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I. Question #1: Develop a routine on how to change the behavior(s) you identified from week 2. Describe the routine and how the other forces of the SCIENCE model can reinforce it.
—Consistent healthy sleeping habits, and my routine would feature a focus on remitting negative habits and fostering positive ones. Like turning off the TV and putting my phone away at least 30 minutes, if not an hour before getting into bed (removing a negative habit). Or possible reading a book or stretching and doing some yoga to help me wind down prior to bed, maybe in the 30 minutes after I put my phone down, giving me something to occupy myself in the meantime. The most critical aspect that I have identified as important for sustained change is that first word, consistency. Without consistency its not likely that my changes will lead to longer term benefit. Its great if I can do it one night but it will be the best if I can at least accomplish this every weekday night. I recognize the difficulty however with my schedule, in that its not always easy for a Resident physician to have a consistent schedule.
II. Question #2: Reflecting on your identified behavior(s) change you listed in week 2, use the SCIENCE Model to describe why some changes worked and others did not.
—Stepladders, setting myself up for success. This was critical and an important starting point. Putting my phone away, and especially turning off the TV helped me resist the “Next Episode” urge on netflix, falling into the trap of less sleep for an extra moment of something “I want”. While I want to see what happens I also want to wake well rested, so I have to pick whats more important. For community I recognize many physicians and healthcare professionals have gone through similar experiences, and how critically important it is for me to try to develop these habits early on at the start of a career. It will keep me healthier in the long run and help me fight burnout. Its easy but not at the same time, the steps seem simple but the consistency is difficult. Neurohacks could be as simple as having an alarm before bed to shut all the things off and open the book. Great sleep and waking well rested is captivating enough in my mind, and something that even as I type this on 5 hours of sleep seems like it would be one of the greatest gifts in the world.
1. Discuss the role of friendship, community, and service in living a healthy lifestyle.
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a. This is a difficult question, in particular because these things carry differing importance for different people. For instance in my own example I was born into and raised within a household that held no religion in particular. This was very deliberate and a result of the experiences of my parents and grandparents. Religion as a result, and the community some gain from it, never played a part of my life, and as a result I was always curious as to the experiences of others. Growing up and having religious friends allowed me to vicariously experience these aspects through them, and I had other glimpses at things like bar/bat mitzvahs, Ramadan dinners where they broke their fasts, and even when I went to a Catholic mass twice out of curiosity. For me however service is extremely important, as I was given very much throughout my life. My non-religious parents were also extremely hard working well educated engineers who prioritized the effort of the individual, teaching me that I can do anything I want if I work hard enough for it. Those experiences helped me get to where I am today, with my medical school graduation in two weeks. Service for me however is my way to give back, to provide a benefit to the world that has given me much, and is a huge motivator for me to provide care, especially internationally, to underserved communities where they otherwise may go without what they desperately need. I think a healthy lifestyle can be lived with all of these things, and also with none, but its all up to the individual. Meaning comes from where you glean it, and we all have to carve out our own reason for getting out of bed each and every day.1. What motivates you to change the identified behavior from week 2? Use both the Quick Fix and Trick Fix to discuss motivations. (healthier sleeping habits)
a. Besides from the bags under my eyes my motivation towards healthier sleeping habits is multifactorial I suppose. I know I need better sleeping habits for my own health and mental and emotional longevity in particular, but it also comes down to what I’ve personally experienced. After the first month of medical school being pretty overwhelmed by the sheer volume of the MSK system I found myself sacrificing sleep quickly, to the point I was getting about 4.5 hours per night and trying to maintain productivity on that. It wasn’t till a few weeks later that I saw the positive change more sleep awarded me, I felt better and my time was spent more productively when I had more sleep. In other words while I may have had an extra 3 hours to study in the day, overall with that little sleep the time I did spend studying was not as productive as it would have been if I had gotten more sleep. So sleeping a bit more allowed me to be more productive and get more done in a shorter amount of time, and since then I try not to let myself go into sleep debt, but I will admit I do still struggle some nights. So with the Quick Fix and Trick Fix methods, I suppose the Quick Fix is the bonus productivity I got from extra sleep leading to less hours spent studying for a greater reward. After reading on in this chapter I realized I actually used a Quick Fix when trying to learn piano. I mastered a simple tune from a video game pretty quickly, and while my commitment to becoming a virtuoso waxes and wanes I appreciate that I can always sit down in front of a piano and pull out that tune. For the Trick Fix I suppose the next song I learned, a more difficult one serves as my example. Learning the game of thrones theme song on piano was much tougher than my entry song, and to be honest I let it slip, haven’t practiced in a while, and cannot pull it out as readily as I used to be able to. Probably serving as an indicator that I should hop back to it.
1. Develop and/or discuss your own self-care plan for preventing and managing acute and daily stress.
The compassion fatigue article struck a nerve, as I worked under a physician who showed many of these classic signs. There are many times I wanted to chime in and try to help but not knowing what to say. The resources provided here help me plan for the future if I find myself in a similar situation. One thing I love included was the “Recharge your batteries daily” portion, with at least one thing on a daily basis dedicated to yourself and to self-care. For me, and sorry if I’m a broken record here, that one thing is yoga. The air, room to breath, and the breath I gain from a youtube “Yoga With Adrienne” session each time leaves me refreshed and serves as a remind of how important it is to find these things by which you can recharge or find renewal. That’s my acute fix, but long term its traveling without a doubt. Getting out in the world provides a very important context for me on my life, and my past travels around the world have helped illuminate the ways in which I should appreciate my own life.
2. List at least three reasons for health professional burnout or compassion fatigue. For each reason, please provide a tool for prevention and management.
The compassion fatigue article made this question easy. First and foremost “the health care system for forcing him to see more patients in less time”. Then there is Andy being annoyed in his patients for what he perceives to be their increasingly demanding nature. And finally the fact that his patient relationships no longer bring the joy they once did. Those stresses are very real and must be acknowledged by the clinician and the administration. The feasible and tolerable nature of a workday sometimes must take more precedence over the money that day brings in. I think the first problem directly relates to the next two, with Andy so overwhelmed he can no longer have the time to enjoy his conversations with patients. This stress compounds when their requests to him become increasingly demanding. In this sense it is not worth overloading your plate each and every day for a paycheck if it leaves you hating your career. Prevention and management for this would be recognizing these signs and knowing when to pull back, and hopefully having an administration that responds to this positively and understands an emphasis on the health of the provider as well.
This premise takes an interesting form for me, as someone who typically perceived change as a one way path. I always envisioned that the change that one wishes to become must begin within the mind, and only then can the body and the actions follow. I always used to think without the thought behind it how could any meaningful and lasting change be accomplished. So these neurohacks with their position of actions first, and perception change later was a bit of a juxtaposition for me. Either way one thing I’d love to change is a struggle with food. I wouldn’t say I’m addicted to getting take out but I do love it, and spend far too much of my money on it. I want to start cooking more and being cooked for less, and in turn save some money from it. In the past I’ve always had the plan to “eat out once a week”, typically on the weekend, but sometimes in the middle of the week I would find myself reaching for the phone to order chinese. Instead of trying to restrict and limit myself, I’m going to focus on the things I can cook rather. Tonight will be a nice chicken parm, one of my favorite dishes and one I know I cook better than the local place anyway.
I already knew throughout my life sleep was a troublesome area, as it has been something I have struggled with for a long time now. Usually my trouble is falling asleep, as it will take me hours of tossing and turning to get there. Luckily when I’m asleep I can usually stay asleep, and if I wake back up its not too difficult to fall back asleep unless I woke up violently, say to a dog pouncing on my face, a common occurrence. The practical plan I have laid out in prior posts actually has been helping a bit, I turn off the screens and read a good book for a bit before I head to bed, and this has made the transition to sleep a bit easier. Like I said before however sometimes it is tough to put the book down. Maybe I should get one of my textbooks instead.
Using the components of each action would hopefully make it easier to strip down any complexity. So with eating healthy for instance it all starts with a plan. I need to have a plan for my meals. Having things prepared ahead of time reduces the stress of in-the-moment meal prep, and its easy to microwave a healthy meal if you’ve already spent your Sunday cooking it all. Since my breakfast is usually the same this also takes some guess work out of the equation. Once I wake up I’m right to it, some cold brew and ice and eggs on the frying pan, since it’s usually the same each morning I can do these things without much thought. Similar to the way you would stretch after getting out of bed naturally, almost as a reflex from having been laying still for so long. I think this works easily with food, but even easier with exercising. It’s easy to get overwhelmed focusing on an end goal that may seem lofty and far off, but its important to remind yourself that Rome was not built in a day, and that Mt. Everest cannot be climbed in a leap. These incremental steps may feel small, but each one brings you closer to your target. For me in particular working out in the morning is difficult unless I have a severe time stress that forces me too, so in this month being “off” clinical rotations waiting to graduate I’ve been happy to let myself sleep a little later, move a little slower, and let my body decide its rhythm.
Sorry, this ended up longing than I expected, I like fitness stuff. 11 parts of physical fitness in total, 6 health related and 5 skill related. “Health-related” because scientists in kinesiology have shown them to reduce risk of chronic disease and increase overall health. The 6 health related are: body composition, cardiorespiratory endurance, flexibility, muscular endurance, power, and strength. The skill-related physical fitness components are “less linked” to health but are still very important, especially amongst an aging patient population. These skill-related components are speed, balance, agility, coordination, and reaction time.
I think something essential when developing a fitness plan is a specific goal. Vague goals such as “get in shape” or “get more fit” may seem like good targets at first, but without measurable standards or targets to chart improvement these lofty goals can seem very far off and unachievable. Instead having more specific goals allows me to figure out how to specifically tailor my training program to this focus. Here my focus will be able to do the Spartan Race “Beast” at Mountain Creek, NJ (a ski slope) in under 5 hours. This is a half-marathon obstacle course race up down and around a ski-slope, and is likely the most challenging athletic endeavor I ever attempted. I completed this race in 2021 at about 5 hours, and now I hope to return and complete the same race this year with a shorter time.
Breaking these down one by one. Cardiorespiratory endurance is essential to maintain a good pace throughout the 13+ miles, and conditioning through various trail-runs will be essential for this. I have been running about 6 miles of the trails and then hiking afterwards with my dogs. Increasing my run distance by 1 mile each week should put me in good shape. Strength is essential to accomplish many of the obstacles that the Spartan Race has, and many of these are upper body or “climber” based. Take monkey bars, swinging between gymnastic rings, or a rope climb for instance. I will prepare for these through a Resistance Training regimen, including various bodyweight exercises. Weighted pull ups, handstand push ups, push ups, rows, and a variety of core work. I’ll increase my reps or weights each time to maintain the difficulty. Power is something I’ll specifically have to train for, and I get through sandbag training. Through moving around a sandbag as quickly as I can or pulling myself through sprints I’ll be able to build Power. Muscular Endurance will be training through my resistance regimen, but engaging in higher level rep counts will help focus on this. Flexibility is essential when it comes to maintaining recovery and injury prevention, so I do yoga every day for this reason and for general wellness. Body composition of course matters because if I have excess weight then moving my body through the rope climb let alone the 13+ miles will be difficult. It is in my best interest to maintain a healthy body composition as it will improve overall performance.
I definitely resonate with something Emma touched on, how easy it is to fall out of a routine but how difficult it is to get back on track. I commonly find that I can do maintain habits more often if it is a daily occurrence, but I struggle more when there are days off. Getting back to the gym after a really intense workout and a few days off is sometimes more difficult than getting back there at the same time you went yesterday.
So for my two things I tried to select changes that would facilitate each other, or in other words things I could change in conjunction with each other. My ideas were healthier diet habits and some exercise change, or healthier sleep habits. I think the latter would work a bit better so I made it my goal to attempt to sleep at roughly the same time each night but also to read a book for about 30 minutes or so each night before bed. This would allow me to have some “wind-down” time as well as to help stay away from Screens like my laptop, television, or mobile phone shortly before bed.
I will admit the first night was difficult, mostly for the sleeping part. This was earlier than I had fallen asleep the night before so I expected it to take some time to drift off but I didn’t realize how tough that might be. A bit of tossing and turning but I still made it asleep all the same. I found myself much easier to drift off the next few nights, as well as much more excited to turn off the screens and open my book before sleeping. This also may have backfired when my 30 minute timer went off and I thought “wait but I need to know what happens next”. It felt like a book version of the common Netflix cliffhanger prompting me to hit “Next Episode”. I appreciate how easy it was to get accustomed to this change as well, these were tiny changes that built on each other but once I made a plan it was easier to stick to.
I am a man of habit when it comes to breakfast and I should probably work on that. My go to is 3 eggs scrambled with oatmeal and some granola, or maybe 3 eggs with the same cereal and milk. Sometimes I would add a protein shake in the morning, others I would add PB to the oatmeal, but its almost always the same. Switching up my variety to include some berries and greek yogurt, maybe some pancakes and french toast, I think in the long term will help me with my nutritional goals in terms of staying consistent. While eating the same thing every day can be okay if I enjoy it, I think it can be a quick way to get tired of something I enjoy. Coffee is my staple, and I always reach for my cold brew first thing when I get up, maybe I can switch that out for some green tea some mornings in order to get my caffeine intake down. I do not emphasize lunch heavily I realized, and its usually the form of a snack or two. Dinner for me is heavy and usually is chicken over rice or turkey chili over rice with some vegetables. Other things like a frozen pizza or a rack of ribs will get included depending on how tired of chicken over rice I am.
As far as three areas that you want to change or improve with my nutritional habits. I think working in more fatty fish to my diet would be great way to get more essential Omega Fatty acids. Like Tilapia, Salmon, or Shrimp for instance I can easily increase the nutritional value of my food while adding some healthy variety. I also think working in a wider variety of vegetables would benefit me. My go to vegetables are either broccoli, cauliflower, or peas, so broadening my vegetable horizon to include some more colorful options is probably in my best interest. This will help with adherence as well I think just to have a bit more variety in my culinary life. One thing making this diary definitely made me realize is that I need more chocolate in my life! While healthy eating habits is something that is absolutely important to me, enjoying life is also critical. I am a die-hard chocoholic and to see the minimal amount of chocolate in my diet was sad. So that will be something I will be incorporating more of in the future, maybe some cocoa bits in the oatmeal in the morning or some chocolate ice cream after dinner. I will admit when I drink milk its almost always exclusively Fairlife Chocolate Milk, and that makes me pretty happy.Using the Cult examples were an interesting segway into the strength that the community bond can hold, and I appreciated the personal anecdotes provided in Janja’s story. I think one of the most important aspects behind your community/person as a social magnet is that it is one you personally align with. The book quickly details a difference between communities based on things you may have chose or things that may have been chosen for you. In this I believe a chosen community will hold stronger bonds than one that was not voluntarily engaged in. The high school student will have a much stronger connection with the theater group they want to attend on the weekends rather than the sports group their parents force them to be a part of on the weekdays. I appreciated the example of scavenger hunts as well, and thought that was an interesting parallel drawn to games like PokemonGO. In particular the team based nature allows for individuals more heavily motivated to help pull individuals with lacking motivation along, as the “magnetic force” in the chapter provides. In this way the crowdsourced motivation can be a powerful force for continuity. I know many people that love and prefer to exercise at a CrossFit gym rather than a regular gym, and when asked why a common answer relayed is the community that the CrossFit gym has. These people do not show up for the workouts only, but to cheer each other on as their peers set personal best workout times or personal records on specific lifts. I understand this crowdsourced peer pressure to an extent, I basically exclusively workout at home since the COVID pandemic began, but recently while traveling I went through some yoga classes with an instructor and other classmates. Motivation to push myself further was present in part due to the instructors influence, but also in part to almost “impress the group”. I think I wanted to do extra well at yoga this day just because I was placed in front of people, or on a “stage”, which provided me motivation to go deeper into squats or folds or longer for holds like Crow or headstand. Other environments can provide a strong sense of support, and these can be an essential source of “peer-pressured” motivation. Alcoholics and Narcotics Anonymous can be powerful tools for habit cessation when used productively.
1. Discuss examples for each transtheoretical change model stages.
Precontemplation, Contemplation, Preparation, Action, Relapse, and Maintenance. Precontemplation is before people are aware of the need for change, or the negative consequences associated with their habit/behavior. Contemplation is when people recognize their behavior is deleterious, and change must occur; they just don’t know how to start yet. Preparation or Determination is when the person begins to plan how to change and how to take action, specific measurable targets for changing their behavior. Action is where they act upon their preparation and move towards positive change. Maintenance is keeping their actions in line with their new positive behavioral change, and relapse is if they fall back into their old negative habits. This is a constant cycle that one may move through when trying to enact effective change. For weight loss it will look like the following. Precontemplation before they realize their weight is an issue. Contemplation when they know it is an issue for their health but do not yet know how to change. Preparation when they are preparing to change their diet and exercise habits. Action when they actually change their habits, maintenance to keep with healthy new exercise and dietary habits, and relapse if they fall back into old unhealthy habits.2. Describe variables that could contribute to the success of transtheoretical change model.
A wide variety of variables can contribute to the success or failure in each individuals attempts at change. Take healthy dietary habits for instance. The impoverished individual working a minimum wage job and relying on cheap nutrient-poor fast food has less choice with both their dietary options and their time use, so this person will naturally struggle more when it comes time to make effective change. It is easy to say eat healthy well balanced whole food meals, but much more difficult when one is working two jobs just to stay afloat. One variable that can greatly increase success however is also having a support network. Having a community support network to help out in times of difficulty can greatly increase one’s chances of success and prevent relapses.1. List and Describe the “SCIENCE” (acronym) of lasting change.
Stepladders, Community, Important, Easy, Neurohacks, Captivating, Engrained. Stepladders for people to take little steps towards their target behavior. Community to understand the power of crowdsourced energy. Importance to understand why the behavior change is worthy of our time and energy in the first place. Easy to take the complication and complexity out of things, pick up the weight, and put it down. Neurohacks to train the brain to envision change, and then become it, or tricking the brain and the change follows. Captivating in order to “gamify” the behavior and draw out the competitive aspects of persons. Engrained because life inside of a routine can build room for growth, and through efficiency we can maximize our potential efforts.2. List at least one behavior(s) you want to change. Ask someone who knows you well to provide an honest opinion on whether this is a realistic or not a realistic goal. Develop your stepladder steps to achieve the identified goal.
I’d like to develop consistent healthy sleep habits, it starts with changing my negative habits and building positive ones. Turning off the TV and putting my phone away, maybe reading a book or stretching and doing a little yoga, winding down before bed. I’ve gotten used to taking a shower before bed but this isn’t essential. The most important thing for me is probably the time however, setting a consistent time I go to bed should hopefully help me maintain a set schedule. With this set schedule I hope to wake up less in the middle of the night and to wake in the morning better rested.I appreciate the anecdotes Emma provides in regards to technology. I also agree that it can be a powerful tool and greatly Supplement the information gained in the clinic, but at the same time it can also detract from the visit if the patient thinks they already “know everything they need to”. I have a personal example in this regard. My brother is a bit of a hypochondriac, and through much experience has become quite the WebMD aficionado. When he uses it to self diagnose himself with a subarachnoid hemorrhage while experiencing a minor headache after bumping his head, it becomes difficult for him to perceive less severe causes after having researched such a devastating thing. This practice of reassurance is difficult even for the physician, who may laugh initially like I did when sitting there talking to me he name dropped “subarachnoid hemorrhage”. Being compassionate and redirecting these patients towards productive trains of thought and uses of their time must be a priority, as well as working together as a team towards the end goal of improved health.