Well, the answer is I am writing more than I ever have. Ever. The posts I write now are called SOAP notes, on a type of blog called the “electronic medical records,” about people and their medical issues . I write about my experiences, and when I spend most days of the week experiencing patients, that’s what I write about. The blog is closed to the public, and not shareable except to the subjects who I write about and to those that have received a signed medical release from the subject.

Who knew that becoming a doctor also means becoming a writer. According to a 2016 Forbes Article, a study from Annals of Internal Medicine reveal that doctors now spend on average 27% of their time seeing patients and 49% of their time doing paperwork. And even while in the exam room, doctors spend 53% of the time examining and talk with patients and 37% on paperwork. The study included not just primary care physicians like family physicians and internists, but also specialists like cardiologists and orthopedic surgeons. And it wasn’t always this bad. According to this Annals in Family Medicine article back in 2005, before electronic medical records were common, medical charting and dictating accounts for just 11.5% of the time doctors spent in the office. 

What kind of paperwork is there? For every patient encounter, doctors document the patient’s complaints, our findings, our assessment of their issues, and our plan. There are specific rules we have to follow when writing our notes, as laid out in this 90-page document on the CMS.gov website, and the rules apply to both medicare/medicaid and private insurance patients. The notes we write serve as legal documents that can be used by other doctors, lawyers, social security office, insurance companies, and other multidisciplinary professionals. Fortunately, I enjoy writing, so I don’t mind writing visit notes since they remind me of blogging, but prior authorizations and FMLA paperwork are a different story.

Another paperwork we too often encounter is the prior authorization form. Just because a doctor orders a medication or diagnostic study doesn’t mean the patient will be able to get it through their insurance. Often insurance companies do not cover certain medications that a patient needs, for which the healthcare provider fills out prior authorization forms to explain why a patient needs that certain medicine and not another one that may be on the patient’s insurance’s preferred medication list. We also fill out formsf to insurance companies to explain why a patient needs speech therapy, physical therapy, a wheelchair, or some other equipment, on top of providing the notes from our encounters to the patient. We fill out pre-certification paperwork to order an MRI or ultrasound for our patients, only to get a rejection from the insurance company, then we try to appeal it with more paperwork. Approvals for medications, procedures, and diagnostic studies take time, delaying patient care and diverting the time we could be spending more with our patients.  Sometimes it takes 30 minutes to up to an hour on the phone with an insurance company to get something approved for a single patient. Imagine if you have to do several of these per day. 

In addition to our CMS-guideline-compliant visit notes and precertification paperwork for insurance companies, our patients often bring us their own paperwork to fill out, including disability forms, FMLA paperwork, housing accommodation forms, EED forms, IEP forms, and numerous other acronymically-named forms. Some people will ask for letters to the school excusing them for certain missed days or allowing them to have certain foods at lunch time. Others ask for letters to their work place to let them forgo a certain dress code or let them have certain number of bathroom breaks a day. Some ask for letters to their landlords to allow them to keep an animal for emotional support without paying a pet fee because it is medically necessary for their depression or what not, or a letter to their power company telling them not to shut off their power just because they can’t pay, because they need that power for their nebulizer or CPAP machine. 

As you can see, there is a lot of paperwork to be done, which requires a lot of unpaid time on the part of the physician.  There is a CPT code for filling out paperwork, but no insurance company in my experience has ever paid for it. The insurance company will only pay for face-to-face encounters with the patient and/or their family.  We don’t get paid by insurance companies to fill out FMLA paperwork, letters to schools, letters to housing authorities, letters to patient’s lawyers, letters of necessity to insurance companies, prior authorization forms, or any other letters — all of which takes time.

This is the practice of medicine today. More and more time-consuming paperwork is required for anything to get done. More and more, it seems that the doctor’s prescription is no longer enough for the patient to get a medication, without a letter explaining why they need it to the insurance company. And the doctor’s signed order for a study or a procedure is no longer enough to get the patient a study or a procedure, without a letter explaining why they need it to the insurance company. It’s no question that this loss of autonomy, increase in paperwork, and increase in bureaucratic tasks required by insurance companies that do not improve patient care lead to the increasing physician burnout we see today. 

What solutions do we have out there? Standardize and simplify the prior authorization process to make it faster and easier, or better yet, just get rid of it and let doctors have the authoritative direction in their patient’s care? Probably not going to happen. Make the electronic medical record universal and simplify the required documentation guidelines? That would be nice. Increase your practice’s overhead costs by hiring scribes to write the notes for you and nurses to fill out the prior authorization forms and other forms for you? If your business can afford it. It’s a little harder as a solo practitioner and as a primary care physician who isn’t paid as high as specialists who have the same amount of student loan debt. I don’t know of an easy solution that would be agreeable to everyone. 

So to all you all out there who are thinking about pursuing medicine, this is a reality you will have to understand and accept about the profession. Whether or not we like the rules of the game, we must play by them, and not lose focus of our patients.

I am thankful for:

• Two healthy kids. They know that they need to finish dinner all gone before getting any dessert. Fruit is a dessert in our family. They eat their greens because they know it’s good for them. They are fine with drinking water when thirsty. They know to brush their teeth and tongue every night, or else they’ll get bad teeth. They feel shame when they do something wrong. They have the desire to do the right thing, and they think the world of us. This might change a few years from now when I write another Thanksgiving post.
• A patient and supportive wife. When people learn that Irene and I work together, we get a lot of “I can’t imagine working with my wife” or “I would never work with my husband,” etc. Maybe it’s cultural difference, but to me, I can’t imagine NOT working with my spouse. We love each other. We want to spend time together. We want to share experiences together. I enjoy working with Irene a lot, both in the clinic and at home raising our kids. I can’t imagine the alternative – us being apart 8-10 hours a day working different jobs and coming home not understanding what each other did.
• A career. There are people I know who have not been able to match into a residency program, year after year. There are also people I know who do match into residency, but do not make it through. That could have easily been me. Looking back, I am thankful for all those seemingly dreadful sleepless nights with back-to-back admissions and 24 hour shifts during residency, as they were opportunities to further my career and do what I was trained to do.
• A healthy work environment. Work takes up at least 8 hours of the day for most (a third of our lives!). Thus, it’s important we make sure it’s at least tolerable (and if possible, enjoyable). I’m thankful that we have a great staff at our clinic. I enjoy working with each and every one of them – our receptionist, our phlebotomist, our practice administrator, our housekeeper, and our physician assistant (and wife). At this time, there aren’t any workplace drama, no toxic personalities, or bad attitudes. We come home much happier now. I hope this can continue.
• Health. As evidenced by my ever-receding hairline, I am aging. While age is not something I can control, I am nevertheless thankful that I can maintain my health. My BMI is normal. My blood pressure is normal. I don’t smoke, I don’t drink alcohol, and I hardly even drink any caffeine. I haven’t needed any meds. I continue to exercise a few times a week, and I cook most of my meals.
• Hobbies. Some people have nothing to do and are bored all the time. I can’t imagine what that’s like. Irene and I always have something to do – there’s work, there are notes to write and things to look up. There’s grocery shopping, preparing meals, laundry, and cleaning. There is bathing and dressing the kids, and putting them to sleep. And if this doesn’t take up the whole day, there’s hobbies. Irene got her Yoga instructor license this year and started teaching yoga classes in her spare time. For me, if I’m not working out or trying to figure out how to cook something new, I may be putting together a new family travel video, or learning a new piano piece. This year I have learned: Chopin Nocturne Opus 9 No 1, La Valse d’Amelie by Yann Tiersen, and Pirates of the Caribbean piano solo by Jarrod Radnich. I may also be reading, or learning a language, or checking updates on Instagram, Facebook, or YouTube.
• Family. This year’s Thanksgiving broke tradition. For as long as I remember, my parents have always hosted a big Thanksgiving dinner at their home in Macon, Georgia. My aunt, uncle, cousins, and their kids would come down from Atlanta, my big brother and his family would drive up from Florida and my younger brothers would fly in from California to come celebrate. This year, my parents traveled to Europe to celebrate their retirement, thus could not host Thanksgiving this year. Irene and I decided to have our own little Thanksgiving, with just our little family, plus my sister-in-law Emily and my niece Sylvia, who is about Lyra’s age. It was great to reconnect with them. This year, we also reconnected with reconnected with Irene’s cousin Alice Chan and her family. Lyra met her new favorite second cousin, Vincent.

• We did away with the old paper charts and completely switched to electronic medical records.
• We explored several options for billing and found one that works for us.
• We added many new services to the clinic such as venipuncture, EKG, and pap smears.
• We offered more types of vaccines for more patients.
• We joined physician groups and accepted a lot more insurances than before.
• We started accepting adult patients in addition to children, now that we converted the practice from pediatrics to family medicine
• We changed the work hours a few times until we settle with one that allows us to get home at a reasonable time to cook dinner for the family, take care of the kids, and spend some quality time together.
• We extended our services to the cadets at the National Guard’s Youth Challenge Academy.
• We hired and trained new staff, and created a new employee manual.
• We created new forms for patients.
• We re-branded the practice with a new name, new log, new sign, and new merchandise.
• We bought new medical equipment, new examination tables, and new furniture.
• And thanks to the help of our landlord (my father), we were able to get a new roof, new floor, new sidings, new paving, and a much-needed remodeling of the building, which probably had not been updated for 20-30 years.

Irene and I knew the first year was going to be hard, but we had faith that with patience and perseverance, we can pull this off. The past year and a half has been a test of our strength as a family and as business partners. During residency, we didn’t get much experience in practice management and so to come fresh out of residency into a world where we have to deal with CMOs, ever-increasing bureaucratic regulations, credentialing, prior authorizations that delay medical care, rising drug costs, and different insurance company’s different interpretations of the CMS billing/coding requirements, was a little daunting. Practicing medicine is one thing, but to make bread from it is a completely different skillset altogether, as you can see. When you’re busy trying to figure out how to navigate the complex world of healthcare business today, it’s easy to become disconnected from the actual practice of medicine – of being a life-long academic who is constantly acquiring knowledge and honing the skills needed to help those who call us their physicians.

I’m way overdue for this “honing,” and the number of CME credits I have earned thus far since graduation reflects it. Now that we are much more stable in our business, it was time for me to catch up on some live CME credits needed to maintain my license and certification. That’s when I signed up for AAFP’s Family Medicine Experience 2018 in New Orleans.

It was my first conference so I didn’t know exactly what to expect. I had anticipated it would be back-to-back 1 hour lectures on various medical topics, then maybe a break for lunch, then maybe some more back-to-back 1 hour lectures. I thought, it would be a nice break, just sitting and listening and being a student again. I would get 28 credits, meaning 28 hours of lecture during the conference, working my way up to the 50 I would need for the year.

The drive from our home in Georgia to New Orleans would take about 8 hours and the conference was 5 days, so we took a week off from work and made it into a family trip. As any parent can attest, an 8 hour straight car ride is never a good idea when you have two younglings with you. So to prevent any meltdowns, we planned for several stops along the way.

After spending the night with Irene’s parents in Valdosta, we stopped in Tallahassee to visit Irene’s sister, Emily, who we had not seen in more than a year. Aria and Lyra reconnected with their cousin Sylvia who is about their same age and together we checked out a festival in a beautiful downtown park covered by a canopy of live oak. The cousins were inseparable and it is never enough time to catch up with family so the next day, we decided to continue our conversations in the beach town of Gulf Shores, Alabama, where the cousins were able to build some sand castles and collect sea shells before the heavy clouds of Hurricane Michael hit shore.

We didn’t know it when we planned it, but Irene and I had escaped Hurricane Michael during our trip, which had weakened to a tropical storm by the time it reached our home. After the news confirmed that Hurricane Michael was heading straight to Tallahassee, it seemed to be a safe and logical choice for Emily and Sylvia to also join us in New Orleans, and a great excuse for a long overdue chance to reconnect.

Despite the image of people flashing for beads on Bourbon Street, New Orleans to our surprise, is actually a very kid-friendly city. Our girls and their cousin had a blast! The kids got to learn about, play with, and even eat bugs at the insectarium – they’ll eat anything if it’s in a cookie. They got to feed parakeets and touch stingrays at the Audubon aquarium. They got to role-play running a restaurant and serving Emily, Irene, and me at the Children’s museum. And when I asked them about their day at the zoo, the kids kept talking about “Roman Candy” more than they talked about the animals there – apparently it’s a very local thing here and featured on Travel Channel. Then, of course, there are the beignets.

During our trip, we also had the chance to meet up with Irene’s long-time family friends in Diamondhead, Mississippi, the Howells, who used to live in Valdosta but retired to the Magnolia State. We also reconnected with my childhood friend Tess and her mother, who moved to the Crescent City a few years ago. Tess has always been very accomplished and passionate with anything that she do, ever since I remembered her in middle school and she continues to do good work in her field of antiquities law. I looked up to her mother growing up and I still do today. Irene, the girls, and I felt very welcomed by them and were glad to be able to meet up with them after so many years.

The FMX conference turned out to be much more than just a bunch of classes and workshops for the 4000 or so family doctors who attended. There were interest groups, happy hour meet-and-greets, community service volunteer activities, energizing talks from special guest speakers (ZDoggMD was one of the guest speakers this year), poster competition, yoga sessions, a huge expo, live music, a big party near the end of the conference, and even a 5k specifically for the conference. Family docs sure do know how to make a potentially bland conference into actually a lot of fun, and I thoroughly enjoyed it. Back at home, sometimes I feel lonely being the only family doc around my work and community environment, but coming here and being surrounded by 4000 others like me (many who also experience the same headaches as I do in their practices, and who have the same ideals and goals as I do) reassured me that not only was I not alone, I was part of this awesome greater professional community, and it makes me feel proud to be a family physician.

During the week of the FMX conference, my medical school alma mater, American University of the Caribbean (AUC), also organized an alumni reunion at a posh social house in downtown New Orleans for all the alumni in the area who may or may not have come for the conference. I reconnected with some old classmates and talked about where life has taken us now post-AUC, as well as met new colleagues from graduating classes before and after my own. I also got to reconnect with staff and admin at the reunion, like Dave Jones who helped us with our MSPE letter sent to the residency programs, or Sekou Smith and Gus Galue who worked in admissions (and now in alumni relations). I was also pleasantly surprised to see some of my old professors as well, like Dr. McIntosh who taught me molecular cell bio in my first and second semester on the island, as well as Dr. Gagne, who was one of the instructors who taught us clinical exam skills during our ICM courses from second through fifth semester. These individuals from AUC were the ones that helped get us to where we are today, and I am grateful for their guidance in my journey. I think AUC is doing an awesome job staying well-connected with their alumni. I don’t know of any other medical school that would follow national professional conventions like FMX and host a special VIP reception for its alumni. I think reunions like these make us feel proud to be a part of a larger AUC family.

I am so thankful for this trip, which turned out to be a lot more than just a way for me to catch-up on my CME credit. This was a trip for reconnection – a reconnection with family and friends, with colleagues, and with my community of family docs and of AUC alums. And during a time when practicing medicine seems harder than ever before – with rising medical costs, increased bureaucratic requirements, decreased reimbursements – this trip was a reconnection with my roots of why I became a family physician.

It breaks my heart to see what happened to St. Maarten during Hurricane Irma. This place had been my home for two years while I was studying medicine at AUC, and it was where Irene and I got engaged. We had a lot of sweet memories here.

I feel bad for the current students there right now. When I was there, we had Hurricane Earl in 2010, and we rode out the storm safely in the campus shelter. But what we went through was not even close to the destruction that Irma caused. According to a source in St. Martin, an estimated 95% of the island infrastructure has been damaged or destroyed. My alma mater is now evacuating students from the island, especially with food and watery supply running low, and with another storm, Hurricane Jose, just around the corner, potentially threatening to batter the island yet again

Looking at AUC’s history, this appears to be the third time since AUC was founded in 1978 when students and faculty had to be evacuated from campus – first in 1989 when AUC was located on Montserrat and Hurricane Hugo (another category 5 hurricane) flattened the island; and then in 1995 when the Soufriere Hills Volcano erupted, leaving 2/3 of Montserrat (and the old AUC) covered in lava and ash and uninhabitable, leading to the university’s subsequent relocation to the island of St. Maarten. Despite natural calamities, the school has been able to survive, stay strong, and recover, and graduate more than 6000 doctors since its founding. I believe the school will do the same this time with Hurricane Irma.

Reading my Facebook feed from students who are down on the island, I have been touched to hear some heroic stories coming out of the AUC community during these hard times. One of my friends when I was at AUC, the now Dr. Aleksandrova, and her husband, Dr. Pleener (also an AUC grad), were visiting the island when Irma struck. They, along with several other doctors, faculty, and students, including first-year students, came together to form a makeshift hospital in Building 2 on campus. They carried out several rescue missions during those few days, saving a woman trapped in a building, attending to injuries, and even helped deliver a baby in Building 2. Hearing these accounts make me proud to be a part of this community.

St. Maarten will always have a special place in my heart. Recovery will take a lot of work, man power, money, and hope. Stay strong AUC and St. Maarten.

A few GoFundMe effort for the recovery and rebuilding of the St. Maarten and AUC community:
https://www.gofundme.com/sxmauc-recovery-rebuilding
https://www.gofundme.com/auc-students-post-irma-help

Video footage by current AUC student Michelle Arsenault. #AUCStrong.

UPDATE: Students have now been evacuated from St. Maarten to Chicago, via a combination of efforts from the US military and AUC, who has chartered flights and provided accomodations for students.

CME comes in many shapes and forms. It can be study material that you order online that contains an exam for you to take to receive credit. It can be a live lecture, or a webinar. It can be a question bank. Or it can be an interactive workshop. In general, 1 hour is equal to 1 CME credit. The important thing to know is that it has to be an accredited CME, meaning it is approved by a CME accrediting organization. It can’t be just any random event or lecture you attend. You will then need to report the CME to your specialty’s board.

For me, as a Georgia state-licensed and ABFM-certified family physician, here are my CME requirements for the rest of my career:

• Requires 20 CME/year or 40 CME per 2 years. I have to renew mine by 3/31 of every even-numbered year.
• You don’t need to submit proof that you’ve done the CME (so more of an honor system), but you better have it documented just in case you get audited.

AMERICAN BOARD OF FAMILY MEDICINE (BOARD CERTIFICATION)

• Requires an active state medical license (see above).
• Every 3-year certification stage, I must get 50 points (which are not the same as CME) through the following ways:
  • Knowledge Self-Assessment (KSA), found on ABFM website – 10 points
  • Performance Improvement (PI) – 20 points (can include PPM or MIMM or hand hygiene PPM, all found on ABFM website)
  • Then another 20 pts in any other way (KSA, PI, CSA 5 pts)
• CME Requirements: 50 CME/yr or 150CME/3yrs.
  • Minimum 50% of it must be Division 1 credit per 3 yrs. Division 1 CME are your regular accredited CMEs, like lectures, study material, quizzes.
  • Maximum 50% of it can be Division II credit per 3 yrs. Division 2 CME are other non-accredited activities that you do on your own like precepting or research, and they must be reviewed and approved by the ABFM before they can count for CME.
  • These also have CME credits: KSA are 8 Div I CME credits, PI are 20 Div I CME credits, CSA 4 Div I CME credits.
  • The CME can be either AMA Category I CME or AAFP prescribed CME credit.
  • I have to document 150 CME by July 1 of 2020, 2023, 2026, 2029, etc. 
• Family Medicine Certification Exam (valid for 10 years) – 8 hour exam. I have to renew mine by July 1 of 2027, 2037, 2047, etc.

•  As a family physician, it is not required to join a professional organization like AAFP. However, if you want to join as a board-certified physician here are the requirements:
• You must pay for both national and local dues: $440 (National dues) + $365 (local Georgia dues) = $705 annually (valid 1/1-12/31). If apply after 7/1, dues pro-rated 50%.
• CME requirements to maintain AAFP membership: 150 credits/3yrs (same as ABFM). However, 75 credits needs to be AAFP-prescribed credits, and 25 must be live activities, unlike ABFM, which doesn’t specify it has to be AAFP-prescribed or live.
• Memberships last 3 yrs. If I want to continue being a member, I will have to renew mine by 1/1 of 2018.

• AAFP CME Search – great place to start your search for family medicine CME.

• National Procedures Institute (NPI) – They offer hands-on, live CME procedural training. Want to incorporate botox or cosmetic procedures to your primary care practice? Or perhaps ultrasound, or allergy testing/immunotherapy? If so, then this is where you go. Courses range from $850 to $1495.

• Medscape Family Medicine CME – comes as an app too.

However, there was no time that I felt unsupported. I am thankful for my attendings and colleagues who have welcomed me to this residency program, believed in my potential, and guided me to reach my goals. Not only do they have super smart brains to pick, but also lots of collective years of experience and wisdom to guide us in our career as family physicians.

I am thankful to have co-residents who have made all those night floats and 24 hour calls as smooth as anyone can hope for, and even a pleasant experience. We step up to cover each other when we get sick or have family matters to attend to. My co-residents have been our friends, and the first people we call whenever we want to hang out, have dinner or get-togethers, have kids play dates,  or a work-out partner. We include each other in our weddings, baby showers, and other important life events. I will truly miss the individuals I have grown a relationship with during the last three years.

My family has been my core support, and a big reason why I am here today in Macon, as a family physician. Living five minutes from my parents have been amazing. Prior to residency, I had lived away from home for 12 years, my educational journey taking me from St. Louis for undergrad, to Athens (Georgia) for post-bacc and research, and St. Maarten, Miami, New York, Gainesville (Florida), and the United Kingdom for medical school. Now, with my parents just down the street, my daughters can grow up having a relationship with their grandparents. Irene’s parents are not too far either, in Valdosta, just 2 hours from here. And Irene’s sister, with her two kids, are just an hour north in Atlanta. My dad, as a physician, has also been a part of Irene’s and my growth in medicine. My mom provides us with childrearing tips and of course, fresh vegetables from her garden. And then of course my wife Irene has been the best partner in crime I can ever have, and has made this journey even more meaningful.

And not to forget, there are my patients, who had been the brick and mortar in my training to become a family physician. I have patients who I have delivered, advised on important health decisions, and given comfort at the end of life. I have given good news, and I have given bad news. I have grown a lot, not only in my medical knowledge or clinical skills, but in my ability to treat the whole person and not just the disease.

Lots of things have happened in the last three years. When we first started off intern year, Irene and I were new parents, and Lyra was just 2 months old. We rented an apartment in North Macon. I had just graduated from medical school at AUC. I was 195 lbs and had a head with a decent amount of hair. Today, Irene and I are now parents of two daughters – Lyra is now 3 years old and running all over the place, and ordering us to do things; and Aria is 9 months old and growing teeth and will eat anything if you are not paying attention. I’ve lost about 20 lbs and part of that is from my balding hair. I passed USMLE step 3 on the first try. I got my Georgia license, my DEA, and got to moonlight during residency. I passed my ABFM family medicine board exam prior to finishing residency and graduated on time with my fellow residents. I can’t ask for more during these three years.

What’s the next chapter in the Gung-Ho story? Irene and I will be starting our own private outpatient family practice in Macon. My dad will be retiring from outpatient pediatrics and we will be taking over his practice and changing it to family medicine. We are grateful to him for this. We will see both kids and adults. I’m looking forward to working with Irene and starting this venture together. More to come!

Graduation photos courtesy of Navicent Health.

A few months back, I received a question from a blog reader concerning staying fit during medical school. Jonathan writes:

“Benji, I have some questions regarding maintaining overall health and fitness during medical school, something which you obviously appear to have done. What did you personally do and what advice would you give to incoming students? Was there a specific training routine, method or practice that worked out the best for you? If you had to physically and mentally do it all over again, what would you do differently?”

I wanted to address this in a post because I believe this is an important topic. With classes, studying, tutoring sessions, and all things academic, it can sometimes seem like there’s no time for anything else when you’re in medical school. And you’re right… sometimes there isn’t. However, it’s important to keep in mind that you gotta take breaks, so that you don’t burn yourself out. Some people take smoke breaks (not healthy) while other people get on Facebook (although with what’s going on recently in the news, you may need to find another way to take off the stress). I think exercising is a great way to destress the mind. It gives your mind a break from memorizing the branches of the brachial plexus in anatomy, or making sense (or not) of the clotting pathway in physiology, or trying to understand when to use the chi-squared test in biostats.

One great thing about exercise is there’s so many ways to do it – there’s weight lifting, yoga, tai chi, cycling, team sports like basketball, swimming, or just plain old running. Which ones you do depends on what you enjoy and what your goals are. If your goal is to destress, I can imagine that all of these are great. I personally like the solo sports of weight training and running. I never really cared much for team sports growing up, never had a good aim, let alone know the rules of basketball or football. I never had the patience to sit through an entire game, let alone play it. Tai chi and yoga are slow sports that I never found the patience to do. I’ll talk about running first.

Running for me is an activity where I don’t have to think, and we all need a break from thinking sometimes during med school. I just put on my earphones, turn on some classical music, and I’m off running. Running involves repetitive motions, which can get boring, so I think it’s good to counterbalance it with non-repetitive music. Classical pieces Dvorak’s New World Symphony, Holst’s Planets, or Smetana’s Ma Vlast are long symphonic pieces, with little repetition, and they tell stories. I forget that I’m running, and I end up running longer and feel less tired.

For me, I like weight training, because you don’t have to spend too much time to get a good workout. You can work out 2-3 muscles per day, hitting the muscles with high intensity to the point of soreness, not spending more than 30 minutes in the gym – if you do it right, you’ll be spending the next few days recovering those muscles, burning calories even while you sleep.

Personally, I don’t like following strict work-out routines. My goal isn’t to be the next Mr. Universe. However, I do follow a few principles:

• I’m not the type of person to say workout biceps on Monday, chest on Tuesday, quads on Wednesday etc… Instead, I just work out whichever muscles that are not sore that day. If a muscle is still sore, I wait until it is no longer sore before working it out.
• If a muscle does not get sore the next day, I didn’t work it out enough. I try to put enough intensity so that I make sure it feels somewhat sore. It does not always happen, but it pushes me to work harder.
• For weight training (or any high-intensity workout), I don’t believe you need a long workout to have a good workout. I try to focus on 2-4 muscles per day, and I’m usually in the gym no more than 30 min.
• I try to workout 4-6 days a week. It doesn’t always happen, depending on my schedule, but it is an ideal I try to go for. Even if I can’t make it to the gym, I try to do something at home, like push-ups, even if it’s just a few minutes.
• Feeling tired is not an excuse to skip a workout. For me, feeling tired is a reason to go workout, to wake me up.
• Eat right and get enough sleep, otherwise you’ll negate the health benefits of the workout. I don’t consider myself having a strict diet, but in general, I don’t buy cookies, cakes, ice cream, sodas, or juices. I drink sodas on less than a handful of occasions per year, if that. If I have a sweet tooth, I usually eat fruit. The only beverages you’ll find in our fridge are water, milk, and soy milk. We cook a majority of our meals and I bring my own lunch to work.We almost never cook with butter, cream, or cheese – these ingredients aren’t really found in Chinese cooking anyway. We boil, steam, and pan fry. If we pan-fry, it is with olive or vegetable oil. We dont ever deep fry, and we dont use lard. Generally, about half of what we eat are vegetables. I don’t mind drinking out of the faucet. I don’t mind eating canned or frozen foods. I have no problems with GMO or non-organic foods. I don’t take protein powder (tried it in the past but gives me diarrhea, maybe from all that sugar alcohol?). I believe I get more than enough protein from my diet already. Though I’m not opposed to it, I generally don’t drink alcohol either (I have the “Asian flush” and I’m also allergic to red wine).

I’ve heard some of people say that they do not want to exercise because they are happy with their weight and comfortable in their own bodies. I think the reason to exercise shouldn’t be just to lose weight and look good. You can be thin but still have a high cholesterol level and a bad heart. One should exercise to stay healthy – to maintain a healthy heart, muscle mass, and strong bones – all of which would deteriorate as we age if we did nothing at all, and none of us are getting any younger. If you don’t use it, you lose it. Exercise also helps with many conditions people may come to a doctor’s visit for… Did you know studies have shown that moderate exercise (earlier in the day) is just as effective as benzodiazepines in the treatment of insomnia, and has a SORT evidence rating of “A” to recommend it as a treatment for chronic insomnia? Did you know supervised exercise has been shown to be more effective than cilostazol for the symptomatic treatment of intermittent claudication? Aerobic exercise is also a SORT A recommendation for being an effective treatment for fibromyalgia, just to name a few examples.

I think as future physicians, med students should practice what they preach and maintain a healthy lifestyle. If we are going to be battling cardiovascular disease, obesity, COPD, diabetes, etc. then we need to make sure we also stay fit, eat right, don’t smoke, and don’t develop those conditions we are training ourselves to fight for our patients. We need to be role models in our communities and be advocates for health.