It has been said that the Inuit people have a hundred words for snow. When you live in a dangerous environment, it’s important to learn the variations of snow to survive. But, when you look into the origin of the “hundred words for snow”, it turns out it’s not exactly true – Inuits don’t have more words for snow than other languages…Their detailed understanding of snow is a lived, not spoken vocabulary.
The same is true for those who spend nights awake working in a hospital. We, too, have a lived vocabulary that includes hundreds of subtle variations of fatigue, even though we don’t have words to describe them. (The closest I’ve come to being able to describe this fatigue is in “sleep equivalents”, specific events or things that makes you feel like you have had more sleep than you actually did. For example, a shower after being up all night can give you the equivalent of anywhere from 20 to 60 minutes of sleep depending on how tired you are. Brushing your teeth after a hard night of call is usually 5-10 minute sleep equivalent. A good strong cup of coffee can be as much as 45 minutes of sleep equivalent – although it’s important to titrate it so you don’t end up with anxious jitters instead of just being awake.)
Knowing how to manage this level of fatigue it is part of medical training. (Don’t get me wrong… I’m not advocating that trainees must get tired on a regular basis to “learn how to manage it”) Learning to successfully manage the fatigue of long days and nights on call hinges on two things and both have to do with deliberate choices.
Learning not to trust your first instinct if you are sleep deprived is the first important lesson. Even if it’s a drug you know well, or the chest x-ray looks ok, stop and be deliberate. Consciously review the data, look at the options and, for really important decisions, ask someone to look at the situation with you.
The second lesson in managing fatigue is maybe even more important. The bone deep fatigue of medical training is not solely the result of sleep deprivation. When you stay up all night you also lose the liminal spaces of waking and falling asleep, the threshold between night and day. In scientific terms, this means there is a major disruption of your circadian rhythms. But it’s more than just physiology. The drowsy moments between sleep and being awake take place in the liminal spaces of dawn and dusk. We lose more than orientation to daylight when we lose this liminal space. The Irish poet and priest John O’Donoghue, teaches that liminal spaces are moments and places where the spiritual touches the finite. By losing the profoundly important rhythm of rest – including these liminal spaces – we end up physiologically, psychologically, and spiritually unmoored.
You have to be deliberate here, too. By trial-and-error work to find the things that ground you, the things that help you recover in a deeper way than just catching up on the sleep. Make lists of anything and everything that helps you recover from call for the times you are too tired to remember or choose. Look at those lists before you leave for your call day and choose something to do for yourself when you leave the hospital the next day. It might be going to the gym for a light workout, having a great cup of coffee in a cafe, a slow, grateful walk outside, playing with a pet, a hug from a loved one…or finding a way to “play” outside.
May the sacrifice of time and sleep you make for others come back to you as joy … and may you find deep rest in knowing you make a difference in so many lives.
Every year about this time I put out a list of the best presents for folks about to start medical school, nursing school, physician assistant school or any medically related school … as well anyone “leveling up” to the next level of training in their field (i.e. internship, residency, fellowship, etc). This is my edited post for 2023. I hope it gives families and friends ideas on how to support the people they love who are learning how to heal.
The Gift of More Free Time
The everyday needs of a household can become oppressive if you are working 80 hours a week. And, because bathrooms need to be cleaned, and floors need to be vacuumed, this is time that takes away from downtime needed to recover from hard work.
Here’s a list of things that just about every healer or healer in training would appreciate to help free up time:
A cleaning service. Hire someone to do a “deep clean” of their home once a month. Look on the internet for bonded cleaning services or call people who might know the best companies.
Car washes. Who doesn’t love a clean car…. and who has the time to wash and vacuum their car?
Instant Pot. The number one time saving kitchen appliance for busy people is the Instant Pot. My Instant Pot has fundamentally changed the way I cook – and has made it easier to eat well.
Air Fryer. I’m a new convert to air fryers. 15 minutes to get wonderful roasted or air fried veggies is amazing! Hard to choose between this and the instant pot. There is an instant pot with both, but I’m not sure it does quite as good a job as an air fryer.
Gift certificates for food. Do a little sleuthing and find a healthy grocery store near where they live. Other ideas might be a smoothie or juice shop, their favorite restaurant(s), or coffee shops
Prepared meals. Most cities have small, local companies that deliver prepared meals to your door. That would be my first choice (support local!) but there are also national companies and do this, too. Most companies offer gift certificates which is probably the best plan to give flexibility between a subscription or a la carte ordering.
Home cooked meals. If you live near, think about cooking a batch of favorite food(s) and putting them in single serving containers to freeze. You might also want to create a certificate for your personal “cookie/meal/soup of the month club” with a promise to deliver food once a month.
A Good Cookbook. Mark Bittman’s cookbooks are all wonderful, but How to Cook Everything Fast is a particularly good choice for busy people.
Vitamix. It may seem expensive for a “blender”… but this is much more than a blender. These are the blenders you see in professional smoothie stores. Smoothies become a lifesaver for busy healers. (The Vitamix also makes great soups, sauces, etc…..)
The Gift of Good Beverages
Insulated Coffee Mug. Rounds in the morning often starts with “running the list” around a computer, often at “dark thirty” when the rest of the world is just thinking about getting up. Having good coffee or tea from home or a local shop that stays warm for several hours is such a pleasure. The mug of choice for just about everyone I know is a 10 or 16 oz Yeti tumbler.
Water Bottle. No one drinks enough water at work in the hospital (and we all agree on this). Again, having a great water bottle that you can fill in the morning with ice water (and a slice of lemon if you like) makes the day better.
Nespresso (or other) coffee maker. If they are a coffee drinker, a good coffee maker is key. Nespresso is my personal favorite, but be creative and look at all the options!
Good coffee (or tea). There are local roasters in most cities, so rather than support the big chains, look for them and consider a gift of coffee.
The Gift of Music
For those who find solace and joy in good music (and isn’t that just about all of us?):
A good Bluetooth speaker for their home or study space. I love the Klipsch The One II speaker I have at home, but I’m sure there are other equivalent speakers, including some that aren’t as expensive.
Air pods or noise cancelling headphones
A subscription to one of the many streaming music services like Spotify or Apple Music.
Tickets to the symphony, ballet, jazz performances, or opera in the city where they live.
The Gift of Good Sleep
Good mattress, pillows, sheets. How we sleep determines how well we function the next day, particularly in high stress jobs. Is it time for a new mattress? Is there a better mattress that might help? High quality sheets are usually a welcome gift, too.
Light blocking curtains or shades. Post-call sleep is during the day and sunlight can interfere with sleep. Special curtains or shades to block the sun really help.
Nothing Much Happens. This is a free podcast with the subtitle of “Bedtime stories for adults”. Since it’s a present, think about supporting this wonderful series with the very cheap subscription (which means you get the stories without ads.)
The Gift of Healthy (and not aching) Feet
Working in the hospital means a lot of time on your feet. John Wooden, probably the most famous basketball coach of all time, spent the first week of training every year teaching his players how to put on their socks…. because he recognized that if you didn’t pay attention to your feet, it would affect your game. The same is true in medicine.
Good socks. Don’t go for cute, go for high quality, well padded, and functional.
Compression socks. There is some debate about whether compression socks can really prevent varicose veins, but there is no debate that your feet feel better at the end of a long day when you wear them!
Pedicures. Lots of women (and some men!) have learned the joy of a professional pedicure for tired feet. Don’t underestimate the power of a gift certificate for pedicures. But, as an alternative, put together a kit for home pedicures.
The Gift of Fitness
This might not apply to everyone, but most people who work hard know that they feel better if they exercise a little every day. But – a word of caution – tread lightly with fitness gifts since they can be misinterpreted as conveying a “need” to exercise.
A bicycle. For many people a good bicycle can make it easy to add some exercise by commuting to work by biking instead of driving. Regardless, it’s a great way to get some exercise outside. If they have a bike they use to commute, you might think of some ways to make it easier such as
A gym membership. You may have to do a little detective work to find the right gym that is close to where they live, but it’s worth it.
New shoes. Runners are supposed to get new shoes every year or so. Give them a gift certificate from a running store near them, if there is one. Or, be creative and put cash in a tiny toy shoes and wrap them in a shoe box.
Fitness equipment for home. Resistance training is important for all of us, regardless of gender or age. Although a bench and weights are part of the classic home gym, they take up a lot of room (and weigh a lot!). I’m a big fan of the TRX system, which makes a great present. Since it has become almost a cult among physicians during the pandemic, I have to at least mention Peleton as another potential fitness gift for healers and healers in training.
The Gift of Calm
Massage and/or Spa Services. This, too, may take a little effort to find the right place, but this is a wonderful gift for stressed people.
Headspace. This might seem a little unusual as a gift idea, but I can’t recommend it enough. Meditation is discussed in most medical schools and hospitals as a tool to gain insight and recover from the depletion that is part of the work we do. The best way I’ve found to learn this practice, and then stick with it is Headspace, which is a great app. The first 10 lessons are free, but for a gift, go ahead and get the annual subscription.
The Gift of Time and Stories
Human beings heal their hearts and souls by telling stories. Although there are many stories your loved one can’t tell you (at least not the specifics) you can totally ask how what they are seeing and doing is making them feel. Set aside some time for a coffee or another beverage and ask – with intention – “How are you doing?” And then just listen. Don’t try to “fix” anything … just listen.
Along the same lines, think about a letter… yes, a handwritten letter or note. Maybe a long one for a specific holiday or birthday, maybe a series of shorter ones through the year. Imagine how you would feel after a particularly hard week if you had a letter to reread that talked about how proud someone was of you, filled with funny stories and words of support.
Every year about this time, I try to put together a list for people trying to find the right gift for someone they know who is graduating from medical school.
If you haven’t heard of @medgradwishlist on Twitter, it’s an amazing grassroots effort to create Amazon wish lists for URM medical students with financial needs to help them get ready for their internship. This is a brilliant “pay it forward” initiative. I’ve been a Program Director and a Dean of Student Affairs and I know how many new grads finish medical school with enormous debt and empty bank accounts. The ~17,000 students graduating from medical school this year are about to start on the exciting – but stressful – path of becoming a physician. Not being able to afford the things that make that journey possible just isn’t acceptable. You can buy things on their list anonymously (or not). When you find the right thing for the right person, don’t forget to include some memories of your internship, advice, and words of encouragement!
If you are a student (or even a struggling resident) in need, please join this effort to get what you need. We are sure you will pay it forward to extend this support future classes! If you are a student who can afford to support others, please do. And regardless of whether you participate in #medgradwishlist or not, the following ideas will help with graduation presents.
I spent quite a bit of time looking at all the #medgradwishlists on Amazon, and I’m happy to share what I learned. In addition to their great ideas, I have some suggestions to add…
Instant Pot. This was on a lot of the Amazon lists, and I agree!!! II had to suggest one item to make life as a resident easier, it would be this. Several people asked for air fryers on their Amazon lists. I love my air fryer and use it all the time so please put it on your list if you think it will help. Just as an FYI, you already (sort of) own an air fryer since your oven set on convection does close to the same thing!
Someone to help clean and do laundry. I know you can’t put this on an Amazon wish list, but if you have a family member who either can do this for you, or pay someone to do this for you, it’s one of the best gifts you will ever receive.
Digital gifts to make communicating and studying easier. The single most important tool for an intern is their phone. If they don’t have a new phone that can reliably work with WIFi and cellular, this should be at the top of the list. A computer that works, has the ability to do streaming well, and is reliable is also key since it’s how they will study, write, and watch educational videos. They’ll want the flexibility of studying in a coffee shop (once we get COVID19 under control) or on their couch so make sure it’s a laptop and not a desktop computer.
There were some great ideas on the Amazon lists for items that aren’t quite as expensive as computers that you might consider as well: ring light for Zoom meetings, LED study light, lap top desk for your lap, iPad Pro, Apple pencil.I should add that buying a large quantity of pens to be “borrowed” by attendings would be a big win, too.
The kitchen (other than the Instant Pot). It’s so important to eat well when you work as hard as interns work (and to stay well caffeinated). There were some great ideas from my new colleagues on their Amazon lists including single serve coffee makers, pot and pan sets, nonstick bakeware set (if they are a baker!), wine opener :-), food storage bags and containers. A box or two of Kind Bars (my favorite) or other meal replacement bars is a great gift, too. And for the times cooking is just one task too many – Door Dash, Uber Eats, and/or Grub Hub gift cards are a great gift. One other must have… a Yeti mug to keep coffee hot during rounds!
Clocks and watches. We all have phones that can serve as alarm clocks, but an alarm clock that gently lights up the room is a much better way to wake up than sudden noise. I wouldn’t say an Apple watch is essential (and if you do a lot of procedures it might be easy to lose) but it is worn by a good percentage of docs.
USMLE3 study book. If you are a family member who is thinking about getting this as a present, you might also want to include a check for $895 as a “bookmark” to cover the cost of registering for this exam.
Make your home a stress-free zone. If you are setting up a new home, this list can be really extensive. You’ll need to go home to a clean, happy space, so whatever you can do to make that happen is important. There were a lot of good ideas in the Amazon wish lists including self-cleaning cat boxes, pet hair removal brushes, furniture, shower curtains, towels, and a video doorbell. I’d add a Roomba vacuum cleaner to this list, too! BTW, a good TV is important, too. We all need to binge watch the Great British Baking Show as therapy sometimes.
Sleep. In this category I would include good quality pillows, a new mattress, light blocking curtains, white noise machines, and electric or weighted blankets.
Music. Most people fill their space at home with sound as well as light, so think about good WiFi speakers like Sonos and/or gift certificates for ad-free music services like Apple Music, Spotify, Pandora.
Health. Last but not least! The most important thing on this list in my opinion is a great water bottle since, particularly with masks on all day, none of us drink enough water. A new Sonicare toothbrush or WaterPik for dental health will be appreciated. Foot care is another important part of being a healthy resident, so consider gifting compression socks, new shoes for the hospital, work insoles and/or a foot massager. Anything that promotes or makes fitness easier is also a good gift – a new bicycle for commuting, workout gloves, free weights, resistance bands. You might also consider a meditation app like Headspace, or subscription to yoga classes on line.
Scrubs. I noticed a lot of folx asking for scrubs. Nope – don’t do it! You will be required to wear the scrubs from the hospital since there are rules about them being washed in the hospital laundry. Ditto for things to wear under scrubs. You’ll get too hot, they get dirty, and they are against the rules in all operating rooms (and many hospitals)
Textbooks. You are pretty much guaranteed to have access to a library where these books will be in digital format and free. These books are heavy! You aren’t going to take them to work and when you get home, you may have other things to read that take priority.
Printers. Printers (and printer ink) are expensive and you just won’t use them. You are going to have to stay digital to really learn what you need to learn as a resident. Besides, if you do need to print out the return slip for Amazon, there will always be a printer at the hospital you can use!
Black bag. If you are a family member thinking of getting one of these… don’t.
May your journey through this liminal time be as stress free and as joyful as possible. May every day as an intern bring you hearts to heal and hands to hold, new learning, and a sense of wonder and awe.
We are so happy you are joining us in this noble and sacred work!
Every year about this time, I create a list of presents I think busy healers (and healers in training) would appreciate. I don’t have to tell you that this has been a year that for all of us, but especially for everyone in medicine, has brought a new level of stress and sadness. The healers need healing… and in that spirit, here are some ideas of what you can send your friends in medicine for Hanukkah, Kwanza, Christmas, the Winter Solstice… or to celebrate the end of 2020 and beginning of a new year of hope.
#10.White coat, jacket and/or scrub “bling”. Everyone who works in a hospital has a badge that must be worn all the time. And we all need pens (except for the attendings… we just “borrow” pens that students and residents keep in their pockets for us … just kidding … mostly). Here are some suggestions: Find a lanyard or badge holder from their favorite sports team or that will otherwise have meaning for them. Buy a box of cheap pens (that can be given away to needy attendings) + a great pen that will remind them of you every time they write with it. For white coats, find a meaningful or humorous pin that could be worn on other clothes as well.
#9 Happy Feet. Think about putting together a “happy feet” box – include things like warm slippers, good socks, a certificate for a pair of shoes to wear in the hospital, compression socks, toenail clippers, and any other foot care products that sounds right.
#8 Better sleep. Sleep can be hard if you have had a really hard stretch at work. It’s especially hard if you’ve worked all night and have to sleep during the day. You can put together a combination of gifts like new high-count sheets, eye covers and ear plugs for sleeping after a night shift, a certificate for a new mattress, a white noise machine or a weighted blanket.
#7 Work food. Busy students and residents frequently miss meals. Think about creating home made “snack packs” for the hospital by combining options like nuts, dried fruits, and high quality candy into small zip lock bags. Or buy healthy meal replacement bars in bulk. Make sure they are high quality, real food bars. My favorites are Kind bars but there are many other bars that are healthy and delicious.
#6 Gift cards. When you ask students and residents which gift cards would be most appreciated it’s pretty consistently these three: Amazon, Trader’s Joes, Whole Foods or other grocery stores, and Starbucks.
#5 Digital upgrades. A high-quality phone is a critically important tool in the hospital. Everyone in medicine spends a good part of the day texting each other, looking up patients on Haiku (the Epic phone app), checking UpToDate for the latest treatments, finding other medical information in many other places and – of course – staying in touch with our teams, friends and families. Up to date computers, iPads, and AirPods (or equivalent) are also great gift options for any student or resident.
#4 A cleaner house. Pre pandemic, I recommended someone to help clean as the number one gift for medical folks. But, even with the limitations imposed by COVID, there are still gifts that can help! Number one on this list would be a Roomba so they don’t have to vacuum.
#3 Healthy meals at home that don’t take time. The Instant Pot has been my top recommendation as a gift for students, residents and busy healers for several years. Another wonderful gift I’ve recommended before is How to Cook Everything Fast: A Better Way to Cook Great Food by Mark Bittman. This year, I would add a certificate to meal delivery plans. The one I use is Clean Creations (because I like to have vegetarian options), but many of my friends swear by Freshly. Every city has companies that are similar, so do some homework and you’ll find several to compare. If you are a good cook, you might consider creating your own “meal deliveryservice” for your loved one, especially if you live in the same city.
#2 Caffeine. This comes in different forms for different people, but unless they avoid caffeine for religious reasons, almost every healer and healer in training I know has a go to form of caffeine they love. For most people, it’s coffee. The number one gift on the list (my opinion) for coffee lovers is a Nespresso machine (and some pods to go with it). You can also get them a metal “pod” for their own coffee rather than the Nespresso pods which will save some money. There are other options for pod coffee machines, so you might want to read about them all before deciding. Having tried coffee from a variety of machines, I personal think Nespresso makes the best cup of coffee, but I am partial to espresso. Another great gift option for serious coffee drinkers is programmable coffeemaker so their coffee is ready when they get up at “dark thirty” to get to work. For tea drinkers, there are many options for teas, brewing systems, and pots. For all healers, regardless whether they are coffee or tea drinkers, a gift at the top of the list would have to be a Yeti or Contigo tumbler. These tumblers keep coffee or tea hot for hours… so your drink is still there and still hot when you get pulled away from that first sip.
#1 Money. Students and residents, with rare exceptions, don’t have money for special things. Some don’t have enough money after rent and loans for things most of us would consider essentials. Giving money may seem a bit impersonal, but you can make it personal with a letter, a card, or creative packaging.
Like most of
you, my New Years resolutions in past years have been something like “Exercise
every day” or “Eat fruits and vegetables with every meal.” And, I bet that you
had the same experience I did… a few weeks of “success” and then they seemed to
fade away. The problem with these kinds of goals are how they are structured.
They end up being “either-or” goals … you are either able to do them or, more
often, you miss a day (or two… or three) and feel like a failure.
It’s a simple, but very powerful concept. Set your goal as a destination… as a “lighthouse” in the distance, and then head in that direction every day. As Ryder Carroll explains, “When goals are lighthouses, success is defined by simply showing up, by daily progress no matter how big or small…”
So instead of the usual New Year’s Resolutions, pick a few “lighthouse goals”. Write them down and keep track of how you are doing (every journey needs a map). This can be as simple as one piece of paper for each goal, but I am such a fan of the Bullet Journal, I hope you consider using it.
When you get up every morning think about how to move towards your goal(s). If you veer off course, that’s part of the journey…. look up, find your lighthouse, and correct your course. Every once in a while (maybe monthly?), look at the progress you’ve made and celebrate it! If, on the other hand, the goals you originally chose don’t make sense for you any more, pick some new goals, draw a new map and start over.
Potential New Year “Lighthouse” goals
Learn
more about compassion and practice it
Be
a better friend
Write
genuine thank you notes to people who have helped me
Become
more fit
Eat
real food for as many meals a week as I can
Find
out more about who I really am through meditation
Keep
a “stop doing” list
Be
better at my work through deliberate practice (practicing and learning the
things I don’t like and aren’t good at until I’m better)
Stay
organized so I don’t waste time (and end up focusing on trivial things instead
of what’s really important)
Read
things that bring me joy
Learn
about and use a Bullet Journal
Find
a community to support me
Learn
the names of as many people at work as I can
Take
the stairs as often as I can
Make
my living spaces enjoyable spaces
Keep
a journal to remember milestones and work out struggles
Today I have the incredible joy of talking to the medical students on our rotation. No agenda, just a conversation that they requested for some “advice”. They just started their surgery rotation last week and it’s their first rotation. First rotation, beginner’s mind, unbridled enthusiasm… it is so wonderful!. I decided I would come up with what I wish someone had told me at the beginning of my rotations…
Be mindful, deliberate and excited about learning.
This is probably the most important piece of advice I can give. Clinical rotations are often a whirlwind of work and you can be swept away without realizing it. Residents can ignore you, people can be cranky, patients can be difficult… and in the midst of all this, you are expected to learn to be a doctor. You have to stay in charge of that mission, no matter what is happening around you.
Take a little time to reflect on why you are doing this and what kind of person/doctor you want to become. When times get tough (and they will) hold on to it. If it helps you, come up with a slogan to repeat, keep on a piece of paper in your wallet or on your wrist
Learn about the practice of mindfulness. Mindfulness has been shown to be effective in decreasing stress and may help to prevent burnout. It’s not hard to learn, but it’s hard to master … which is the point of a “practice”. (e.g. the practice of medicine)
Learn to keep a “beginner’s mind”. When I was a student on core medicine I had a senior resident that showed me what beginner’s mind looks like. It was 2am and I was tired. We were seeing a gentleman at the VA hospital for his diabetes, hypertension and some electrolyte abnormalities. I presented the patient to the resident and then we went to see him together. He had a rash, which I thought was so insignificant that I didn’t even include it in my presentation. But, instead of scolding me, this resident got excited. Yes, you read that correctly, 2am and excited about a rash – because he didn’t know what it was. (This next part will date me, but it’s a great example to make us grateful for the access we have to information now). He called security and had them open the library. We spent a wonderful hour looking through books – like a treasure hunt when we were little kids – until we found the rash in one of the books. We were laughing, excited and couldn’t wait to get back to start the appropriate therapy.
Understand what you are going to learn (the big picture)
On every rotation, you will be given a list of learning objectives. By all means, know them, study the things listed and make sure you know them (they will be on the test). BUT… please realize that diseases don’t stay conveniently siloed in a single specialty so this is not learning “surgery”, it’s learning about how surgeons approach a specific disease you will see elsewhere, too. You also need to know that what is listed as learning objectives today may well be obsolete tomorrow (if they aren’t already).
You have chosen a career that ethically demands life-long learning. That means that one of the most important skills to learn is how to develop a system of learning that you can use in medical school, residency and later in practice.
Learning is iterative. You will learn broad concepts on each rotation along with a “fly over” of the entire terrain of the specialty You will need the information you learn on your surgery rotation on your medicine rotation when you are consulted on a patient with an ischemic leg who needs surgical treatment, or on your pediatrics rotation when your patient with a pneumonia develops an empyema. If you choose surgery at your career, you will read and learn the same topics throughout your residency (and after) but with increasing depth.
Pay attention to ergonomics, diet, exercise and sleep. Most importantly, take care of yourself emotionally and spiritually. You can’t learn or serve others if your tank is empty. Come up with what is important for you and make a list. Seriously. Make a list of what you find helps you stay on track and then check it off every day. Look at it before you go to bed. Celebrate the things you did and don’t be hard on yourself for the ones you didn’t get to.
If it gets too hard, seek help. It’s a sign of strength, not weakness, and most (if not all) of the people around you have been there.
We have the most amazing job on earth. When the administrative issues or political conflicts get to you (and they will), just remember – you get to take care of another human life with the goal of relieving their suffering. What could be more important than that?
Starting medical school is one of the most exciting moments in a physicians career… but it can be a little daunting! This talk is one I gave recently to the college students in the Baylor College of Medicine Summer Surgery Program. In addition to talking about how medical school is different from college, I also included my top 10 tips for successfully making this important transition.
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.
“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.
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
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
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.
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
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!
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.)
Log all cases (if this applies to you) the same day and finish medical records within 24 hours.
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)
This is a truly wonderful piece from Emily Gibson, re-posted here with her permission from her beautiful blog, Barnstorming. Enjoy!
As 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.
