your basal metabolic rate stays elevated for about 1-2 hours after the workout (for an additional ~100 calories worth of calories burned)
  2. Injury prevention.  There are good data that show joints are protected when you build muscle mass.  Most occupational injuries for doctors are related to the joint injury – usually spine, hips or knees.  Strengthening your muscles will increase your stamina and decrease your risk of injury.
  3. Bone health.  Critical for women, but important for men, too. You can prevent osteoporosis with strength training.
  4. You’ll look great. Women worry about looking “big” – but don’t.  You’ll get strong and lean without building bulk.
  5. You’ll feel better. Working out, in general, improves your mood.  But, there is something (literally) empowering about getting strong.


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Beginner or experienced gym rat – here’s what you need to know

  1. Warm up first! Get on the bike, walk fast, just do something to increase your heart rate and warm up your muscles.  5-10 minutes is usually enough…. but don’t skip this important step!
  2. Target specific muscle groups. The goal is to get strong in a balanced way.  Don’t neglect one muscle group in favor of another.  In general, strength workouts are divided into back, chest, shoulders, legs (quads and hamstrings) and abs, but you can get even more specific if you want.  Here is a great list of exercises for each muscle group (and a good anatomy review!):  Exercise Directory from ExRx.net
  3. Pick the right weight. It doesn’t matter if you use machines or free weights.  What is important is to pick weights that are heavy enough.  The goal is to be able to move the weight 10-12 times – but struggle with the last rep or two.  If it’s not hard to finish the set, increase the weight.  You’ll also have to increase the weights as you get stronger.
  4. Maintain your form. If you lift weights that are too heavy, you will “lose form”.  This is classically the guy (sorry, it’s usually a guy) who is trying to bench press too much and ends up arching his back to be able to lift the weight.   The problem is that “losing form” means using accessory muscles to lift the weight instead of just the ones you are trying to train.  This is how injuries happen.  Don’t do it!
  5. Do sets of repetitions (reps). Lift the weight 10-12 times (one “set”), rest, then repeat the set. Three sets of 10-12 reps should be your goal.  There is a good physiologic reason that this works , especially for beginners.  Once your muscles get used to it, though, you may want to change to different patterns.
  6. Lift weights every week. Getting every major muscle group once a week is important.  Twice a week is better.  More than twice a week can lead to injury, unless you are getting enough rest days between workouts.  The ideal goal is to work out every muscle group twice a week.  If you want to split your workouts to do more days (but less time per day) that’s fine.
  7. Rest between workouts. Don’t work out the same muscle group two days in a row.

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How to get started

If you’ve never lifted weights before, or have limited experience it can be intimidating.  This is particularly true for women, who often feel that it’s just easier to hit the cardio machines than deal with the “foreign language” of the weight room.  But – it’s really important to do this, and – I promise – it’s not rocket science.  Here’s how to start:

  1. Buy a book or go on line.  Learn one or two exercises at a time from these sources then go to the gym.  Start with light weights on purpose so you can concentrate on correct form.  As you learn, add more variety.
  2. Pay for a trainer.  If you can afford a weekly trainer, that’s fantastic – you just hired a combination of teacher and motivation!  For most students and residents, it’s more realistic to pay for just one or two sessions to set up a training program and teach you good form.  Most gyms have trainers, which is probably the easiest way to go, but you can find independent trainers in your area who will meet you at a gym or your house to do the same thing.  You can also ask a friend or colleague who is a seasoned veteran to help you.
  3. Buy weights for your home.  A set of weights is actually pretty cheap.  Add a balance ball or a bench and  you can do a lot of this training at home.

Alternatives to weights

 

  1. Resistance bands. Resistance bands are probably best used to supplement weight training with machines or free weights, but they can be used as your primary training tool.  These are great for when you are on call (assuming you have 15 minutes at some point for a quick workout) or when you are travelling. They come in a variety of shapes and sizes.  When you buy a set, the exercise program is usually included or you can find examples on line.
  2. Your body. The Marine Corps (and a lot of trainers) know that you can use your own body weight to build muscle mass.   Some great examples are pull ups and  push ups, among others.

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