Nutrition 2019

I’m not one to make New Year’s Resolutions.  Why?  Because I used to make a list of 10 things and NEVER got any of them completed.  My goal these days is to constantly re-asses my goals daily.  Every day is a new day to accomplish something or try something new or go outside your comfort zone.  So, this year, my husband and I both want to work on our nutrition.  It’s more evident now (we’re in our 40s) than ever before that we really take responsibility not only for our own health, but the health of our littles.  Therefore, this is a top priority for both of us.  The more we learn about nutrition and what to put into our bodies, the more we can teach our kids the importance of health and nutrition.  I hope this knowledge continues to transfer down into our kids, grandkids, etc.  The gift of good health is more valuable to me now than before.   The older I get, the more I see my parents/family aging.  Luckily, my family has good genes are have lived into their 90s.  However, I want to take what I can into my own hands and make sure it stays that way.  I come across so many patients who either have bad genes, poor diet, poor access to nutrition, lack of knowledge of nutrition and exercise, or simple complacency with an “I’m gonna do what I’m gonna do” attitude.

Three Books that I’m tackling this year:

 

recommended-weekly-exercise
From CBHS Fund
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Make Nutrition a Priority

This past weekend, we went to my mom’s for Mother’s Day.  It’s always a treat to be able to catch up with the fam.  Both my aunt and my mom are extremely health conscious.  My aunt has been practicing a very healthy lifestyle since 1999 when she had a health wakeup call.  My mom has more recently adopted a health-conscious lifestyle probably in the last 8 years when she moved out to California.  Nutrition is my aunt’s passion — any chance she gets, she’s always interested in educating me about eating whole foods.  I feel like I’m pretty healthy, but I certainly make my food mistakes: preferring quick and easy to wholesome nutritious, craving sweet and/or fatty foods over better choices to satisfy my craving, and stress-eating without hunger.  Sure we all do it.  But, I got to thinking that now is a great time to really educate myself on nutrition and taking care of my family.  I don’t know why it was such an epiphany, but now that I’m responsible for a tiny human… I’d really like to educate her on good food choices.  So, it starts with me… leading and setting a good example for my daughter.  It’ll be a bonus when the whole family jumps on board.

Green-Breakfast-Bowl
From JSHealth

There’s a ton of nutrition info out there as well as recipes.  Recently, I came across a gal’s website on nutrition: JSHealth.  She has a very relatable story regarding her relationship with food.  I think what she’s trying to accomplish is fantastic, and it should be a goal of not only girls and women, but anyone we love in our lives.  Food is something that will be with us for life.  There are so many fad diets out there.  Some claim quick results — hey, who wouldn’t want to drop 10lbs in a month?  But is it sustainable through life?  If not, then you’ll just yo-yo back and forth and continue to look for “diets” instead of a “lifestyle”.  Plus, look at the health gains or losses from a diet vs. whole food lifestyle.  Will this be easy?  Probably not.  I will be changing the way I’ve eaten for the last 39 (eek) years of my life.  But, it’s important, and I wish I knew and started sooner.

Here is her program.

Have you been on yo-yo dieting?

How do you feel on your current diet/eating routine?

 

Responsibility for your own health

I was shocked to see that the NHS could ban surgery for the obese and smokers.  That’s socialized medicine.  You take a conglomerate group of people (the UK) on a limited budget for healthcare… and basically find the cheapest most cost-effective way to deliver healthcare.  But in a way, it’s empowering patients to take responsibility for their own health.  Smoking, for sure — I agree 100% that surgery should be banned for this population.  Obesity is a bit trickier — there’s genetics and environmental factors at play in this one.  I don’t think anyone chooses to be obese.  But, people do have the power to change their eating and exercise habits.  Despite these efforts, there are some people who are still obese…. and these people should not be faulted.

Why single out the obese and smokers?

obesity-and-cv-disease-1ppt-44-728
From SlideShare
obesity-and-cv-disease-1ppt-43-728
From SlideShare
tobacco-health-statistics
From TobaccoFreeLife.org

Smokers and the obese have elevated surgical risk and mortality, which means more cost to treat and hospitalize and provide ongoing care.

150423sambydisease
From HealthStats

I think the NHS is on to something here.  They’re opening doors to moving the liability and responsibility away from physicians and towards patients.  This is a plus.  Outsiders may see it as separatism and elitist to only provide care for people who are healthy.  But look at the facts and the data…. obesity has a lot of co-morbidities associated.  Smoking has a lot of co-morbidities associated as well.  Why should physicians be penalized for re-admissions, poor wound healing, longer hospitalizations when the underlying conditions themselves are already challenging enough?  In fact, I would urge insurance companies to provide incentives to patients/the insured with discounted rates for good and maintained health and wellness.  With all the technologies, medications, and information out there, it’s time patients take responsibility for their own health.  I take responsibility for mine — watching my diet, exercising, working on getting enough rest, maintaining activities to keep my mind and body engaged, meditating for rest and relaxation.  It’s not easy, but my health is 100% my responsibility.  I refuse to pass the buck to my husband, my family, my physician, etc.  I do what I can to optimize my health and future — and if that doesn’t work… I call for backup.

Patients need to change their mindset re: health.  It is not your spouse’s responsibility to track your meds.  It is your responsibility to know your medical conditions and surgical history.  The single most important (and thoughtful) thing a patient can do is keep an up-to-date list of medications, past/current medical history, surgical history, and allergies to bring to every doctor’s appointment and surgery.  This helps streamline and bring to the forefront your conditions and how these will interplay with your medical and surgical plan and postoperative care.  Please do not forget recreational drugs, smoking habit, and drinking habit in this list.  It is very important to know all of these things.  Also, your emotional history is very important.  Depression, anxiety, failure to cope, etc.  This all helps tie in your current living situation with stressors and your medical history.

Links for educating yourself in taking responsibility for your health:

obesity
From SilverStarUK.org

Responsibility for your own health

I was shocked to see that the NHS could ban surgery for the obese and smokers.  That’s socialized medicine.  You take a conglomerate group of people (the UK) on a limited budget for healthcare… and basically find the cheapest most cost-effective way to deliver healthcare.  But in a way, it’s empowering patients to take responsibility for their own health.  Smoking, for sure — I agree 100% that surgery should be banned for this population.  Obesity is a bit trickier — there’s genetics and environmental factors at play in this one.  I don’t think anyone chooses to be obese.  But, people do have the power to change their eating and exercise habits.  Despite these efforts, there are some people who are still obese…. and these people should not be faulted.

Why single out the obese and smokers?

obesity-and-cv-disease-1ppt-44-728
From SlideShare
obesity-and-cv-disease-1ppt-43-728
From SlideShare
tobacco-health-statistics
From TobaccoFreeLife.org

Smokers and the obese have elevated surgical risk and mortality, which means more cost to treat and hospitalize and provide ongoing care.

150423sambydisease
From HealthStats

I think the NHS is on to something here.  They’re opening doors to moving the liability and responsibility away from physicians and towards patients.  This is a plus.  Outsiders may see it as separatism and elitist to only provide care for people who are healthy.  But look at the facts and the data…. obesity has a lot of co-morbidities associated.  Smoking has a lot of co-morbidities associated as well.  Why should physicians be penalized for re-admissions, poor wound healing, longer hospitalizations when the underlying conditions themselves are already challenging enough?  In fact, I would urge insurance companies to provide incentives to patients/the insured with discounted rates for good and maintained health and wellness.  With all the technologies, medications, and information out there, it’s time patients take responsibility for their own health.  I take responsibility for mine — watching my diet, exercising, working on getting enough rest, maintaining activities to keep my mind and body engaged, meditating for rest and relaxation.  It’s not easy, but my health is 100% my responsibility.  I refuse to pass the buck to my husband, my family, my physician, etc.  I do what I can to optimize my health and future — and if that doesn’t work… I call for backup.

Patients need to change their mindset re: health.  It is not your spouse’s responsibility to track your meds.  It is your responsibility to know your medical conditions and surgical history.  The single most important (and thoughtful) thing a patient can do is keep an up-to-date list of medications, past/current medical history, surgical history, and allergies to bring to every doctor’s appointment and surgery.  This helps streamline and bring to the forefront your conditions and how these will interplay with your medical and surgical plan and postoperative care.  Please do not forget recreational drugs, smoking habit, and drinking habit in this list.  It is very important to know all of these things.  Also, your emotional history is very important.  Depression, anxiety, failure to cope, etc.  This all helps tie in your current living situation with stressors and your medical history.

Links for educating yourself in taking responsibility for your health:

obesity
From SilverStarUK.org

When to let go

20140805-021753-8273975.jpg
I came across this blog post and was really struck by it’s honesty regarding the nature of medicine and death/dying. Back in 2011, I was faced with a very real scenario regarding my father’s health. Throughout medical school, we are taught to do no harm. However, there is a fine line between living and just barely surviving. Even as an MD and having been trained to deal with death and dying, I had to eventually come to grips with what was best for my dad. It has been said that medicine is both an art and a science. Practicing the art of compassion and empathy, I have learned a great deal from patients and their families as well as my own. Despite all of the advances of modern medicine, nothing helps more than listening to the patient.

The Greatest Act of Courage

Advice from an anesthesiologist…

Any operation under general anesthetic usually...
Image via Wikipedia

The post below was originally posted here:

http://forums.studentdoctor.net/showthread.php?t=817516

Originally Posted by UTSouthwestern View Post
Well you know that the smackdown is coming if I post a reply:

I find it more than a little irritating that anesthesiologists seem to complain about respect issues, lifestyle, pay, nurses, etc. and just stew over it.

I have been in practice six years, do every kind of case known to man, 100% solo/no supervision, work hard but play hard, and only twice can I recall being disrespected/questioned in that time.

Both times, by nurses, a quick, educational, and authoritative response quelled any further insubordination. Surgeons, nurses, and administrators know that when I say something, request something, order something, do something, it has a legitimate purpose and MUST be done. It is a confidence they have in my judgement and more importantly, my compassion.

Conversely, I am told regularly about how some anesthesiologists have little to no ability to make a firm decision, bounce back and forth between totally opposite treatments/decisions, speak/act like scared mice, rush out of the PACU or ICU to make a haircut appointment, talk about anything EXCEPT medicine or THEIR patient, etc.

With that backdrop, it becomes increasingly difficult to keep the lines distinguished.

These are YOUR patients, not just the surgeon’s. Take ownership of your patients, your situation, your facility, and be heard. Too many expect that M.D. or D.O. acronyms on their badges will instantly afford respect or authority. With Hollywood medical vomitus on TV and in the movies creating an overgeneralized image of the lazy, incompetent, vain, self-centered, dangerous physician, the deck is stacked against you.

Don’t jump up and down on the down side of an overloaded ship, throw the baggage overboard.

Get involved in every phase of every case you do. The more you do that, the faster and easier it becomes and the more indispensible you become. “Dr. CT surgeon, I spoke with your AVR, redo CABG patient last night and he has worsening cervical stenosis with OPLL diagnosed over a year ago. I am recommending full neuromonitoring for this case and will consult with his neurosurgeon on post-op followup and care.” In the ICU give a full report and direct the care. “This patient requires Q 4h neurochecks including full upper and lower extremity range of motion and strength exams.” Do the first one yourself.

When you walk into an OR, or PACU, or preop holding area, or ICU, your presence should be anxiolytic, not anxiogenic. You can see and hear the difference when different anesthesiologists walk in. We need to make a concerted effort across the specialty to change the attitude of and towards the specialty.

It starts with the medical students. I cannot tell you how many PM’s and e-mails I still get from this forum from med students with subpar grades and docile personalities, looking for the high pay, easy lifestyle, no stress field. I no longer respond to those students, because this field does not need foot soldiers. It needs leaders and visionaries to push the boundaries of the field and take ownership of our future. It doesn’t need fearmongers, supporting cast members, or the spineless.

Work in a hostile environment? Defuse it. Find out what the issues are and tackle them head on. Do it with zeal, a positive, helpful attitude, but most of all with authority. As I have said multiple times in the past, you have to get involved from the top down to understand and develop all facets of your practice and your facilities. That means spending some off time in administration and rooting out problems before they start to fester. I spend a large portion of my free time in administrative meetings both teaching and learning from administrators about issues they may not even have considered.

Cost considerations are always a concern. This group will do it cheaper, this group uses CRNA’s, this group will come out to location X, etc. I have been asked to change my practice by facilities before and each time, I have clearly delineated the pros and cons and emphasized the depth and experience of my group to administrators. I am more than willing to take those assets and develop your competitor. That happened again and two months ago, I was reapproached by the facility I left to come back and resume our practice there. I declined. When they sweetened the deal, I accepted with stipulations.

In the future, we need to develop physician specific, core business concepts that will provide reproducible, sustainable models in all situations. The “cheaper is not better” approach combined with sustainable revenues and proven outcomes starts with the ASA and legislative efforts. It is a comprehensive model that can be used to not only sustain our presence but also redefine our roles as providers, leaders, and business developers.

Why does society frown upon doctors making a reasonable living?

Example of an American grocery store aisle.
Image via Wikipedia

Read this article about sacrifices doctors make just to bring good care to ailing patients.

http://www.kevinmd.com/blog/2011/04/society-frown-doctors-earning-reasonable-living.html

Think twice before you decide to not pay your hospital bill.

You pay the grocery store and shopping malls.  You pay your phone bill.  Why wouldn’t you pay your doctor?