The strategy behind winning

I have always been impressed by individuals and organizations that are the best at what they do. Examples would include the San Francisco 49ers under Bill Walsh (pro football), Google (web based search engines and more), and the University of California (world class public education). Robert Burgelman, a professor of management and expert on the role of strategy in firm evolution helped me to understand how competitors become the best in their fields. He explained that "you win when you've got what it takes and you do what you say." For example, in the health care sector, leaders of top ranked plans know that the building blocks of success are top physicians and support staff, a robust information technology system, and seamless integration between the medical group, insurance company, and hospital system. Managers then work to ensure that the different parts of the team work together to deliver on the promise to provide high quality personalized health care at a competitive price. The next time you design a new product or seek to improve a current one, let your first step be to make a solid investment in strategic planning.

A prescription for happiness: stop focusing on yourself

I see a lot of unhappy people in my practice. See if this story sounds familiar: the self-centered pursuit of shiny things and prestige eventually leaves you feeling empty and asking "is this all there is to life?" Though merchants of materialism would have you believe otherwise, big houses, fast cars, exotic vacations, fancy job titles, and sculpted body parts don't add up to the long-term inner happiness that you yearn for. Regretfully, this epiphany often comes late in life as you are recovering from your mid-life crisis. Fortunately, there is a tried and true alternate path to happiness and the sooner you follow this path the better: figure out your purpose in life and pursue it. Go crazy. Pick something virtuous that will stand up against the test of time such as serving others and creating a benevolent society where you want for other people’s children what you want for your own. Commit to eradicating tuberculosis, spreading literacy, creating a strong public education system, or housing the homeless. The happiest people I know are those who have found such meaningful work and have the strength to do it. These are people on a mission. Happiness is something they are. What would have to happen before you could claim this type of happiness?

Intentional balance

Leading a "balanced life" sounds like a good idea but what does that mean and how does one achieve it? Let me suggest that intentionally seeking a dynamic balance between diet, exercise, work, family, passion, and spirituality is one path to a fulfilling life. A healthy sustainable diet is a good place to start. Shop and cook for yourself as much as possible because you care more about your health than restaurants or prepared food manufacturers. Make 5-7 servings of fresh fruits and vegetables the foundation of your daily intake. Layer on some healthy carbohydrates like whole wheat bread and brown rice; proteins like baked chicken, legumes, and poached fish; low fat dairy products; and be sure to reward yourself with the occasional treat (because gosh darn it, you deserve it). Engage in physical activity you like (heavy gardening, walking, swimming, bicycling, basketball) and do it for at least forty five minutes four or more days of the week. Work hard so that you can earn a decent living and maximize your job security. If you are fortunate, your work will be part of your life's mission. However, don't fret if that's not the case because no matter what some people say, the main purpose of work is to keep food in your stomach and a roof over your head. Make spending time with your family and close friends a top priority. Every parent with grown children will tell you that babies turn into eighteen year olds in the blink of an eye and we all know of a healthy person who suddenly dropped dead before anyone had a chance to say goodbye. Don't blow your chance to bond with the people you love while they are still around. The regular pursuit of something you are passionate about is the spice of life. Reading, golf, painting, fishing - whatever makes you want to wake up at 5am and do it is fine. Over pursuing your passion and turning it into an obsession is not part of a balanced life. Finally, I think it is important to tune into the spiritual part of your being. For some, that means God but for others it is simply spending regular time acknowledging the awesome part of life that transcends the material world.

Pearls from the sunset of life

Old people rock. They've lived a little and want to share their wisdom before they leave us. Their #1 piece of advice? Don't sweat the small stuff - and definitely don't worry about the things that can't be changed. If you must indulge in worrying, worry just enough to motivate yourself to do better and not a bit more. The second most common pearl? Spend less time in the office and more time with your family and loved ones. If you have been blessed with children, make time to be with them while they are young and eager to spend time with you. Invest early and often in those relationships dearest to you and reap the benefits for a lifetime.

"Turn your head to the right and cough"

Just as women dread the pap smear, men aren't too happy to come in for a genital or rectal exam - something about it being awkward and embarrassing to talk about your "private parts" and even worse to have them inspected. Indeed, some men would rather live with a softball sized hernia or a hemorrhoid bigger than an heirloom tomato than have to strip down and be examined by a medical professional. So what are we checking for in the genital and rectal areas of a man? First off, we're looking for any visible skin lesions such as herpes, warts, or the increasingly rare syphilitic chancre. Most of us then proceed to palpate the the contents of the scrotum for any abnormalities such as tumors of the testicle. Then comes the request to "turn your head to the right and cough." Why turn your head? Mostly so you don't jettison some fatal Ebola from your mouth into our eyes. As you cough, you increase the pressure in your abdominal cavity and press your intestines against the inner side of the abdominal wall. We simultaneously place a finger up your inguinal canal to make sure that your guts are not protruding down that canal towards your scrotum. If something bulges out or "kisses" our finger ever so gently, you have a hernia. Next comes the request to "turn around, place your elbows on the table, and bend slightly at the knees." At this point pray for three things: your life, small fingers, and lubricant. Gloves are a given - or should be. The "finger wave" is our way of checking your rectum and prostate gland for any abnormalities such as cancer. In conclusion, the genitourinary exam is an important part of comprehensive health care and is not as bad as many men fear. In addition, in a recent survey conducted in my mind, nine out of nine men preferred the exam to being poked in the eye with a stick.

Your body only gets worse - so take good care of it

Just in case your parents or doctors forgot to tell you, as you get older your body only gets worse. My guesstimate is that one physiologically peaks in the late teens to early twenties. I agree with Farah Fawcett that the 40's are the best years of your life - but that's only because you are so much wiser by then, not because your body looks or feels any better. The two major themes of aging are the narrowing of your arteries and joint spaces. You need blood to nourish your body's cells and to carry away the by products of metabolism. Atherosclerosis is the process by which your arteries narrow over time and this process is accelerated by smoking, high blood pressure, high cholesterol, and diabetes. Strokes, heart attacks, kidney failure, and peripheral vascular disease are the consequence of not enough blood getting to your brain, heart muscle, kidneys, and extremities respectively. What can you do to help retard the narrowing of your arteries? Make healthy food choices, engage in physical activity that you enjoy for 45-60 minutes most days of the week, and don't ever smoke. As for your joints, age is their enemy. When you are young, the joint spaces found in places like your shoulders and knees are nice and roomy. There is no friction or pain when you throw a baseball, comb your hair, walk, or go up and down stairs. As you age, the bones on the two opposing sides of your joints get closer and closer together, pinching and damaging the cartilage, ligaments, and tendons that formerly lived in peace and quiet. This process is accelerated by overuse (the baseball pitcher who throws too much), repetitive high impact weight bearing activity (running on hard pavement), and repetitive trauma (the soccer player with recurrent knee injuries). Here's what you can do to help your joints last longer: don't keep working through pain (pain is your body's way of saying "give me a break for a while"); cross train (engage in a variety of exercises as opposed to the same one over and over again) so that you won't overwork any particular joints; keep your weight within a reasonable range (obesity will accelerate the progression of your wear and tear arthritis); and don't choose running as your primary aerobic exercise unless you have no other choice and/or experience the rare but addictive "runner's high."

You've got to let some things go

I really enjoy taking care of couples because in family practice we believe that understanding humans beings in the context of their relationships is essential to providing good care. One couple married for over five decades stands out in particular because they are always laughing and smiling and seem to truly enjoy one another's company. I asked the wife during one of our visits, "What's the secret to your successful marriage?" She smiled and replied, "You just have to let some things go!" Here's another piece of advice that a wise man shared with my buddy on his wedding day: "There will be many times in your marriage when you feel that you are getting the short end of the stick; rest assured that your spouse will be feeling the exact same way."

Be grateful every day you can wake up and pee

My father was a minister for forty years and during that time he spent much of his time visiting sick people in the hospital. "Be grateful every day that you can wake up and pee," he told me one morning as he shuffled out of the bathroom in his underwear. I must have been about eight years old at the time and I had no idea what he meant. Forty years later as I treat many elderly men who are barely strong enough to get out of bed and who have aging prostate glands the size of grapefruits obstructing their urinary flow, I know full well what he meant: don't take your youth or good health for granted because both are fleeting. Every morning that you wake up continent of urine and can walk to the bathroom under your own power to urinate, thank God for all of the systems in your body that are functioning well enough to make that happen. Ditto for seeing, hearing, smelling, tasting, swallowing, moving your bowels, blinking when dust blows in your eyes, keeping your balance, feeling your toes and finger tips, reading with understanding and retention, and buttoning your cardigan sweater.

It's mostly about lifestyle

I often tell my patients that if everyone ate healthy, exercised regularly, drank alcohol responsibly, and didn't smoke health care costs would plummet and I could work half time. Good health is all about eating fruits and vegetables, engaging in meaningful work (when you can find it), taking your dog for a walk, and getting a good night's sleep. It is not about making donuts the foundation of your food pyramid, being sedentary, & abusing substances for decades - and then demanding that doctors and nurses fix you with surgery and pills. That's why there is hope for the current health care crisis. We have plenty of money to provide care that is both high quality and personalized. We just need to 1) prioritize education and prevention 2) motivate people to make healthy lifestyle decisions 3) practice evidence based medicine and 4) spend less dollars on unproven tests and treatments.