What Keeps You From Making a Change?

Small changes can make a big difference.

Each of us – doctors included – can do something to improve our physical health. It might be increasing our fitness level with more exercise or maintaining a healthy weight by being more mindful of what we eat.

Yet change can be intimidating. It’s hard for many to adapt to the constant change in our world. It’s harder still to initiate positive changes in our own behaviour.

One reason is the comfort of inertia. Even if we’re not totally happy with the way things are, it consumes more energy to make an effort.

Another is the seemingly overwhelming chasm between where we are and where we’d like to be. It’s hard to see yourself in the future with washboard abs when looking down now you can’t even see your toes.

Becoming a nonsmoker may seem impossible if you’re smoking two packs per day. Going to the gym five days a week is an incredible leap for those who are sedentary.

To reduce the intimidation – and your own procrastination – of a significant goal, break it down into more doable mini-goals. It will be like eating mini donuts; before you know it, you’ve consumed more calories than those of a full-sized donut.

So take that first little step – or bite – towards the place you’d like to be. Try out a small change this week, see how you feel and then decide where you’ll step next.

A little bite won’t hurt – if we’re not talking about junk food, poison apples, rabies, malaria or other infectious diseases.

Next: Making One Small Change Towards a Healthier Diet

 

Back to Basics: How to Wash Your Hands, Pt 2 of 2

This week, my theme is small things that make a big difference. This month, I taught my Medical students the key procedure in infection control: handwashing.

I spent some time – 15 seconds to be exact – demonstrating proper handwashing technique to my students. Although this sounds like the kindergarten curriculum, it’s important to start with the basics . . . especially when patients’ lives are at stake.

Like with any other medical procedure, I taught them to plan their approach – just as you would approach a public washroom – with your exit in mind. Make sure you have everything at hand. You’ll need soap of course.

There should be a paper towel available (without you having to crank a contaminated lever with your freshly washed hands) that you will use to dry your hands, turn off the taps and in the case of a public washroom, open the door.

There are parts of our hands that are commonly missed when washing. These include the fingertips and the back of each hands. If you take the time to lather up the soap and wash the four sides of each finger, the palms and the back of each hand, you’ll find that it really does take about 15 seconds.

I teach my students to treat handwashing as a ritual between each patient: do it carefully and mindfully as a transition between the sacred one-on-one time with each patient. When we are with a patient, it is essential to be mindful – to be totally focused on that individual’s problems and experiences. If we are distracted with interruptions, the pressure of time or our own thoughts about the previous patient, we will not fully attend to the patient before us and we are more likely to make a mistake.

If we are not fully present, we will notice the difference and so will our patients.

Today: note how well you normally wash your hands, then take the time to wash them like a conscientious doctor or medical student. By doing this before and after you eat or touch your eyes, nose or mouth, you will greatly reduce your chances of picking up and spreading infections, like the common cold, strep throat and influenza.

Little things like handwashing can make a big difference in your own health and the health of others.

Back to Basics: How to Wash Your Hands, Part 1 of 2

My theme this week is small things that make a big difference.

This month, I’ve been teaching Office Procedures I to small groups of 1st year Medical students at U.B.C.

Although most of the afternoon is spent demonstrating and supervising their first subcutaneous, intramuscular and intradermal injections into oranges and Roma tomatoes  without accidentally poking themselves and each other, we spent some time talking about universal precautions.

It’s hard to believe that in the distant past, doctors didn’t glove or even wash their hands between examining patients, including women in labour. Ignaz Semmelweis was a Hungarian physician who discovered why doctors’ wards in his hospital’s obstetrical clinic had three times the mortality of the midwives’ wards. He pioneered hand disinfection with chlorinated lime solutions in 1847 and demonstrated a drastic reduction in mortality.

His radical ideas were not accepted by the medical establishment, and he died ironically of septicemia in an asylum.

Tomorrow: How to Wash Your Hands

That Small Change That Will Make a Difference in Your Life

Small things can make a big difference. This applies to you as well.

When we think about making a positive change in our lives, we imagine that it would take a huge investment of time, effort or money to make it happen. We can be so intimidated that we can’t even begin to bring about a change.

We may only dream, “Maybe next year when I have more time. Maybe someday when I have more will power. Maybe if I win the lottery.”

Every big change begins with small incremental change, but it requires some reflection and intention. The relatively small systematic changes made in the hospitals involved in the IHI’s 100,000 Lives campaign were scientifically based, carefully planned and standardized.

Think about a small systematic change you can begin this week and incorporate into your daily routine. Ask yourself, “What small simple change can I start today that will have a positive impact on my life?”

Consider first the most important areas of your life. Which areas (i.e. work, family, social, recreational, emotional, physical) need some improvement?

If you’re not exercising at all and you would like to start, why not get off the bus a bit further from work or home and start walking an extra 15 minutes each day?

If you or your spouse is feeling neglected, why not set up a weekly date night (with each other not other people). If you are both busy parents and haven’t found any time to check in and talk to one another, schedule regular time as a couple – maybe 15 minutes at the end of each day.

If you wish to eat a healthier diet but you never get around to eating enough fruit, why not pack an apple or pear in your lunch bag each day?

If you recognize that you’ve been more critical and negative about your life and everyone in it, consider beginning each day with positive thoughts – a meditation of appreciation. By reflecting on the good things in your life each morning before you even roll out of bed, you can frame your day in a positive light – even if it is cloudy and overcast outside. For many, this positive outlook can help you see opportunities instead detours throughout the day. You will be primed to see the positive in yourself, your world and others.

Small Things Can Make a Big Difference

In the Canadian Adverse Events Study published in the CMAJ 2004, 7.5% of hospital admissions result in adverse events (unintended injury) and 37% of these were judged to be highly preventable. The study estimated that between 9,250 to 23,750 deaths each year were preventable.

The Institute for Healthcare Improvement (IHI), recognizing that patient harm is largely due to poor systems not bad people, ran the 100,000 Lives campaign for the 18 months from December 2004 to June 2006. With the goal of preventing 100,000 needless patient deaths in hospital, the campaign focused on 6 evidence-based interventions.

These 6 interventions were: (1) rapid response teams to respond to acutely deteriorating patients, (2) the prevention of adverse drug events, (3) reliable acute myocardial infarction care (to reduce heart attack deaths, (4) the prevention of surgical site infections (with the correct use of antibiotics around surgery), (5) the prevention of ventilator-associated pneumonia, and (6) the prevention of central line infections.

The four keys of ventilator-associated pneumonia prevention were relatively simple: elevating the head of the bed, a daily break from sedative medication, a daily assessment for the readiness to remove ventilation, ulcer prevention and deep vein thrombosis (clotting) prevention.

The campaign was a success. The IHI estimated that 122,300 lives were saved from preventable deaths.

Some of these interventions were relatively simple and they were based on what we already knew to be best practices (based on scientific evidence). The impact was significant.

Over 100,000 lives saved. Grandparents, aunts, uncles, parents and spouses remained alive and well enough to attend weddings, birthdays, graduations and enjoy the oft neglected gifts of being alive and being with those we love.

Small things can make a big difference. This applies to each of our lives as well.

Beginning this weekend and continuing throughout this week, I’d like us all to consider small changes we can make to our routines that will improve our lives.

For example, what small change will have the greatest impact in improving your health?

What small change in your schedule will reduce your levels of stress? What small change at work will make you more productive or happier? What small change can improve your most significant relationship?

Your Last Day

What would you do differently if this was your last day on earth?

This question forces each of us to pause and reflect . . .

What matters most in my life? What do I value? What do I love to do? Who matters most to me?

Would you choose to do your favourite activities? Would you read a favourite book? Would you go for a walk in a special place? Would you call up or visit your best friends? Would you spend the day with family?

Would you write a letter or make a call to tell someone what you’ve been meaning to say? Thank you. I’m sorry. I forgive you.

Would you use your last opportunity to tell the people that you love that you love them . . . again?

Since it’s most likely not your last day of life, reflect on how you will occupy your time today. What will consume the precious hours of this ordinary day? How will you spend your life today?

Most of us don’t know how much time we have left to do what we’ve meant to do, to say what we’ve meant to say, to do what we love to do, and to be with those we love.

You have this weekend, and now that you’ve reflected on what matters most to you, how will you spend your time?

 

Weaving Together the Tapestry of Our Lives

If your life was a straight line – beginning on the day of your birth and ending with your last day on earth and if it were nothing more than the inevitable aging of your body from infancy through childhood and adolescence with the progressive decline throughout adulthood to senescence, then your future would seem bleak and your efforts meaningless.

If you define yourself by your looks, your accomplishments, your possessions and your work, all is futile – for your youth will fade, your accomplishments will be forgotten, your possessions lost, and you yourself retired.

The randomness of illness and accident stymies our best plans. The challenges of chronic and acute disease can seem overwhelming.

But you are more than your body, and your life is more than a single thread on a straight line.

Your life crosses the lives of many others and most significantly it is intimately entwined with the lives of the special few: your deepest friends and your family. Together we weave a tapestry, and it can tell our life stories with the richness of many perspectives.

We define ourselves through our relationships, and in our relationships, there continues to be the potential for further growth at every age. A long-married couple can still grow together as they give, forgive and grow deeper in love. Aging or disabled parents can be supported and cared for by the adult children they once nurtured.

Being the caregiver – a child, a spouse or friend – of an aging or disabled adult is one of life’s greatest challenges. It requires mutual grace: the acceptance of care and the evolution of your changing roles, the acknowledgment of conflicting emotions, and the resolve of continued caring.

Being the caregivers for aging parents who are no longer at their physical, emotional or cognitive best can be more challenging than parenting our own children. We have to see the whole person in our arms – like the infants we once rocked to sleep.

We have to see the present in the context of our loved one’s entire life, and our new relationship within the backdrop of our relationship over a lifetime – the tapestry we weave together.

This Friday, October 21^st at 7 pm, I will be giving a free presentation at the Norman Rothstein Theatre at 950 West 41^st Avenue (at Oak Street) in Vancouver. My topic, “The Positive Potential of Caregiving: Surviving, Thriving and Finding Meaning” is part of the Tapestry Foundation for Health Care’s Dialogue on Aging Public Presentation Series. For more information contact www.tapestryfoundation.ca or by phone 604-877-8335.

Keys to Staying Young #7: See Your World With the Eyes of a Child

This past week, I’ve posted a tip a day on staying young and healthy.

#7 See With the Eyes of a Child Continue to see each day, your world and the people in your life with the eyes of a child. Greet each day with the enthusiasm and open mind of a toddler, and see the extraordinary in the ordinary. Laugh as loudly and as often as a child. We see a lot of ridiculous and silly things in our lives; instead of complaining, we can giggle.

Do you remember a time when your days were full of giggles? When was the last time you laughed until you had tears in your eyes or when you laughed so hysterically that the people around you who didn’t know why couldn’t help but laugh as well?

When was the last time you laughed so hard you wet your pants? (Don’t answer if you have stress incontinence.)

Kids laugh freely, and that laughter is liberating. They can laugh at something as simple as someone passing gas, they can laugh so hard that they can pass gas . . . and then they’ll laugh all the more because of it.

The next time you’re in an elevator – where most grownups are really uptight, staring straight ahead, not acknowledging one another and getting really upset if someone presses the wrong button or if the elevator stops on too many floors – and if someone passes gas, replace that stunned silence  (wherein everyone hopes that no one else thinks it was them) with laughter.

Before you know it, everyone may be laughing and tooting their own horns. Everyone will be relieved, and when the elevator doors finally open, you can all take a breath of fresh air.

And if someone barges into the elevator before the rest of you get a chance to exit, maybe they’ll get what they deserve.

This Friday, October 21st at 7 pm, as part of the Tapestry Foundation for Health Care’s Dialogue on Aging Public Presentation Series, I will be speaking on “The Positive Potential of Caregiving: Surviving, Thriving & Finding Meaning” at the Norman Rothstein Theatre 950 West 41st Avenue (at Oak Street) in Vancouver.

Caring for a loved one is a special challenge. I will present a caregiver’s guide to healthcare: the challenges of caregiving, care of the caregiver, seeing the whole person and finding meaning as we weave together the tapestry of our lives. You can register for this free presentation online http://www.tapestryfoundation.ca or by phone 604-877-8335.

For more on healthy living and positive change, listen to my Positive Potential Medicine podcast at wgrnradio.

Keys to Staying Young #6: Calculate Your Real Age

#6 Check Out Realage.com. Calculate your physical age, based on your health risks and lifestyle choices. It may give you a better age than the calendar and it’s based on medical science rather than the preferred methods used by most over 30: fantasy and denial.

This website will also show you what a difference a healthy diet, regular exercise and a supportive social network of friends can support your health and promote longevity.

Of course, it will also show you how bad lifestyle choices, such as smoking, can shorten your life.

Next: See With the Eyes of a Child

This Friday, October 21st at 7 pm, as part of the Tapestry Foundation for Health Care’s Dialogue on Aging Public Presentation Series, I will be speaking on “The Positive Potential of Caregiving: Surviving, Thriving & Finding Meaning” at the Norman Rothstein Theatre 950 West 41st Avenue (at Oak Street) in Vancouver.

Caring for a loved one is a special challenge. I will present a caregiver’s guide to healthcare: the challenges of caregiving, care of the caregiver, seeing the whole person and finding meaning as we weave together the tapestry of our lives. You can register for this free presentation online http://www.tapestryfoundation.ca or by phone 604-877-8335.

For more on healthy living and positive change, listen to my Positive Potential Medicine podcast at wgrnradio.

Keys to Staying Young #5: Life Begins at Forty, So Start Counting Backwards

This week, I’m posting a tip each day on staying young and healthy.

#5 Life Begins at Forty If you were born before 1962, start counting your birthdays backwards each year. You might even begin looking forward to your birthdays again. “30” will be the new 50.

When we were in our 20s, my friend, Stan and I put together a list of things we hoped to accomplish by age 30. I’m looking forward to my next “30” and a second try at some of those things that I still want to do.

This moving backwards is not far off the reality of aging. All of us who work in geriatrics see the grand reversals over time. Adult children become the caregivers of aging or disabled parents; they tuck them in at night, look after their financial affairs, accompany them for all medical appointments, speak as their advocates, look after the meals and the household, and sometimes must feed and change them.

Keep flossing and brushing so that you will have more teeth when you are five again, and if you are lucky enough to be one again, let’s hope that you won’t need diapers and spoonfeeding.

Next: Calculate Your Realage

This Friday, October 21st at 7 pm, as part of the Tapestry Foundation for Health Care’s Dialogue on Aging Public Presentation Series, I will be speaking on “The Positive Potential of Caregiving: Surviving, Thriving & Finding Meaning” at the Norman Rothstein Theatre 950 West 41st Avenue (at Oak Street) in Vancouver.

Caring for a loved one is a special challenge. I will present a caregiver’s guide to healthcare: the challenges of caregiving, care of the caregiver, seeing the whole person and finding meaning as we weave together the tapestry of our lives. You can register for this free presentation online http://www.tapestryfoundation.ca or by phone 604-877-8335.

For more on healthy living and positive change, listen to my Positive Potential Medicine podcast at wgrnradio.