Tag Archives: Exercise

Things I Wish I’d Known From the Beginning: Preventing Back Pain and Injury

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When it comes to protecting your lower back as a surgeon it’s all about multifidus. 

So says Professor Takuya Shimizu, an orthopedic surgeon and professor of sports science at Chukyo University who I heard speak at the 124th meeting of the Japanese Surgery Society. 

I never learned about multifidus in anatomy class, and if you are a physician, I suspect you didn’t either. According to Wikipedia, “The multifidus (multifidus spinae : pl.: multifidi) muscle consists of a number of fleshy and tendinous fasciculi, which fill up the groove on either side of the spinous processes of the vertebrae, from the sacrum to the axis.”

I hope the experts forgive my “translation” of their expertise, but here is what I wish someone had told me about protecting my back (and decreasing back pain). 

Anatomy. In the first year of medical school we learn about the large muscles that flex and extend the lower back – rectus abdominis anteriorly and the erector spinae posteriorly. Deep to these muscles are the muscles that stabilize the segments of the lumbar spine, and multifidus, for surgeons, is probably the most important of these muscles. 

This is the slide from Dr. Shimizu that explained this in a way I could really understand. The “global” muscle in his slide is the rectus abdominis which we contract when we lean forward to operate or examine patients. If you have weak segmental muscles (i.e. the multifidus), a disproportionate force will be transmitted to the weakest point in the spine. For most people, that’s L5-S1. If you work to strengthen the multifidus (“segmental strategy”) the force generated with flexion will be distributed along all the vertebrae – which helps prevent pain and injury. 

How to strengthen the multifidus. 

“Walk like a model”… which is a conscious, three step process as explained by Dr. Shimizu. The goal should be to do this as often as you think of it (on rounds perhaps?) … and hopefully for 10,000 steps a day! (any amount helps, though)

There are also specific exercises you can do to strengthen the multifidus. The classic core exercises known as  “bird dog” and “superman” are among the most effective. (Dafkou, 2021). Others that help include side planks, quadruped leg lift, and one arm pushup on a counter or bench. There are many more, so if you want a complete list, just google “multifidus exercises”.

Another excellent option is Pilates, which has been shown to be effective in strengthening deep core muscles and reducing low back pain. (Eliks, 2019). Tai Chi, yoga and other similar practices are effective in strengthening core muscles as well. 

This amazing art is from the team at Codex Anatomicus… make sure you check out their website! 

p.s. If you are a physical therapist, sports medicine expert, or have other expertise in this area, please comment below to add your expertise!

p.p.s If your back really hurts, please go see a good physical therapist.

To Those Whom Much Is Given…

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96. everything is power-law distributed

97. everything is power-law distributed

When someone writes about 137 life hacks and two of them are a) identical and b) something you have never heard of, you can’t help but dive down that rabbit hole… 

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So, what is a power-law distribution? 

A power-law distribution is the statistical description of change that is proportional to the power of the change, in other words, change that is logarithmic, not linear. One of the classic examples of a power-law distribution curve is how income is distributed in society. 

Although there are many uses for this principle in the world of finance and economics, power-law distribution can also serve as a mental model to help us understand ourselves, each other, and the world we live in.

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For those who are healers, or who are studying to be healers, there are three uses of this mental model that I think are particularly relevant: 

1) Hacking your studying

2) Investing in your future

3) Understanding inequities 

Hacking Your Studying

I unknowingly wrote about power-law distribution when I explained the “forgetting curve” in this post: “How to Ace the NBME Shelf Exams, In-Training Exams and Your Boards”. I recommend you read the entire post, but the take home message is this: Cramming never works if your goal is learning how to heal. What works? Repeating information you want to learn at least five times in gradually increasing intervals (ok, you type A folks… get out the spreadsheet).

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The best time to plant a tree was last year. The second best time is today.

The power-law distribution also helps you understand why you need to start investing for your future – today.  The chart below is what happens if you invest $100 a month starting as a new grad and keep doing it for 35 years (assuming a 6% return on your investment) 

p.s. Here’s the website to do this calculation with different variables-  investor.gov calculator

This kind of “investment strategy” also works for exercise. Wow, do you gain strength and fitness fast at the beginning… and how sad that it only takes about six weeks to lose most of what you previously gained if you stop (both are examples of power-law distribution). Like financial investment, investing in your body with small “doses” of consistent exercise is the best strategy. For most of us who work in a hospital, the amount of walking we do at work is close to the recommended minimum for fitness (#GoodNews). Just accumulate a few more minutes at a higher heart rate (take the stairs, speed walk to the next consult, etc), add some body weight strength exercises like pushups, and you are good! 

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Understanding Inequities

Investing for the future and how to hack your studying are important, but there is an even more important use for this mental model… It can help us better understanding the inequities in our society and in our work. 

It’s easier to accumulate resources if you start with more. This principle is why young faculty members with limited mentorship or disproportionate service at home or at work end up not advancing. It’s why marginalized youth without resources to obtain education or connections struggle to break free from the cycle of violence and poverty. It’s why those who “have” (money, education, privilege) end up with disproportionate success (or access to care) when compared to those who started with less. Yes, there are exceptions, but they are just that… exceptions to the powerful force of power-law distribution. 

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There are hundreds of examples of power-law distribution including the beauty of fractals like the pattern in this beautiful head of romanesco broccoli or the curve of a beautiful seashell. (It’s worth looking at the list… some of them are fun!)

Maybe Alexey Guzey is right…

96. everything is power-law distributed

97. everything is power-law distributed

A Hundred Words for “Tired”

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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.

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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.

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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.

Rethinking “Exercise”

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I recently read a book that changed the way I think about exercise…for real. It not only provided scholarly (but very readable) insights –  it also made me feel less guilty about “not exercising” while giving me some new tools to think about caring for my body. 

If you are in the 10% of people who exercise regularly without thinking about it, great. For the rest of us, here are my key takeaways from Daniel Lieberman’s book, Exercised.

Along with many other aspects of our daily life, exercise has been “medicalized”. 

Every week in clinic, I talk to young parents who have been sent home from the hospital with instructions to feed their baby [xx] mls of formula every three hours. They set alarm clocks! They often end up feeding their baby when the baby isn’t hungry, and don’t give a little more when they know the baby is still hungry after they are fed. This is “medicalizing” food and it is not only silly, it can be harmful. 

In our personal lives we medicalizing food (aka diets… which don’t work in the long run)…and we medicalize exercise. We have all learned the “dose” of exercise that is now recommended: 150 minutes per week of moderate exercise or 75 minutes/week of vigorous exercise (plus weight training twice a week). When you step back and think about it… really? The same “dose” for all of us? The same “dose” every week? 

We evolved to be couch potatoes

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The struggle to exercise is normal! We are fighting evolutionary pressure to not waste energy, to move only enough to take care of our needs and the needs of our community. Our bodies haven’t changed over the centuries. What has changed is our environment, which has become so efficient that we don’t have to move as much to walk through our day. So how do we fight back against our programing to be couch potatoes while honoring the need to keep our bodies physically healthy? 

Just move (which you already do)

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“… if you are a typical person who barely exercises, it would take you just an hour or two of walking per day to be as physically active as a hunter-gatherer. (p. 19)

The average healer in a hospital easily meets the goal of walking for more than an hour a day, Congratulations! You don’t need to “go to the gym” for another hour! There are other reasons to exercise (you will have to find a way to lift weights and stretch), so don’t take this as carte blanche to ignore your need to be fit, but quit beating yourself up for not “exercising”. 

Stand up.

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Sitting for prolonged periods is not good for you, primarily because it promotes the slow burn of mild inflammation. You don’t have to medicalize this, either, but don’t sit without breaks. Just stand up, fidget, walk to the water fountain… whatever it takes to move.

Play.

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Breaking a sweat doing something you love is not only good for your body, it’s also good for your soul (and your sleep). Reframe! Find something you love to do that will let you break a sweat. (Note, the key word is “let”, not “have to”). If it’s outside, even better, but just go play. 

Even a little exercise can make you happier!

Take the Stairs

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When I was an intern, I had an attending who always took the stairs.

Twelve flights.

Fast.

Multiple times a day.

We’d be on the second floor and he’d announce “Let’s go see Mr. Smith.” He would take off to the 12th floor with a trail of panting residents and students spread out behind him. Here’s the punch line: Every summer he would take a vacation to climb a mountain. To get ready for the climb he did…nothing. Climbing the stairs was enough.

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Why you should take the stairs

It is a great way to keep from gaining weight during med school and residency since it burns three times the calories of a brisk walk (even at a slow pace)

As little as two flights of stairs climbed per day can lead to losing 5-6 lbs of weight in a year.

You burn 8-11 kcals per minute climbing stairs.

Climbing stairs is essentially a series of vertical lunges.  You’ll tone your leg muscles – good for both strength and appearance.

55 flights of stairs/week = overall decreased risk of mortality.

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Tips on taking the stairs instead of the elevator

Even if you are fit, you’ll be out of breath climbing stairs. It’s normal.

Make sure you don’t overuse your calf muscles to power up the stairs – use your quads, hamstrings and gluts to protect your knees.

It’s ok to take the elevator down if you want to. Walking down stairs is actually much harder on your joints than taking the stairs up.  If you choose to walk down, use the rails (it’s stupid to fall).

It’s ok to use the rails going up the stairs. It provides a little upper body workout and doesn’t really diminish the advantages of climbing stairs.

Want to add more?  Find a more isolated stairwell and do additional exercises on the landings (e.g. crunches, burpees, pushups). Do “ladders” – up and down one flight, then two, then three, etc.

Want to go to the next level? There are actually “races” to climb the stairs of tall buildings.

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Top 10 Holiday Gifts for Busy People (including medical students and residents)

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What’s the best gift for a medical student or resident (or any really busy person)?

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Seriously, anything that frees up time for them is the best present you can give them.  If it supports their health or decreases stress, it’s even better!

Here are my top ten choices for best presents for medical students and residents – or any really busy person:

  1. A service or person to help clean their home.  Once a month?  Once a week? Any time they don’t have to vacuum or clean the bathrooms is a true gift.

Portrait of man with cleaning equipment

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  1. An Instapot. I’ve long been a fan of pressure cookers, but the Instapot takes it to the next level.  This is my new favorite kitchen tool and it’s high on my list because it both saves time and increases healthy food consumption!

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  1. A subscription to Headspace. This might seem counter-intuitive since it adds a 10 minute task to their day… but there are data (and lots of testimony) that a daily mediation practice “expands time” by decreasing stress.

Link to Andy Puddicombe’s TED talk (the founder of Headspace)

 

  1. If they live close enough to walk or bike to school/work, think about something that might help them combine that commute with getting some exercise. How old is their bicycle?  How about panniers to store gear on a bike? Would a great backpack help if they are likely to walk?  How about a gift certificate to a bicycle shop?

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  1. A gift certificate for Whole Foods or any place near them that has good, healthy prepared food.

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  1. Cookbooks with quick but healthy recipes like Thug Kitchen or Mark Bittman’s How to Cook Everything Fast.

 

  1. A Roomba vacuum cleaner. Plus, they may go viral with a cat on a Roomba video if they have a feline roommate.

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  1. A gift certificate to have their car washed and vacuumed every few months.

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  1. If they are a coffee drinker who spends time stopping at Starbucks, think about a really good coffee maker. I prefer Nespresso because the pods are recyclable (and the coffee is delicious).

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  1. Your time. Can you cook some meals once a month and put them in their freezer?. Do laundry? Bake cookies and mail them? Get their car washed? Make an elaborate certificate with something you could do for them and wrap it as a present.

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New Year Resolutions

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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.

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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.

 

It’s the First Day of Medical School – What Should I Do?

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I’ve written before about what to do before medical school starts, how to study in medical school and strategies for succeeding in the basic sciences. But how do you put this information about organizing your studying and your day into a system that works?   Everyone will have variations on how they do this, but there are some fundamental principles that apply to all.

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Don’t get behind

From day one, the material matters and, from day one, it is voluminous. If you get behind, it’s really hard to catch up.

Study, don’t just read and reread.

You have to actively engage this material and review it (multiple times) to really learn it. You are no longer studying for a test, you are studying to take care of other people. The SQ3R method is used by many students, but there are other systems as well. What is important is to develop a system that works for you.  One tool used by many students is Anki, software that allows you to create electronic flashcards to review key points.

Tips on active studying from UCSD

Tips on active studying from the University of Utah

 Use going to class as time to “study”

One of the important components to active learning is to review the lecture material before it is presented.  This is the opposite of what most of you experienced in college, but it’s key.   Survey the handouts or slides and make a list of the important points to be covered. Stay actively engaged.

p.s. You can’t learn medicine if you are on Facebook in class.

Create a summary page for each lecture

Include the big concepts, and key points. Include specifics that are stressed by the professor, but avoid listing all the details. You may choose to hand write this, but most of you will come up with an electronic format and will organize the class notes, and your summaries using One Note, Growly or an equivalent software. Although your personal notes are fine on the cloud, don’t put copyrighted material or your professor’s slides where other people can see them (it’s illegal).

Begin with the end in mind

In the long term, what you are learning (yes, all of it) will be applied to taking care of patients. In the slightly less long term, you will be tested on this information on the USMLE Step 1, a high stake exam and the first part of your medical license.   Although some dedicated time to study for Step 1 is important, having a system to really learn the material in your basic science courses is by far the best way to do well on this exam.

Don’t sacrifice sleep.

If you don’t sleep you don’t learn as well. Organize your schedule so you get at least 7, but preferably 8 hours of sleep every night.

Eat well, play hard and stay connected.

Clay Goodman,MD the Associate Dean of UME at Baylor, tells our first year class that the first year of medical school is a 60 hr/week job. They need to get up in the morning and “go to work”, using the afternoon and evening to study. He then points out that if they work 60 hours and sleep 56 hours (8 hours a night) they still have 52 hours to work out, spend time with family and friends and do whatever else they want.

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So, what should you do the first day of medical school?

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Here’s what your schedule might look like…

The night before – pack your breakfast for the morning break and lunch for the next day. Review any posted slides – survey them to understand the “big picture” and use them to start your summary of the lecture. Write down what you don’t understand from the slides (yes, at this stage it may be every line… but that will get better!).

7am – wake up (If you prefer morning workouts, you can get up earlier and workout before class)

7:30 Grab a piece of fruit or a smoothie if you don’t like to eat an early breakfast. (If you are ok with it, eat the full breakfast now, but whatever you do, don’t skip breakfast)

8-12 Attend class – Stay engaged. Take notes, make sure the questions you asked yourself in the review are answered, raise your hand and ask questions if they weren’t. Eat your breakfast or a snack at the 10 am break.

12-1 – Lunch with your classmates. Play foosball, talk, or just eat, but take a real break.

1-5 Study. One hour of studying for each hour of class is about right for most people.   This may need to go until 6 or 7 if you have afternoon labs.

7 – Workout and then make and eat dinner. Working out is an important part of self-care. Exercise is essential to decrease stress and also will help you avoid the “freshmen 10”. Your dinner should be healthy, not processed, and definitively not Ramen noodles. Make sure you have fruits and/or vegetables at every meal.

9-10 Look over tomorrow’s lectures and start your summary pages for those lectures. Once you are a week or two into this, you’ll be adding in reviews of material from previous weeks on a schedule.

10-11 Read a novel, watch TV, decompress.

11 Go to sleep!

You are starting on one of the most amazing journeys any human being can have… enjoy it! Don’t forget to keep a journal and take photos (but not of patients). The first time you actually interview a patient, put on your white coat, hear a heart murmur or take a test in medical school are just that … the first time. Write about the experience.

Let me know in the comments what other advice you have for the students starting medical school this summer!

 

 

Top 10 Holiday Gifts for Physicians and Physicians in Training

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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!