Things I wish I’d thought of as a Medical Student

Here are some thoughts that came to my mind one day as I reflected on what I wish I had done earlier in my career. There are likely a lot more…

  • Never forget WHY you went into medicine.
    • Write it down today. This is something to keep close and to reference during the difficult times that will surely come your way through your training.
    • Make it less than 3 sentences – concise, personal, written in the active form
    • Keep it close at hand.
    • Memorize it.
  • Invest in people – money and time
    • Pick good friends – take your time to choose who you want to be close to and then develop those key friendships
    • Support – Be willing to support others, be willing to ask for support before you depend on it to stay afloat
    • Identify mentors – mentors in medicine, leadership, life
    • Experiences – Enjoy the ride
  • Study hard – This is just prioritizing your life – work hard. As I was told in the Army, learn to “embrace the suck”
  • Emergency Fund
    • Start an emergency fund – put $1000 in today. Build it up to cover up to 6mo over time
  • You will have debts – be smart about them
    • It is ok to have a cheap car -don’t be embarrassed driving an older car as you learn to succeed in life.
    • It is ok to have a small home – Live for experiences, these will mostly be out of your home. A home while in medical education is only a place to sleep, study, and eat. The bigger it is, the nicer it is, the more time and money you will throw away in maintenance and upkeep.
    • Prioritize for the long term – Keep the distance in mind.
  • Learn about finances.
    • Start a budget and follow it
    • Develop smart finance habits now
    • Open a Roth IRA and start funding it as you are able to
    • Learn what protected assets are and use them (IRA, Homestead/Home loan, 529s, etc)
    • Invest in Index funds and Diversify those index funds
    • Pay off loans ASAP – at minimum, develop a plan and stick to it.

Recommended Smartphone Apps for Medicine

Here are the apps I find useful for my daily work as a Family Medicine Physician:

Daily-Use Apps

Android iPhone
ABG Interpreter ABG Acid Base
ePocrates ePocrates
GoodRx GoodRx
Medscape Medscape
MenoPro MenoPro
MyFitnessPal MyFitnessPal
Omnio Omnio
Stop, Breathe & Think Stop, Breathe & Think
CDC Vaccines CDC Vaccines

Continue reading Recommended Smartphone Apps for Medicine


I recently finished the outstanding book written by John Ratey called, Spark: The Revolutionary New Science of Exercise and the Brain. As both a medical professional and an active person who loves to exercise, I found this book enlightening, encouraging, and inspirational.

I learned the connection between fitness and attention spans, education, and academic performance. The author broke down neurotransmitters in a simple way that I have never seen so well described before. I loved reviewing the physiology of the brain as Dr. Ratey walked me through.

I found how running reduces anxiety through seven ways: (p106)

  1. It provides distraction
  2. It reduces muscle tension
  3. It builds brain resources
  4. It teaches a different outcome (conditioning)
  5. It reroutes your circuits (relearning)
  6. It improves resilience
  7. It sets you free

None of these are a surprise to those of us who run.

I learned of evidence showing not only does exercise increase norepinephrine but more complex exercise does more! This is perfect for those with ADHD like me….It is better to dance than to walk.

Exercise can combat addiction. It can help people regain control. It helps with PMS – raising tryptophan and thus serotonin in the brain. By balancing dopamine, norepinephrine, and synaptic mediators like BDNF it modulates the effects of hormone changes.

Another interesting effect exercise has on the body is regarding aging. Exercising helps us age – we maintain cardiovascular fitness, fight cancers better, and maintain cognition longer. Dr. Ratey provides a list of how he claims exercise keeps you going as you age: (p233)

  1. Exercise strengthens the cardiovascular system
  2. Exercise regulates fuel (improved glucose metabolism)
  3. Exercise reduces obesity (burns calories and reduces appetite)
  4. Exercise elevates stress threshold
  5. Exercise lifts your mood (staves off/fights depression/anxiety/dementia)
  6. Exercise boosts the immune system
  7. Exercise fortifies your bones
  8. Exercise boosts motivation
  9. Exercise fosters neuroplasticity (improved learning ability, memory, emotional stability, and critical thinking)

The three pillars of a healthy lifestyle: (p238)

  1. Diet
  2. Exercise
  3. Staying mentally active

Interval training was also discussed. Increased intensity was shown to improve congnitive testing results and learning abilities immediately afterward. This is from increases in BDNF and norepinephrine. A single sprint for 30s was shown to generate 6x increase in HGH peaking 2hrs after the sprint. HGH, as he describes, burns belly fat, layers muscle fiber, and pumps brain volume!

All in all, I highly recommend this book to all.


This book (Fidel: Holywood’s Favorite Tyrant) was an interesting read. Some bias can be heard from the author as you read through, but the facts listed are difficult to argue against and the bias is then understood, especially given his personal connection.

Some of the things that surprised me:

  • In 2003, the US was Cuba;s 6th biggest trading partner despite the embargo (p55)
  • Before Castro, more American’s lived in Cuba than Cubans in the US
  • Cuba went from having the highest per capita immigration rate (higher than the US including Ellis Island years) to a situation where 20% of the population fled the country. p61
  • I didn’t realize how the role of race played in the revolution. Cuba, which was majority white, elected a black man. Almost all of Castro’s rebels were white. p87
  • Today, Cuba’s jails are 80% black with government hierarchy 100% white

The author describes many of the atrocities that the revolutionaries performed. These are disgusting and add to the understanding of the embargo we have had for so long. That said, this book also goes into the way many of popular culture have looked the other way to these atrocities and celebrated the Cuban revolutionaries. This is disappointing to see so clearly, but also sadly not always unsurprising.

The cost of a new phone

Last evening, my phone was accidentally stepped on by a child. The screen was smashed. This was disappointing, but also an opportunity to evaluate my options for a new phone.

The injured phone (it is still limping along) is a Nexus 5 and was purchased from Google immediately after it was released. This has been a perfect device, staying up to date, relevant, and functioning without issue for almost 3 years! I have not seen another modern phone with similar abilities.

I have ordered its newer version , the Nexus 5x. The life of my previous Google phone definitely played a role in my immediate acceptance of its younger sibling, but so did a strong recommendation from a friend who loves his after switching out from an iPhone.

I wanted to evaluate my monthly cost with both the phone and my plan. I use the $24 PureTalk plan and mooch off of all the free WiFi around me for my data. This keeps me off my phone and present with friends, family, and while driving. (I encourage all people to do something similar – it really helps keep your sanity.)

To estimate my cost of ownership, I made a quick chart to average out, by month, what my cost will be:

Cost of phone - Nexus 5xAs you can see, the first month is the most expensive (full cost of the phone at $300 and the plan $24). The second month is much better at around $150 (+$24). The more months I own and use the phone, the more balanced out my cost will be. I decided that for me, a monthly bill less than $50 is acceptable, especially if it continues to decrease with each month. I will pass that point around month 11, which I find reasonable.

I really want something less than $35/mo. At 18 months, I will be approaching $40/mo and by 2 years, I will finally be at an average of $35/mo. Given the track record of my recently broken phone, I think this is a reasonable life expectancy for my next phone. For all the time after 24 months, I will essentially have an average monthly cost of somewhere between $32 and $35!

This is outstanding, and after contemplating potentially paying $50 or so to try and fix the screen myself knowing I will need a new phone before long anyways, this seems like the most responsible and financially wise move forward.

Life Philosophy – 2016 edit

My Values:

  • Poise/Presence – When you’re speaking emotionally, the words only account for 7% of what get conveyed. Vocal tone and body language count for much more.
  • Consistency – Exemplify Excellence
  • Efficiency – Done is better than perfect
  • Balance – Life is all about perspective
  • Commitment – Do it, Do it right, Do it right now

Attributes I want to exemplify:

  • Listening
  • Stewardship financially and temporally – Invest in experiences; Focus on time, not money, in life
  • Organized
  • Being moderately overconfident and warm – People like confidence and trust warmth
  • Curiosity
  • Risk taker (both large and small)

Things I improved on in 2015:

  • Nail biting – still a struggle
  • Returned my Spanish fluency
  • Unplugged more
  • Simplified my wardrobe

Things to improve on in 2016 in personal life:

  • Work on my Classical Guitar skills
  • Learn to ignore distractions

Things to improve on in 2016 in professional life:

  • Become a diplomate in Obesity Medicine
  • Improve on arriving on time

My Routines:

  • Daily:
    •   Exercise
    •   Sleep 7-9 hrs
    •   Inbox-0
    •   20 min Quiet Time
    •   Send 1 email to a friend, family member, or coworker to say thanks for something
    •   Make a priority list of 3 items
  •  Weekly:
    • Review Journals
    • Send an email to boss to sum up what I did that week
    • Go for a purposeless walk
  •  Monthly:
    • Send an email to a potential mentor in life or work
    • Wash car
    • Update budget

2016 Desired Experiences:

  • Travel
  • Motorcycle project
  • Write a book

Who am I in life?

I am a man who loves to see and experience the World. I love seeing what I believe is evidence of God in landscape, people, animals, water, and more. I love time spent with family and friends, growing together and sharing experiences with each other.

Who am I professionally?

I am a doctor who values the individual lives of my patients. I care to prevent long term medical disease through healthy living, prevention, screening, and management. I am an ethical provider, recommending what I understand as the medically right thing to do in every situation.

Top Running Books

These are books about running which I love and think all runners would enjoy:

  1. Born to Run: A Hidden Tribe, Superatheletes, and the Greatest Race the World Has Never Seen by Christopher McDougall
  2. Once a Runner by John L. Parker
  3. Spark: The Revolutionary New Science of Exercise and the Brain by John Ratey, MD
  4. Eat and Run: My Unlikely Journey to Ultramarathon Greatness by Scott Jurek and Steve Friedman
  5. Why We Run: A Natural History by Bernd Heinrich
  6. Ultramarathon Man by Dean Karnazes
  7. 50 Marathons 50 Days by Dean Karnazes

Why We Run

I just finished the book Why We Run: A Natural History by Bernd Heinrich. I loved this book. It was the perfect blend of science, medicine, history, running, and storytelling. Mr Heinrich uses his experience training for the 1981 100K Chicago race to discuss the human desire to run.

Describing a moment in his 100K race, he describes feelings all runners can relate to:

…My body is screaming at me to stop, and it would always win if it did not have a mind to play tricks with it, boss it around, and delude it.

To psych oneself up takes self-delusion. That’s where the use of logic comes in. Logic is less an instrument for finding truth than a tool that we use to help us justify what our lower emotional centers direct or demand. Lacking this self-delusionary logic, we would be less able to rationalize, and so be unable to succumb to such mad, senseless, crazy things as trying to see how fast one can run 62.2 miles wtihout stopping. Ultimately, our logic may get wacky enough that we see through our rationalizations, and then they don’t make sense anymore. This almost invariably occurs sometime around halfway through the race, and you ask yourself, Why am I doing this? Why am I here? Why? There is no answer.

At that point, one needs faith – a combination of ignorance, deliberate blindness, hope, and optimism. It defies logic yet makes us able to strive and to survive. p250

Be Nice

I heard an uplifting song on the radio the other day called “Be Nice.” Later, I was at church and as I was thinking about things, I thought about how the beatitudes really are excellent guidelines to live life by:

Blessed are the poor in spirit, for theirs is the kingdom of heaven.

Blessed are those who mourn, for they shall be comforted.

Blessed are the meek, for they shall inherit the earth.

Blessed are those who hunger and thirst for righteousness, for they shall be satisfied. “Blessed are the merciful, for they shall receive mercy.

Blessed are the pure in heart, for they shall see God.

Blessed are the peacemakers, for they shall be called sons of God.

Blessed are those who are persecuted for righteousness’ sake, for theirs is the kingdom of heaven.

Blessed are you when others revile you and persecute you and utter all kinds of evil against you falsely on my account.

Matthew 5:3-11


  • Be humble
  • Be empathetic
  • Be compassionate
  • Do the right thing
  • Be true to yourself and others
  • Be a peacemaker
  • Stand up for good
  • Stand up for your beliefs

Outstanding words to live life by.