I was taken aback by a recent conversation I had with a gym owner. She is interested in encouraging middle-aged women to come to the gym for beginner-level fitness classes and was planning a strategy meeting for her staff and key clients. I asked if I could join and she said that I was expressly un-invited. Slightly miffed I asked why that was so – after all, I’m a rehab physician who has devoted my career to getting people moving.
“You’re too advanced.” She said. “Beginners wouldn’t relate to the way you work out, we’re really more focused on creating a less intimidating environment for women.”
“You mean, like the Planet Fitness ads? The ones where athletes are not welcome?” I asked, confusedly.
“I don’t like those ads but the idea is the same. Beginners feel deflated by working out with people who are in far better shape. They don’t even want their instructor to look too fit.”
“You’re kidding me. Women would actually prefer working out with a chubby trainer?”
“Yes. In fact, I’ve had some women come to the gym and actually request NOT to be paired up with some of our personal trainers specifically because they look too fit. They are afraid they will be asked to work too hard, beyond their comfort zone.”
“So why are they coming to the gym in the first place?” I asked. “What is motivating them if they don’t want to work out hard or change their bodies in the direction of athletic-looking trainers?”
“They’re just interested in staying the way they’ve always been. Maybe they’ve started putting on weight after they hit their 40’s and 50’s and just want to get back to where they were in their 30’s. They’re not interested in running marathons or lifting the heaviest weights in the gym. They don’t want to be pushed too hard, and they prefer trainers who look healthy but not extreme.”
Medically speaking, it doesn’t take extreme effort to be healthy. Many studies have shown that regular walking is adequate to stave off certain diseases, and weight loss success stories (chronicled at the National Weight Control Registry for example) usually result from adherence to a calorie-restricted diet and engagement in moderate exercise.
In a sense, these women who “don’t want to work that hard” are right – they don’t have to perform extreme feats to be healthy. However, I am still fascinated by the preference for “average looking” trainers and the apparent bias against athleticism. This must be a fairly common bias, though, because national gym chains (like Planet Fitness) have picked up on it and made it the cornerstone of their marketing strategy. “No judgments” – except if you’ve got buns of steel, I guess.
When I choose a trainer I am looking for someone who embodies the best of what exercise can offer. An athlete who has practiced their craft through years of sweat and effort… because that’s my North Star. Sure, I may never arrive at the North Star myself, but I like to reach. And that’s what motivates me.
But for others, having a professional athlete for a trainer may be a mindset misfit. If your aspiration is to be healthy but not athletic, then it makes sense to find inspiration in those who embody that attitude and lifestyle. The important thing is that we all meet the minimum exercise requirements for optimum health. According to the CDC, that means:
* 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking) every week
and
* muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).
How you get there, and with whom you arrive, is up to you. Chubby or steely – when it comes to health and fitness the best mantra is, “whatever works!”
Six weeks ago I had a skin lesion removed by a plastic surgeon. About 7 days after the biopsy, I received a letter from the pathology lab where the sample had been analyzed under a microscope. I eagerly opened the letter, assuming that it contained test results, but was disappointed to find a bill instead. As a physician, it felt strange to be in a position of having to wait for a colleague to give me results that I was trained to understand for myself. However, I knew that in this case I was wearing my “patient hat” and that I’d need to trust that I’d receive a call if there was an abnormality. I haven’t received a call yet, and I assume that no news is good news. But what if no news is an oversight? Maybe there was a communication breakdown between the path lab and the surgeon (or his office staff) and someone forgot to tell me about a melanoma? Unlikely but possible, right?
Patients experience similar anxiety in regards to lab tests on a constant basis. In a perfect world, they’d receive results at the same time as their doctors, along with a full explanation of what the tests mean. But most of the time there’s a long lag – an awkward period where patients have to wait for a call or make a nuisance of themselves to office staff. Shouldn’t there be a better way?
As patients wait for test results, anxiety rises as time slips into slow motion. But experts say patients can regain a sense of control.
Start before the test itself.
Because fear can cloud memory during talks with doctors, take notes. If you can, bring a friend to catch details you may miss.
Some pretest questions:
What precisely can this test reveal? What are its limitations?
How long should results take, and why? Will the doctor call with results, or should I contact the office?
If it’s my responsibility to call, what is the best time, and whom should I ask for?
What is the doctor’s advice about getting results online?
Do I think that patients should have access to their results without their physician’s review? While my initial instinct is to say “yes,” I wonder if more anxiety may be caused by results provided without an interpreter. There are so many test results that may appear frightening at first (such as a mammogram with a “finding” – the term, “finding,” may mean that the entire breast was not visualized in the image, or that there was a shadow caused by a fatty layer, or -less commonly – it can also indicate that a suspicious lesion was observed). I’m not arguing that patients can’t understand test results on their own, but medicine has its own brand of jargon and nuances that require experience to interpret.
Consider the slight deviations from the mean on a series of blood tests. They can be perfectly normal within the patient’s personal context, but may simply be listed by the lab as high or low. This can cause unnecessary anxiety for the patient. And what about PAP smear results that are listed as “ASCUS” – atypical squamous cells of undetermined significance? These can occur if the patient merely had recent sexual intercourse, and are not necessarily indicative of cancer at all.
And what about the “ambulance chasing lawyers” out there? Will there be additional frivolous law suits created by lab test results reported direct-to-consumer as abnormal in some way (when they really aren’t, given the full clinical picture) and patients assuming that their physician was negligent by not reporting the abnormality to them sooner? It could happen.
In the end I think that physicians all need to make a concerted effort to forward (with an explanation when necessary) lab test results to patients as quickly as possible. But since doctors are the ones ordering the tests in the first place, they do have a right to see them (before the patient when appropriate) – and an obligation to pass on the information in a timely and fully explained manner. That’s the value of having a physician order a test – their expertise in interpreting the results are part of the package (and cost). When patients order their own tests (and in some cases they can) then they should be first to receive the results.
As for me, I’m going to have to resort to “office staff nuisance” to get my results confirmed… just like any other regular patient. Oh well. 😉
I just spent the last 8 days in the hospital, at the bedside of a loved one. Although I squirmed the whole way through a tenuous ICU course and brief stop-over in a step-down unit, it was good for me to be reminded of what it feels like to be a patient – or at least the family member of one – in the hospital. The good news is that the staff were (by and large) excellent, and no major medical errors occurred. The bad news is that the experience was fairly horrific, mostly because of preventable design and process flaws. Having worked in a number of hospitals over the years, I recognized that these flaws were commonplace. So I’ve decided to tilt at this great hospital design “windmill” on my blog – with the hope that someone somewhere will make their hospital a friendlier place because of it.
Most of these design and process flaws have one thing in common: they prevent the patient from sleeping. In some circles, sleep deprivation is an organized form of torture reserved only for the most dangerous of terrorists. In other circles, it is hospital policy. And so, without further ado, here is my top 10 list of annoying hospital design flaws:
#1: False Alarms. Every piece of hospital equipment seems to be designed to beep for a complex list of reasons, many of which are either irrelevant or unhelpful. I snapped a photo of a particularly amusing (to me anyway) alarm (see above). This was a bed alert, signaling the “patient exit” of an intubated and sedated gentleman in the ICU. Not only was the location of the alert sign curious (if you could get close enough to the alert screen to read the text, you would surely already have noticed that the patient was AWOL) but it was triggered by mattress pressure changes that occurred when the patient was repositioned every 2 hours (as per ICU pressure ulcer prevention protocol).
The I.V. drip machines are probably one of the worst noise pollution offenders, beeping aggressively when an I.V. *might* need to be changed or when the patient coughs (this triggers the backflow pressure alarm, leading it to believe that a tube is blocked). Of course, I also thoroughly enjoyed the vitals monitor that beeped every time my loved one registered atrial fibrillation on the EKG strip – a rhythm he has been in and out of for years of his life.
#2: Intercom Systems. Apparently, some hospital intercom systems are wired into every patient room and permanently set at “full volume.” This way, every resting patient can enjoy the bleating cries for housekeeping, tray pickup, incoming nurse phone calls,physician pages, and transport requests for the entire floor full of individuals undergoing the sleep deprivation protocol.
#3: The Same Questions Ad Nauseum. Over-specialization is never more apparent than in the inpatient setting. There is a different team of doctors, nurses, PAs, and techs for every organ system – and sometimes one organ can have four teams of specialists. Take the heart for example – its electrical system has the cardiac electrophysiology team, the plumbing has the cardiothoracic surgery team, the cardiologists are the “minimally invasive” plumbers, and the intensivists take care of the heart in the ICU. Not only is a patient assigned all these individual micro-managing teams, but they work in groups – where they rotate vacations and on-call coverage with one another. This virtually insures that the sleep-deprived patient will be asked the same questions relentlessly by people who are seeing him for the very first time at 20 minute intervals throughout the day.
#4: Inopportune Intrusions. There are certain bodily functions that benefit from privacy. I was beginning to suspect that the plastic urinal was attached to the staff call bell after the fifth time that someone summarily entered my loved one’s room mid-stream. Enough said.
#5: Poorly Designed Tubing. Oxygen-carrying nasal cannulas seem to be designed to maintain a slight diagonal force on the face at all times. This results in the slow slide of the prongs from the nostrils towards the eye. Since the human eye is less efficient at absorbing oxygen than the lungs, one can guess what might happen to oxygen saturation levels to the average, sleep-deprived patient, and the resulting flurry of nursing disturbance that occurs at regular intervals throughout the night (and day). My loved one particularly enjoyed the flow of air pointed directly into his left eye as he attempted to rest.
#6: The Upside Down Call Bell. In an age of wireless technology, where almost every American has a cell phone and/or a flat screen television, it is odd that the light, TV, and nurse call bell control system must be tethered to a short cord positioned just outside of the patient’s reach. The controller is also designed so that the cord comes out of the box’s farthest point, causing it to remain upside down in the hands of anyone lucky enough to reach it from a chair or bed.
#7: Excessive Hospital Bands. In addition to multiple rotating IV access points, my loved one’s wrists and ankles were tagged with not one but four hospital band identifiers, including one neon yellow band sporting the ominous warning: “Fall risk.” If that little band is the only way that a staff member can ascertain a patient’s risk for falling down unassisted, then one is left to wonder about their powers of perception. In a moment of rare good humor, my loved one looked down at his assorted IV tubes and three plastic wrist bands and concluded, “I’m one stripe away from Admiral.”
#8: The Blank White Board. Sleep-deprivation-induced delirium can be rather disorienting. To help patients keep track of their core care team names, most hospital rooms have been outfitted with white boards. Ideally they are to be filled out each shift change so that the patient knows which activities are scheduled and the names of the staff that will be performing them. Filling out these boards is tiresome for staff members (not to mention that the dry erase markers are usually missing) and so they remain blank most of the time. This has an anxiety producing effect on patients, as the boards boldly proclaim that no nurse is taking care of them, and no activities are scheduled. I also noted that the size of the board lettering was a fraction smaller than a person with 20/20 vision could make out from the distance of the bed.
#9: The Slightly-Too-Tight Pulse Oximeter. Because being tethered to a bed with IV tubing, telemetry cords, and a nasal cannula is not quite irritating enough, hospital staff have devised a way to keep one unhappy finger in a constant, mild vice grip. This device monitors oxygenation status and helps to trigger alarms when nasal cannulas achieve their usual peri-ocular destination every 30 minutes or so.
#10: The Ticking And Creaking IV Drip. During the few rare moments of quiet, we did not enjoy any sort of blissful silence, but rather the incessant ticking of the I.V. drip machine. My loved one remarked that he felt as if he were trapped in an endless recording loop of the first 5 seconds of the TV show “Sixty Minutes.” And so if the alarms, tethering, interruptions, PA announcements, tubing, or white boards didn’t drive you mad, the auditory reinforcement of a ticking time bomb next to your head could bring you close to tears.
And so, because of all these nuisances (not to mention the ill-fitting hospital gowns, inedible food, and floors covered with various forms of “seepage” that penetrated patient socks on hallway ambulation attempts) we had one of the most unpleasant experiences in recent memory. All this, and no dissatisfaction with the surgical team or the primary procedure performed during the hospital stay. In the end, it’s the little things that can drive you crazy – or make you well.
A friend of mine had a bad reaction to a heart medicine, dropping her blood pressure to as low as 76/49 as a result. She was feeling understandably dizzy but didn’t want to go to the ER so she asked me if there was anything she could do at home to help raise her blood pressure. I recommended that she drink a large volume of water and take some salt tablets. She had no salt in pill form, and didn’t want to take it straight out of the shaker so asked if there was any other way to get the salt in. I asked her to describe the contents of her refrigerator and pantry, and made a mental note of what I thought had the highest salt content.
My friend thought that potato chips might do the trick, and was surprised when I told her that she had something almost ten times saltier at her disposal. Four ounces of prosciutto contained almost 2g of sodium, an entire day’s worth of salt! So she dutifully consumed the sliced meat, washing it down with about a liter of water. Two hours later she was back up to 98/66 and six hours later her blood pressure had returned to a healthy 116/83.
This was a rare case where a “high salt diet” had its benefits. In the case of ham versus hypotension, ham won… and saved my friend a costly, and unnecessary ER visit. Let’s hear it for deli meat!
This weekend I accidentally stepped way outside my comfort zone. A friend of mine had invited me to compete in the Primal Games – an event that she described as a “fun time for all fitness levels with some guys dressed up as cave men.” Sounded innocent enough. And it appealed to my sense of whimsy, so I signed up without a second thought. A couple of weeks prior to the event I decided to do a little more research and discovered that this competition *might* be a bit more challenging than I had originally thought. The event website was somewhat vague, but alluded to things like “Atlas balls,” climbing over walls, obstacle trail run, military crawls, and medicine ball tosses. Hmmm. I’d never attempted to scale a wall in my life, nor was I too thrilled about the idea of hoisting around beach-ball-sized cement objects. I was getting nervous.
I soon discovered that my nervousness was more than well-founded. As I arrived at the event, the temperature was rising above 90 degrees Fahrenheit as I was greeted by shirtless male competitors (see photo above). Apparently, almost everyone at the Primal Games was on a team of some sort already, and many had prepared for the event for over a year (mostly at CrossFit gyms). As I gingerly approached the registration tent a well-muscled woman wrote a number in permanent marker on my arm and calf. I was branded and there was no turning back, so I decided to spend some time watching the other athletes warm up. I was astonished by some of their capabilities.
Take this guy for example (photo at left). He was able to hurdle the “women’s wall” that I struggled to scale and climb over. I stood there, staring aghast at the fellow like some kind of animal in headlights. I realized that I belonged on the sidelines as a spectator, not a competitor – but alas, I was in it for the duration.
The women at the event were only slightly less intimidating. Some looked like Olympic weight lifters, others were lean, mean, muscle machines. Very few were as old as I was. My fantasies of a day tossing water balloons back and forth with people in spandex and super-hero capes were fading fast.
And so the games began – three individual events arranged in heats, requiring a whole lot of “hurry up and wait.” My first challenge was a 1.5 mile trail run with obstacles. The distance seemed fairly innocuous so I took off at full tilt when they blew the air horn for my group. About a half-mile in I began passing members of the group that started ahead of mine. I wondered if I had misjudged my pace, but figured I’d deal with that later. I navigated jumping over some hay bales (no problem for a former dairy farmer), threw myself into the Army low-crawl and bolted across a boardwalk to come into the finishing stretch. And that is when I hit the wall. Literally.
I had never scaled a wall in my life and apparently there’s some technique to it. I ran up to the 6-foot obstacle, jumped up and grabbed the ledge and then hung there like some kind of limp towel. Nope, that was definitely not the right way to do it. Race officials tried to explain more successful strategies to me as I failed to scale the wall in a second embarrassing attempt. I opted for the penalty Burpees and crawled under the wall… only to face the next, slightly shorter wall. There was no way around it this time – I had to do it. A miss was a disqualification on the shorter wall.
Panting, sweating, and wearing all black in the midday sun, I somehow muscled my way over the short wall in the least elegant way known. I jogged ahead to the water slide, took a hard dive onto my chest and bolted to the finish line with no energy to spare. That performance was good enough for an 11th place finish in my age group (the “Masters women” – which hardly seemed a fair category title considering my lack of mastery of this challenge!)
The second event appeared deceptively straight forward. I had three minutes to launch 6 medicine balls backwards over a wall. But for every 7 feet closer to the wall you got, you had to do increasing numbers of penalty Burpees. I figured I’d be pretty good at this since I’m built more like a water buffalo than a gazelle, but no dice. This event was 70% technique, and figuring out how to get the ball to make the correct-shaped arc (so it cleared the wall) had a steep learning curve. Even the strongest-looking women often missed the wall because their ball ended up going straight up and down instead of backwards. I opted to get as close to the wall as possible and just “gut out” the high reps of Burpees.
I was relieved to see a familiar face in the crowd as I approached my med ball toss challenge. The owner of my home gym had arrived, video phone in hand, to memorialize my event. She was my only fan, and asked if I’d mind if she yelled out encouragements during my event. I agreed hesitantly, both nervous about the permanency of the video that was being made of my potential “flailings” and unsure if her shouts would induce panic or perseverance. Luckily for me it turned out to be the latter. And here’s the video to prove it:
The final event was a true soul-sucker. I watched some of the men compete, and they made it look easy. It was a combination of cement (aka Atlas) ball carries (up and down a field) and tire rope pulls. Again, as a “water buffalo” I figured I’d have an advantage on this one, but here is where I crumbled. As they started the timer, I ran out to the end of the tire pull rope and started dragging it towards myself, hand-over-hand. The weight of the tractor tire was startling, and it moved at about 1/5 the speed of the men’s pulls as I realized that this event was MUCH harder than it looked. I finally got the tire across the line and had to drag it back to the start. I was the slowest in my heat and could tell this wasn’t going to go well.
And then the race official pointed to the Atlas ball that I needed to pick up and put on my shoulder. I had never even touched one before. I squatted down, got my arms under it and used my quads to get it on my lap. The weight (75lbs) took my breath away. I knew there was no way I was going to be able to get this thing up and down the field and I lost heart. Somehow I managed to muscle it up to my shoulder, where it perched on my clavicle ominously. I started taking steps across the field. The weight was crushing. I marveled at the women in lanes next to me who were managing to make it down the field. Time stood still in the 95 degree heat with no shade and no relief anywhere in site.
By some miracle I got that ball all the way up and back, and made it through the next tire pull. Then back to the start again where the official instructed me to pick up the same Atlas ball and do a second lap. I felt the will drain out of my body. There was just no way I could do it. I struggled to get it on my shoulder again and made it on my third attempt but then got about 20 feet down the field and dropped the ball. I tried to get it up again but couldn’t. I tried to carry it like a baby in front of me but it broke through my arm hold. I asked the official if I could take a penalty and get a lighter ball. Nope. That was not an option. So I spent the last few minutes in a futile effort to move the ball down the field and then finally the merciful timer signaled the end of the heat. I was the only woman who couldn’t get the ball back the second time.
And it was at that point that the infamous words of Dirty Harry Callahan came to me, “A man’s gotta know his limitations.” I had certainly found mine, and the humble pie was bitter-sweet. On the one hand, I was pretty amazed that I had not given up and gone home at any of several understandable points during the day. On the other, I was keenly aware of my physical limitations – and had to bow the knee to the truly gifted athletes who won the day. Would I do this again? Hmmm. Ask me once my cuts and bruises are healed. All I can say is that other competitions seem less frightening now, and maybe that’s the best gift that the Primal Games has given me.
In the future when I’m asked to join friends for a half-marathon or similarly grueling event, all I need to ask is, “does it include Atlas balls?” And if the answer is, “no” then I’m in! Thanks to the Primal Games my comfort zone has permanently expanded. I hope you’ll join me in the zone sometime, my friends! Misery loves company, after all. 😉
P.S. The team winners of the Primal Games:
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I was taken aback by a recent conversation I had with a gym owner. She is interested in encouraging middle-aged women to come to the gym for beginner-level fitness classes and was planning a strategy meeting for her staff and key clients. I asked if I could join and she said that I was expressly un-invited. Slightly miffed I asked why that was so – after all, I’m a rehab physician who has devoted my career to getting people moving.
Six weeks ago I had a skin lesion removed by a plastic surgeon. About 7 days after the biopsy, I received a letter from the pathology lab where the sample had been analyzed under a microscope. I eagerly opened the letter, assuming that it contained test results, but was disappointed to find a bill instead. As a physician, it felt strange to be in a position of having to wait for a colleague to give me results that I was trained to understand for myself. However, I knew that in this case I was wearing my “patient hat” and that I’d need to trust that I’d receive a call if there was an abnormality. I haven’t received a call yet, and I assume that no news is good news. But what if no news is an oversight? Maybe there was a communication breakdown between the path lab and the surgeon (or his office staff) and someone forgot to tell me about a melanoma? Unlikely but possible, right?
A friend of mine had a bad reaction to a heart medicine, dropping her blood pressure to as low as 76/49 as a result. She was feeling understandably dizzy but didn’t want to go to the ER so she asked me if there was anything she could do at home to help raise her blood pressure. I recommended that she drink a large volume of water and take some salt tablets. She had no salt in pill form, and didn’t want to take it straight out of the shaker so asked if there was any other way to get the salt in. I asked her to describe the contents of her refrigerator and pantry, and made a mental note of what I thought had the highest salt content.
Take this guy for example (photo at left). He was able to hurdle the “women’s wall” that I struggled to scale and climb over. I stood there, staring aghast at the fellow like some kind of animal in headlights. I realized that I belonged on the sidelines as a spectator, not a competitor – but alas, I was in it for the duration.
