Attitude, Composure, and Peak Performance

Posted on June 2, 2010 by marylbrandt

Anger is the only emotion you can’t show if you are a professional. You can be angry, you just can’t show it. Last week I lost my temper at work. It’s rare for me to lose my temper, but when it happens it’s a good time for reflection on what happened.

Tennis is unique as a sport for a lot of reasons. It’s an individual sport (which immediately puts it in a different class than team sports). It’s also not a race, so that makes it different from cycling, running, swimming,etc. It requires a lot of strength and cardiovascular fitness, like gymastics, and a lot of strategy, like golf… but it’s different than those two sports as well. To be a successful tennis player you have to be fit, strong and smart. But like other athletes, these are necessary but not sufficient – there is still one more critical skill that has to be mastered – the ability to control your emotions.

Athletes at their peak have mastered the sport, but they also have learned how to manage adremalin and control emotions. “Peak performance” is a term usually applied to athletes, but the concept applies to physicans as well. How do we “train” to be able to work at our “peak”? As someone who teaches surgeons, it’s one of the biggest challenges I face. We can teach young surgeons how to operate, we can teach them when to operate… but we can’t convince them that they can do it on their own. The ability to stand with confidence at the baseline in the French Open or at the OR table to start a big case has to come from within and is the result of practicing the task and managing the stress.

Sam Stosur is one of my current favorite tennis pros to watch. Her game is magnificent but its how she has struggled with and learned to manage the stress of competition that I really find fascinating. During a recent match she had two words written on her wristband – “Attitude” and “Composure”. It served as a reminder to her to take a deep breath and focus on the task at hand. Physicians are no different – we need to find ways to remind us to adjust our attitude and maintain our composure.

Next time I’m tempted to get upset at work, I think I’ll remember Sam Stosur’s wristband…

Photo credit

iPhone apps for Docs

Posted on April 29, 2010 by marylbrandt

1. Epocrates – this is probably on the phone of every medical student, resident and practicing doc in the United States. It’s a great database of information that’s easy to navigate.

http://www.imedicalapps.com/2010/02/epocrates-app-review-iphone-medical-app-ipod-touc/

2. Medscape – similar to Epocrates, but not as commonly used (at least where I practice). It sounds really good, though.

http://www.medscape.com/public/iphone

3. MedCalc. The name says it all – easy calculation of medical formulas. This is another app that is on the iPhone of every doctor I know.

http://www.imedicalapps.com/2009/06/medcalc-v12/

4. Eponyms. Medical students struggle with learning the eponyms associated with diseases, anatomy, etc. This is a mini dictionary of 1700 eponyms.

http://app-store.appspot.com/?url=viewSoftware%3Fid%3D286025430%26mt%3D8

4. Medical Spanish. This really lets you do the basics (until the interpreter gets there)

http://www.imedicalapps.com/2009/09/app-review-medical-spanish-app-adds-audio-in-latest-update-and-were-definitely-smitten/

5. iMurmur. You have to use the earbuds, but this is really good app to learn (and review) heart sounds.

http://www.imedicalapps.com/2009/07/imurmor-v10/

6. Evernote. You have to play with this to fully grasp how powerful it is. In a nutshell, you store “notes” on a server for free. (Premium, which is $45/year lets you add attachments and increases your storage and is well worth the money). Notes can be web pages, text from the internet, documents, photos, or voice recording. Most importantly, you can search all your notes (and it has text recognition for photos, too). In effect, it’s like having a “google” of your own notes. Download the desktop app as well as the iphone app if you choose to use this – it makes it even more flexible by letting you create folders.

www.evernote.com

7. Remember The Milk. This is the “to do list” app that I use. It’s gotten really good reviews, but I’m sure there are other task lists that are good out there to. This has it’s own email address for you, so you can forward emails to your RTM account which then become “tasks” on your list. You can create categories, set reminders, etc – all in all it’s a great app.

http://freelanceswitch.com/product-reviews/review-remember-the-milk/

www.rememberthemilk.com

8. Pandora radio. Check this out on the web first and then download the iphone app. This started as a PhD dissertation on the “music genome” – trying to find out what make certain music similar to other music (and why that could be used to define what you like). The end result is personalized music – for free. It’s nice to have on your phone to listen to when doing paperwork or waiting on call.

www.pandora.com

9. Peggle. Ok, you may think this one is silly (and it is a little). I’m not at all a video or computer game person, but I read about this game in an article on stress reduction. It’s addicting, fun and most people who play it would agree with pilot studies that show it reduces stress.

http://www.popcap.com/games/peggle

If you have an app that you think should be added to the list, please comment!

Managing Money as a Medical Student and Resident

Posted on April 20, 2010 by marylbrandt

Financial issues are a source of intense stress for most students and residents. It costs a lot to become a doctor and is costing more each year. The goal is to finish your training without being handicapped by financial issues. Doctors (including me) are not experts in financial issues (even if they think they are). There are financial counselors at every medical school, or they will at least be able to refer you to someone. It’s a really good idea to learn about this early. Make an appointment and go talk to them about they best way for you to approach your own financial challenges. There are some basic principles that will help get you started:

Limit your debt. Pay off credit cards every month. There is really no exception to this rule. The interest on credit card debt is obscene. You have to avoid it at all costs. You have to make a conscious effort to live within your means. It may be you have to have a car, apartment or clothes that aren’t what you would consider ideal. But, in the long run, not running up the debt is far more important. Make a budget, keep track and monitor your spending. This is a really good resource from the AAMC to help you understand how to manage your money in medical school, including how to budget: http://aamc.financialliteracy101.org/welcome.cfm

Your credit report is important. Let me repeat that… Your credit report is important. It doesn’t take much to have the score slide (a few late payments, missing a payment) and it will follow you a long time! It takes about 7 years of perfect credit to get the score up to a level where you can buy a car or a house. It is really easy to not pay attention to this during your training… and then pay the consequences after you finish. http://aamc.financialliteracy101.org/graphics/factsheets/creditscore.pdf

Before you worry about investing, you should worry about protecting what you have (even if it’s not very much). You should automatically have life insurance and disability insurance from your institution, but you need to check. Unfortunately, if you are a resident, the “MD” behind your name makes you more vulnerable than the general public – and lawsuits can be against future earnings, not just current salary. Many attorneys recommend that you spend the relatively small amount it costs to obtain an “umbrella” personal liability policy to help prevent a large lawsuit from someone if you are involved in an automobile accident or someone trips on your front porch. When you are in training, these kinds of insurance policies seem like a waste of money. But – they aren’t that expensive when you consider that all your money can be wiped out with a single disabling injury or personal lawsuit. When you go to meet with the financial experts, this would be a good question to ask.

Once your insurance is covered, and you start having a salary (i.e. when you start your residency) invest a little on a regular basis through payroll deduction. Having the money taken out before you see the check is key. This is a habit that you want to start early. This can be for a retirement account (pretax money) or another kind of investment account. Again, talk to the financial counselors to learn about these options and decide which is best for you. The pretax dollars are important…. If, for example you earn $1000, you will be taxed roughly 30% on that money i.e. $300, leaving you $700. If you invest $100 dollars into your retirement fund, you will only be taxed on $900. That means you will pay the government $270 instead of $300. You will now have $630 to spend, instead of $700. But – the $100 will compound incredibly. Try it out.. http://www.econedlink.org/interactives/interest.html

Why You Should Run and How to Get Started

Posted on April 18, 2010 by marylbrandt

I hate running. Whew.. that’s out of the way. BUT – I have been a runner in the past, I live with a runner, and it’s absolutely clear to me that running is the ideal cardio exercise for medical students and residents. So, I’m going to try to convince you that you should incorporate running – even in a very small amount – into your daily routine .

Why Running is Perfect for Medical Students and Residents

It’s cheap. Other than an good pair of running shoes (and don’t buy less than good ones), there is no expense.
It’s portable. A bag with your shoes, shirt and shorts can stay in the trunk of your car.
It’s social. Once you identify a friend or two who agree it’s a good idea to run, you can do it together.
It’s efficient. Short runs are still a great workout. Unlike other workouts which require planning, travel and time to complete, you can walk out the front door and run.
It’s empowering. You can set goals and easily accomplish them. There are a lot of times during your training that you will feel things are out of your control. Setting a goal (I’m going to run a mile) and then doing it (Yeah!) is empowering.
It does more than just get you fit. There are good data that show that exercise in general (and running in particular) decreases stress, improves depression, helps sleep, etc. etc.

How to get started

Here is a great guide for beginners from the New York Times that I recommend you read. Another qreat source is the most recent online Runner’s World guide on how to start running. It’s hard to find now, but here are some tips from the Runner’s World May 2010 Special Beginner’s Guide:

Don’t do too much to start with. Start with walking and add in small amounts of running. “Every able-bodied person can be a runner,” says Gordon Bakoulis, a running coach based in New York City, :Just start slowly and build up gradually.”
Be consistent. Your goal is to exercise every day. Cardio is an important part of your exercise, but not all of it. You can run every day, but you’ll have to find time to do resistance and flexibility training as well. Alternatively, you can view resistance days as “recovery” from running i.e. alternate the days. Commit to some kind of exercise everyday. Plan your week to make sure you get at least 3-4 cardio sessions/week – and then cut yourself some slack if something happens that pushes you off track. It’s human nature – if you say you are going to run every day, you’ll probably run 4 or 5 times. But, if you say you’ll run 3 times a week, it will probably end up being only once.
Read, ask questions, learn about this skill. Every city has a “runner’s store” (which is different from a store than sells running shoes). Ask the runner’s in your class where they go to buy their shoes. The store will have shoes, but it will also have very knowledgeable people who will be delighted to help you learn about running.

How to fit it in and how to stay motivated

I know you don’t want to hear this, but early morning is the best time to run. It’s an energizing way to start the day, you “get it out of the way”, and you don’t have to fight the siren song of the couch at the end of a long day. If you do choose to run at the end of the day, change into your clothes before you leave school or the hospital and run before you get home. If you have willpower of iron you might be able to lace up the shoes and run before you go to sleep … if it works for you, great! (but it won’t for most people) .
Think about signing up for a fund raising group. Running for kids with cancer makes you feel pretty silly about whining….
Register for a 5K race – having a goal to finish (and getting your first time) will be motivating
“Gratitude is contagious.” Kristen Armstrong suggests that instead of feeling like you “have” to run that you think about what a gift it is that you “get” to run. “If you view your run as an opportunity, your attitude will get an adjustment”.

Physician wellness: a missing quality indicator – Lancet. 2009 Nov 14;374(9702):1714-21

Posted on April 3, 2010 by marylbrandt

This is an excellent review of the topic. They also describe a model for intervention and – most importantly – make the case that caring about physician wellness is important for patients. This is an article that will help anyone making an argument to improve the workplace for physicians.

Lancet. 2009 Nov 14;374(9702):1714-21.

Physician wellness: a missing quality indicator.

Wallace JE, Lemaire JB, Ghali WA.

Department of Sociology, Faculty of Social Sciences, University of Calgary, Calgary, AB, Canada. jwallace@ucalgary.ca

When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.

PMID: 19914516 [PubMed – indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/19914516