Monday, October 31, 2016

Hillary Pumpkin

Happy Halloween everyone! So what exactly is the Hillary equivalent of "Trumpkin"? I heard Howlery, but that seems more like a werewolf costume... and Clint-kin or Clinton-kin doesn't sound very nice. Pumpkin-ary? Pump-tin? Hillary-kin? I think I like that... Hillary-kin.

Not to be outdone, and not wanting my pumpkin carving to seem like I'm making any sort of political statement, I thought I'd follow-up my Trumpkin carving with a Hillary-kin. Just some good 'ol Halloween fun.

For the record, this pumpkin took me much longer than the Trumpkin. I think it is was really hard to find a photo that I thought I could translate into a pumpkin. I went through around 11 photos and kept asking friends which ones looked distinctly "Hillary". In the end I decided her smile and cheeks were her more attributable characteristics and thought the following picture (by photographer Gage Skidmore) captured her nicely.

Click Here for Original
After deciding on the photo, I created a black and white version and started carving. About halfway through, I cursed myself for deciding to pick one with teeth as I had to carefully carve out her gumline. On the plus side, if being a doctor doesn't work out, I think I have potential as a dental hygienist. And then the hair... that took a while too. I actually stopped fussing with the hair because midnight struck and I could feel myself turning into a pumpkin (pun intended... I crack myself up).

I've learned some things about both candidates from doing this exercise. For instance, I learned they both have double eyelids, and those are annoying to carve. Although it might not influence my decision this election cycle, overall this has been a fun project. So regardless of your political views, hope you enjoy.

Below is a picture of the pumpkin itself without the lighting.

Sunday, October 23, 2016

My Trumpkin

After a four year hiatus from carving (I blame residency), I got back into pumpkin carving this year! 

This year, I jumped on the trend and carved a Trumpkin!

I took the original picture from the web: 

Then created a black and white version to trace onto a pumpkin. All in all, it took me around 6 hours to do.

Previously I've memorialized recently passed celebrities that have inspired me, like my last pumpkin of Steve Jobs. 

This year, however, the election has just been so pervasive in our live that I just decided to adhere to that theme. Although I do obviously have my own political inclinations, this is really just to have some fun with an otherwise not fun election cycle. I actually tried to carve a Hillary pumpkin too, but it didn't end up looking like Hillary at all. I might try again next weekend. 

In case you're curious, this is what the pumpkin looks without the light.

Wednesday, August 10, 2016

My new job to innovate in primary care

I finished residency this year in June. After 7 years in training, I finally get to do what I set out to do: make my patients healthier. One tiny problem, I'm not exactly sure how to do that. 

It isn't just me though, as a healthcare system, we haven't figured out how to improve overall health outcomes of our patients. This is despite being the most expensive health care system in the world spending an estimated $9,451.30 per capita or 16.9% of our GDP in 2015 according to OECD. In comparison, the country with the next highest expenditure would be Switzerland, which spends 11.5% of its GDP on health care, and then Japan at 11.1% of its GDP. At least Switzerland and Japan have more to show for their expenditures though, according to CIA's estimated rankings for 2015. For example, in terms of life expectancy, Japan is ranked 2nd highest at 84.74 years and Switzerland ranked 9th at 82.5 years. Similarly, Japan ranks 3rd lowest for infant mortality in 2015 with 2.08 deaths per 1000 live birth, and though significantly lower, Switzerland still ranked better than the US at 26th lowest with 3.67 deaths per 1000 live birth. Comparatively, the US is ranked 43rd in life expectancy at 79.68 years (right under Turks and Caicos Islands and Virgin Islands) and 58th lowest in infant mortality with 5.87 deaths per 1000 live births lagging right behind Croatia, as well as Bosnia and Herzegovina. 

So when I say I don't know how to make my patients healthier, I'm only partially exaggerating. It isn't as easy as just going to medical school and doing residency, after all, if that were the case, wouldn't our system be performing much better than it is already? So what can we be doing better and differently to improve our overall health? I'm not sure, but that's what I finally have the opportunity to try to figure out.

This month I joined The Wonderful Company's Health and Wellness Initiative as the Associate Director, Clinical Innovation. The Wonderful Company is dedicated to improve the health and wellness of its employees and families, many of whom are agricultural workers in more rural areas of Central California, and believes that the answer includes better primary care. Given I decided to specialize in Family Medicine, I obviously agree. 

However, the answer isn't in the primary care as we know it now, which often time is the 15 minute per patient visit, see as many patients as you can to become financially sustainable type of primary care we've become so used to in our system. Instead, can we re-imagine what primary care could look like to improve our country's overall health outcomes to a state better than it is today? Could we partner more with patients for their health? Could we more effectively teach and inspire better health habits? Could we coordinate care better? Could we bring in other healthcare workers to function as a team? Could we do more in the community? Could we address social factors that impact health? Could we use data better? I personally believe the answer is yes to all of the above, but I guess we have to prove it, and I'm thankful for the opportunity and flexibility to try new things and do exactly that. So my mind now is constantly churning with one question: How can it be better? Because, I know it can be better. It is actually just like when I was the senior resident on our hospital team and one of the junior residents was confronted with a road block, and I always gave the same advice: the question shouldn't be if, but how.
One of the company's sites in Lost Hills, CA


Friday, June 10, 2016

You can only do what you're going to do

I'm continuing on my series of posts on advice I share with patients who are interested in losing weight or starting a healthy lifestyle. Today, I'm going to share my most used motto that I tell all my patients interested in lifestyle modification. They've all heard it at least once, but probably more, because it is represents my most firmly held core belief in approaching behavior change: You can only do what you're going to do.

I've heard colleagues complain about how patients never do what they tell them to do, particularly for diet and exercise. In my head, I think, "I feel like a lot of patients do what I tell them to do..." and then I realize, "Oh yeah, that's because I never tell them to do anything." That makes it a pretty easy goal to reach! However, as lazy as that sounds, this is more than me just lowering my standards of success.

When a patient asks me what they should do to be healthier, I won't answer. Instead I ask, "You tell me, what can you do to be healthier?" I want people to tell me what they think they can realistically do to be healthier. Maybe I'm just cynical, but I feel like if I tell someone what to do, they're not going to do it anyways, so I don't see the point. Sure, I can spout out the American Heart Association's recommendation of 150 minutes a week, or 30 minutes a day for 5 days a week, but if only it were that easy, all of us would be doing what we were supposed to be doing. Being un-athletic myself, when I first started exercising, hearing something like 150 minutes a week would have floored me. Someone might as well have told me to train for the Olympics to get a gold medal in men's gymnastics. In my mind's eye, both would have been equally impossible and unobtainable, so why bother trying?

Instead of giving recommendations that might seem unrealistic, I try to get people to tell me what they'll actually do. And that's when I say it: You can only do what you're going to do, so tell me, what is it that you're going to do? I never care how small the goal is, someone could tell me they'll eat 1 more raw baby carrot a week for 2 weeks. Fine. I'll take it.

It isn't about having good habits, it's about learning you're capable of making changes to develop better habits. It's about shifting the internal monologue from I can't, to I can, one baby step (or baby carrot) at a time. One might think that my general reluctance to educate patients on diet and exercise is absurd, but my other philosophy is: Patients aren't stupid. For the most part, people know some foods are healthier than others, or that exercise is good for them. They don't need me to tell them that. Granted, there are exceptions, including those that have been led astray by food marketing, or have already made obvious changes and are running out of ideas, or have a question if a proposed change is actually a healthy decision. However, the majority of average people, like you and me, probably have some pretty obvious things that we can think of to change for the better.

So my advice from today's post: don't rely on someone else to tell you what to do, because only you
Do, or do not. There is no try. - Yoda
know what you can and can't do. These are your habits and it's for your health, so take control and own it. Pick a healthy habit you're going to do for two weeks. Not "try" to do, but actually do. When I have a patient say they'll "try" to do something, I work with them to think of smaller goals until they stop saying, "I'll try" and start saying, "I will". I've named this very official medical technique, the Yoda maneuver. Then, once you've achieved one goal, pick something else you're going to do for a few weeks. Just keep focusing on what you're going to do. Don't worry about what you "should" be doing, because what's the point of knowing what you "should" do if you're not going to do it? In the end, you can only do what you're going to do.

Thursday, May 26, 2016

Don't lose weight to be healthy

For the next few posts, I just want to talk about pieces of advice that I give patients who tell me they want to lose weight. This isn't so much for other clinicians who have their own styles (that may or may not work better for you than mine would anyways), but more so for people that have thought about losing weight, and just want to hear the advice I give.

The first piece of advice is not to lose weight to be healthy. Instead, find a more concrete aspiration. Let me explain what I mean. When I ask patients why they want to lose weight, more often than not, I get told some variation of, "I want to be healthy." It seems like the right answer that a doctor should be happy with, I mean that's what we want for all our patients right? The problem is, I'm not really sure what it means "to be healthy", and I don't think most people do either. It is just something that sounds good.

Let me explain before my medical training gets called into question because someone thinks that, at baseline, a doctor should know what "being healthy" means. For me, the concept of "being healthy" is too conceptual and abstract. It can mean different things to different people. For instance, imagine you were walking down the street and happen to bump into someone you haven't seen in a while, who says, "Hey, you're looking really healthy since the last time I saw you!" I don't know about you, but I'd be like, "Wait, I think they just called me fat..."

The term healthy is just so vague. It's not like we can wake up and go, "I'm more healthy than I was yesterday". There's no real way to know when you've progressed. It is a very abstract descriptor, like being rich. When would you know if you were rich enough, and similarly, when would you know if you were healthy enough? So instead, I try to look for more detailed answers to define health, specifically, what are the things a patient would like to realistically do that he/she currently can't do. What are they trying to get out of this improved health? Sometimes it is as simple as getting off of a medication, but sometimes it is more emotional, like being able to do some activity with their children. I believe you can't take away something someone enjoys (and unfortunately a lot of unhealthy habits are really enjoyable), without finding something else that is worth giving it up for.

So that's my first piece of advice, don't try to lose weight to be healthy, instead try to soul search to find a more detailed answer as to what it means to you to be "healthy" and why you want to be healthy. (Plus I don't like how weight is a proxy for health, but that's another topic for another time). What is it you're hoping to achieve? Hopefully the desire to achieve whatever it is you are driving towards will override the desire to have a donut, or ice cream, or fried chicken (all the above are my vices, everyone has their own). Dean Ornish, Clinical Professor at UCSF and preventive medicine guru, put it nicely in his Ted Talk when he said, "Many of you have kids, and you know that’s a big change in your lifestyle, and so people are not afraid to make big changes in lifestyle if they’re worth it[...] For many people, those are choices worth making -- not to live longer, but to live better." So would make you feel like you were living better? What are the things you love that you want to be able to do more of or better? Everyone has to answer that for themselves, but I don't think it is even worth talking about diet and exercise, as mentioned in a previous post, until we've figured out why we're going to undertake a healthy lifestyle journey in the first place.

In case you're curious in what ways I'm living better and how it motivates me, I'll say that what brings me great joy is to be able to do fun activities that I never thought possible. It makes me really proud to do something new, like finishing my first sprint length triathlon earlier this month. I always put people that could do things like that on a pedestal and felt like I'd never be good enough enough to do it, and so it feels kinda awesome to know that I am good enough! It is a huge self confidence booster. The other thing is I love to travel, explore, and have fun adventures, so I love being in shape enough to do unique activities when traveling and/or exploring. For instance, this past weekend I biked 32 miles around Los Angeles to see the sights, and am preparing for a trip to Scandinavia this July to bike from Norway to Finland. I'd never be able to do these types of unique adventures, or experience a country in this way, without being in shape enough to do it. This makes me happy.

Map of Los Angeles bike ride for "City of Angeles Fun Ride"
Biking in the Wildflower Triathlon May 1, 2016

Tuesday, May 17, 2016

Return to Blogging

"Trust me, I'm a panda"
Sorry for the hiatus from posting, but being a family medicine resident the last 3 years left me with little time to do much else. As mentioned in a previous post, "You can do anything, you just can't do everything". Something had to give, and unfortunately for me, I had to stop blogging. However, recently, a few incidents got me thinking about restarting up my blog (including almost finishing residency).

The first incident came a little over a month ago, when a medical student was working with me in clinic. That particular day's schedule was filled with one success story after another of patients that I had been working with to successfully lose weight. The medical student asked, "How do you do that? Your patients are so compliant!". The compliment triggered a thought that maybe I should start blogging about the ways I counsel my patients, as it seems to work for some, so maybe others could find some value in the advice I give in clinic on a daily basis.

I'd also like to note that the either intentional or unintentional brown-nosing totally worked in making me feel good about myself, and I subsequently wrote that medical student a stellar evaluation.

The second prompt to have me thinking about blogging again came in a form of a text message from a fellow resident, also about a month ago. She asked me for my blog address. I let her know that I hadn't blogged in years, and her encouragement to start back up to inspire others also got me thinking.

Finally, the third reason to start blogging again was the recent article in the research journal Obesity, (or a more digestible summary/characterization here from the New York Times) that discussed how many of 'The Biggest Loser' contestants regained their weight after the show. They talked about how each contestant's body metabolism changed and subsequently sabotaged their efforts to sustain their initial weight loss. I personally found the article to be really discouraging. I felt like it made the journey to sustainable weight loss seem almost impossible. However, three and a half years after my own weight loss journey, I'm still about the same weight/body composition.

I'm just an average person. I believe if I can sustain a healthy lifestyle, then others can too. I hope coming back to blogging, I can share strategies that have helped me so that others can benefit. I'm going to start off in the next month with a series of common things I tell my patients that helped some (definitely not all) find success.