80 Day (not exactly) Obsession

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Differences: 3 weeks of 21 DFX workouts, stopped snacking, improved sleep schedule, and a few 80 DO workouts. Same: pants, camera, and pager.

I recently finished up 21 Day Fix Extreme for the second time around and have moved on to 80 Day Obsession. I have few thoughts after finishing the first week:

  1. I am not and never will be a beach body coach and I do not want one! I appreciate the offers but I’m just not into the idea.
  2. I also don’t want to try shakeology. Sorry. Vega makes an objectively better and cheaper product and I’d rather my calories come from actual food anyway.
  3. Names like “fix” and “obsession” when it comes to food and lifestyle choices really bother me. When I think of being “obsessed” with food I think of eating disorders and for that reason I wish Autumn et al would have come up with a name that implies that balance is important. Nobody needs orthorexia to live a long and healthy life. In fact, it’s counterproductive.
  4. I may be wrong about this, but whoever has a flexible enough schedule and the mental energy to do the timed nutrition must not have an 80 hour a week job. I physically can’t do it. There are weeks that I can’t meal prep and there are days where eating every 2-3 hours isn’t practical. I’m not one of those people that “forgets to eat” but when you work in an intensive care unit there are times when you can’t just be like “sry brb to finish these chest compressions, gotta go eat my snack!”
  5. I will have to skip the days when I work 28 hours at a time, and I am cool with that. I’ll try to shuffle things around to make them up but I’m not going to be so “obsessed” that I sacrifice sleep pre-call.
  6. I genuinely enjoy cooking and most nights that means I want to make something that isn’t an exact breakdown of macronutrients. If I don’t end up looking like a swimsuit model because I practice the self-care exercise of cooking dinners that I enjoy making and eating and aren’t just fish and sweet potatoes, then so be it.
  7. In general I’m more into the idea of an 80/20 rule than strict no-wine-no-chocolate-no-cookies-no-cocktails-no-anything-delicious for 13 weeks. If I’m out with friends I’m having the drink and when it’s 10pm and I’m on call and everyone is eating the free cookie from ABP I am eating a freaking cookie. However, I did cut out junk food at home which was actually not as hard as I expected it to be.
  8. My rest days are on Friday instead of Sunday. I’m 6x more likely to be tired on a Friday than I am on a Sunday so I scheduled the two 60 minute workouts for my weekend days when I’m at least somewhat more likely to have a day off.
  9. The workouts themselves are great!! They seriously fly by. I was nervous about going from 30 minutes with 21DFX to mostly 45-60 minutes with 80DO, but so far it has not bothered me even a little bit.
  10. I like the live aspect of the workouts. You can’t always hear what the cast are saying (probably would have been a good idea to mic them and edit heavy breathing out) but it makes you feel like you’re really in a class rather home alone.
  11. I love that there’s no music! Full Taylor Swift albums can be played in the background! I used a couple of Autumn’s playlists too and they are pretty good as well.
  12. I work out on my Lululemon The Mat every time. Otherwise the hardwood floors are too painful on my wrists.
  13. Some of the band and slider stuff feels a little gimmicky at times and can be difficult to figure out, and especially with the sliders I felt like I made the moves harder by ditching them. I’m sure with practice it’ll make more sense.
  14. I can honestly say my arms and legs feel more toned and my backside feels more lifted. Can’t say that I see a huge difference visually in my core yet but I am holding planks more easily and I’m sure over the next 74 workouts there will be more of a change. (Also probably would help if I cut out the late night cookies and followed the nutrition plan exactly, but mental health > six pack.)

And then a few thoughts on each workout:

  1. Total Body Core: this is a good circuit workout. The heaviest weights I currently have are 10 pounds and that is probably a little too light. I love writing that because I used to think 3 and 5 pound weights counted as “light” and “heavy.”
  2. Booty: squats on squats on squats with some lunges thrown in for good measure. It does not feel like a full hour, which is good.
  3. Cardio Core: 30 seconds of jumping a theoretical rope and 30 seconds of plyo are repeated 3 times, followed by a core move that usually entails a slider. I could see this getting a little repetitive from week to week but you do work up an incredible sweat.
  4. AAA: another decent circuit workout, and another workout where I am realizing I’ll want more than 10 pound weights by the end of this.
  5. Legs: this workout induces subacute death, in a good way. There is a move where you squat down like you’re tying your shoe at the end of the circuit that I almost didn’t survive.
  6. Cardio Flow: this is neither true cardio nor a yoga flow, so the name confuses me, but I really liked it anyway. It’s basically escalating levels of full body torture (again, in a good way!) and you blink and the workout is over. It’s probably unladylike of me to share this, but I was absolutely dripping sweat by the end.

And that’s my first week! I’m SO excited to use my foam roller tomorrow!

21 Day Fix Extreme Review

I did this whole program about two years ago right before residency started and really loved it, but being at the lighter end of the spectrum even my “maintenance” calories didn’t really feel like enough so I started to bonk towards the end and sort of fell of the bandwagon. (Sorry, 12 almonds do not make up a “snack” when you are starving.) But I did feel like I had a good level of fitness and was glad I didn’t just totally couch potato it before getting to Chicago.

Over the last 2 years, my (super awesome and super cheap) health insurance requires me to get weighed, vitaled, and blood tested annually if I want $400 off my premiums (I do) and it’s been a little disheartening to watch almost every number head in the wrong direction. For example, my good cholesterol used to be higher than my bad cholesterol (this is unusually good) and now it is most definitely not, and I have gained about 4 pounds that I just don’t need in the last 2 years (a trajectory that will set me up to be 200 pounds in 20 years, which would be suboptimal).

So it’s time for me to invite Autumn Calabrese back into my life but with a sustainable amount of food this time around. I’ve been cooking almost exclusively the last two weeks and feel like I’m in a good spot mentally to get back into a workout routine, which to me is more than half the battle when it comes to staying active. I just completed the first week of 21 DFX again and thought I’d jot down some thoughts in case anyone cares.

*Disclaimer that I am NOT and NEVER WILL BE a “beachbody coach” and I do not and will not drink shakeology. Good for you if you choose to have this as a side hustle, but I hate the feeling of the pyramid scheme even though I think beachbody creates some of the best and most scientific programs out there.

Plyo Fix Extreme

This one wrecks your legs in a good way. Taking the L the next day, where elevators are super sketch and stairs are really the only option, was mildly terrifying. There are approximately 1024953 squats in this one and yes, you will feel it even if only using light weights.

Upper Fix Extreme

I have never been a big fan of working out chest and shoulders (mainly because mine are weak) but I like this workout anyway. I would recommend not trying to blow-dry your hair immediately afterward.

Pilates Fix Extreme

I am so used to yoga breathing that pilates always feels kind of backward to me, and the church wrap always seems to get me confused, but this is a great active recovery day mid-week and the more I remember to breathe correctly the more I feel I get out of it.

Lower Fix Extreme

I think this one is my favorite! Obviously your legs are already super sore but this workout pretty much flies by.

Cardio Fix Extreme

I’d rather do resistance than cardio, but I like this one because it will leave you a dripping, sweaty mess. I also like that there are still some weights included, even though it is cardio.

Dirty 30 Extreme

This one is probably my least favorite, just because the moves are a full 60 seconds and my mind starts to wander after about 40. The mixture of moves is either too easy or way too hard – I really hated the bonus move because I straight up cannot do it. Goals maybe?

Yoga Extreme

Yoga is mentally tough for me after I seriously fractured my arm a couple years ago and lost a lot of strength and almost all flexibility in my right wrist. I haven’t been to a real yoga class since then and so this just reminds me of what I wish I was doing but have been too nervous to try. I don’t think Autumn is an RYT, so if you have the time in your day it might be worth swapping this out for a nice yin yoga class at a studio instead.

I’m now trying to psych myself up for 80 Day Obsession, but I don’t like the idea of 60 minute workouts (I’m busy) and calling anything food-related “obsession” borders on disordered eating territory in my mind, which makes me a little uncomfortable. And let’s be honest, I also don’t like the idea of completely missing out on drinks and desserts for 3 months so I might be inclined to do the workouts but follow more of an 80/20 rule for nutrition. I don’t need to look like a swimsuit model! I just want my HDL back up in the 70s where it belongs.

Have you tried any of Autumn’s workouts? Any tips for 80 Day Obsession?

How I Chose Neonatology

Like many 3rd year medical students, my friend Clare is currently making a huge life decision: what specialty to go into after medical school. Although everyone’s thought process is a little (or maybe a lot) different from anyone else’s, she inspired me to share how I got to where I am and I hope someone thinks it’s useful!

When I started medical school I was absolutely certain that I was going to do something surgical and was pretty convinced I’d never want to work with kids. I remember telling classmates I wanted to do surgical oncology and almost as distinctly remember feeling like I didn’t really believe it myself.

During our first two years of med school we were all assigned a primary care preceptor that we worked with one week per semester for a total of four weeks, and I happened to be assigned ob/gyn and surprised myself by really enjoying it, partly because I thought I’d like getting to be in the OR as part of my job description. After that, I started getting involved in the ob/gyn interest group, started a Well Woman Clinic at the free clinic I was running, shadowed in labor and delivery almost every weekend, and when my classmates placed bets about what everyone would end up going into, there was a very clear prediction that this is what I would end up doing.

Then I got to third year of med school. I started out on pediatrics and felt a click, even though I tried to ignore it at the time. Everyone I was working with made me want to be a better version of myself and there was not a single person in the department who didn’t seem to enjoy coming to work every day. I remember feeling some disappointment because I thought that lumbar punctures were the most exciting thing they got to do in terms of procedures, but overall I really felt at home on that rotation and the standards were very high for my next rotation, ob/gyn. At this point I was expecting to like it even more and was so excited to get started.

The first part of my ob/gyn rotation was gynecologic oncology and thought I was for sure going to find the perfect fit – surgery and ob/gyn and interesting medicine! What could be better? But even though the residents all seemed like they wanted to do a good job (and one even liked it so much she received her match letter that week to stay at that hospital for gyn onc fellowship), no one seemed as happy as the pediatricians I’d just left. I thought the OR cases were long and dull and even the attending surgeons seemed to wander in and out during long, drawn out pelvic exenterations (google that only if morbidly curious) and outcomes for the patients were incredibly depressing to me. Ok, I thought, not gyn onc but I still am going to like ob/gyn in general!

I got to labor and delivery after that and did fall in love. I liked c-sections, rounding, catching babies, and going to triage and to emergency situations. But what I noticed was that my attention after deliveries was almost never given to the mom – she and her placenta were nowhere near as interesting as the actual human being that had magically just appeared in the room.

The rest of third year I spent comparing things against pediatrics, and briefly entertained the notion of family medicine so I could do both children and women’s health, but decided I wanted the option of further sub-specialization. I thought for about 2 seconds that pediatric surgery would be cool, but then had the worst four weeks of medical school on that rotation (no one seemed happy or well rested!) and quickly crossed that off the list. Anesthesia seemed appealing too, but I missed the opportunity for continuity of care and so off the list it went. I randomly really liked the neuro ICU (probably my favorite 2 weeks of medical school) which in hindsight was actually fairly foreshadowing, but couldn’t see myself taking care of adults only, forever. Or doing a neurology or emergency medicine residency. I never really considered psychiatry, derm, radiology, neurosurg, ENT, ophtho, pathology, internal medicine, or ortho, but did briefly flirt with the idea of urology or CT surgery after enjoying both of those rotations. I decided against them due to the lack of variety I’d end up getting to see.

So I matched in pediatrics and started developing my interest in health care delivery, which was something I’d first discovered I liked before med school when I was working at a free clinic and had picked up some experience in while running my own free clinic during MS2-MS4. Access to care and the way it affects outcomes is fascinating and at times disheartening, so I wanted to find ways to address it. I got so far as taking the LSAT with a plan to pursue advocacy work with a law degree, but found myself developing a serious case of imposter syndrome. Something just wasn’t quite right.

Enter the NICU. At first I’d been dreading it: tiny, fragile, confusing humans who are locked up in boxes which they don’t leave for weeks and months at a time. Kind of creepy when you think about it that way. The first month I was there I didn’t let myself even entertain the notion of a career defined by tiny humans, but I did love going to deliveries, doing procedures, and helping families take healthy babies home. After I covered the unit for Christmas and came back to the NICU for a second full rotation, I couldn’t deny that I was coming in early and leaving late and reading everything I could get my hands on in a way that I just hadn’t in a long time, and once I finally started letting myself believe I was going to do this forever, I felt like my whole personality changed and my imposter syndrome started to really quiet itself down.

Meanwhile, I’d applied for and gotten into LUCENT, which is a primary care track that meant I got extra elective time to do outpatient rotations and gave me protected academic time to work on projects that improve healthcare delivery for our underserved urban population. I loved that too, and liked the continuity a pediatrician has with patients that creates a fun and special bond. One of the attendings that I worked with (and continue to work with) is actually a neonatologist who follows patients in a high-risk clinic after discharge, and this helped me find the final piece of the puzzle that tied all my interests together. (Except inserting IUDs. I haven’t found a way to get to do that with this plan…)

Neonatology with a focus on outpatient follow up gives me just about everything I could possibly dream of, from critical care to primary care, intense and interesting inpatient experiences to expanded clinic appointment slots for complex medical needs, deliveries and code situations to advocacy opportunities for improved access to care for high risk patients, and unique transitional physiology to unique children with different developmental needs and personalities. I feel like I’ve found the perfect fit and want to encourage anyone who doesn’t feel 100% certain about forced career choices that there is a very strong likelihood that you’ll find something you love and excel in if you trust the process and stay open to new ideas along your path.

I know this is really long-winded but it took nearly six years for me to figure out what I wanted to do with my life after deciding to become a doctor, so the thought process was also fairly drawn out! If you have thoughts on specialty choices I’d love to hear about them!

Anonymous Evaluations: Helpful or Hurtful?

If you are in medicine, you are probably quite familiar with the process of writing and collecting online evaluations that are anonymous and generally unhelpful. (I’m sure this is true of many other professions too, but my only experience with them is in medicine.) They do form the bulk of our MSPEs (short for medical student performance evaluations) and later for other self-promotion when looking for a job, but are they actually helpful in practice?

First, let’s talk about why positive evaluations are nice but not helpful. Everyone gets to cherry pick their best comments to showcase how great they are when sending them out for review, so out of the many applications I’ve read for both med school and residency candidates, I’ve seen one mildly negative comment. One. Ever. And they framed it in a way that showed the person had addressed a shortcoming based on in-person feedback, so in the end it was actually nice and demonstrated how important real life communication is. The anonymity of online evaluations does nothing to improve performance, and by their nature it is difficult to use them to stratify applicants. If the evaluation is written about you, it makes you feel good about yourself for a minute and maybe even a little complacent, but the vast majority of evaluations are generic and non-specific, something along the lines of “Elizabeth has an excellent fund of knowledge for her level of training and was a pleasure to work with on a busy service.” We’ve all gotten that exact comment on more than one occasion, and according to the numerical component of our evaluations we are all above average. But that’s just not how math (or life) works!

I know I am not alone in my frustration about the Embarrassment of Riches awarded to medical trainees in that they are difficult to wade through and often rather superfluous. The linked article comes from the Journal of Pediatrics (Rockney, 2014) and is written by someone who is both a clerkship director and a residency selection committee member. What are we achieving with our overabundance of positive comments?

Conversely, negative evaluations given behind a veil of secrecy have the power to be really hurtful. Although I’ve been fortunate to mostly avoid negativity in evaluations I’ve received, I exist in the real world and therefore there have been occasions where I’ve been on the receiving end of rude or thoughtless criticism. They come from people I’ve worked with who haven’t given me any face-to-face feedback but then weeks or months later drop an anonymous comment that makes me feel really terrible about myself, just because there is a compliance deadline and they feel some sort of clerical urge to put pen to paper. It’s confusing when all other evaluations from the rotation are positive and then this one person takes it upon him or herself to let you know they think you suck. It leaves you wondering who you rubbed the wrong way and makes you wary of anyone who could have been the author. It has the potential to poison you against a large group of people and that is not a healthy dynamic to create between people working together to save lives.

Regardless of the positive or negative nature of the feedback, in written documentation, there is also some gender bias and differences in terminology used based on the gender of the student being described. There was a very interesting article published recently in Academic Medicine (Riese et al, 2017) discussing the differences between the way male and female medical students are described, in addition to the differences between the way male and female evaluators grade their students differently.

This year I stopped turning in evaluations about my co-residents and our fellows/attendings and I am not apologizing for it. It has really given me more confidence in giving face-to-face constructive criticism and genuine compliments to the people I work with for up to 80 hours a week at a time, and I would encourage more individuals and programs to consider supporting this approach. It also gives me the feeling of a clean conscience when one of my co-residents receives a negative evaluation – they know it wasn’t from me and they know if there was something I felt I needed to address with them that I would have respected them enough to have done it without hiding behind the internet. I’ve also made the decision to stop reading things that are written about me, with the expectation that the people I work with would have a similar level of respect for me and would help me improve my patient care skills by having meaningful human interaction. (As a bonus, I save a lot of time staring at a computer screen.)

What do you think? How do you handle rude commentary from someone you’re supposed to trust and feel supported by? Do the potential benefits of written performance evaluations truly outweigh the cons of secretive and generic feedback practices?

Creating Your Rank List

This post is for all the current and future fourth years out there who are making a rank list – it’s an overwhelmingly important decision and you’re almost certainly going to second guess yourself at least a little. Although I definitely had more flexibility in my free time and really enjoyed the absence of regular testing in MS4, I think I was just about as anxious as I had been throughout medical school just because so much feels like it’s being left up to fate, and that was kind of tough to deal with! There’s nothing left to do but decide where you’d like to spend the next 3-7 years of your life and then to wait and hope that it works out the way you want it to. The good news is that it ends pretty well for most everyone I know!

The biggest piece of advice I got and will give is that you need to trust your gut. I was actually interviewing at U Chicago when my now-program director was chatting with us and told us about how she’d created spreadsheets on spreadsheets of things that she like and didn’t like about the various programs she’d visited, but in the end decided to trust herself about what she wanted and picked what felt right. At the time of that conversation, I was about halfway through interviews and had definitely been making some spreadsheets of my own. What I realized was that I was tweaking some of the things I was putting into each column to make the programs move into the order I wanted them to be in based on my gut reaction. After that I ditched the spreadsheet and just put them in the order that felt right to me.

I would also encourage you to put literally anything into the NRMP the day it opens just so that something is on the books in case you get put into a coma or get kidnapped until the deadline. You can always change things around after you certify, but you might find that putting in a list early and quickly is actually the least stressful way possible to do it.

In terms of actual program selection, there are probably a million factors that are unique to each applicant and to each program, so I imagine my reasons for choosing pediatrics at U Chicago are probably very different from someone choosing ortho at Rush, even though we’re in the same city. I’ll share with you some of the things I considered, just to give you a sense of my thought process.

  1. Program size and catchment. When I was applying to programs, I really thought I wanted to be in a medium-sized program and in a city that had only one children’s hospital. While interviewing I realized there was such a thing as too big, but there was also such a thing as too small and that shifted a few larger-than-medium programs higher up my list. I also realized it didn’t really matter to me if there were other children’s hospitals in the city, as long as we weren’t constantly shipping our patients out to them. There are a few really large children’s hospitals in the Chicagoland area, but ours is the only one on the South Side, so I’ve sent a grand total of 2 interesting patients to other hospitals for very specific indications.
  2. Location. I was terrified of Chicago when I came to interview, but had a great weekend touring the city and felt a pull to come here. It was nice to know that if I ended up hating it, it would only have been a 3 year commitment and then I’d have a definitive endpoint where I could leave without anyone being surprised or disappointed. It has been an excellent decision for me to have left my home state and I’m glad I didn’t stay in NC for training.
  3. Underserved population. If you don’t want to work with underserved patients, please please please be honest with yourself about this. I have interviewed numerous candidates here at U Chicago who really didn’t seem to get that taking care of children with disadvantaged backgrounds is a huge privilege and honor and should not be taken lightly. It is absolutely ok not to want to do that – everyone needs access to care, including the rich! Being in a hospital where our payor mix is 80% Medicaid/Medicare presents some unique challenges and is often not very glamorous. This is where my heart lies and I can’t really see myself doing anything else, but if that’s not you, don’t pick a program where you will not be happy just because it seems cool to say you take care of the underserved.
  4. Co-residents. I really enjoyed meeting the residents at almost every single program where I interviewed, but there was something about the “Comer family” that felt really right to me. They were a little less saccharine than the average pediatrician, and I felt like my sometimes-snarky commentary on life would fit in better here than anywhere else. I also really liked the program leadership here – most PDs gave a powerpoint about why we should choose their program and ours just had a really honest conversation with us. I loved that!
  5. Resident-driven program. I interviewed at a couple larger programs that were largely fellow-driven and could definitely see the appeal, but moreso the appeal for being a fellow there. I like that we have a mix of specialties with and without fellows here, but even on services that have fellows, it’s almost always the resident making decisions (with their support and teaching) and not the other way around. I have a ton of autonomy here and I absolutely love that, but if you want more supervision, consider a program where you are less likely to be making decisions on your own.

There were obviously many other factors that were probably more specific to my own goals and needs, but I hope there’s a pearl in there that someone might find useful when creating a rank list! Comment below if you have any other tips that a 4th year might need to know!

Vaccine Hesitancy Counseling

I recently gave a morning report lecture on a case of influenza that I saw in the emergency room that resulted in really serious complications for the child. As part of the talk, I spent some time discussing the strategies I use to get my patients and parents to accept a flu shot, since not everyone is all that excited about an “extra” vaccine. I have posted a couple times on instagram about how important I think the flu shot is and have gotten a lot of great responses and some requests for more tips on counseling on vaccine hesitancy especially as it pertains to the flu shot, so I thought I’d share some content from my slides on here. I hope you guys find it useful!

Q: Does the flu shot actually work?

  • A: Yes. In an average year there is a 40-60% risk reduction on infection. Some years it is higher and some years it is lower, but even a 10% risk reduction is better than a 0% risk reduction.
  • A: check out the CDC’s list of studies published on how effective the flu vaccine is!

Q: Does the flu shot benefit society?

  • A: For healthy adults, there is not a huge economic advantage in getting the vaccine. However, for older adults, children, and people with significant chronic disease, there is definite economic advantage in immunizing. If you’re interested, there was a study published in 2008 in the Journal of Pediatrics about how vaccinating preschool-age children paid off in terms of number of days of work missed by parents and child hospitalization rate, among other important points (Eisenberg et al).
  • A: The Journal of Infectious Diseases published an article citing benefits of 75% reduction in cases of life-threatening influenza infection in children in 2010 to 2012 (Ferdinands et al. 2014)
  • A: herd immunity is more difficult to achieve with a shot that must be delivered annually in comparison to other routine immunizations like measles or hepatitis shots, but there is definite benefit when a higher number of people are immunized.

Q: What resources are out there to help pediatricians (and other interested parties) learn to counsel patients and families more effectively?

  • A: There is an incredible e-course that is free to AAP members on all types of vaccination counseling. Most points can be applied to the flu shot. If you’re more interested in the executive summary, check out this article from Pediatrics: Clinical Update on Vaccine Hesitancy (Edwards et al., 2016).

The AAP also published a list of common questions parents are likely to ask about the flu shot (starts on page 14, although the table of contents says 17). It’s nice to be able to anticipate their concerns and to validate what they’re saying, but also important to educate and reduce belief in some myths. Here are some of my favorites:

Q: “My kids have never had the flu!”

  • A: I’m glad to hear that and I hope they don’t get it this year, but avoiding the flu in the past is not a predictor of who will get the flu in the future. Getting vaccinated is the single most important thing you can do to prevent the flu. The flu kills up to 49,000 people each year and makes many more sick. Many of these deaths occur in healthy individuals. Even one unnecessary death is too many.

Q: “I got the flu shot and it gave me the flu” or “the year I got the flu shot was the sickest I’ve ever been.”

  • A: The strains of the flu that are put into the flu shot are killed viruses. The flu shot does not and cannot cause the flu.
  • A: If someone gets a flu shot in the middle of flu season, they may already have been exposed to the flu and be coming down with it or another virus (colds are very common during flu season and can vary in severity). Because the shot and getting sick happened ate the same time, they think the flu shot gave them the flu.
  • A: It also takes about 2 weeks for the body to build protection after the shot, so some people getting sick just before or during that time period blame the shot.
  • A: The most common side effects of a flu vaccine are soreness at the site of injection and sometimes a low-grade fever. Sometimes people who experience side effects think “they got the flu.”

Q: “It doesn’t work; my kid got the flu shot and still got the flu.”

  • A: While the flu vaccine is not 100% effective, we do know that those who are vaccinated and who later get a flu virus are less likely to get really sick, be hospitalized, or have serious complications.
  • A: There are hundreds of strains of the flu and there are only 3 or 4 strains of flu in the flu vaccine. Each year scientists determine the 3 or 4 most common strains of flu virus circulating and that’s what’s included in the upcoming year’s flu vaccine. There is always the possibility that the child could get a different strain of the flu than one that’s included in the vaccine; however, if that happens, the duration and severity of symptoms is generally much less.

Q: “The flu is not really that bad, no worse than a bad cold.”

  • A: Although it is sometimes challenging to tell the difference between a cold and the flu, the flu can have serious complications and even lead to death, especially for the very young, very sick, and very old. It tends to last for several days, keeping you out of work and your child out of school. Getting vaccinated not only protects you, but those closest to you as well.

Here are some other counseling techniques I have found to be particularly effective:

  • I remind families that I got a flu shot and did not get the flu. Although it’s purely anecdotal, parents often give anecdotal reasons of their own for not vaccinating, so I fight fire with fire.
  • Remind parents of kids 3 and under that their child is getting a smaller dose of the vaccine (but keep in mind that all first-time vaccinators 8 and under need two doses at least 28 days apart).
  • Share your personal concerns about close contacts. Is there a grandmother living in the home? Dad has cancer and is immunocompromised from chemo? There is a 4-month-old ex-preemie who is too young to get the shot? These people are at high risk from infection and you should do everything in your power to protect them, including immunization of your child.
  • Remind parents who try to say “he’s already getting other shots today, let’s do it later” that that means two days of feeling pain, plus anticipation of another shot. You’re already having a bad day today with other routine immunizations, why prolong your child’s suffering?
  • It takes somewhere between 30 and 100 flu immunizations to prevent one case of the flu. That sounds like a lot, but think of it like insurance – you wouldn’t not have house insurance just because it takes 30 to 100 people paying in for you to get a payout if your house were to catch on fire.
  • Remind parents that the Vaccine Adverse Event Reporting System exists, and while not perfect, it doesn’t suggest that the flu shot is any more dangerous than any other shot.

I think the most important point about all of this is that you should never let the flu shot be a question in your mind, or else it will be a question in the patient’s mind. When I changed my catchphrase from “so… do you think you might want to get a flu shot this year?” to “your child is due for routine immunizations today, including the flu shot” my “yes” rate increased astronomically.

Let me know what questions you have, or if you have other strategies you use that are effective! (And I’m sorry in advance if I delete your comment if it’s not polite or contains profanity. For whatever reason, anti-vaxxers sometimes tend to use rude phrases when responding to me on instagram on this topic. I definitely don’t mind hearing opposite points of view, I just expect it to be professional and kind on this blog!)

 

A Day in the Life: Pediatrics Clinic

Although at some point I’ll post a review of the rotation as a whole, I thought I’d share what a day looks like for me when I’m in primary care clinic as a resident pediatrician! Let me know in the comments what questions you have or what you’d like me to talk about in my review later!

06:30: wake up and feed my diva dog who demands his kibble be mixed with water and wet food. He’s a great and affectionate alarm clock and it’s pretty difficult to snooze. Pour coffee into my body and try to put on enough mascara and concealer to not look like death.

07:32: leave to make sure I get a good parking spot at work.

07:44: actually leave, will not get a great spot but will show up exactly on time.

08:00: morning report starts, which is often a case-based session led by one of the chiefs, an attending/fellow/resident, or, on occasion, me!

09:00: head up to clinic and look at the list for my morning preceptor. Check any labs or imaging I ordered recently and call families as needed to give results. Find a patient to see and let my preceptor know where I’m headed!

  • typically I run the whole visit at this point in my training as “the” doctor, with attending backup. It’s a great way to learn to be efficient and pick up tips on things to improve, but always with the knowledge that when I don’t know something I have an immediate support.
  • I don’t usually give SOAP style presentations anymore since they take up a lot of time. Especially with well child checks, I’ll let my preceptor know what the parents’ concerns were, what the child’s concerns were, what my concerns were, and then my plan, but otherwise report only the most pertinent positives and negatives.
  • What’s really fun is when either a) my preceptor checks on the patient after I’m completely done just to “bless” the encounter, or b) my preceptor goes with me into every visit and watches me see every patient on the schedule. The first is fun because it really feels like it’s my own clinic, and the second is fun because I get real-time feedback from an experienced pediatrician, with actual time constraints on the appointment that I’ll have in real life as an attending.

12:00: wrap up my last encounter, then head down to grab lunch to take to noon conference. This tends to be a bit more didactic and is likely to be a lecture from an attending. Sometimes we also use this hour for housestaff meetings or ethics conferences.

13:00: at this point I have a few possibilities: go back to clinic (usually with a different preceptor), drive to my own continuity clinic at an FQHC a few blocks away, head to a seminar for my leadership program, or find a quiet space to get some work done on my quality improvement project. Occasionally I get the afternoon off to read which I sometimes do from home in order to spend more time with Auggie! (Not that he’s spoiled…)

18:00: clinic ends and I go home to make dinner and study! I like reading from Nelson’s or Peds in Review about something I saw that day. I also usually have at least two books going so I’ll spend some time reading, and I have to admit that most nights I turn the TV on for a while too, mostly for some noise.

That’s pretty much it! What would you like more details about?