Monthly Archives: September 2014

The Restaurant With the “Unhealthiest Meal” Does a Lot of Things Right – Go, Red Robin!

In general, mine is a family of food snobs.  My eldest son crossed a school off his college list because “Really, Mom, how can I be in a town for four years that doesn’t even have Indian food?” And those of you who know me (or are at least familiar with me through my writing) know my propensity to push healthy food choices. So it may seem somewhat strange that I’m about to extol the virtues of a burger joint. But it’s actually totally consistent.

As far as general food snobbery, most people like a good burger now and then, and Red Robin makes a good burger.

As far as the healthy food choice thing goes, Red Robin makes it a lot easier than many other places to make nutritionally sound picks.

This past summer, one particular combination of items at Red Robin was called out for adding up to 3540 calories. It included a bacon cheeseburger (with lots of other stuff on it, like battered, fried onions and creamy sauces) with an extra meat patty, “bottomless” fries, and a large milkshake (with an extra refill glass). Anyone could tell you that a meal like that will pack a lot of calories. And fat. And refined carbs.

I am not defending that meal. But I am defending the restaurant.

Red Robin has a full array of meal options, has multiple ways to make your lunch or dinner healthier, and tends not to be financially punitive for healthier choices. Rather than ordering a huge milkshake with a refill included, you may order an unsweetened iced tea. As far as the burgers go, you can substitute a ground turkey burger, a veggie burger, or a grilled chicken breast for no extra charge. You can choose a whole grain bun or even a lettuce wrap for the sandwich (which they do quite well, I must say). If you choose not to have their “bottomless” fries, they do not charge you extra to substitute (also “bottomless”) salad, steamed broccoli, or cut-up fruit. And they have many other meal options, all of which they readily tailor to your specific dietary requests.

I cannot tell you how annoyed I become when a restaurant “punishes” me for trying to choose a healthier modification to their meal. A local trendy breakfast place, when I wanted to skip the large pile of fried potatoes that came with my eggs, charged me $2.50 to instead serve me two completely anemic tomato slices. This was several years ago, and I have not gone back there.

So when a major restaurant chain provides me with choices that include vegetables, fruit, and lower fat proteins, and when they don’t up-charge the healthier options, I say, “Bravo!”

I’m fine with the milkshakes remaining on the menu. It is my choice to avoid them most of the time, and I discourage my kids from indulging regularly in them. But every once in a while, it’s ok if we split a mint chocolate shake. Especially if our preceding dinner had sides of broccoli rather than fries.

The person doing the ordering has the power to determine what they will ingest. Use common sense. Eat veggies. Use olive oil. Drink water or unsweetened iced tea. Save the indulgences for rare occasions, and share them so that there is reasonable portion control. And give props to the establishments that make it easy to do so.


Response to a Medical Student in Pain

This evening, I read a post by a medical student on, a social media platform of voices in health care. The post is written by a woman who finds herself feeling alone, depressed, desperate, and afraid of losing herself as she goes through medical school (the post may be found here:

This post is my response to that woman.

Dear Colleague and Friend,

You are not alone.

You are far from home. You are far from your family. You are far from the desert, the open sky, the beauty of vast open space. And you have discovered a new desert, a new open space inside of yourself. You feel alone.

But you are not alone.

You have seen the business-ification of medicine, the reduction of education to rubrics, and have felt the isolation of having your feelings categorized as solely intrinsic, with the concomitant dismissal of the thought that much of the problem may be extrinsic. You feel alone.

But you are not alone.

There are many of your med school colleagues who feel as deeply as you do, who cherish their time connecting with their patients, who struggle with existential questions and resent the relentless pace and endless volume of information thrown at you. You were studying in your apartment for two years while many of these colleagues were complaining amongst themselves while studying together or while out at the bar on a weekend. Find these people now. Join a study group. Start a study group. Join one of your med school organizations. Join another one. And another one. And another, until you find the people you need to find. And drop the organizations that don’t have the people you need.

You are not alone.

There are people who have been through this before you. Find them. Talk to residents. Talk to attending physicians. They have been down this path. Some of them will have had a similar journey to yours, and can help you navigate your way through. Some are jerks. Stay away from the jerks.

You are not alone.

Keep speaking to mental health care professionals. You’ve spoken with the school counselors – ask them for a referral to a psychologist or to a psychiatrist who does therapy. If you don’t like the first person they send you to, get a referral to another. It might take a few tries to find the right person. When you get yourself as healthy as you can be, you will be best able to help fix the flaws that you are finding within the system.

You are not alone.

There are others outside of your profession who you may find yourself being the closest to. That they have not walked the same educational and career path that you have does not mean that they cannot empathize with and connect with you on a fundamental level at the core of your soul. Call your family and friends. Vent to them. Listen to their venting. Share jokes with them. And find new friends geographically close to you – join a religious institution, a volunteer organization, a community center. Some people will not click with you. Some will.

You are not alone.

Not everyone who starts out in medicine stays in medicine. It’s ok to go in another direction if that is what you ultimately chose. No matter what kind of flak you get from others, it is your choice. You do not need to defend your choice. Know in your heart that education is never wasted – every piece of information that you’ve learned, every struggle you’ve gone through, every book that you’ve paid for, every exam you’ve studied for and taken, contribute to the overall gestalt of who you are, of what you know, and of how you interact with the world. The paths a person takes give that person perspective and wisdom.

You are not alone.

The desert inside you needs a quenching rain. May you find it during the leave of absence you are currently taking. May you re-connect with those close to you from that other life before medical school, which seems a world away but is as close as a phone call. May you visit your family’s home and take in the view of the physical desert and open sky, which can quench your inner desert like a tall glass of ice tea.

You are not alone.

You are a writer. Keep writing. Share your writing. And read. Not textbooks, but books, articles, blogs. Find the voices that speak to you, and speak back to those voices and about those voices.

You are not alone. And I wish you the very best.

Docs vs. Glocks – A Matter of Trust

Doctors talk with their patients about many things that might make some people uncomfortable – sexual issues, abuse (physical or emotional), anxiety, depression, sleep habits, bowel habits, and fears about health-related topics – things that many people might not talk about in casual conversation at the coffee shop or at work. Doctors talk with their patients about smoking, weight, eating habits, exercise, seat belt use, helmet use, and a myriad of other health and safety issues. Talking about really personal stuff is what doctors do – we’re privy to some of the most intimate details of people’s lives. We have to be. We can’t do our jobs right without thorough and open communication with our patients.

But Florida recently passed a law (which a federal appeals court ruled constitutional) that will punish doctors who ask about firearms unless that discussion is “relevant to the patient’s medical care or safety, or the safety of others.” Well, a pretty big point of discussing firearms with patients is that unlocked, loaded firearms can be exceedingly relevant to the safety of the patient and others. This is a bizarre incursion of the legislature into a doctor’s office. And I don’t like legislators in doctors’ offices. The only people who belong in a doctor’s office are the doctor, the patient, and other people whom the patient expressly invites.

As Dr. Francis W. Peabody of Harvard Medical Service famously said in his speech to medical students in 1925, “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” A good doctor cares about her patient. She asks questions so that she can understand her patients and best provide information that will benefit them. And our words frequently make a difference in people’s lives. Our thoughts, explanations, time, and support make a difference. Patients are more likely to address smoking and weight issues when these issues are broached by their doctors and specific risks are explained to them. I would extrapolate that parents would be more likely to keep firearms locked away out of children’s reach if their children’s pediatricians discussed firearm safety with them the same way pediatricians discuss car seat safety.

The arguments of the people who pushed for and are in favor of this particular piece of legislation state it as an invasion-of-privacy concern. Extrapolating from the comments sections of the online articles pertaining to this issue, there is a not-insignificant number of folks with the perception that doctors are the puppets of the government, gathering information and putting it into a big governmental database. Basically, people don’t trust that they have any privacy in their doctors’ offices.

There have been other “gag order” laws restricting what doctors are allowed to discuss with their patients (e.g. women’s health issues), but these have historically been put in place to prevent physicians from providing certain medical information to patients. The recent Florida legislation was put in place to prevent physicians from receiving certain information from patients. This particular legislative control of informational flow thus differs from others in its directionality. Traditionally, the intrusion into the doctor’s office has been due to the proponents of the laws not trusting patients (read: “not trusting women”) with information, but the current law in question indicates that its proponents don’t trust the doctors.

Pretty much any doctor-patient interaction could be construed as an invasion of privacy. Clothes are off. Orifices are inspected. Intimate subjects are discussed. And in the past there has been an understanding that all of that stays in the exam room. It’s not anyone else’s business.

But now there’s a computer in that room. And it’s pretty much a government mandated computer.

The computer certainly has some benefits for patients – it can help with remote access to records and it can catch potential drug interactions. It can help remind doctors when someone is due for a mammogram or colonoscopy. Of course it is only as good as the data entered, but when that is done with care and diligence, it can definitely be clinically helpful. And the data can be mined, hopefully in ways that provide useful clinical insights. Of course the main impetus behind that computer, and the reason it was mandated, is Medicare/Medicaid billing and payment decisions.

That computer, despite its clinical benefits, has costs. It draws a doctor’s focus and attention away from a patient and onto a screen. When was the last time your doctor spent more than 10 seconds in a row making eye contact with you? Doctors end up staring at the computer screen, reading down a list of questions and clicking boxes with the answers. So there is the sense that someone else is in the room. And there is a subsequent loss of trust.

As many thousands of pages there may be in the HIPAA laws (which are there to protect electronic patient information), I haven’t met anyone who trusts a computer more than (or even as much as) they trust a person. And most doctors I’ve spoken with don’t completely trust their electronic medical record systems or the infallibility of mandated practice protocols. Maybe the general public isn’t trusting us because we’re not completely trusting ourselves.