CASES!
Case One
After watching her interns eat McDonald’s for breakfast, lunch, and dinner three days in a row, a resident becomes deeply concerned for her team’s cardiovascular health. She tells them that from now on they will take the stairs everywhere (rather than the elevator) and they will do attending rounds on foot.
One of the medical students says scornfully that the resident is misguided — to reduce cardiovascular risk, one must perform aerobic exercise. If anyone would like to come to the gym and stairmaster with her, she’d be happy to show them the equipment. A second medical student says exercise may reduce blood pressure and improve lipids but he prefers to sit and take Monopril and Zocor.
One of the interns says that the relative risk of sleep deprivation is much higher than the risk of a sedentary lifestyle.
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The resident should respond by:
A) Quoting the literature about the reduced mortality and morbidity associated with occupational physical activity.
B) Gently reminding the second student that all recent studies have controlled for potential confounders such as blood pressure, cholesterol, diabetes, and smoking; thus they show that there is an independent benefit to exercise. The resident should then suggest possible other mechanisms mediating the salutary effects of exercise.
C) Confessing that though she can flaunt numbers about the risk of being sedentary, she is not well-versed in the sleep deprivation literature.
