Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Using Every Tool

As all of us in academics (professors, students) enter the final stages before the semester/quarter ends, we make the push to finish strong. If you have been struggling with your studies, now is the time, just like tax time, to get your work shored up for that strong finish. It also a good time to take and inventory of sorts, in your thinking about why and how you master your studies to have the best outcome in your classes.

We finished our spring breaks with the hope of resting perhaps getting away from our studies in order to come back with renewed energy. Depending on how you spend your break-some catching up, some getting away, some planning for the next steps, you may be feeling that the “break” was not a break at all. If that was the case, then take this weekend to put some strategies into place to finish this term/semester/school year as best you can.

I always advise my students at the beginning of the year, that regular planning/study is the key to mastery of your subject matter. Making schedules and sticking to them is as important to success as my daily workouts are key to my training for an upcoming marathon. I have to work out regularly in order to complete my distance race. I can’t arrive on race day and run a marathon, half-marathon or even a 10-kilometer race without doing some daily training/conditioning work.

Like anything that I have to train for, there are days when I don’t feel like putting in the time. Sometimes, I just want to take a break but I can’t take too many breaks. My training runs, like your daily study periods are a time to work on those little details to develop the strength and tools to complete my goals. If I don’t put in that time regularly (do something) I won’t be ready for my long-distance race.

Sometimes, I do take a very short break from my training but at the end of the day, my tool is that I do something more intense so that I get a small benefit of even not running on that particular break day. These are my mini-spring breaks away from training. This strategy, I apply to studies (yes, even as a professor, I am constantly learning, honing and refining). That short break is the tool to remind me to get back onto my regular schedule as soon as possible.

I have used preparation for a long distance race because when I made the change from short-distance running to long-distance running, many other items in my life became easier and better. My studies, like your studies whether you are an undergraduate, graduate or medical student require daily work and refinement; in other words, daily training. We are all preparing and using the tools of preparation for finishing strong in our endeavors.

Consistent work is always key to academic success. In today’s world of electronic delivery of materials, one still has to devote regular study time for complete mastery of subject matter. We have millions of bits of information at our fingertips, online and even on our thumb drives, that we must master for our programs of study. Organization and regular consistent study of our academic materials is more relevant today than back when I was in medical school and graduate school.

Organize your materials, plan your study schedule and take short breaks over the course of the day but be consistent in your study. As I have written in other pieces on this blog, my tools of organization have been to review the previous material, study the present material and prepare for what will come next. These are your tools for making sure that this period before finals and before the semester/year ends are in place so that you may finish strong.

Just as I want to complete my upcoming distance race as strong as possible, I want to complete the race. Use your time wisely, take short breaks away from your studies but make those breaks matter. Don’t give up at this point because you are overwhelmed. When those feelings of being overwhelmed enter your mind, take a short minute, jot down that you are feeling overwhelmed and write out only the next small thing that you will complete.

As you complete many small things, they always add up to completion of the big items. Completing those small items also keeps procrastination from derailing your studies at this time. Until you have taken that final exam, nothing is lost and you can keep preparing but if you stop, give up and allow feelings of “everyone is doing the better that I am” to enter your strategies, you won’t be see any success. Fight the feelings to make comparison to those around you; only compare you with you yesterday.

You can’t change the passage of time and you can’t change the past but you can decide in the next minute to change your thinking about how you deal with the present to affect the future. This is the most valuable tool for anything. I can’t change how I ran my last race but I can keep preparing for the one that is coming up. This is what I tell myself as I head out the door to the gym to do a bit of speed work and lift some weights. Every weight I life, every step I take is moving forward. Use those tools and adapt as you make adjustments to finish strong but don’t forget a tiny break/ reward for keeping things going.

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14 April, 2018 Posted by | academics, medical school | , | Leave a comment

Why Don’t We Feel Safe?

Today, March 24, 2018, many high school students and teachers are marching/assembling in major cities to bring attention to their increased feelings of not being safe in their educational settings. I would add my support to them as everyone should feel safe in their homes, schools, places of employment and places of recreation. Safety is a right of every individual in any environment. When individuals don’t feel safe, they experience increased stress far above what is expected in their day-to-day lives.

Even in hospitals, safety has always been of importance both in how we treat patients and the patient environment. We always pay very close attention to situations that potentially put individuals at risk but of recent, safety issues for those of us who are just going about our jobs in emergency departments, hallways and classrooms have come under scrutiny. In short, physicians, professors, students, and patients have been harm’s way because of disgruntled employees and colleagues who seek revenge for perceived wrongs.

It’s persons who feel the need to inflict harm on those who have no role in their perceived situation that is most troubling for the public at large. When guns are fired, even with intended targets, others get hurt and killed. When mentally ill individuals have access to weapons (guns, cars, knives, explosives), individuals without warning, are subjected to random violence. When the electronic and television news media spends hours and hours attempting to find motives and uncover a “story” in these random acts of violence; creating stress in individuals.

Perhaps this 24-hour scrutiny is a product of the electronic information age but there is nothing that prohibits us from turning off the news and disconnecting from social and other media. From the time I first acquired a pager as a medical student, I became acutely aware of the need to just “turn the thing off” in order to reconnect with a world that doesn’t need access to my attention at all times. I never want to be the person walking along staring at my smartphone and ignoring the world around me. Yes, I look at it when I must but certainly, I strive to look around; be aware of those around me.

As those who march in the streets today want to emphasize,  all individuals have a fundamental right to pursue their lives not only in freedom but in safety. As a physician, I don’t want to take care of even one more innocent individual who has become a victim of random violence. My stress is worrying about those I love and whether or not they will come home. The stress is palpable across many in my environment which include where I work and study. There is simply no reason in a civilized society for this to happen.

My answer is to be vigilant and to be aware of those around me at all times. My answer is not to lock-down hospitals and campuses but to pay attention to people around me who may be suffering. My answer is to not look to electronic and television media to examine what I as a physician, must examine for myself. My answer is to treat all people, even those who are struggling academically and personally, with dignity and compassion.

Just recently, more than a few of the medical students that I have taught, found out that they didn’t match into a residency position. The stress of finding employment for next year is gut-wrenching for them and for me as well. The lack of post-graduate positions coupled with a system that is in dire need of an overhaul is necessary. The feelings of despair were very deep for those who didn’t find a match when those around one are celebrating. I found more than one person who is derailed by the process.

Disappointment, anger, and despair when one does not obtain the end result of work and study or any other desired outcome is often a trigger for actions that are uncharacteristic. Even more disturbing is that those who are successful may be perceived as “bragging” on social media when they are just celebrating the next step in their training. My answer to those who didn’t match is that it’s not a personal failing and my answer to those who did is well-done but have compassion for those who are struggling.  My answer is to do everything within my power to allow my students to feel safe as they study and work. As a human being, I can do no less but I can do more.

24 March, 2018 Posted by | academics, medical school | Leave a comment

Spring Break

Whenever the hype for March Madness comes around, my thoughts go toward Spring Break for undergraduates. For many in the Northeastern United States, a nor’easter has dumped enough snow (continues to dump snow/ice) that the prospect of heading to a warmer climate most attractive. Even if one heads to the ski slopes, it’s important to take this time, if available, to get away from your academics to recharge and see new scenery.

Some students will use the time to catch up or write papers that may be due towards the end of the semester but don’t use the entire break to work on academic matters. Go to a movie (check out the Oscar nominees for Best Picture) or see a musical, hear a concert or attend a play. In short, do something outside of your normal routine that expands your mind. Even exploring a new cuisine or reading a fiction novel is a great way to break out of the academic world for even 24 hours.

Rest, relaxation and breaks are as important as hard work in the pursuit of excellence. One can argue that if one “breaks” every weekend, one does not need much of a vacation but if those weekend breaks are your routine, do something different over Spring Break. It’s the different activity that allows the mind to recharge and sets new neural networks for use as you need them. Humans were never “wired” for routine and do best with change.

Knowing that one needs a break in routine is a useful characteristic to hone at the undergraduate level. Pursuit of medicine is stressful, long and can be all-consuming which isn’t good for mental health. Taking a break, even those weekend breaks is as important as disciplined, dedicated study during the week. Planning and executing plans are great but not planning, especially during a break is good too.

As a physician/surgeon, I took pride in not taking vacations as I built up my practice and research. Fast forward to today and I recognize the value of doing something different, interacting with colleagues outside of medicine/science and enjoying nature, sporting events and travel. I need my vacations now more than ever but I needed them as I started my career too. There is no pride in having a stress level that is on the verge of causing mental/physical breakdown.

In medicine, we often place our patients ahead of our families and ourselves. I can recall countless times, my father left the dinner table for an emergency or left a family gathering to take care of a patient. I have left graduations, dinners, weddings and other events because I was called into the hospital. At this point, I realize the toll that “being too available” has taken on my relationships and mental health. Today, I head out of town for my Spring Break to catch up on my reading (novels), watch those Oscar nominees and lie in the West Coast sunshine because I will return a better physician and professor for doing so.

8 March, 2018 Posted by | academics, stress reduction | Leave a comment

In Service, In Reality

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I found out a short time ago, that I am a match for donating a kidney to a colleague. The reality of my choice has been weighing on my mind as I perform my early morning runs through my little mid-western suburban town. I will donate one of my kidneys to help a colleague who is suffering on hemodialysis with many complications. It turns out that his son is also a match but refuses to donate to his father. I can’t refuse being of service to those who need something I can provide.

I did not make this choice lightly, to donate one of my kidneys. I am in robust good health, taking no medications as I run 6-8 miles each morning in the very early morning darkness. At my age, I am something of an anomaly with defying the odds; continuing to challenge myself physically and mentally. At a time when most of my colleagues contemplate retirement, I contemplate my next adventure be it sailing an ocean, flying cross country or running a marathon. In short, physical and mental challenges enrich my life and will continue to enrich my life.

I would be less than honest if I didn’t say that the timing of this transplant is worrisome for me. Minimally, I will be away from my running and teaching for a few weeks. Runners always worry about losing conditioning if we are not out crossing pavement but I can do other things such as swimming (need to work on my strokes) and biking as I recover. I plan another shot at the marathon distance in the late spring thus I know that this surgery will challenge my training for that run. This recovery will be problematic for me who strives on being as independent as possible.

My service to others is something that is part of me. I grew up in a family of physicians who always pushed me to give as much as I can. We were fortunate to have the advantages of good education and great guidance from our parents and extended family. “To those that much has been given, much is expected,” was ingrained in me as early as I can remember; much of why I chose medicine/surgery as a career. My service to other has recently extended to my study for the priesthood too. I have an opportunity to give a gift that will enable another human to live a high quality life.

While I intellectually understand the physical implications of my choice to donate an organ, I face the mental challenges of this donation with much trepidation. My feelings are not of “what if I need it later” but how can I minimize not being available for my students and patients at this time of the year. We are in the midst of epidemics and the start of a second semester which always bring challenges to those of us in academic medicine. I also didn’t have the wonderful luxury of input from those whose opinions I value most, my touchstones as both are busy with academic duties and so forth.

As I see my students, some now quite comfortable with their clinical duties and some who have made the adjustment to the rigors of the first-year curriculum, I am concerned that my brief absence from teaching may make an impact. Still, my duty to service forces me to recover as fast as possible and be present to guide those who are training under me. These are the thoughts that occupy my meditations on my distance runs these days.

In a time when many are quite self-absorbed, it is my duty as a human being and as a physician to help those who are in the direst of need.  Does that duty to help extend to organ donation? In my mind, it does extend to giving as much as I can for the good of another human being. The last thing that I consider is the effect on me physically as this will be minimal in the long-term scheme of my fortunate life.

My mentor for the priesthood suggested that I speak with the son of my colleague who because of choices made by the father, refuses to donate an organ. My mentor says that my best service extends to make another attempt to heal this family spiritually too. There is much merit to my priest mentor’s input here as there is still a small window of time but a challenge for this fledgling student of theology. In reality, I see many facets to this challenge which I meet as I meet all of my challenges.

My colleague is in need; his family needs him and I am honored to serve both this man and his family. He has much to live for and many depend on him.  In short, his life is very valuable to those who love him. It is those relationships of love and connection that must be preserved as long as possible. I am dedicated to organ donation both living and after death. Organ donation is one more aspect of my life of service to others. My reality is that through my service to others, my life has value and that my value is only through my service. I live a rich life of serenity that is a great gift given to me. I do this because I can do this and will do no less.

31 January, 2018 Posted by | life in medicine | , , | Leave a comment

Flu to You too!

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This year’s flu season is in full swing! Here in the Midwest where I live, there have been deaths from this strain of influenza, affecting people who are younger and apparently healthy before acquiring the virus. Along with this deadly strain comes the news media reports that the flu vaccine isn’t as effective as in previous years; related to me by my patients who complain that the vaccine “makes them sick” or that they don’t want to get the immunization.

My reply is that while the vaccine isn’t 100% effective, it does make any bouts with the flu, milder. I also remind them that along with the flu vaccine, good hand-washing is paramount. Wash hands often, don’t touch face and try to avoid those who are already sick with viral upper respiratory infections. Smokers are at increased risk for having a rough time this year because conventional cigarette/pipe/cigar smoke defeats the cilia in one’s respiratory tract allowing increased susceptibility to pathogens. In short, if you have folks who are smokers, this is a good time to either quit or move to nicotine patches, e-cigarettes/vapers or other smoking cessation-devices.

Grumbling that one does not want to be forced to receive the flu immunization or that one is going the “die from something” isn’t sound thinking for long-term health preservation in order to continue risky behavior. Along with getting proper rest, proper exercise and stress-reduction, one needs to eat properly. “I don’t have time to breathe, let alone work out”, is not going to help keep one healthy during these times when most of us are surrounded by patient’s suffering from viral illnesses.

My final thoughts center around those who become ill. Please stay home, get some rest and don’t bring your viral illnesses to the hospital/clinic/school for sharing with others. Keep your children home even if you must stay with them. Rest and self-care are more important than ever with this year’s influenza strain. H3N2, the predominant strain (it’s a strain of Influenza A) is not trivial. I would rather err on the side of caution and care than put more at risk. This is not the time to “soldier through” or “tough it out” because many who consider themselves young and invincible are ending up with serious complications.

Your first step in taking good care of your patients is to take good care of yourself in this new year. Don’t start 2018 off  by adding to the patient population because you want to be a trooper. Yes, I have excused any of my students or trainees who have picked up the flu! Get that flu shot too!

13 January, 2018 Posted by | medical school, medicine | | Leave a comment

Challenges to Come in Medicine

As everyone takes a much-needed holiday break, it would be good to look at some of the challenges ahead, the greatest of which is adequate delivery of health services to all of our patients. We continue to hear that the wealthy have adequate access but numbers those who are in the world of adequate access  to good health care are getting smaller. Even two years ago, the solid middle-class had tools available for access to health care but those tools are getting scarce. This scarcity of health care resources will increase largely from increased costs for everyone. The wealthy will weather these changes but more and more of our patients will not.

What do these changes mean for us who are charged by profession, to deliver adequate health care? These changes mean that we must take valuable and scarce time to study the political consequences of closing clinics, increased cost of insurance premiums and the disappearance of the mandate for having health insurance. Mandates are only a tool but they were decreasing the numbers of the uninsured in this country. More patients who are uninsured has always translated into increased costs for facilities that must provide health care. Those increased costs are passed onto patients who are more and more on the fringes of not being able to afford increased premiums.

We are charged with increased efficiency in the delivery of health care in today’s world of practice. These efficiency mandates have resulted in increased pressure for us to see more patients in a shorter period of time. While decreasing the time I can spend with a patient, my patient’s problems haven’t changed. When one is attending to a patient problem with potential life-altering consequences, adequate time must be given to those problems.

Mid-level practitioners are physician extenders and not substitutes for physicians who have dedicated themselves to years of training and hours of continuing medical education post training. While there is a role for all of us, physicians by training will and must continue to remain at the helm of delivery of health care to all. In some locations the middle class and the poor have been priced out of being evaluated by a physician which is not a sound practice.

As we head home to celebrate holidays, we all have to strive at every level not to take shortcuts for efficiency. We all have to give our best and make sure that our patients receive the best care possible. Currently the health of patients in this country, while we are at the forefront of medical device and scientific discovery, lags behind other developed countries. If even one person comes into my clinic with Stage 4 cancer because of lack of access to even basic preventative services, our whole system suffers.

Most of us entered medicine with the compassion to work long hours for our patients without regard for social, insurance or financial status. A child from Appalachia who barely finds regular food deserves the best medical care that can be provided in this country. Families are under increased pressure to take valuable income resources to provide food and shelter by putting of much-needed preventive services; often the parents skip important screenings for their children.

If I sound as if I am a socialist, perhaps I am by the standards of this country. My belief is in a basic level of health care for all humans regardless of ability to pay. One’s health is key to one’s life, well-being and quality of life. When I see a patient with uncontrolled hypertension who doesn’t take inexpensive medication; which can result in permanent loss of renal function or stroke,  I am disappointed and sad.

As a physician, I can’t settle for allowing human beings, my patient’s to suffer because of lack of access to health care. I have challenged myself to be proactive in anticipating the affects of lack of health care funding on the health of my patients. I have challenged myself to find solutions and to keep finding solutions for my patients, all of my patients. For me, this is my holiday present to those I serve not because this will make my life easier but because it’s my challenge.

Read, evaluate and educate yourselves in the political aspects and the business of medicine. If you don’t have classes in medical school that offer this, form groups that can advocate this practice. I can’t say that it will be easy but I can say that your present and future patients will have better health because of you actions. It’s not too late to make a start and it won’t be easy or quick but this must be done by the greatest health care minds on the planet.

21 December, 2017 Posted by | medical school, practice of medicine | | Leave a comment

Teach Your Eye to See

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In becoming a physician, one of the adjustments that must be made in medical training, is teaching your eye to “see” what needs to be seen. There is no medical test or radiographic imaging study that can replace what the human eye powered by the human brain can see and process by looking at a patient who comes into your care. It’s important to see the extraordinary in the ordinary.

One of my favorite exercises this time of year, is to find a point of observation in a crowded shopping mall and observe the shoppers. I look for musculoskeletal pathology in terms of gait abnormalities. I look at who uses those shopping scooters, usually young morbidly obese or elderly people. I look at how parents, children, friends and others interact as they hurry about their shopping. I allow my brain to observe as much as I can in the short period of time that people move past me.

I look at the complete environment of the mall such as the location of security cameras, the noise level, the composition of the floor as well as how many people can pass my observation point. I note the location and characteristics of security guards who are likely observing me as I observe shoppers.

The point of learning to observe is to allow your brain and eyes to focus in order to hone your observational skills. If you set the f number high on the lens of your camera, everything comes into focus. If you set the f number lower, the object in the center of your photo comes into focus but the background is blurred for emphasis on the intended object. This is often how one’s attention can be directed but as a physician, I have to look at everything, much like the higher f number.

Take everything into the context and get a complete picture first but then focus on what needs the most care. Learn to use all of your senses especially your vision and hearing as you put your patient’s story into context. Learn to see posture, gait, and overall affect as you interact with your patients. If family members are present, look at their interactions as well. In short, learn to see the whole picture, evaluate it and see the extraordinary in the ordinary.

In photographing the ordinary document clip on my desk, I see aspects of it that I don’t usually evaluate. I see the shadows along with the background as the clip rests upon it. Today, I never saw the small black dots as I think of my computer desk as only non-reflective gray. Today, as I look at my photo of one of many clips, I see something that I hadn’t noticed before. This is another exercise that I often engage in with my camera which is becoming an extension of my eye.

Along with visual observation, I attempt to hone my mental processing by using my daily morning distance runs to enhance my meditation skills. As I run along, generally after warm up, taking my attention from how my body moves, I allow my mind to go where it will. Thoughts enter and leave or stay with my like a song that I can’t get out of my head. This is a great reason to take 30 minutes each day to do something aerobic for your mind and body.

Along with training my eye to see beyond the ordinary, I strive to train my mind to consider all possibilities. The more possibilities I consider, the better my diagnosis. As my experience in medicine/surgery has increased, I want my mind to absorb as much of those experiences possible. Take some time over these holidays and observe, evaluate and enjoy the processing. Observation is a practiced and honed skill; good for any physician.

18 December, 2017 Posted by | medical school, medicine | | Leave a comment

New Gross Anatomy

Many medical schools have gone from cadaver dissection to prosection to digital dissection in their Gross Anatomy labs. Certainly concerns of inhalation of formalin are removed with digital delivery but hands-on dissection of the human body is quite sacred and tremendously educational for a physician. I also understand that digital dissection is far cheaper than having cadavers for teaching purposes.

With digital dissection, many lose the ability to see the variations possible. When I was in Gross Anatomy Laboratory, it was wonderful when another group shared an anatomic variation or a great dissection with the rest of the class. We could see and touch it. It was the touch with the appreciation for anatomy in three dimensions that was a wonder. That three-dimensional anatomy and seeing structures within context probably crystallized my love and appreciation for the variations I see in surgery on a daily basis.

All human bodies are a wonder to observe, examine and treat. On any given day, each patient with their capacity to heal, is a marvel that can’t be made by man. My study of medicine after study of biochemistry, deepened my appreciation for all that the human body is capable of performing without exception. Dissection and observation with hours of hands-on work only served to deepen that appreciation.

We might argue that digital learning is powerful because the medical student can be in the anatomy lab at any time. Digital anatomy platforms like Anatomatage can move through the body layer by layer but just as something is lost with a text message instead of a phone call, looking but not touching the structures is a loss.

The best use of digital dissection is as an adjunct to dissection of the cadaver. During those hours in the Gross Anatomy lab so many years ago, I carried my Netter Atlas, my Grant Dissector (filled with notes) and my list of structures that I needed to find so that I could see and feel them in all of their dimension.  The experience was profound; deepened my appreciation for those physicians who had spent hours doing the same thing in the quest to learn medicine.

Today, education experts and designers look at teaching and delivery of curriculum as a profit-making entity. Many of these experts have never studied my discipline, practiced medicine/surgery or even taught in a classroom. My duties as a professor are to be leader and coach for my students. I give them the benefit of what my anatomy professors, surgery professors and mentors in medicine passed on to me. Education experts tend to discount experience, one of the essentials of medical practice, and attempt to replace with newer (read cheaper) substitutes.

Yes, digital delivery of curriculum is a great adjunct but it doesn’t replace hands-on experience especially in the Gross Anatomy Lab. Prosections are great but the process of discovery is lost when one does not find structures for oneself. Vivid memories of the dissection of the venous supply of the face remain in my memory today though I seldom perform surgery on the face.

I would hope that those who didn’t get a chance to perform cadaver dissection at least spend some time in the Pathology lab assisting/observing autopsies. The marvel of the human form will not be lost upon you taking the time to do this. Even today, unless you are near a forensic lab, you don’t see too many post-mortem exams taking place. If you have an opportunity to observe one, take advantage and watch. Every structure, normal or abnormal is miraculous.

23 September, 2017 Posted by | academics, medical school | | 5 Comments

Continuing Medical Education

During the summer, I attempt to ramp up my efforts to complete as much continuing medical education as possible. During the academic year, it seems as if time gets away from me and I find myself busier and busier. Continuing medical education (CME) is a great way to refresh one’s knowledge of basic science while learning new information that will be of benefit to the patient’s in my practice.

I strive to keep work on my internal medicine knowledge as well as my surgical knowledge because my patients often have complex medical problems that send them to my care as a result of complications. While I have no problem consulting my family medicine and internal medicine colleagues for assistance in patient management, I need to be a vigilant as possible in the total care of the patient.

CME is far from being a chore for me because I love the learning process. It was the constant quest to learn how medicine and surgery works, that drew me to medical study in the first place. One becomes familiar with the volume of information in medical school but comfortable with the constant upgrading of one’s basic knowledge base in practice. I have found that every time I read even familiar information, I gain new insight and strategy for providing better care.

Certainly, one hates to be forced to do anything which is why the Maintenance of Certification (MOC) requirements became an expensive burden especially for newer physicians who are already struggling with heavy debt from medical school and pressure to build a practice. Most physicians are employees of large health care groups which adds to the pressure of practice building and maintenance. There are only 24 hours in a day; time becomes a precious commodity.

Finding a schedule that will allow one to keep up with journal reading, CME and MOC can become an added burden to already long hours and stressful work. Again, finding a balance becomes more and more important in order to have a lifestyle that can be enjoyed. Additionally, one does need precious “down-time” for mental sanity these days.

I don’t use my vacation time for CME or MOC as I need the vacation time for taking time away from academics and medicine. As I am older now, I appreciate my vacation time as valuable to my practice and teaching. There are few points for suffering in medicine on the part of physicians. This suffering can lead to “burn out” which isn’t good for anyone physically or mentally.

In closing, my recommendations are to find some manner of CME/MOC that works within and compliments one’s schedule. Take some time and try many methods of obtaining the hours that are needed for licensure. The worst stress comes with putting of CME until the last hours which like anything last-minute, becomes more stressful. Embrace the reinforcement of learning and find something that’s enjoyable, just like exercise, something that one can incorporate into one’s life on a regular basis.

28 July, 2017 Posted by | medical school, medicine, practice of medicine | | 6 Comments

Getting Into Routine

Since the nature of medicine (and life) is change, getting into the best routine to greet and excel in a changing environment is being in the best mental and physical condition possible. It’s very easy with study, long hours of duty and other demands, to gravitate towards anything that bring rest and relaxation/lack of stress. My challenge for those who are starting school, getting ready to start school, starting a new year of clinical duties or any changes; is to have a routine with good stress that allows for optimal performance within the context of changes and challenges.

For many in medicine, stress is the bane of our existence. We are stressed with long hours that often demand the good performance in early morning hours, as most of the population sleeps. We are stressed with keeping up with our academics and studies that mark our ever-changing profession. We are stressed with keeping a sound balance in life that will enable us to enjoy our personal lives in addition to our professional lives. This sound balance is as vital to having a great career and general well-being but finding that balance is not easy or quick.

As the summer has always been the time that I try to improve on my routines and make changes, I will invite you to consider making small changes that will help you deal with the mental and physical challenges to come as your careers change. These challenges need not derail your health and mental resilience but might enhance the enjoyment of your career at any stage.

Good Nutrition

When one is tired physically, mental acumen wanes and one becomes both mentally and physically exhausted. This mental and physical exhaustion can lead to choosing foods that are high in sugar or fat which might lead to a quick energy fix but weight gain in the long run. Trust me, carrying extra weight around doesn’t help with mental or physical exhaustion, often leading to more of both.

Eating a well-balanced diet that has more fresh fruits and vegetables with less fat and refined sugars helps keep your weight under control in addition to keeping you healthier. You can make small changes in terms of grabbing a piece of fresh fruit for a snack rather than relying on the high fat alternatives of the vending machine. Also cooking a week’s worth of healthier food that you pack rather than eating the burger and fries in the hospital/school cafe can help make small changes.

Small changes can lead to larger changes or that routine that becomes more comfortable for you. While I love an occasional burger and sharing fries/chips with my friend (the only way I indulge in these), I keep these occasions as special and not routine. Not only does eating a healthier diet help my immune system, my healthier diet helps me avoid long term chronic disease such as obesity, atherosclerosis and diabetes.

Regular exercise

Exercise tends to be one of those activities that suffers when one enters a demanding profession. It is easy post call, to come home, drop on the sofa and rest. This was my routine in medical school where I gained significant weight after being robustly active during my graduate school years. It took years of work to rid my body of the excess weight but once regular exercise became my routine, I found that I had more energy and more time rather less.

Today, I am a distance runner, using that time on the running trail to work out problems, meditate and simply enjoy myself. I have strength and energy for my work and for recreation. I also have a greater capacity for dealing with stress and the physical stress of a 10-mile run helps everything in my life. Running is quite solitary which appeals to me but anything that gets your heart rate up at least 30 minutes 5 times per week is better than nothing.

My workout time is as precious as my work time. I have mapped out running routes around my hospital, in my neighborhood and when I travel. I keep running gear in my locker (running shoes and shorts) so that I have no excuse not to move. I also try to get my workout done in the early morning before I start my day.

You don’t need to block hours of time for a bit of an aerobic challenge as you can run up a flight of stairs several times per day; park the auto further away and walk briskly to your workplace; take a brisk walk for 10 minutes as a time over lunch with a friend. Distance running isn’t for everyone but most of us can do something as simple as walking. Incorporate small changes which can become a habit that becomes part of your life.

Avoiding excuses (reasons)

As one becomes mentally stressed and physically exhausted, reasons for not adhering to healthy habits abound. For each of us, there will always be challenges that take us out of our routines. Take a moment to reflect on what reasons/excuses become commonplace and how you might meet or avoid them. For me, I looked at every hour of my day and examined where I could make small changes. Those small changes became my routines.

For example, I wanted to have more time for journal reading thus I looked for where I could set aside 30 minutes daily for my journals. I ended up finding at least an hour for my journal reading which became a welcome habit. I looked at where I could “sneak in” a workout even on my busiest day. I also left time for complete relaxation when I needed that too.

Staying in good physical condition is the best way to stay in good mental condition. As I look around me, those friends who are physically fit are the most mentally resilient too. In my life, my good physical condition has been a key to many successes in my career. As my physical capacity increased, with a combination of endurance and strength training, the greater my capacity to work and play with my pleasures coming from enjoyment of craft beer, good food and fellowship with friends and colleagues.

Final Thoughts

Take a moment and look for the following:

  • Where you might incorporate small changes that will increase your physical conditioning.
  • Where you might substitute better food choices in terms of avoiding high fat and high refined sugary foods for foods that are whole grain, fresh fruits and vegetables with leaner meats.
  • Where you might take time for small tasks that enhance your professional development.
  • Where you can find some time for pure recreation and enjoyment of life.

Make the changes today, that will help your life and enjoyment of life in the long run. It’s easier than you imagine as you don’t have to become a spartan or fitness nut. Your studies and your mental health with be much stronger which is the key to success in today’s world of medicine.

18 July, 2017 Posted by | academics, medical school, practice of medicine | | Leave a comment