The Practice of Discipline

OK, so I am kinda lazy. And I forgive myself a lot. For instance, if it’s workout day and I don’t feel like it? Ok, don’t do it. Don’t want to go to the thing? Blow it off. Want to eat an entire cheesecake? What the hell? Which is likely why I weigh what I do, and my house is a mess and I spend hours and hours on Pinterest (LOOOVE Pinterest!) rather than do useful work.

But there are consequences to that, right? Like the kids wear wrinkly clothes off the floor because nobody put them away, I spend too much money because we end up eating out, and the kids catch my bad habits and are turning out to be the same way.

So it’s time to be a grown up. And only good can come of it, right? More discipline. So here’s what we’re going to do.

I grew up Catholic, and so the idea of Lent is ingrained up in my head. So once a year I give something up for 40 days. Last year it was Pinterest. That was hell. This year, it was a toxic relationship and restaurant food. And 40 days is doable. But instead of going back to being a schlub this time, I’m going to pick another thing for the next 40 days. Not necessarily to ingrain a new habit, or to get a permanent change going, but just to practice. Practice the art of self discipline on the theory that it will improve me somehow.

There’s a long list of things to choose from.

coffee, coffee creamer (100 calories a day)
diet coke
snacks (OMG 1000 calories a day)
bedtime snack
pinterest, again
or jelly splash

Or- alternatively I could DO instead of avoid.

drink 2 bottles of water.
work out
draw
read

That’s all I can think of off the top of my head. but that’s 400 days worth, so a decent start.

On the Plus Side…

The 44 year old woman who cried when I told her she had to have her gallbladder out. She thought she had cancer. I hugged her when she cried, and she sent me a gushing thank you note, pink envelope with a love stamp.

Ohhhhhhhh…that’s what it means

So I’m on pinterest last pm, and run across a pin from Greatist.com called  “67 science-backed ways to lose weight.” There’s a sentence in there you’ve heard 1,000 times, right?   ” We’re advocates for making small changes each day, rather than making drastic changes all at once.”  Last night, the light bulb went off.  My thinking to this point was go all in, and sustain the energy  forever.  But what’s the rush?  I have 30 lbs to lose.  That’s a lot.   there’s 52 weeks in a year.  So this is a year long project at least.  Can it be done in 6 months?  probably.  With perfect performance.  With drastic changes all at once.  But what’s the rush?  if you gotta sustain it forever anyway, then let yourself work up to it.  You wouldn’t hop on a treadmill, hit level 9 and run it for 40 minutes (Personally, I get nauseous and dizzy and headache at about 2 minutes.  yes, yes, i know i need a stress test. Don’t even start.)  But when I hit that barrier, I go, “shit, I can’t do this yet.”  and then I go down to 30 second intervals with rate-decreasing rest intervals in between.

When I hit behavioral or psych or emotional barriers, my response is different.  “I suck!  I can’t even do one day without snacking.  I’m so lazy.”  Shouldn’t I have the same response to emotional stuff as I have to physical?  I can’t do this yet.  what CAN I handle?  baby steps.

carry a water bottle

switch to tea

gimme 5 challenge

ditch simple carbs first.  let the oatmeal and beans stand for now.

one alcohol a week?

picture log your food.

eat home food only, no snacks at work and no restaurants

no eating after dinner/work

 

I have started the #gimme5challenge, so that’s one thing.  I can try a picture log.  lets just see how that changes things for now..

It’s Time

So.  I work in Urgent Care.  Which markets itself as a valuable societal service; convenience, walk-in visits, longer hours, avoidance of ER visits,  keeping costs down and avoiding overuse of expensive high-level emergency services.

Here’s the truth.

90 % of what we see is self-limiting.  meaning it’s gonna go away and the patient will be fine, no matter WHAT I do.  Another good 5% is stuff that does need to be here (stitches, fractures, grandma has a UTI.)  The last 5% is divided between people who have no business being in an urgent care (grandma fainted, I want to make sure I don’t have appendicitis, I’m having chest pain) and people who have no business being in an urgent care (refill my anxiety meds, my back has been hurting for 6 years, and I had diarrhea yesterday and couldn’t go to work.  Can I get a note?)

So if you analyze the math up there, only about 5% of our charges are legitimate.  Because 2.5 % should be primary care  charges, and get referred to primary care, so the system is paying double.  And 2.5% should be emergency charges, and get referred to emergency services, so the system is paying double.  And 90% of our charges are illegitimate and didn’t need ANY intervention or charge AT ALL.

Problem #2:  Urgent care is a retail, for-profit BUSINESS.  Which means, as everybody knows, that the customer is always right.  Cold symptoms?  antibiotics “just in case.”  Your foot hurts all of a sudden for no reason whatsoever?   Xray.  A speck of poison ivy?   10 days of prednisone.  Not that any of these are needed, mind.  Or even help.  But I heard, I HEARD a trainer tell a new hire physician that, “It’s a little like Burger King – they can have it their way.”  Oh, I shit you not.  No matter how stupid the request, you gotta get a 10 on your customer service rating, so you stroke the egos.  “that’s so hard”  “I’m glad you’re ok” “oh, no pneumonia, no bronchitis, no wheezing, the ears and the throat look good–I think it’s just a cold this time. ”  When what you REALLY want to say is, ” it’s a fucking man cold!!  suck it up before I give you some Vagisil you goddam pussy.”

And C:   It’s ALL about the throughput times.  45 minute visits, door to door.  Overstaffed, according to corporate, understaffed according to us.  So triage, X-rays, medications, splints,urinalysis, blah blah, all done by the same 3 person staff.  for 80-100 patients per day.  3 people.  I want bloodwork?  Outpatient testing?  ultrasound, CT, physical therapy consult?  Too bad.  It takes too much time.  refer to GI for endoscopy, getting preauthorizations?  Not a corporate directive, but definitely a culture.  “we don’t do that here.”  What we DO do is say, ‘yep, you need a doctor.  why don’t you call yours ?’

It is all kinds of disheartening and soul-crushing to deal with people who THINK they have need when they have NO IDEA what need really is.  Who THINK they are sick when the truth is that they are inconvenienced.  I am tired of re-arranging the deck chairs and not making actual progress.

It’s time