Alcohol and Sleep:

• The interplay between alcohol and sleep is complex and problematic. We have all seen the data showing sleep deprivation to be as detrimental to driving ability as alcohol. This study looks specifically at how alcohol and sleep deprivation cause cognitive impairments. It appears that both cause changes in the adenosine receptor, and have overlapping biochemistry. 
• In fact, individuals who have a low tolerance for alcohol seem to be more vulnerable to the cognitive effects of sleep deprivation. Authors suggest “additive or even synergistic detrimental effects on cognitive performance.” ie. drinking plus no sleep = more than the sum of the two. Another quote: “assessing sensitivity to alcohol might be cautiously used as a means to identify/protect individuals who are at greatest risk.” 
• So if two drinks makes you pretty tipsy, you should really watch yourself at the end of a night shift or 24 hour call. And of course even if you have higher alcohol tolerance, no one can overcome or even habituate to sleep deprivation.

Every patient as VIP:

• I instruct residents to use a tool in the middle of a busy shift. On every interaction, consider that this is probably the worst day of your patient’s month or even year. A new idea recently came to mind related to how we treat patients. 
• In his book, Damon Tweedy talks about an interaction he had in an urgent care center for his knee pain. Initially feeling blown off, Tweedy noted a complete change in his doctor’s aloofness when he found out Tweedy was also a physician. We have all been there. Going through the motions, practicing solid medicine, and then finding out the patient is married to the hospital CEO, or is a mildly famous musician, etc. 
• The new exercise: imagine, as you interact with a patient (or any client depending on your job), that your friend (or “someone important”) sent that person to see you. You will be more deliberate and patient with your words and actions, wanting to treat that person very well but also feeling more accountable for how you are perceived. Try it at work today. 

“It doesn’t mean everyone exercises”:

• More from the AAMC conference in Austin. Drs Shanafelt (Stanford), Ripp (Mt Sinai), and Rogers (UAB) are CWOs (Chief Wellness Officers) at their institutions. They gave a panel presentation and discussion on how to facilitate wellness in a large medical institution. One very important slide showed Stanford’s WellMD Professional Fulfillment Model, comprised of three components: 

Culture of Wellness
Shared values, behaviors, and leadership qualities that prioritize personal and professional growth, community, and compassion for self and others.
Efficiency of Practice
Workplace systems, processes, and practices that promote safety, quality, effectiveness, positive patient and colleague interactions, and work-life balance.
Personal Resilience:
Individual skills, behaviors, and attitudes that contribute to physical, emotional, and professional well-being. 

• Notice that the individualskills and behaviors only fall under one of the three pillars. Just because you and your colleagues do yoga and go cycling together (Personal Resilience) does not mean your office or institution has a true “culture of wellness.” Those values and behaviors should be shared, and those habits that lead to communal growth should be prioritized by the leadership (Culture of Wellness). Leaders ideally would streamline workflow and eliminate barriers to your wellness (Efficiency of Practice). 
• While we all should work to become more personally resilient, we should also work with our leaders to make the learning and work environments efficient, prioritizing health of patients andourselves. 

Mental Models: 

• Recently was introduced to James Clear, an American author, entrepreneur, and photographer. He writes about habits and human potential, and has great content on his website. This post on Richard Feynman describes mental models – specifically how Feynman taught himself physics and therefore had a more diverse repertoire to tackle complicated physics puzzles. Clear said mental models “guide your perception and behavior … [are] tools that you use to understand life, make decisions, and solve problems.”
• Yuval Noah Harari said, “Scientists generally agree that no theory is 100 percent correct. Thus, the real test of knowledge is not truth, but utility.” I am kind of partial to a Platonic idea of Truth out there in the world, but do agree that the disciplines and mental models are asymptotically striving for and therefore never quite reaching Truth.
• So study as many disciplines and mental models as you can if you want to understand the world, solve problems, and make connections. Thanks Dr. Ben Bobrow for the recommendation. 

Quote:
The mind that is not always
caught up in details
is your only treasure. 
Stop chasing details and become
still to feel it. 
The mind that sees details clearly, but is not caught up by them
is like a vast border-less mirror.
– Ji Aoi Isshi