Tag Archives: self-care

Starting Internship (I know what you are worried about)

Posted on by
9

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?

Drawing credit

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.

Photo credit

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.

Photo credit

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.

Posted on by
Reply

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.

????????????????????????

blog-Sedentary-continuum211

  Photo credit

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.

Photo credit

Under the desk pedals are inexpensive, and are particularly effective if you are reading and studying.
ways_healthy_desk_Cycle_modis

 Photo credit

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.

BLog-fitdeskpro

Photo credit

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.

blog-FitDesk-2

Photo credit

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.

628x471

 Photo credit

Fast, Easy Recipes: Kalyn’s Kitchen

Posted on by
2

I’m always looking for good websites for recipes that are healthy, simple and easy to make.  In other words, the kind of food that makes it easy to avoid eating fast food when you are on call.   Kalyn’s Kitchen is a fabulous website for delicious, healthy, and often low calorie recipes that meet the “pizza rule” for medical students and residents (i.e. recipes that take less time to prepare than it takes to order a pizza). She also really goes out of her way to teach each step in the recipe, so if you are new in the kitchen, this is a fabulous website for you!

 

Tuna Salad Lettuce Wraps with Capers and Tomatoes

Not-so-Dumb Salad with Cucumbers, Tomatoes, Onions, Avocado, and Balsamic Vinegar

Mediterranean Tostadas with Hummus, Feta, and Kalamata Olives

Crockpot Double Lentil, Sausage, Brown Rice, and Spinach Soup

The Best of Wellness Rounds 2011

Posted on by
1

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

This Week’s Highlights from @drmlb

Posted on by
Reply

Twitter has become a wonderful way for me to send out a variety of ideas and links that I think are helpful (and/or interesting).  Here are this week’s highlights!  If you are new to Twitter RT means Retweet (just “forwarding” it as is) and MT means Modified Tweet (“forwarding” it with a comment).

  • “This is definitely a 15 minute video every medical student should see.” The art of the physical exam bit.ly/nnmaTN @drmlb
  • Comments one makes to colleagues: as important as the interview. Professionalism = doing the right thing when no one’s watching. RT @MedPedsDoctor
  • Beginner’s mind in medicine. How to keep what we do exciting! MT@KevinMD bit.ly/qle7SJ
  • One flight of stairs = 16 calories burned. One day on call = ?10 flights ?20 ?30)..it adds up! @drmlb
  • Epidemiologist with humor?!? This is a great talk about drug development. bit.ly/ovkPyS @drmlb
  • “…small things often adds up to produce a far greater impact than any of us realize.” Surgery through different eyes bit.ly/q5XUkh  @drmlb
  • “..those of us who spend our emotions at work are not the kind to view our work as “just a job.” MT@Kevin MD bit.ly/pRAbmm  @drmlb

Time off, Days off, and Vacations

Posted on by
Reply

As my vacation is winding down I’m struck again by how restorative time away from work can be, and how much we all need these breaks.

The word vacation has the same roots as vacate (from Latin vacātiō – freedom, from vacāre – to be empty).  Vacations – whether daily, weekly or annual are effective only if you really walk away from work.    It’s particularly hard to disconnect from email, the internet and texting … but “needing” to stay connected electronically may keep you from connecting with your surroundings and your loved ones. If the idea of emails piling up adds to your stress, compromise by scanning, deleting (and not answering) your emails when you are on vacation.

There’s a tendency to think that vacations have to be a planned trip away for at least a week… but here’s another perspective from WebMD.com:  “While it is ideal to have a full week or two off from work, it may not always be feasible, and there’s still the rest of the year to deal with. Weekend getaways are also good for rejuvenation. So is an hour to yourself during lunchtime or a few hours on weeknights.”

Some ideas….

Plan a half-hour or hour (on days you can) to disconnect and “vacate” from your work in whatever way makes you happy.

Try to really have a full day off every week (call schedule permitting). There’s a reason most religions in the world build in a day away from work – it’s part of the rhythm of rest we need as human beings.

Plan a long weekend away (or even a day) by yourself or with loved ones every couple of months.  Make it time free of electronics – go hiking, sit on a beach, stay at a great bed and breakfast, eat great food.

If you have vacation days you are storing up – start using them!  And, when you take those days off work, don’t use them to “catch up” on chores or other tasks…take the time you need to recharge your batteries.

Why we need vacations from treecitytimes.com

The Science Behind Vacations: Why we Need a Break from lbtimes.com

Why Summer Vacations (and goofing around on the Internet) Make You More Productive from TheAtlantic.com

Shoes to Wear in the Hospital

Posted on by
6

I got home recently after a 14 hour day in the operating room with (predictably) a pair of really tired feet…. which lead me to think about shoes, foot rubs, and the fact that no one ever talked to me about this in my training.

What kind of shoes should you wear in the hospital?

There’s a lot of walking in the hospital, but there’s even more standing.  Running shoes don’t provide the right kind of support for standing, which means your feet will suffer if that’s what you wear.

It goes without saying that you should not wear open toed shoes in the hospital.  It’s not only against the rules, but it’s going to gross you out one day.

Basic concepts to choose good shoes for the hospital

Look for good support.  The classic “nursing” or “operating room” shoe exists for a reason – they are designed to provide the support your feet need during long days of standing and walking.

I have recently become a huge fan of Allbirds. They are amazingly comfortable, incredibly light and even after a long call night my feet really don’t hurt.  The website says they can be washed in the washing machine which is obviously a big plus, too!  Other comfortable shoes you might try include  Clarks, Rockport and ecco.

Photo credit

 

If you will be standing for long periods on rounds or in procedures, think about getting shoes that slip on and off.  When you are standing for a long time, being able to slide out of your shoes becomes important.  If you’ve been standing for hours, it really helps to stretch your calves and change the pressure points.  It’s also easier to step out of your shoes all together and stand barefoot for a little while.  When you are sitting, you can slip them off and let your feet breathe. Dansko  professional clogs are expensive but they are the “classic” OR clog..  Sanita clogs are supposedly now made in the original Dansko factory, tend to be a little less expensive and are also loved by many.  Birkenstock or Clarks clogs are alternatives to consider, too. Crocs are tempting but have poor support, minimal ventilation and have been banned in some hospitals.

Try to get shoes that breathe.  Examples include Merrell’s Encore Breeze (a great OR shoe) or Allbirds.  These shoes are not only comfortable, but they can be put in the washing machine (minus the insoles) if they get really dirty at work.

Once you’ve met those criteria, lighter is better.

Long days standing at work also make for stinky feet.  Just like long-distance runners, you have to learn some tricks to deal with this.

  1. Have more than one pair of good shoes and alternate them.
  2. Don’t buy cheap socks. Wicking socks like Balega socks are worth the price.
  3. Take an extra pair of socks with you for long days and change them in the middle of the day.

Foot massage, pedicures, and other foot care

After work, in terms of “bang for the buck” there is nothing that will make you feel better than a little attention to your tired feet.

Use a good foot scrub in the bath or shower like Bath and Body Toe the Line of The Body Shop’s peppermint scrub .

Take 10 minutes and try some methods to soothe tired feet.  If you are lucky enough to have a significant other who will rub your feet … congratulations!  (and, by the way, it really is “true love”…)

Even if you are a guy – don’t blow off pedicures.  If you’ve had one… you know.  If you haven’t… try it before you decide.

How To Succeed In Medical School

Posted on by
1

Yesterday was the first day of orientation for the new medical students at Baylor.  One of our traditions is to announce the winner of the DeBakey Scholar Award at the beginning of orientation.  The DeBakey Scholar award is one of the most prestigious awards given at Baylor; it is awarded to the rising senior whose academic success and character best emulates Michael E. DeBakey.  This year’s award winner, J. Mason Depasse, was asked to give some advice to the new class of medical students.  His remarks were so exceptional I asked his permission to post them here.

Welcome and congratulations on your admission to Baylor College of Medicine. My name is Mason, and I spoke to many of you during your interview day and second look weekend, when I told you why I loved Baylor. I hope that, after your retreat, you are already beginning to love it here as well. You made an excellent choice, and you will appreciate that more and more as you progress. I could go on and on about what makes Baylor great, but today I’m not here to talk about that. Today, I’m here to talk to you about how to succeed in medical school.

I remember my first day of orientation, and I know the mix of anxiety and excitement you are all feeling. I’m sure you have been told about the flood of information coming your way, and many of you may already be bracing yourself for the impact, particularly those who have had time away from biology or those who have an eye for a highly competitive specialty. While nervousness is perfectly natural, I want to stress that, when the material starts building up – and if you remember nothing else from this talk, remember this – you should not panic. Don’t freak out. People from all manner of academic backgrounds do it every year, and no matter what you’ve been doing or studying for the past four or ten years, you will get through it. It might take a little elbow grease, but you’ll make it.

To help you get started on the right foot, I’ve compiled a short list of things to keep in mind as you begin the basic science curriculum.

First and foremost, try to keep up. This is far harder to do than it may sound, but try your best not to procrastinate. The easiest and most reliable way to successfully tackle any seemingly overwhelming task is to break it into stages, and absorbing the enormous volume of information in basic science is no exception. In college, most of the testing in the sciences focuses on concepts, particularly for upperclassmen. You studied a set of rules for how to calculate electric fields and… something about nucleophiles, and you demonstrated that you could apply those rules. You all have the aptitude and the study skills to succeed in those courses, or you wouldn’t have gotten into medical school. Unfortunately, these skills will not be as effective here because you can’t outsmart basic science. You can’t do it. It’s a whole world of knowledge, and as our professors told us, you just “gotta know it.” You have to put in the hours, and keeping up with the material by regular studying makes this manageable. Get into a routine, and try to stick to it. And when you get a bit behind, and we all get behind at times, catch up as soon as you can.

Second, find a way to study that works for you. This may sound obvious, but I’ve seen students become concerned that they are not in a study group, or aren’t making flash cards, etc. But study groups and flash cards may not work for everyone. There is no “wrong” way to study; if it works, then you’re doing it right.  Your PRN leaders can give you all manner of suggestions for study tips and tricks, and you should feel free to try them out. You have a practice diagnostic exam before your first set of real exams, and you should use it to determine whether your method is working. But even when you find a strategy you like, your study method may not always work. Medical school is a long haul, and there are a lot of different challenges to face. Keep in mind that succeeding here is about adapting and persevering in the long-term. I wasn’t always happy with my performance, I was frustrated at times, but I found that it’s not worth beating yourself up about it. Adjust and prepare for next time.

Third, use your resources. Your professors will provide you with documents and powerpoints of their lectures, and these will sufficiently cover the material. However, you may find it helpful to supplement your reading with outside sources. Don’t overwhelm yourself, but there are all manner of texts and reviews available. Even looking over a topic in First Aid, the Bible of USMLE Step 1, can be helpful for solidifying your knowledge. Furthermore, don’t be afraid to ask for help. Baylor has a culture of cooperativity. Your classmates, your PRN leaders, upperclassmen, and professors are all here for you and will be happy to provide advice and support.

Fourth, stay balanced. Medical school can be very demanding, and it is easy to burn out if you don’t take care of yourself. Go out with your friends. Join IM sports. Go to the gym. If you’re applying to orthopedics, go to the gym again. Whatever you do, take a break. Two productive hours of studying are far more effective than four hours of staring blankly at the same page. Believe me, I know. There will be weeks along the way during which you will work a ridiculous amount of hours and balance isn’t really feasible, and when those come along I recommend trying to make it up afterwards.

Finally, once you’ve gotten settled into a routine, be aggressive. You’re here because you want to be physicians, and you’re paying through the nose for it – though not quite so much at Baylor. Thankfully, you chose an institution with just about every opportunity for research, service, and clinical experience that you can imagine. Seize them. Join student groups. Email professors you want to shadow or work with in the lab. Go to Ben Taub and learn how to start IVs and suture. When you’re on clinics in what feels like forever from now, I want you to remember that you are the only member of your team who is paying to be there. So get your money’s worth. Know your patients, and I mean really know them, and imagine that you are making all of the decisions. Think of your own treatment plans, and ask questions if yours differs from the final one. Medical school shouldn’t be four years you just have to get through in order to become a physician. Don’t let medical school just happen to you. Medical school is your chance to sample the spectrum of clinical medicine and gain the experiences necessary to begin forming more concrete career goals. So once you’ve got your rhythm going and you’re comfortable with your routine, I strongly encourage you to get out there and explore.

J. Mason Depasse, MS4

 

Advice for New Interns

Posted on by
5

The summer is the time that the roughly 16,000 new doctors in the United States start their residency training. For all new interns, 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:

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. In the era of the EMR, much of the information you need can be easily accessed… but not really organized the way you need it. If you have developed a good system that doesn’t require physical cards, please send me a message so I can see it!

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. p.s. Don’t lose your cards!!!! (HIPAA violation)

Don’t confuse gathering information with studying information. Taking notes is a critical part of learning. Don’t just store chapters and articles in your Google drive… 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. 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 (e.g. 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 well-being 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!

Gifts for Medical Students and Residents

Posted on by
8

Gift ideas for college graduates who are getting ready to start medical school and medical students getting ready to start their residencies are surprisingly similar.  Medical school and residency are both times of hard work, less free time and increased stress.  The following are gifts that should make life a little easier (and more enjoyable) for medical students and residents:

  • A maid or housecleaning service once a week.  No one in medical school or residency has time to clean (or likes it)!  This will be one of the most appreciated gifts you’ve ever given someone.
  • Along the same lines, a highly functional laptop computer is a critical piece of equipment.  For new medical students, the laptop they had in college is probably not going to be enough.  For residents, if it has been several years since their last computer, an upgrade will make studying and research easier.  To avoid getting the wrong computer, a hand-made certificate that you will pay for the computer of their choice may be a better idea (to make sure they have a computer that really meets their needs.)
  • A year’s subscription to EverNote premium (to allow them to store notes on a cloud server)
  • If they are avid readers (of non-medical works), consider a Kindle, Nook, or other electronic reader.  (If you are considering an iPad, it can be used as a reader, so this might be redundant).  These devices can easily go into a backpack or call bag and make it easy to take 5-minute breaks from studying or work.
  • A really good alarm clock.
  • Membership to a gym for a year.  Working out is important both for physical and mental health during medical training.  But – unless you know which gym is the closest to where they live (or most used by their friends), it might be better to create a homemade “gift certificate” and let them decide.
  • Anything to help promote more exercise.  A bicycle to commute to school or the hospital?  A gift box with exercise equipment?  Yoga classes?
  • An iPod nano or other mp3 player to listen to music while studying   Electronic speakers for their computer will also help provide music while studying.
  • A subscription to Pandora One to create and listen to internet radio stations without commercials.
  • A gift certificate to Whole Foods (or any grocery store that makes take out food), or a healthy prepared food service.  In Houston, we have My Fit Foods, Snap Kitchen, Diet Gourmet, Real Meals 365 and several other services.  These types of businesses exist in almost every major city and can be easily found with an internet search.
  • If you are going to buy a watch to celebrate graduation, don’t make it an expensive watch.  No one wears them in the hospital for fear of losing them (they have to be removed when procedures are done).  It also is inappropriate when caring for patients who may not have many resources.  Ditto for expensive pens.
  • A digital camera or small digital video camera.
  • Anything to support a hobby that they enjoy (but will have to work to keep up during their training)
  • A couple of comments about what not to buy.  Don’t buy stethoscopes, otoscopes or any other medical equipment (unless you are a physician yourself… and even then it’s probably not a good idea).  Don’t buy anything for an office (they won’t have one for a long time) and – absolutely – don’t buy a “black bag” (no one uses them anymore).