How to break up with your phone, Double Arrow Metabolism edition, Days 25-29

This is it. Was it. My last week in Catherine's tutelage. It wasn't a great week, phone-wise. The NCAA Tournament was a meltdown of epic proportions, with upsets every day, and I couldn't help but hit refresh on the ESPN website (but not the app; I learned that buzz-filled lesson long ago) a couple times an hour for score updates. We even had the tournament here in Wichita, complete with artisanal basketball folk art:

The geometry of the stripes is wrong, but I like where the artist's head is at. 

The geometry of the stripes is wrong, but I like where the artist's head is at. 

For Day 25, she told me to Clean Up the Rest of my Digital Life. Step one: unsubscribe from email lists that don't interest me. I actually did this a few years ago. I was prompted to do it by my former employer's excessive institutional email habits. The university collectively never met an email it didn't like. Need safety training? Email. Leftovers from Grand Rounds available? Email. But Catherine's reminder was a good way to re-examine my inbox and hit the delete button on the bottom of a few emails. It felt good, like electronic spring cleaning. 

Step two was to save myself from the tyranny of my inbox. As an aside, I've seen screenshots of people's unread email badges, and I don't know how they sleep at night:

Honestly, either read the emails or disable the badge.  *cold shiver*

Honestly, either read the emails or disable the badge.

*cold shiver*

Catherine recommended apps to help me prioritize email senders, but I feel like I do this pretty well already, and after my less-than-great experiences with Freedom and Moment, I'm not excited about adding new software. So instead, I decided to set a 6 pm hard stop on email checking. It's not hard to do, since I don't have an email alert on my phone, and the little red badge doesn't show up when I have an unread email.

Next was a suggestion to use folders to keep myself sane. Catherine had some very specific advice in this regard. One piece was to make a "needs response" folder. But that's what I use my inbox for. Anything still sitting in there is unresolved. I move resolved emails that I want to keep to topic-specific folders and keep a to-do list on Wunderlist (with alerts/notifications turned off, natch). So I didn't change anything.

Then Catherine recommended setting up a "commerce" email for the Amazons and Zappos of the world, so that those emails wouldn't come to my main address. Nope. I actually like getting shipping updates from those companies in my inbox, and I fastidiously unsubscribe to any lists that don't deal with those. I'm not interested in sales, because I rarely buy anything that I don't need pretty quickly.

She followed this advice with instructions to set up a VIP list on my phone and email so that I'm sure to get emails from important people. Good idea, and done. 

Next I was instructed to set up a "Justin_Important" email to alert people who emailed me on vacation that if it was really important, they could send an email to the "Justin_Important" address and I would get back to them. But honestly, it seemed impersonal, and I'd rather have some email pile up while I'm on vacation than put people off. Maybe that makes me soft. So I didn't do it, but I will continue to use auto-respond emails when I'm out of town to let people know I'm not immediately available. 

Catherine gave me some instructions to use for social media, but I was like, "What? I haven't had a social media app on this phone for years. Get outta here."

We're in the home stretch (Day 25 was labor-intensive). Catherine told me to activate drive mode for my phone, which I did with the last big iOS update and which I love. Then she told me to unlink accounts I might be using for log-ins. I don't have many (or any) of these, but if I did, the recent Cambridge Analytica mess would've scared me off them a lot faster and harder than Catherine ever could.

Day 26 was my day to Check My Checking. What Catherine means is, when I reach for my phone, I'm supposed to ask myself, "What's the best thing that could happen? What's the likelihood of this?" The idea is that mindlessly checking my phone has a much higher risk of making me sad than of making me happy. It's a good strategy, and it reminded me to stop mindlessly clicking through the news websites whose bookmarks I deleted a couple weeks ago, but whose URLs I still have locked in. Day 26 reminded me of one of my college roommates who is now a college professor. He publishes a lot, and the work and focus required to do this makes his mornings pretty valuable. So he has a rule to never check his email before 12 pm, because there is a very high chance of there being something in his inbox that will ruin his day. 

Day 27, Catherine reminded me to perform some Digital Sabbath Life Hacks. That is, come up with some ways to separate myself from my phone periodically. I can't do a day a week like she suggests, or probably even a day a month. My income is just too tightly bound to phone availability, probably like many of yours. But I tried three-hour breaks, and I liked it. Catherine took Day 28 to remind me of The Seven Phone Habits of Highly Effective People, which was a nice review of the strategies we'd gone through in the last few weeks. 

Day 29, Catherine told me to set a monthly reminder to evaluate my phone usage. Wunderlist to the rescue:


How to break up with your phone, Double Arrow Metabolism edition, Day 24

Today's the day Catherine tells me I need to Manage My Invitations. At first I thought she meant calendar invitations. But she means invitations from my brain

She seems to be getting back to mindfulness. Okay. But the more actionable advice for today comes from one of the quotes she includes in her book, in which a person relates the feeling of discovering that she was reaching for her phone out of habit, not necessity, and that if she pauses and asks herself what she needs from the phone, she discovers she needs nothing. So she puts it down. I think I'm at that point. 

How to break up with your phone, Double Arrow Metabolism edition, Days 18 and 19

Day 18 is to Meditate. Spoiler alert: I didn't do it. I know meditation brings many people a lot of joy and meaning. I know that some very high-functioning, productive people like Yuval Harari swear by it. I know some good evidence (albeit tainted by low adherence rates) exists for its practice. 

Here's the thing: I hate it. Every time I've tried meditation, on my own or in groups, I've heard a voice inside my head yelling "You're wasting your life. You're wasting your life. YOU'RE WASTING YOUR LIFE," over and over. I don't think that counts as an insight.

 There is one exception. I have trouble going to sleep at night. It's not a new problem. Once upon a time, someone taught me to repeat a mantra to myself as I lie in bed. I take a deep breath and think to myself, "I'm relaxing my feet, I'm letting go." I exhale and do my best to completely relax my feet. Then I take another breath and think to myself, "I'm relaxing my calves, I'm letting go." I exhale and relax my calves. And so on, until I'm either asleep or to the top of my head. It works. But I don't think true meditation is supposed to put me to sleep.

And since the entire reason I'm trying to break up with my phone is to stop wasting my life in a different way, I refuse to meditate. And I damn sure refuse to download a "meditation app." Using my phone, which I'm trying to free myself of, to engage in an alternative activity that also makes me feel bad is what they call a "double whammy" in my neck of the woods. No thanks.

So on to Day 19: Prepare for Your Trial Separation. Catherine tells me to identify what it is I'll be taking a break from. She recommends going screen-free, including movies, computers, and television. I'm not sure I want to do it. My kids loooooove going to movies, and A Wrinkle in Time just came out, and I'm not sure I want to miss seeing it with them. Plus, Catherine says to make plans for fun things to do. So I'm making plans to see a movie.

Then I'm supposed to tell people what I'm doing and get them on board. This is actually pretty easy. I don't want to be obnoxious about this. My goal here isn't to make people think I'm superior. And I suspect people who can't get ahold of me will just call my wife. She recommends setting a phone greeting to let people know I'm phone-free, but I don't think I'll need it. I don't have a landline, so I can't forward calls. 

Preparing with hard-copy instructions is next. I have a bike race Saturday that I'll be using my Garmin to navigate. No phone needed. But Sunday, I'm expecting no travel. So I shouldn't need a map.

Catherine says to carry a pen and paper for a "to-phone" list once I'm done. I've already started doing this, so I'm set. 

Podcasts: those are gonna be hard. I'm not sure how I'll brush my teeth without the sweet, sweet, honey-filled timbre of Mike Pesca's voice in my ear. But I'm committed to giving it a shot. 

How to break up with your phone, Double Arrow Metabolism edition, days 16 and 17

Day 16 was to Practice Pausing. In ironic honor of this, I decided to try to write this blog post while listening to a podcast. Couldn't do it. I've never been a good multi-tasker. I'm so bad at it that I suspect anyone who says they can multitask is a liar. Which I suspect is exactly what Catherine would say. So I've proved her point. 

Anyway. The idea for Tuesday was to deliberately practice being still. To embrace boredom. She told me to pick a situation when I find myself reaching for my phone to kill some time. As I've said before, this time for me is almost exclusively potty time. And it's a problem. I go in for what ought to be a very simple procedure, and I walk out ten minutes later because I've been sucked into a New Yorker article about the Steele Dossier, and anyone in the vicinity mistakenly thinks I'm suffering from weapons-grade constipation when I've really just had a driveway moment on the toilet. 


So I committed to doing it the old-fashioned way. Not by dragging a newspaper into the stall with me. I don't have that kind of self-confidence. By staring at the stall door, or by wondering why the screws on bathroom partitions are always loose even though they use those one-way screws:


And it worked! I mean, I didn't time myself, even though the little scientist in me said that I should. I was in and out of there in no time. Nobody in the office thinks I'm all bound up over the last couple days. Good stuff. 

What I didn't experience was any kind of zen moment of really having my brain lock in on something profound. But it's early in this experiment.

Day 17 was to Exercise My Attention Span. This is like weightlifting, but for my brain. Catherine tells me that my newfound phone-free time can be spent doing something as simple as reading (done), something just for the sake of it, like practicing math in my head, or putting focus toward more meaningful tasks. I chose option 3. Yesterday I decided to spend some down time planning out a strategy for a clinic I'm consulting with to incorporate team-based strategies into their routine clinical care. In a ten-minute session, I planned out several steps to get a diabetes educator trained for the clinic, to get the clinic hooked up with their local pharmacy for a collaborative practice agreement around medication adherence, and to track outcomes related to these interventions. I raced to write all the steps and contact information down because I was afraid of forgetting it. But that's okay. The exercise made me feel like a downmarket Cal Newport.

How to break up with your phone, Double Arrow Metabolism edition: Day 15

Welcome to week three, Reclaiming Your Brain!


This week is all about "mindfulness." You know, the technique that doesn't seem to help with weight loss? But this week isn't about weight loss, its about getting my attention span back.

Yesterday, Day 15, was my day to Stop, Breathe and Be. Catherine tells me the idea is to remind myself to pause before I reach for my phone. I'm to stop what I'm doing, take a slow deep breath, and tune into the details of my experience at that moment. This could mean taking note of the physical sensations my body is experiencing, or it could mean looking at my fellow human beings, or it could mean noticing my thoughts. It doesn't mean checking my phone calendar for the eleventh time that day.

What I found with my two Stops, Breathes, and Ams, was that I most frequently reach for my phone when I need to take a note. Since writing may lead to better memory formation than typing, carrying a pen and a scrap of paper seems like a good strategy moving forward. 

And I almost forgot: I was supposed to by an alarm clock several days ago. But my inner Money Mustache took over, and I couldn't bring myself to spend the money. Lucky for me, my wife dug this baby out of a drawer, and two new AAA batteries later, I'm rocking like it's 1999:

Probably only doctors can afford a bedstand as sweet as this one. 

Probably only doctors can afford a bedstand as sweet as this one. 

My first night with it had some hiccups. My son had a nightmare and kicked me out of bed at about 2 am, so I had to lug the clock to the guest room with me. But when it went off this morning, it was a rush of nostalgia straight to the brainstem. That almost mechanical beeping took me straight back to residency. I was up for good at 5:45. Did I ride my bike like I'd planned? But I did read Joan Didion, and that's a pretty good way to start the day. 

How to break up with your phone, Double Arrow Metabolism edition, Days 13 and 14

Catherine has short assignments for me from the weekend, so I'm batching them.

Day 13 is a day to set physical boundaries for my phone:

1. Establish no-phone zones

These are places where no one uses a phone, period. The idea is to remove the decision making, and to reduce conflict. If everyone knows that the kitchen table is a place they're not allowed to have a phone, then we don't need to discuss it. It's settled. 

Our dining room table and bar in the kitchen have long had this designation, so we were ahead of the game. I would like to add bedroom to this list, but my family physician wife's call schedule makes it impractical. So my phone is staying out of the bedroom, but hers stays. I can live with that. 

2. Give your phone a wake-up time

  • I'm to assign my phone a wake-up time at least an hour after I get up

Done. I actually did this a few years ago after leaving my full-time academic medicine position. I no longer needed to worry about midnight emergency calls, so I decided to make it official.

  • I'm to choose something restorative or fun to do with myself in my phone's sleep time

I'm not completely sure it counts, since Catherine uses very morning-specific examples, but I'm working my way through the Joan Didion collection We Tell Ourselves Stories in order to Live

Day 14 is the day I'm to stop "phubbing." (phone snubbing = phubbing) Lucky for me, the things Catherine has had me do so far have set me up nicely for this. No phone at the table? Hard to phub my wife and kids, then. Having notifications for texts and whatnot shut off? That's that many fewer potential phubs. I'm not sure I'm at 100% un-phubbiness, but I'm asymptotically approaching it by the day. 

Other people's phubbing of me, though: that's another story. It is becoming hard not to be the grumpy old man demanding uninterrupted eye contact from people. Catherine recommends leaving a "phone basket" by the door of my house, but that seems pretty weird. Instead, what I think I'll try is a game the next time I'm with friends, especially if we're out: first person to touch his or her phone at the table buys dinner. I think this will make it seem more like a shared activity and less like me judging others for their phone habits. 

One of the many privileges I have in life is that in many social situations I have most of the power. Often, I'm the person in the room that people want to talk to. I know that sounds conceited or self-important, but it's just the way it is. I'm there because someone is paying me to be there, and it makes face time with me valuable. So as the powerful person in the interaction, I recognize that it's easier for me to set and enforce these rules on others than it would be for them to set the rules for me. Translation: my position makes it easy for me to be kind of a jerk about these things, and it's important that I self-consciously try not to be a jerk. 

How to break up with your phone, Double Arrow Metabolism edition, day twelve

Today's assignment seemed a lot like the assignment from Day One, when I downloaded Moment to keep track of my phone time. Because today is Day 12: Download an App-Blocker. The idea, Catherine says, is to download an app to block specific sites and apps that I get sucked into. The irony of this is not lost on her. She recommends FREEDOM.


You knew that was coming. 

The idea is to set up "block lists" of problematic sites or apps. I came up with "News" and "Blogs."


  • The Atlantic
  • CNN
  • ESPN
  • FiveThirtyEight
  • Slate
  • The Ringer
  • Vox


  • Kottke
  • Longform
  • Geekologie
  • The Morning News

I don't really have any time-sucking apps; they were all deleted earlier in the project. I guess I could put email in that category, but occasionally I'm in a pickle and have to use my phone for email. So I didn't want to block it, especially since I have all the alerts turned off, anyway. I'm lucky that I don't have to use social media for work. 

Next, I'm supposed to set times. My most productive time of the day is generally about 9-12 AM, so I thought it might be good to block myself during that time. Off I went. But even though I consider myself to be at least fluent in technology, I could. not. figure. out. FREEDOM. FREEDOM (the app, not the idea) sucks.

Is this a joke? Should I follow Freedom right before I block it? 

Is this a joke? Should I follow Freedom right before I block it? 

FREEDOM was more like this:

I feel your pain, Mel. Just don't go  blaming this on the Jews . 

I feel your pain, Mel. Just don't go blaming this on the Jews

So I deleted FREEDOM. Instead, I decided to get rid of all non-essential bookmarks. All the websites you see above got deleted. If I get a hankering to see what they're saying, I'll have to type in the URL manually. I'm pretty happy with my compromise. 

How to break up with your phone, Double Arrow Metabolism edition, Days 10 and 11

Playing catch-up here at Double Arrow Metabolism after being on the road for work. Today (yesterday, actually) is day three of Changing Your Habits week: Change Where You Charge It.

Catherine tells me that to break the automaticity of checking my phone before bed, in bed, and first thing in the morning, I need to create a charging station for my phone and other mobile devices that is outside my bedroom. In effect, I'm transforming my cell phone into a landline. So the ringer volume is going to the top, baby. 

This means I'll have to get an alarm clock, which I still haven't done. 

But in the meantime, I'm to pick a new charging station. I think my kitchen island is a good candidate: 


Then I'm supposed to take all my chargers from other places in the house (especially the bedroom) and move them to this spot. To enforce this for everyone in the house, Catherine tells me to start a "phone bank" where I'll have to pay money every time my phone gets charged somewhere else. I'll put my daughter on the case.

Day 11 is Set Yourself Up for Success day. Catherine tells me this is when we add triggers to make it more likely to do the things I want to do, or things I know I enjoy, instead of reaching for my phone. 

One thing that my phone delivers that I love almost without guilt is podcasts. Trouble is, sometimes podcasts don't play in the order I want them to, and I end up messing around with my phone at stoplights. I don't text and drive; Apple's Do Not Disturb While Driving feature, while the target of some criticism, has basically fixed that temptation for me. But the update to the Podcasts app that's system-delivered on iPhones was a nightmare for this. I never could figure out how to get it to auto-play, and I was constantly looking at my phone at stoplights, trying to get the next podcast to play. Mike Pesca, host of The Gist (one of my favorites), fixed this for me. He recommended the Overcast app. It's spectacular. It allows me to have podcasts enter my feed in order, and it'll just play them one after the other. I highly recommend it. I literally deleted the Apple Podcasts app after I tried it. 

Sometimes, though, I'm just not feeling the podcast I'm listening to. I can only take so much news about the dysfunction of the White House, for example, before I have to turn to something else. And there's not really a good control on the dash of my car that lets me go to the next podcast. So I end up janking around with my phone at intersections, trying to skip to the next show. I can think of a couple interventions for this: First, I'm going to try to set up a playlist before I get in the car for long trips. Second, I'm going to take advantage locally of a new radio station that I really like, or just listen to NPR when I get stuck on a podcast I'm not into. 

At home, I plan to keep going to the library and having a book from my "to read" list nearby all the time. That's not a big change, but it's a part of my routine that I like and that I'm proud of.

How to break up with your phone, Double Arrow Metabolism edition, day eight

It's Week 2, Changing Your Habits!

In which Catherine tells me that my smartphone is an emotional and physical cue for me to reach for it when I'm bored (my lizard-brain response to boredom) so that I can not be bored anymore (my reward). And the way that response is hard-wired into us can't necessarily be eliminated, but it can be modified. 

That brings us to today, Day 8: Say "No" to Notifications. Catherine points out that our phone notifications are a little like the ringing bell in Pavlov's dog experiment. We are so preoccupied with the next notification that we are driven to distraction when we're even near our phones. I agree with her that this may be the reason I used to get phantom buzzes from my phone all the time. 

So today's the day that I eliminate all push notifications from my phone, except for phone calls and (if I want, and I don't) messaging apps and my calendar. So to clarify: I will only get notifications from my phone ringer and my calendar (and, as previously mentioned, RubiconMD). Catherine says that since those notifications represent a chance for interaction with a real-life human, we can leave them on. Agreed. Done. Done weeks ago, actually. But it felt good then, and I don't regret it. 

How to break up with your phone, Double Arrow Metabolism edition: Days Six and Seven

Saturday's (Come back to [real] life) assignment: Get back in touch with what makes me happy in my offscreen life. I'm asked to complete an exercise:

  • I've always loved to...ride my bike
  • I've always wanted to...publish something non-academic
  • When I was a kid, I was fascinated by...reptiles
  • If I had more time, I would like to...write more
  • Some activities that I know put me into flow are...none. Ever. Don't get me started.
  • People I would like to spend more time with include...friends from college

I'm supposed to make a list of specific fun, off-phone things to do in the next few days. Here goes:

  1. Visit the Monet to Matisse exhibit at the Wichita Art Museum
  2. Volunteer for Bike Walk Wichita
  3. Meal plan for the week
  4. Ride my bike every day
  5. Visit the herpetarium at the Sedgwick County Zoo

Sunday's (Get physical) assignment: Make some time to get back in touch with your body by doing something physical and enjoyable. I plan to commute by bike to my volunteer activity with Bike Walk Wichita today. Two birds, one stone.

The second assignment is to buy an alarm clock so as to more effectively banish my smartphone from my bedroom. I've been thinking about doing this for a while. My trusty, rusty old clock radio from college has been commandeered by my daughter, so now when I wake up in the night I can't tell what time it is without looking at my phone. My beloved George Nelson clock is hard enough to read during the day:


I'm not super-pumped about the style of the normally reliable Wirecutter's top pick, so I'll add "shop in-person for a clock radio" to my list of non-phone activities for the weekend. 

How to break up with your phone, Double Arrow Metabolism edition: Day Five

Today's instruction from Catherine is to delete all my social media apps. Since I don't have any social media apps on my phone to delete (I'm not counting Strava), I moved immediately to the second instruction for today, Day Five of Technology Triage, which is to download and use a password manager. I've been using Keeper for years, so I'm good there. Ironically, I've worried that Keeper is one of the apps that keeps me attached to my phone. So be it, I guess. I have hundreds of passwords, and I can't see myself going back to pencil and paper for them. Finally, she recommends that I spend some of my newfound phone-free time with friends and family. So I'm going out to dinner tonight with my wife and some friends. On my way out, I thought I'd share a couple breakthroughs from today:

First, I was a few minutes early to the student capstone presentations for the University of Kansas School of Medicine-Wichita's Population Health in Practice course. Today I leaned into my boredom. I sat without checking my email or looking at Vox. I was super-creepy with all the eye contact. I didn't even start this blog post, in spite of the presence of the app on my phone. Don't get me wrong; I made notes. But I wrote them on paper, which is somehow less off-putting (I think) than tapping away on a device. 

Then this afternoon, I was in a meeting with a clinic administrator and my phone buzzed in my pocket. I knew it was either a new e-consult, a calendar appointment, or a message from Moment, since those are the only apps that have notifications enabled. In the past, ninety-nine times out of a hundred, I would have taken my phone out of my pocket. I would have tried to be discreet, but I think in reality my discreetness has historically come off more as "drunk high school kid tries to play it cool with his parents." Not today. I left the buzzing device in my pocket, finished the meeting, and walked all the way back to my cubicle before checked the messenger and completed the e-consult.


How to break up with your phone, Double Arrow Metabolism edition: Day three

Today's imperative is to Start Paying Attention. We're still in the Technology Triage, which seems to be a set of steps toward mindfulness about phone use. I've been instructed by Catherine to take notice of:

  • Situations in which I nearly always find myself using my phone.

Honestly, the most consistent place I use my phone is the bathroom. People used to take the newspaper in there. Now we take our devices. I don't have to tell you that, on reflection, this is a disturbing habit. We have studies of the general uncleanliness of white coats and stethoscopes. I have little doubt that my phone is an equally dangerous fomite. At least the literature says so. Because here's the deal: I'm a religious hand-washer. But I never, ever wash my phone. I may take the cover off once in a while to wipe off visible dirt, but even that procedure is purely cosmetic. I'm not going for any kind of deep clean. And I damn sure don't do it after the bathroom on any consistent basis. And the phone touches my face!

  • Note the first time in the morning and the last time in the evening that I typically look at my phone.

I looked at my phone about an hour after waking up this morning to see the weather. Well, that's not completely true. My phone was my alarm clock, so I turned off the alarm, if that counts. And I hit play for an hour while I Zwifted and showered. But I didn't get past the lock screen, which is what Medium counts as opening my device, until about an hour after waking.

  • How my posture changes when using my phone.

Meh. Not much. Like I've said before, I don't get the physical manifestations of phone overuse. It's just like reading a book for me. And I don't text enough to get smartphone thumb

  • My emotional state right before I reach for my phone (for example: bored, curious, anxious, happy, lonely excited, sad, loving, and so on).

Well, it's sure as hell not loving. I don't even know what that means. It's definitely bored. B-O-R-E-D. Escape from boredom is the #1, 2, 3, and 4 reason I reach for my phone. #5 is probably curious. I want to know if say, Tessa Virtue is a made-up name (it's not, by the way), so I reach for the old accessory brain and have at it. But maybe curiosity is just an excuse for reaching for my security blanket. 

  • My emotional state right after I use my phone (do I feel better? Worse? Did my phone satisfy whatever emotional need caused me to reach for it?)

Lately, thanks to Catherine and Medium, my primary feeling is guilt. I know they're watching, and I know I've let them down. If I catch an important email, or if I do a RubiconMD consult, it's relief with some satisfaction mixed in.

  • How and how often my phone grabs my attention (via notifications, texts, and the like)

Almost never. Like I've said, I shut all that off long ago. Any beep or buzz I hear now I assume is an Amber Alert or a tornado warning. 

  • How I feel when I'm not using my phone--as well as how I feel when I realize that I don't have my phone. The point here is to start to become aware of when and how your phone triggers my brain to release dopamine and cortisol--and what I feel like when that happens.

I feel fine, great even, when I'm not using my phone. But I have to admit that realizing I don't have it causes significant stress. My phone is a wedding ring item, and I feel uneasy with it too far away from me. I can't explain why. I don't have a job anymore that relies on prompt return of urgent pages or calls. I wonder: could this be a cause of false positive testing for Cushings? That is, could phone-related stress cause a robust enough cortisol response to bump someone's urine free cortisol level or bedtime salivary cortisol level? The 30-second Pubmed search I just tapped in was unrevealing.

  • Moments--either on or off my phone--when I feel some combination of engaged, energized, joyful, effective, and purposeful. When that happens, notice what I'm doing, who I'm with, and whether my phone is involved. 

Today I gave a webinar on team-based hypertension strategies. My phone was nowhere to be found, obviously. I like public speaking, and I like the topic, but I didn't really feel flow. In fact, I'm not sure I've ever felt flow in the Mihaly Csikszentmihalyi sense. (yes, I had to Google his name for spelling) I get annoyed that so many self-help books beat the drum of "flow." Because I feel like even the things I'm good at require constant care and feeding. I never enter a state of easy, undistracted "flow." Maybe I just misunderstand the concept. But back to the webinar: I was (virtually) with people who were interested in the topic. The talk had a clear purpose. It felt great. 

  • How and when other people use their phones--and how it makes me feel.

Rage. Rage. When I'm trying to carry on a conversation with someone and he or she pulls a phone out of a pocket, I feel like some sacred space has been violated. Worst of all, I know I've done it to other people in the past. 

  • Lastly, choose several moments in my day when I seem to pick up my phone the most often, and see if I can identify a consistent trigger that makes me repeat the habit.

Pooping. Almost always pooping. 


I don't have to check my phone at work because I sit in front of a computer all day, and the computer has 99% of what my phone would tempt me with. This isn't a good thing. It just is. 

  • Finally, Catherine recommends a "phone meditation" exercise. She tells me to take out my phone and hold it without unlocking it. I'm supposed to note any changes in my breathing, posture, focus, or emotional state. 

I feel nothing. 

  • She says to unlock the phone and open an app I use frequently, then scan myself for changes. 

I open Safari to see the score of the Kansas State-Texas men's basketball game:


I feel relief that the 'Cats (EMAW) aren't sabotaging their NCAA tournament chances against the bottom half of the Big XII. Otherwise, I don't feel much. Scratch that. I feel guilty because I'm racking up time on Moment in the process of completing this exercise. *shakes fist at Catherine*

  • Then, I'm supposed to put a reminder on the phone to tell me I'm doing something with it when I reach for it. Catherine says this can be another wallpaper that says "Why did you pick me up?" (this book is really optimistic about wallpaper), or it can be a physical gadget to feel on the outside.

I choose one of my daughter's hair bands. I'd take a picture of it wrapped around my phone, but my only camera is my phone. So you'll have to see it in your mind's eye.

  • Finally, finally, Catherine tells me to put my phone away and see how I feel. 

Ahh. I'm in the clear with Moment for the night. That feels good. 

How to break up with your phone, Double Arrow Metabolism edition, Day Two

Today (Tuesday) is my chance to "Assess my Current Relationship" with my device. I've been instructed to answer the following questions:

1. What do you love about your phone?

I like podcasts. A lot. I don't subscribe to many of them, but the ones I like, I really like. An hour of Zwift time with a podcast in my earbuds is a very, very good way to start the day. Not as good as riding outside, earbud-free, but still.

I also like my calendar. I remember my pre-smartphone days, barely, when I lugged around a thick planner full of crossed out appointments and smudged eraser marks. I graduated to a Palm Pilot in my third year of medical school, and it transformed me. I put surgical schedules and hospital rounds in the calendar and missed or was late to a tiny fraction of them. I am much more reliable as a result of Google Calendar. It may have come at the expense of some part of my brain that would normally be keeping track of my schedule, since my first instinct at the thought of any new obligation or appointment is to put it on my calendar. But on net, the effect seems very positive.

I love doing RubiconMD consults, and my phone helps me get them done. Mostly, it makes me get to a computer to do them, since I don't love the RubiconMD app, but it alerts me reliably. RubiconMD makes me feel like a real doctor, even on the days when I'm doing things that aren't particularly doctorly, at least in the classic sense. I'm not sure I'd have that opportunity sans smartphone.

Finally, I love the idea of having the world's knowledge in a rectangular piece of glass in my pocket. When I watch period movies set pre-smartphone, I want to take an iPhone back in time to the poor detectives and academics.

2. What don't you love about your phone?

I despise notifications. They are the most intrusive thing I've ever encountered, save for 2 am blood glucose calls from the hospital. But back in my days of 2 am glucose calls, I was at least getting paid for the work. Notifications don't pay squat. They're the absolute worst. I've disabled almost all of them. 

I hate that people don't have silly arguments anymore. In college, we settled more than one argument in the dorm by using a neighbor's almanac(!). Phones have destroyed the free-wheeling, ridiculous tavern-style arguments people used to have. Everything is too available now. People don't think about their answer to the problem as much as they think about what somebody else's answer to a problem might be. I think half the amateur economists on the web just go to Tyler Cowen's website and see what he has to say about a problem, then pretend they made up the answer.

I wish people still made plans. Once upon a time, if someone didn't show up for a movie or a dinner date, we went looking for him or her, since we suspected something bad had happened. Now, with texting, people are so squirrelly that I only half-expect anyone to show up for an appointment we've made. Plans mean less than they used to. I can't imagine trying to date in the smartphone era, even without Tindr and its cousins.  

3. What changes do you notice in yourself--positive or negative--when you spend a lot of time on your phone? (Depending on how old you are, you can also ask yourself if you've noticed any changes since you got a smartphone to begin with)

I don't notice any of the physical manifestations that some people talk about. My phone doesn't make my neck hurt. I suspect I read enough already that my phone doesn't change my position much. I'm doomed to have a stooped neck someday. I don't text enough to get the thumb pain I've heard described. I have noticed my eyesight getting worse the last couple of years. Some of it is surely due to nighttime insomnia reading of my phone. (some other fraction is probably due to my advancing [but still young! still young!] age)

But if I let myself get too attached to my phone, I feel like I'm over-caffeinated. I can't focus. I can't feel. I try to drown every little negative thought with another click through my favorite websites or my email. It doesn't work. I stop observing my surroundings. I feel like I miss things that I should be noticing. 

But to be honest, I'm more annoyed with other people's phone use. When I see a family at a restaurant and three-fourths of them are on their phones, I want to slap the phones out of their hands, Dikembe Mutombo-style. Maybe it's because I know I sometimes look as bad as they do. FWIW, I've never actually committed assault on a phone user. But I've definitely fantasized:


In the process of finding that gif of Dikembe, I stumbled across this one. I don't know what he's disgusted with, but I hope it's his phone:

4. Imagine yourself a month from now, at the end of your breakup. What would you like your new relationship with your phone to look like?

I'd like to leave my phone in the car during most of my trips into a place where I expect to either watch or listen to something I've paid for, or into places where I expect to interact with others. I want to no longer feel phantom buzzes. I want to be freed from pre-movie warnings to silence my phone. I want to have the same relationship with my phone that I have with the pliers in my toolbox: I know they're there, but I use them only when I have a task that I need them for.

5. What would you like to have done or accomplished with your extra time?

I like to write. I like public speaking. I'd like to do more of both. I'd like to set an example for my kids that screens aren't the only pastime worthy of our attention. I'd like to ride my bike more. 

6. What would you like someone to say if you asked them to describe how you'd changed?

"The last time we talked, you made me feel like the most important person in the room."

7. Write your future self a brief note or email describing what success would look like, and/or congratulating yourself for achieving it.

Dear Dr. Moore (I didn't do nine years of medical training to call myself "Mr."),

Congratulations on becoming human again. While our cyborg future may be inevitable, with cardiac implants and insulin pumps and brain dust and the like, we shouldn't have to sacrifice our attention or our humanity in order to achieve great gains in health from technology. I hope you're enjoying your extra hour a day. I hope you're using it to do something that makes you a better person and maybe makes the world a 0.00000000001% better place. I hope you can have a conversation without peeking at your phone. I hope you don't feel phantom buzzes in your pocket anymore. I hope your kids don't think that "acting like a grownup" means being glued to a phone non-stop. 



How to break up with your phone, Double Arrow Metabolism edition, Day One-point-one

It's Monday. Which means it's now officially Day One of Technology Triage Week. You'll remember that last Thursday, knowing that my phone use would be a little janky and un-representative of my typical use for a few days, I downloaded Moment and allowed it 1) to know my location, and 2) to send me notifications. The early download was meant to give me a more robust baseline data set. I predicted that I picked up my phone forty (40) times per day, and that I would be on it for about two hours a day.

I was worried that time on Strava would count toward my overall use. This would have made a dent, since I did some Dirty Kanza training with my son over the weekend:

Don't worry: that alert badge is disabled on my homescreen.

Don't worry: that alert badge is disabled on my homescreen.

Strava thankfully doesn't count. That's a relief.

I was also relieved to see that podcasts don't seem to add to any time on the device. I get them for free. Yay! Even though they might not be good for me, either!

As you can see, I came in well below my projected time:

Not. Even. Close. 

Not. Even. Close. 

Catherine Price, the author of How to Break Up with your Phone, told me not to change my behavior, but to just be myself and gather data. That did not happen. I gathered data. But I gathered data that I suspect radically underestimates my true phone usage. In other words, these numbers come with a big, big asterisk: I started seeing changes in my behavior about a nanosecond after activating the app. Anyone who says that adding a tracker to their phone doesn't change habits is lying. This is Hawthorne Effect, big-time. Saturday I was at the library to check out a book, and I was actually hesitant to look in my phone's password app to log into the library's card catalog because I didn't want to add to my phone time on Moment. I thought I needed to disable whatever the feature is on my phone that causes it to turn on when I move it because it makes me self-conscious to see the screen light up when I take it out of my pocket to put it on the charger. Where I used to just stick my phone in my pocket and not pay attention to whether the motion detector had turned it back on, now I quickly tap the button to turn it off, and I confirm a dark screen before I put it away. But then I figured out that the screen lighting up like that doesn't seem to add to my Moment minutes. Whew. 

I was even nervous even going into the Moment app to get the screenshot above. I didn't want to inflate my time. You want to see what's under those "Insights" and "Coach" tabs? So do I. All I can tell is that I'm checking my phone about 25 times a day. But there's no way I'm swiping around the app, wasting my hard-earned phone time on that junk when I could be reading Andrew Tillin's account of how cycling saved him during a marriage separation.

Which leads me to neurotic point number two (or higher; I've honestly lost count): here I sit, tapping out this blog post without (much) guilt while my phone is several feet away from me, dark. I'm afraid I'm just shunting phone time into computer time. In the last couple days I feel like I'm spending more time on the computer since I'm self-consciously avoiding my phone. I almost need a separate chrome extension to track how much time I'm spending on my home and office computers. In other words, it's not just my phone that's a problem for me. I have a problem with screens in general. And I don't know how to track my home computer use since my kids use my home computer to do schoolwork and watch TV. Argh. 

But maybe all this faulty data represents progress. After all, I wasn't worried about Big Brother Moment judging me before Thursday, and I undoubtedly used my phone more then (I'm guessing my real baseline data easily doubles what I'm recording now). So if my mental health holds up, maybe I'm doing something right. I guess. Maybe. I don't know. 

Tomorrow is Day 2 (Tuesday): Assess your current relationship. It's time to come clean to my phone and tell it how I really feel.

How to break up with your phone, Double Arrow Metabolism Edition: Day One

Anyone who has come within ten feet of this blog knows that my relationship with technology, social media, and my smartphone is, shall we say, tumultuous. So I came to read Catherine Price's book How to Break up With your Phone the way I suspect a lot of people do. I've been stewing about my attachment to my phone for a couple years now, and I've made steps to decrease my use:  

I have essentially no social media presence. I've worked to make my phone less desirable. I tried putting it in grayscale, but it made my calendar too hard to read. I developed an unnecessarily complicated strategy for deleting apps. The ones I use monthly or more, I keep on the home screen. The ones I don't use monthly get demoted to the "Misc" folder, where they are in danger of being deleted if they don't get used in a certain amount of time. Any app in the Misc folder that gets used two months in a row gets moved to the home screen. Like I said: complicated. But the system has resulted in a pretty austere home screen:

Just me, Atul, and Tracy. No big deal. 

Just me, Atul, and Tracy. No big deal. 

I've turned off all notifications, audio and visual, with a couple exceptions: I can still see text messages when they come through, but they make no noise. I still have notifications enabled for RubiconMD, an app I use for peer-to-peer consultations with other docs. I want to make sure I know when those come through. My phone still rings when I'm called, but any texts or calls I get that are robocalls or from a telemarketing source get immediately blocked. 

So the big things that I end up using my device for are texting, the calendar, my task list, and old-fashioned telephonery. I also use Strava for recording cycling mileage, but much of my data in it comes via my Garmin or via Zwift. I don't use the phone as my primary GPS very much. I'm not much of a photographer, so I don't really need my phone around for pictures. I also listen to an hour or more of podcasts per day, but I'm not sure that counts. 

But I still find myself excruciatingly drawn to my phone. I use it for my alarm clock. I tap the screen to check what time it is during nocturia rounds. I tap my pants pocket to make sure it's there before I leave the house.

So I bought the book. Catherine is a very accomplished, competent science writer, and it shows. The first half of the book is mostly a recap of the greatest hits of the evils of constant connectivity, referencing expertly many of the books and articles I've posted or talked about here in the last year. She leaves out Cal Newport's Deep Work, one of my favorites, but hits other work by Nicholas Carr and Jean Twenge that are equally good. After the review she gets down to the nitty-gritty of detoxing, outlined in a 30-day plan.

Week One is "Digital Triage."

She says to take notes. Done. And digitally, even! Extra computer karma for me. She also says to invite friends to join in (no thanks; I'm too shy and too much of a loner for that kind of thing). She says to answer a question ahead of time:

What do you want to pay attention to?

Answer: I want to pay attention to long-form literature and journalism. I get more joy out of a well-written book than almost anything. It can be fiction or non-fiction. I like both. I also love, love, love magazine articles. I can take or leave newspaper articles or cable news.

I also want to pay more attention to my kids. I'm not a distant parent, and we have pretty firm rules around the house for when devices can be on. We never have devices at the dinner table, for instance, and electronics of any kind, even the radio, are verboten during meals. But even with those rules I'm frustrated at how often I'm distracted from my kids by my phone. I like my work, but I long to solve problems that can't be solved from a computer keyboard, and my kids are a deep vein of this kind of problem. 

Catherine says to use the lock screen on his or her phone as a reminder. Done:

So long, Dr. Gawande. 

So long, Dr. Gawande. 

She says to schedule my phone breakup, ideally starting on a Monday, and to put it on my calendar. I'm typing this on a Thursday, but I'll be on a brief vacation over the weekend, which may affect my phone use under even normal circumstances, so I want to have a larger dataset to work with. Which brings me to:

Day One: Download a Tracking App

Before I actually download the app, though, she tells me to answer a couple questions:

1. How many times a day do you think you pick up your phone?

I'm going with forty. Four-zero. 

2. How much time do you estimate that you spend on your phone per day?

I know from reading the first half of her book that the national average is about four hours a day(!). I'm nothing if not slightly above average, so I'm going with two hours. Still a shocking amount of time, but at least it's not long enough to complete a medium Tour de France stage. 

Catherine recommends Moment. In the spirit of not spending a bunch of time on my phone trying to find an app to keep me from spending so much time on my phone, I downloaded it. Then, to show how committed I am to this process, I allowed it 1) to know my location, and 2) to send me notifications. Those are privileges that almost no other app gets. And, just to get my rationalization off to a good start, I spent an inordinate amount of time setting up the app and screenshotting for this post. So this afternoon might be an outlier. We'll see. Catherine says not to change my behavior. Just be myself and gather data. Since I'm on quasi-vacation the next couple days, I'm going to wait til Monday to publish this just to make sure my initial data doesn't represent any kind of statistical anomaly. See you then. 

Why are there fewer posts on here than there used to be?

In the New Year, I've been trying to severely curtail my internet use. A side effect of this has been far fewer posts on this blog linking to articles or papers or videos that I've found interesting.

This is the next brick in a path I've been headed down for a while now. When I was a first-year med student, a classmate of mine was famously addicted to her flip phone. It would buzz and ring through lecture, and people would give her the stink eye, and as soon as the last Powerpoint slide clicked off the last reaction in the Krebs Cycle, she would bolt from the room and start making calls like a Wall Street veteran. Like Dan Akroyd in Trading Places. What would she have been like if she'd had a smartphone? Well, we know what she would've been like, because most of us are exactly where her trajectory was headed, and we're doing it with almost no social stigma. She would've answered all those calls with texts, right there in the lecture hall, and she would've checked multiple social media accounts to boot.

Needless to say, I was not an early adopter of social media. Once I had a couple accounts, I quickly found that social media made me act differently than I do in other situations or media. The act of trying to market myself for "likes" or "pins" on a platform of someone else's design was an act perfectly designed to produce insincere, awkward content. And thought I'm generally sincere, or at least I try to be, I'm somewhat socially awkward. That is, I'm awkward enough without someone else's help. I found that the effort I put into social interaction on platforms like Facebook and Twitter didn't enrich me. If anything, it impoverished me. It made me feel bad.

I was mystified by people's willingness to give up all the same information that we try so hard in the medical world to keep private. Facebook in particular seemed to be engineered specifically to tweak my smoldering social anxiety. It tried to choose my "friends" for me. But as I accumulated hundreds of "friends," the value of real friendship seemed to be degraded. And the privacy. Lordy. The day I put it to sleep came on my birthday a couple years ago. In spite of my almost religious tending to social media to keep details like the date of my birth off of them, people knew. Just like Wolfram Alpha knew. And I didn't want them to know. So I deleted it.

A year or so ago, I read Cal Newport's book Deep Work as part of a book club. I was still wading around the fever swamps of Twitter at the time, because I thought it was good to stay engaged for work. It wasn't completely by choice. I had suspended my Twitter account at one point, but then I'd applied for work with a company that used Twitter for much of its internal non-secure messaging. So during my grace period with Twitter (they give you a chance to come back for a month after you delete your account. Surprise!), I re-activated the account.

The discomfort with it remained. I started to talk about social media in less-than-flattering terms in posts a few months ago. Then I paused. I thought maybe I was being stereotypical: the middle-aged guy yelling at younger people to get off my digital lawn. But I kept some thoughts in draft form while I thought it over. I even considered getting a Facebook page for Double Arrow Metabolism, just to drive a little more traffic.

When the 2016 presidential election happened and I got glued to the daily outrage of social media as it responded to a shifting political landscape. I was left with two options: 1) master the software, or use it in such a narrow sense that it didn't control me, which seemed unlikely. I'm a reasonably smart guy, but my reptile brain can't outsmart thousands of computer engineers. Or 2) kill the software and get to know myself better. I don't mean blow up Twitter; I mean kill my interaction with it. I chose #2, eventually. I feared it would hurt business, or make me less knowledgeable about the world.

Then I read Newport's "any benefit" argument: we stay on social media because we can't bear the thought that there's some unknown, as of yet unseen benefit to it. In other words, what will we miss out on? It reminded me of what my parents lovingly called this the "unsmelled fart rule" when I was a kid. I'd be told to go outside, away from the party, and when I objected, I'd be asked, "What's the matter? You afraid somebody's gonna fart and you won't get to smell it?" That's exactly what I was afraid of with Twitter. But after I read Newport's book, I just quit. And it hasn't made a bit of difference in regards to my knowledge about the world. If something bad happens, I'm going to hear about it, social media or not. 

So I've been off social media for a little over a year, I think. Scratch that-it's not completely true. I still have a Strava account, albeit with no notifications enabled. And I still have a LinkedIn page. LinkedIn is like social media status post fun-ectomy, though, so I don't really count it. I even experimented briefly with Figure 1, but I didn't think it was useful. If I'm going to look at cases, I want to either get money or CME credit in return. Figure 1 provided neither.

But it wasn't just awkwardness or privacy concerns that bothered me. It was a gnawing sense of unease. And I couldn't quite put my finger on what bothered me until I read Andrew Sullivan's piece about the phenomenon a year or so ago, "I used to be a human being."

"Every minute I was engrossed in a virtual interaction I was not involved in a human encounter. Every second absorbed in some trivia was a second less for any form of reflection, or calm, or spirituality. 'Multitasking' was a mirage. This was a zero-sum question. I either lived as a voice online or I lived as a human being in the world that humans had lived in since the beginning of time.

And so I decided, after 15 years, to live in reality."

Time on social media, and now to some extent time on the internet, was taking away from time in the real world. You might be pointing out right now the apparent hypocrisy of the position I'm in the process of staking, since you're currently reading these words from a screen. Why, you're asking the screen (and by extension me), do you spew forth on this blog if you're so against public sharing? Fair point. But my content has decreased. And whether you like what I have to say or not, I don't make money off of it, even though I do make money off the consulting work that sometimes makes a guest appearance on the site. And I don't spend a lot of time looking at the analytics on my site to see how many of you are reading. So this particular shout into the void is my way of getting what I consider my fairly radical beliefs about health out into the world. But I figure the people reading this blog have at least a passing interest in me or in what I have to say. If you're here, I've in some way earned your eyes on this page. Artificial intelligence did not move Double Arrow Metabolism higher in your feed. So sure, I'll share with you, like the authors of some of my favorite blogs share with me:

Velominati, Kottke, Study Hacks, Wait But Why, Slate Star Codex, Mr. Money Mustache, Red Kite Prayer, Marginal Revolution

But I won't share with a thousand people who caught wind of my birthday through a complicated algorithm and are only posting about it because said algorithm makes it easy to do and makes them feel bad if they forget. I want to generate content that--good or bad--takes me longer to write than it takes you to view. Call it anti-Twitter.

So the fact that I'm not posting as many links is dual purpose: it keeps me off the internet, and it keeps me from turning this site into something I didn't set out for it to be. If what you want is a bunch of interesting links, many, many websites serve that purpose better than this one. One of them is Twitter. But Twitter has a fatal flaw in that it has no end.

Comedian Aziz Ansari, a guy who it turns out was a creep on a date, but who literally wrote a book on how technology has changed romance, has this to say:

"I’ll say, the times where I haven’t read that stuff, the stuff that I normally read on the Internet, just nonsense blogs or whatever, the next day I’ve felt like I’ve missed nothing...Cause you’re not reading it for the information. What you’re reading it for, and this is just my personal theories about this stuff, what you’re reading it for is a hit of this drug called the Internet...Like, here’s a test, OK. Take, like, your nightly or morning browse of the Internet, right? Your Facebook feed, Instagram feed, Twitter, whatever. OK if someone every morning was like, I’m gonna print this and give you a bound copy of all this stuff you read so you don’t have to use the Internet. You can just get a bound copy of it. Would you read that book? No! You’d be like, this book sucks."

Again, Ansari, a comedian whose job seems to have been created in a laboratory to achieve maximum benefit from social media, had this to say to Stephen Dubner of Freakonomics before adopting his new social media, internet-lite life philosophy:

"I never read anything. I’ve never read all these novels that are like these beautiful stories that have continued to have a resonance with people for so many generations, like beautiful works of art that I could read at any point. But instead, I choose not to read them. And I just read the Internet. Constantly. And hear about who said a racial slur or look at a photo of what Ludacris did last weekend. You know, just useless stuff. It’s like, I read the Internet so much I feel like I’m on page a million of the worst book ever. And I just won’t stop reading it. For some reason it’s so addictive."

Aziz quit the Book of Internet. The Book of Internet is a shitty book. Double Arrow Metabolism will not be a chapter. 

Since my departure from social media and my sharp reduction in internet consumption in general, I haven't come across much to change my mind. I read Jean Twenge's Have Smartphones Destroyed a Generation? I read John Lanchester's A Criticism of Facebook. They reminded me of a teaching course I attended at Beth Israel in Boston in roughly 2009, when "teaching the 'millenial learner'" was already a hot topic. They were different than Gen Xers and Gen Yers, we were told, in that they hadn't been quite so "latchkeyed" (a term d'art for what some might consider excessive babysitting as a symptom of absent parents). They also were perceived to want more of a personal touch in their instruction; more feedback. But Twenge notes that in her data, something shifted a few years after my teaching course on millenials. It was in 2012, the year that smartphone ownership in America surpassed fifty percent. So she calls the group at the tail-end of millenials the "iGen." Smartphones and social media have been ever-present in their lives. They've never known a world without tablet devices. Three out of four of them own an iPhone. 

Rusty's Last Chance, a landmark bar in the Aggieville district of Manhattan, Kansas, was a beacon to Kansas State University students and nearby Fort Riley soldiers for decades, but it closed in February of 2017. Bars and restaurants close all the time, but I cannot help but think, based on my experiences in going back to Manhattan in recent years, that students' taste for virtual contact over the real thing didn't have something to do with it. I'm still volunteer faculty at the local med school, and one of the criteria we're expected to evaluate students--med students! Adults!--is their willingness/ability to stay off their phones during sessions.

At this point, if you're still reading, maybe you're ok with all this. Maybe you don't think your time is worth that much, and maybe you've heard if you aren't that bothered by an algorithm guiding you away from your true self, and maybe then that information you've paid to give up is used to reduce you to a set of numbers or yes/no questions that define you, just as medicine so imperfectly tries to define you by race, body mass index, blood pressure, and soon your genetic "fingerprint." After all, teen pregnancy is at an all-time low, and teens' addiction to their phones surely has something to do with that. It's hard to impregnate someone if you're spending your weekends in your bedroom scrolling through Snapchat. And kids are physically safer than ever; it's hard to die in a drunk-driving accident from the comfort of your bedroom, and I've never seen a drinking game whose rules involved immersion in tindr (but, come to think of it, I'm sure it exists). Psychologically, though, kids may in trouble. Twenge notes that since 2011, depression and suicide have "skyrocketed." I'm not sure this is true. I'm too exhausted by the internet right now to go and find the primary data. But it doesn't take a social scientist to watch toddlers engrossed in YouTube Kids at the grocery store and deduce that we're in the middle of a profound change. We're running an uncontrolled experiment on ourselves and our kids.

So how should we handle smartphones with our kids? Based on no empirical evidence whatsoever, my wife and I have decided that 1) our kids will not have their images posted on social media other than in extremely rare circumstances (nobody wants to be the guy that torpedos an entire birthday party, after all). And our kids, upon entry into middle school, will have access to a good, old-fashioned cell phone. But if they want a smartphone, they'll have to earn the money for it themselves.

At home, we try to enforce what I'll call the "White House" rules. I don't know how the White House handles the issue precisely, but I'm fairly certain that unsecured cell phones are a no-no in the White House. So, like a Jack White or Chris Rock or Dave Chappelle show, people are asked to put their phones away upon entering. So I follow the same rules: when family members come into my house, they put their phones in a central location, and we go about our business. 

In case this all just sounds like so much "get off my lawn"-style old man grouchiness, I engage with technology. I help docs run their electronic medical records more effectively and efficiently. I listen to podcasts in my free time. But I can listen to podcasts while I accomplish other things. And EMRs, at least in theory, have value beyond the immediate. 

Sigh. So that's the story. Expect fewer posts on this site than there used to be, because I'll simply have less to post, because I'll have spent less time on the internet than I once did. But I'll probably keep my smartphone. I like the calendar.

Links for Tuesday, November 21, 2017: more on the new HTN guideline, Gymnastics coaches throwing robot shade, the last iron lungs, Germany bans smartwatches, and Raymond Chandler hated US healthcare

Thoughtful post on the new HTN guideline by Dr. Allen Brett

Representative quote: "Consider, for example, a healthy white 65-year-old male nonsmoker with a BP of 130/80 mm Hg, total cholesterol level of 160 mg/dL, HDL cholesterol of 60 mg/dL, LDL cholesterol of 80 mg/dL, and fasting blood glucose of 80 mg/dL — all favorable numbers. The calculator estimates his 10-year CV risk to be 10.1%, making him eligible for BP-lowering medication under the new guideline. To my knowledge, no compelling evidence exists to support drug therapy for this person."

A gymnastics coach says the Boston Dynamics robot flip was a 3.5/5.0

'In a back salto, says Mazloum, “you want to be able to go as high as you can, and you want to be able to land as close to where you take off as possible.” To do that, the gymnast has to squat, throw her arms up by her ears so her body is a straight line (in gymnast-speak, opening the shoulder angle and the hip), then contract into a “closed” position again. By these standards, Atlas’ trick is “not the cleanest flip,” explains Mazloum.

Here’s Mazloum’s critique: Atlas didn’t quite get to that open position, “so it didn’t really get the full vertical that we look for. That’s why it went backwards a little bit.”'

The last of the iron lungs

Get your kids vaccinated for polio, folks.

Germany has banned smartwatches for kids

If I understand this correctly, it is not because smartwatches cause kids to be distracted monsters (although I don't doubt that that statement is at least a little bit true). The decision stems from the capability of bad guys to hack in and monitor the location of little Dick and Jane:

You have to wonder who thought attaching a low-cost, internet-enabled microphone and a GPS tracker to a kid would be a good idea in the first place. Almost none of the companies offering these “toys” implement reasonable security standards, nor do they typically promise that the data they collect—from your children—won’t be used be used for marketing purposes. If there ever was a time to actually sit down and read the terms and conditions, this was it.
Get your shit together, parents.

Asking parents to destroy them might be a bit of an overreaction, though.

Raymond Chandler paints a dark picture of American healthcare in a newly-discovered story

The title, "It’s All Right – He Only Died," sounds like the title of a video residencies would show interns to convince them that quality improvement and patient safety are part of their job.

The doctor who turned away the patient, Chandler writes, had “disgrace[d] himself as a person, as a healer, as a saviour of life, as a man required by his profession never to turn aside from anyone his long-acquired skill might help or save”.