I am a huge fan of the winter Olympics, partly because I grew up in Canada (where most kids can ski and skate before they can run) and partly because I used to participate in Downhill ski racing. Now that I’m a rehab physician (with a reconstructed knee) I’m thrilled to have the opportunity to interview Team USA’s Chief Medical Officer, Dr. Gloria Beim. As we enjoy the Sochi Olympic games via our TV sets, keep an eye out for Dr. Beim! Please read on to get her behind-the-scenes account of what it takes to care for and keep Team USA Olympians in tip top shape.
Dr. Val: How did you become the Chief Medical Officer (CMO) for the U.S. winter Olympic team?
Dr. Beim: My practice, Alpine Orthopaedics, is located in an area of Colorado that attracts all levels of athletes, especially elite athletes. I initially entered the elite sports arena in a volunteer capacity at major ski and cycling competitions. Fortunately, my skills and knowledge were noticed at these competitions, which resulted in my servicing a number of medical teams that parlayed me into the world games and Olympic arena. I believe my collaborative, tireless work ethic led to being part of the 2004 and 2012 Olympic Games and as CMO of the 2011 Pan-American Games. Most recently, I was a physician at the World Cup Ski Championships in Beaver Creek, Colo. Between my private practice and my volunteering, I am honored to have been appointed CMO for the Sochi Olympic Winter Games.
Dr. Val: What does being CMO mean?
Dr. Beim: It means overseeing 77 other health care professionals and taking care of 228 U.S. Olympians. As CMO, I work in tandem with a team to deliver the highest level of care to our athletes. We are using the latest technology, evaluating a mix of treatments to ensure peak performance, and are ready to respond to whatever might come our way. It means working long and busy hours during the Games, where the team is faced with everything from common colds and illness to traumatic injury. It also means having compassion and understanding while applying your medical expertise in a fast-moving environment. The days can be long, but it is always rewarding to see our athletes rebound and put their best performance forward. It’s an honor to be a part of that process.
Dr. Val: Give me a “behind-the-scenes” description of what the medical support of the athletes looks like.
Dr. Beim: Well, it looks pretty much like any medical clinic you might be familiar with. There have been dozens of boxes shipped to Sochi in preparation for caring for our athletes. Our doctors can see everything from coughs and flu to sprains and breaks. As a result, we have a very comprehensive team assembled to address whatever health-related need might come through the door. We look at the mix of care providers, such as athletic trainers and physical therapists or chiropractors and massage therapists, to assess and provide the best solution to the problem. Our goal is to have our athletes back on the slope, track or rink as fast as possible, performing at their peak.
I have been learning to speak Russian to interact with local hospitals and facilities. We need to be able to communicate our needs quickly and accurately. At other Games, I have found learning the local language to be valuable in the overall care we can access for our athletes. In addition, it is a lot of fun! I really enjoy communicating with the locals and I know they enjoy it, too.
Dr. Val: Does each country bring their own EMS/MDs/coaches?
Dr. Beim: Many countries bring their own medical team, but not all. The athletes do have access to a polyclinic located at the villages, which can address most of the medical issues that can arise during the Games. These polyclinics are generally staffed with excellent physicians and specialists in many areas, as well as a lot of diagnostic equipment and a full pharmacy. Team USA also will have access to these great polyclinics; however, it is quite efficient and simple for our athletes to receive care and recovery modalities in our own sports medicine clinics.
Dr. Val: Who cares for the athletes if there is a life-threatening injury?
Dr. Beim: There would be a team effort between doctors/specialists/emergency providers from the Olympic Organizing Committee and our Team USA doctors. We feel confident that through our collaborative efforts, we will be able to care for our athletes in just about any situation.
Dr. Val: What kinds of on-site medical facilities are there (one at each event or just a centrally located area)?
Dr. Beim: We are fortunate to have a very comprehensive medical area to treat our athletes. There is a polyclinic at both the coastal village and the mountain village, which will have some imaging capabilities and several specialists as well as a pharmacy. We always will have one of our physicians with the team during training and competitions at the various sites. This gives us the flexibility to provide immediate care should the situation arise.
Dr. Val: How are injuries being prevented?
Dr. Beim: Preventing injury is part of the support we provide. Aiding athletes and coaches to condition appropriately and prime their bodies with good nutrition and recovery efforts while in Sochi is all part of the “whole” care we provide to Team USA. We can use technology to assess and evaluate to ensure our athletes are at their peak to perform. The travel and extreme competition can take a toll on a body. We do our best to keep the athletes healthy in every respect.
Dr. Val: Are there any new technologies being used by the US medical team in Sochi?
Dr. Beim: One of the tools we use is GE Healthcare’s Centricity software. This tool is really amazing and provides our physicians and athletes the ability to communicate health information instantaneously and securely. The software maintains diagnostics, treatment evaluations and test results, and it can all be accessed virtually. This is especially critical when you’re traveling from venue to venue in another country. I have implemented this same software in my private practice through Quatris Health. Now, no matter who is involved in the patient’s care, the health care professional has easy access to all the critical information and can respond accordingly. We also have several GE ultrasound machines that we travel with, which is an incredible diagnostic tool for many musculoskeletal injuries.
Dr. Val: How might other young physicians follow in your footsteps?
Dr. Beim: I would encourage any physician that aspires to this kind of appointment to begin connecting with officials in their area of interest. My work with the U.S. Cycling Team helped build my reputation among other elite sports organizations, where I was able to establish relationships and convey my interest in working with them. It can take a lot of time volunteering, but the work is invigorating and stimulating because you learn so much in the process. I really believe I am a better physician and surgeon because I have had the chance to work in these situations. I can bring that experience back to my private practice, which elevates care for everyone.
We’ve known for quite some time that weight loss can reduce the risk of developing insulin resistance and type 2 diabetes. However, a healthy diet alone (without weight loss) may also help to reduce risk. In a recent Spanish study (published in the Annals of Internal Medicine), 3,541 men and women ages 55-80 at risk for diabetes were followed for an average of 4.1 years. Those who ate a diet rich in fish, whole grains, fruits, vegetables, and olive oil were less likely to develop diabetes than those following other diets of similar caloric value.
This is interesting for a few reasons. First of all, it provides us with insight into the importance of what we eat (and not just how much we eat) for optimum health. When considering how to follow a Mediterranean diet, I think it might be easiest to focus on what is NOT on the menu, rather than what we need to add to our diet. Notice that the Mediterranean diet has very low sugar, refined carbohydrates, processed foods and animal fat (with the exception of fish oil). This is not a low carb or low fat diet. It is a low glycemic-index and unprocessed food diet.
Secondly, calorie-restriction alone may not be the optimal way to reduce the risk of developing type 2 diabetes. In the past we have focused primarily on fat loss for diabetes prevention – through calorie restriction and exercise. We’ve often heard that “a calorie is a calorie” and that folks can lose weight effectively on a low-carb, low-fat, or high protein diet. While it’s true that studies have been equivocal regarding the most effective type of diet for weight loss, and people have been able to lose weight on everything from a bacon and grapefruit to a cookie diet, a deeper look suggests that certain diets really are healthier for us in the long run.
Thirdly, what we eat can have a profound effect on our health, and food is an easily modifiable risk factor for illness. Unlike many diseases and conditions (such as type 1 diabetes and other autoimmune disorders) where we have little to no control over whether or not we contract them, it is exciting to know that a healthy diet is a powerful weapon against disease that does not rely on pharmaceutical products or medical interventions.
And finally, I found this study interesting because it confirms what I have noticed in my own life recently – that cutting out refined carbohydrates and sugars can have a very positive effect on body composition and overall health. I have always had a very difficult time with hunger during calorie restriction, and I finally realized that it had to do with being sensitive to blood sugar spikes and drops from too many refined carbs. Once I cut out all added sugars and white flours from my diet (replacing them with lean protein and whole grains) my chronic hunger resolved and I could settle in to a comfortable relationship with food without constantly battling the scale.
If you haven’t tried the Mediterranean diet, there’s no time like the present. While evidence suggests you’ll be healthier for it, my experience tells me you’ll feel a whole lot better too. Say goodbye to the food craving and hunger cycle, and hello to a new way of healthy eating that can be comfortably maintained for a lifetime.
I am consistently bemused by those who recommend more rigorous or more pervasive standardized testing as the primary means for insuring physician quality. The vast majority of physicians have already passed through a complex gauntlet of multiple choice exams, extended credentialing and certification processes, and lengthy tests of knowledge and skill. And yet, some physicians (to put it bluntly, sorry friends) are very bad at what they do.
Intellectual intelligence is necessary, but not sufficient, for doctoring. It is emotional intelligence (EI) that is sorely lacking – because it has neither been cultivated, nor selected for, by many training programs. Some educators openly acknowledge the problem, pointing to “extra-curricular activities” as their primary means of distinguishing equally qualified applicants. The disappointing reality is that non-academic performance may be a tie-breaker for students with similar standardized test scores, but raw scores almost always trump any other factor. In the end, we have a physician work force that is highly adept at assimilating and regurgitating facts, but is only accidentally good at human interactions.
Is there hope for change in this arena? I believe that the prognosis is guarded. As our culture becomes more and more digital data-driven, a tsunami of “meaningless use” threatens to drown us all in false quality measures, electronic medical record documentation “quality assurance” requirements, and analysis of trends without comprehension of context or influencing variables outside the scope of the measuring instruments. Lies, damn lies, and statistics. We can’t get enough! And guess who are the biggest proponents of these methods? Why, people who only excel at standardized testing – mostly because their true flaws also lie outside the measuring instruments. Bad doctors (sometimes turned-administrators) themselves are often fueling the onslaught of fruitless quality improvement initiatives.
Dr. Howard Luks, orthopedic surgeon and social media activist, wrote a provocative blog post on the subject of why physicians don’t engage more in social media. He suggests that many avoid it because they lack people-skills in the first place and don’t genuinely enjoy engaging with patients. If you’re a “jerk” in real life, he argues, then what advantage is there to making that more obvious on blogs, Facebook, Twitter, etc.? Better to stay socially quiet.
The interesting thing is that social media might be the most reliable way to discover whether or not your doctor is kind, thoughtful, observant, and detail-oriented. Reading a physician’s thoughts online can help you get to know their true personality and work ethic. In the future it would be nice if medical schools and residency training programs took the time to read applicants’ blogs (for example) instead of crunching their test scores for admission via the path of least resistance. An extra hour of reading up front could save our medical system from a new wave of low EI providers.
As Seth Godin put it, “Uncaring hands are worth avoiding.”
We all recognize the importance of this statement intuitively, but have a hard time quantifying “caring” with standardized tests. That’s why admissions officers and patients alike must use their judgment when selecting doctors. We pay verbal homage to the importance of “clinical judgment” in medicine but in reality are culturally afraid of straying from numbers to support our decision-making.
How will you know a good doctor? You’ll know him [or her obviously] when you see him. And sometimes you can see him best on social media platforms.
A few caveats of course:
1. Social Media is a sensitive but not specific test. Meaning, you can probably accurately identify caring doctors from their blogs, etc. but if they don’t have one, it doesn’t mean they aren’t good/caring.
2. It may not matter if you find a great doctor online if they’re not in your limited ACA network.
3. Direct primary care is a potentially excellent way to get connected to exceptional doctors. I am a fan of this movement and have been actively involved in a practice in VA. The practices can reduce costs and enhance quality care, though recent caps on Health Savings Accounts (initiated by the Obama administration) have reduced consumer freedom to spend pre-tax income on direct primary care.
I’m very excited to be the nutrition coach for the Boys & Girls Clubs’ Fit Family Challenge again this year. In surveying the finalist families, I discovered that the two most important nutrition issues on their minds were cooking speed and food affordability. Far down the list were things like food allergies, weight loss, and nutrition basics.
Contrary to popular belief, healthy eating doesn’t have to be expensive. A new study showed that a healthful diet only costs an average of $1.50/day more than an unhealthy diet, and the additional cost is mostly related to the expense of leaner protein sources. So with a little bit of shopping savvy, you can change your family’s nutrition without breaking the bank.
Since busy moms and dads are always looking for ways to provide fast, nutritious meals for their children, I thought I’d provide some tips for doing so on a budget. These are strategies that I also use when I’m traveling across the country, working long hours at hospitals with only a microwave and small refrigerator available, and very little time for meal prep. If your day is frantic, and you don’t have much time to cook, then these tips are for you! (I’m not saying we’re going to win any culinary awards for these meals, but they are very practical. Please use your own favorite herbs and spices for flavor. I have added links throughout this post to show you examples of products I’ve used and like – but there are many other good ones out there!)
1. Tupperware. Make sure you have lots of plastic storage containers (Tupperware or other brand) and baggies in various sizes. You can reuse the containers and portion out food into single serving sizes in advance. Don’t worry about finding containers that are “BPA-free” – they may cost more and fifty+ years of scientific studies (reviewed by the U.S. Food and Drug Administration) have determined that they are safe for microwave use and food storage.
2. Prepare meals ahead of time. Set aside one day a week where you will fill containers and baggies with single serving sizes of 1) protein, 2) fruits/veggies, 3) nuts/fats, and 4) complex carbohydrates. Each meal should include one of each. Snacks can contain two or three of the four groups. Each family member can quickly grab portions for their meals, lunch boxes, or snacks, and you can make up plates for dinner by reheating them in the microwave.
3. Fast protein. Pre-cooked, grilled chicken or turkey strips can be found in the refrigerated or frozen section of your local discount store. Four ounces of grilled chicken is a good serving size, and make sure you choose the chicken without sauce or chemical flavorings as your healthiest option. One serving takes about a minute to reheat in the microwave. Other great sources of protein include plain Greek yogurt (a serving is 1 cup), protein powder (whey, egg, or vegan sources), pre-packed hard-boiled eggs, canned tuna or fish in water, smoked salmon, and low-fat cheese sticks.
If you have a stove and 4-8 minutes to spare, quick-fry pork chops, lean beef, fish fillets, or egg beaters (plain, liquid egg whites in a carton are even better) with low-fat shredded cheese with a few chopped veggies can make a great omelet that’s fast and affordable.
You can make egg whites in a microwave (spray a microwave container with a little bit of pure olive oil cooking spray) and cook for one and a half minutes per serving. Top with salt, pepper, cheese, and maybe a little ketchup if you like that. Super fast, super healthy.
In a pinch, beef, pork, and natural turkey jerkies are very portable protein sources. However, they can be expensive, and you must look for the all natural varieties (not the jerky full of salt and chemicals at various truck stops across the country).
4. Fast fruits & veggies. Fruits are pretty easy because you can chop them up or peel them quickly, but if you don’t want to chop them too far in advance, pre-made fruit cups are a little more expensive, but very convenient. Make sure you choose the fruit that is packed in its own juice, not syrup.
As far as veggies are concerned, some can be enjoyed raw (celery, carrot sticks, lettuce, tomatoes etc.) but others need cooking. The fastest way to cook most fresh veggies is to steam them in a microwave. Stores now pack veggies (such as green beans, broccoli, and snow peas for example) in “steam-in bags” where you can just puncture the bag with a fork and then microwave the veggies for a couple of minutes. If you’re buying veggies in bulk, you can purchase ”Zip n’ Steam” bags and use those instead. I’ve used these bags for everything from butternut squash to corn on the cob. They lock in all the vitamins and minerals that you may loose in a boiling or canning process.
Otherwise, frozen veggies are very convenient and are pre-chopped. Canned vegetables are also rich in vitamins (though they tend to lose the water soluble A&B vitamins so you’ll need to get those from your fruits or a squeeze of lemon in your water) and very easy to heat and are affordable.
5. Fast fat. Mostly, what I mean by healthy fats is nuts, seeds, and vegetable oils (especially olive). Fats are rarely cost-prohibitive and it doesn’t take much to “prepare” them. Healthier nuts and nut butters are plain (no sugar or salt added). Avoid candy-coated nuts, sugary spreads, or trail mixes that have “yogurt-covered” anything or chocolate added. Go easy on the dried fruit as it is a simple sugar. Cook with olive oil or olive oil spray when you can. Limit your animal fat intake (butter, high-fat cheese, lard, bacon) as it is not as healthy for you as vegetable sources.
6. Fast complex carbohydrates. I’m a big fan of brown rice. It’s very inexpensive and reheats well with a little moisture in the microwave. You can purchase the rice dry (this is the most affordable way, but you’ll need to cook up a big batch once a week), or pre-cooked in microwavable bags or containers. Brown rice grits, corn grits, cream of wheat, and oats all make quick, microwavable portions of carbs. Whole grain tortillas take 15 seconds to heat in the microwave and can be used as a wrap or side-dish. Whole grain breads, sugar-free whole wheat cereal, canned beans, hummus, and sweet potatoes (not in syrup) are all fast and affordable.
7. Drink water. It’s free, it’s everywhere, it has no calories. Water is the healthiest fluid source available, so make use of it. To save money, you can re-use plastic water bottles by refilling them with tap water. If your tap water doesn’t taste great, a squirt of fresh lemon or lime juice (along with keeping it colder) should solve the problem. Sugary sodas, juices, and energy drinks should be limited. Club soda, sparkling water, or diet sodas are a better choice if you are craving carbonation. Skim milk, almond, rice, or soy milk are healthy options as well.
8. Buy in bulk. So now that we have broken down the healthy, affordable diet into its four components and fluids – it’s time to stock up! Buying large quantities of your favorite non-perishable items can save money. Consider cost-sharing with another family, coupon-clipping, and price-shopping. Some items that you normally don’t think of as frozen goods actually store very well in the freezer – bread, tortillas, nuts, and bananas for example can last for months in the freezer. For a review of the best grocery items to buy in bulk, see this slide show.
9. Skip the organic food. Organic products are very expensive and do not provide a significant nutritional advantage over regular foods. You may wish to buy organic food to support your local farmers or because the items are fresher-looking or their packaged goods may have fewer preservatives or added ingredients, but don’t spend your last penny on organic foods because you think it’s the only way to keep your kids well-nourished. As far as reducing your potential exposure to pesticides, organic foods may reduce pesticide exposure by 30%, not exactly the “pesticide-free” level that some would lead you to believe. Most experts (including the FDA) agree that the amount of potential pesticide residue found on fresh fruit and vegetables is too low to pose a significant risk human health. Washing fresh produce with soap and water, or removing the skin, can further reduce levels if you have concerns.
10. Don’t waste money on vitamins and supplements. Although it seems like a good idea to provide your children with extra vitamins in pill-form, the majority of U.S. children and adults (according to large CDC nutrition studies) are not deficient in any vitamin or mineral. Our fortified food sources, even with sub-optimal diets, are doing a surprisingly good job of getting us all the nutrition we need. If your doctor has determined that you or a family member has a nutritional deficiency, then please follow their advice regarding supplementation. As for herbal supplements, be very careful of those since recent studies have shown that they often don’t contain the active ingredients on their labels and may even contain harmful allergens instead.
There are probably many other terrific ideas that you’ve discovered on the path to feeding your family quickly and affordably. Please share them on the blog so we can expand our creative meal planning together! I’ll be thinking of the Fit Family finalists as I enjoy my brown rice and green pepper chicken fajitas in my hospital microwave this week!
Over the years that I’ve worked in acute inpatient rehab centers, I have been truly vexed by a particular type of patient. Namely, the stubborn patient (usually an elderly gentleman with a military or armed forces background). I know that it’s not completely fair to generalize about personality types, but it seems that the very nature of their work has either developed in them a steely resolve, or they were attracted to their profession because they possessed the right temperament for it. Either way, when they arrive in the rehab unit after some type of acute illness or traumatic event, it is very challenging to cajole them into health. I suspect that I am failing quite miserably at it, frankly.
Nothing is more depressing for a rehab physician than to see a patient decline because they refuse to participate in activities that are bound to improve their condition. Prolonged immobility is a recipe for disaster, especially in the frail elderly. Refusal to eat and get out of bed regularly can make the difference between life and death within a matter of days as leg clots begin to form, and infectious diseases take hold of a body in a weakened state. The downward spiral of illness and debility is familiar to all physicians, but is particularly disappointing when the underlying cause appears to be patient stubbornness.
Of course, the patient may not be well enough to grasp the “big picture” consequences of their decisions. And I certainly do not pretend to understand what it feels like to be elderly and at the end of my rope in regards to prolonged hospital stays. Maybe I’d want to give up and be left alone too. But it’s my job to get them through the tough recovery period so they can go home and enjoy the highest quality of life possible. When faced with a patient in the “wet cat” phase of recovery (I say “wet cat” because they appear to be as pleased to be on the rehab unit as a cat is to being doused against their will), these are the usual stages that I go through:
1. I explain the factual reasons for their admission to rehab and what our goals are. I further describe the risks of not participating in therapies, eating/drinking, or learning the skills they need to care for themselves with their new impairments.
2. I let them know that I’m on their side. I understand that they don’t want to be here, and that I will work with them to get them home as soon as possible, but that I can’t in good conscience send them home until it’s safe to do so.
3. I give them a projected discharge date to strive towards, with specific tasks that need to be mastered. I try my best to give the patient as much control in his care as possible.
4. I ally with the family (especially their wives) to determine what motivates them, and request their presence at therapy sessions if that seems fruitful rather than distracting. (Helpful spouse input: “Mike only wants to walk with me by his side, not the therapist.”)
5. I ask loved ones how they think the patient is doing/feeling and if there is anything else I can do to make his stay more pleasant. (Helpful input: “John loves ice cream. He hates eggs” or “John usually goes to bed at 9pm and gets up at 4am every day.”)
6. I meet with nursing and therapy staff to discuss behavioral challenges and discuss approaches that are more effective in obtaining desired results. (For example, some patients will always opt out of a task if you give them a choice. However, they perform the task if you state with certainty that you are going to do it – such as getting out of bed. “Would you like to get out of bed now, Mr. Smith?” will almost certainly result in a resounding “No.” Followed perhaps by a dismissive hand wave. However, approaching with a “It’s time to get out of bed now, I’m helping you scoot to the edge of the bed and we’re going to stand up on 3. One, two, three!” Is much more effective.)
7. If all else fails and the patient is not responding to staff, loved ones, or doctors, I may ask for a psychiatric consult to determine whether or not the patient is clinically depressed or could benefit from a medication adjustment. Typically, these patients are vehemently opposed to psychiatric evaluation so this is almost the “nuclear” option. Psychiatrists can be very insightful regarding a patient’s mindset or barriers to participation, and can also help to tease out whether delirium versus dementia may be involved, and whether the patient lacks capacity to make decisions for himself.
8. If the patient still does not respond to further tweaks to our approach to therapy or medication regimen, then I begin looking for alternate discharge plans. Would he be happier in a skilled nursing home environment where he can recover at a slower rate? Would he be amenable to an assisted living or long term care facility? (The answer is almost always a resounding “no!”) Is the patient well enough to go home with home care services and round-the-clock supervision? Does the family have enough support and can they afford this option?
9. At this point, after exhausting all other avenues, if the patient is still declining to move or eat or be transferred elsewhere, some sort of infection might set in. A urinary tract infection, a pneumonia, or bowel infection perhaps. Then the patient becomes febrile, is started on antibiotics, becomes weaker and less responsive, and is transferred to the medicine floor or higher level of care. Alternatively at this phase (if he is lucky enough not to become infected) the patient might have a cardiac event, stroke, blood clot with pulmonary embolus (especially if he is a large man), kidney failure, or develop infected pressure ulcers. Any of which can be cause for transfer to medicine. In short, if you stay in the hospital long enough, you can find a way to die there.
10. After much hand-wringing, angst, and generalized feelings of helplessness the wives and I review the course of events and ask ourselves if we could have done anything differently. “If I had acted like a drill sergeant, do you think he would have responded better?” I might ask. “No dear, that would only have made things worse.” She’ll reply. I’ll see how disappointed she is in his deterioration, staring off towards pending widowhood, engaging in self-blame and what-ifs (E.g. “If we had only had more money perhaps we could have taken him home with 24 hour nursing care until he was better…” “If I had cooked all his meals, maybe he would have gained enough strength to avoid the infection…” etc.) I try to be reassuring that none of this would have made a difference, myself reeling from the failure to get the patient home.
This 10 step process happens far more often than I’d like, and I certainly wish there were a way to head off the downward spiral with some kind of effective intervention. Would it help to have a volunteer unit of ex-military peer counselors in the hospital who could visit with my patients and help to motivate them to get better? (Operation “wet cat” perhaps?) Should I change my approach and put on my drill sergeant hat at the earliest stages of recovery to force these guys out of bed? Can educating younger law enforcement and military workers about illness help to prepare them to be more compliant patients one day?
I don’t know the cure for stubbornness, but it sure leaves a lot of widows in its wake.