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Interviewer: So a little bit of elbow pain if you're a pitcher in baseball is okay, but if it starts to get pretty severe, you're going to want to do something about that.

Dr. Chalmers, how much elbow pain for a pitcher is acceptable? And what's kind of the threshold that you maybe want to have somebody look at what's causing that pain?

Dr. Chalmers: Yeah, we've done some studies that have helped to inform of us of that. And I think one thing to understand that it's not a normal human motion to pitch a baseball. There's nothing we're evolved to that makes us good at pitching a baseball. And there's a lot of adaptations pitchers undergo, as they pitch through adolescence, that help them to become better at it for sure.

But we've done two studies that I think help and inform our thinking about this. We did a large study of youth baseball players, kind of youth and adolescent baseball players, where we asked them whether or not they have pain. And about 30% of kind of normal, uninjured players will say they have regular pain with play. Now this study we did, though, I think is even more informative is we took pitchers and we had them throw through a simulative game. So they threw 90 pitches kind of in simulated 15 pitch innings. And what happened is that . . . and we collected pain scores and fatigues scores, and what we found is that as pitchers get towards that sixth inning, pain scores start to creep up to somewhere around 1 or 2 out of 10, which just kind of still qualifies as minimal to mild amount of pain but not zero pain.

So I usually tell pitchers, if you're throwing and you're getting above a 2 or a 3 out of 10, that that's not normal, it's not expected, it's not something that can be just swept under the rug with the classic saying of, "There's no crying in baseball," and that it's something that probably you should look into. But if you're having a little bit of soreness, 1 or 2 out of 10 with heavy use six innings of pitching, that's probably very normal and something that you could expect with this particular sport.

Interviewer: How do you, when you do the 1 to 10 ranking, help somebody understanding like what a 1 what might be? Because somebody's 1 might be somebody else's 6.

Dr. Chalmers: Well, no, I think you're right. I mean, I think this is always the issue with pain is there's no objective measure of pain. We have no way to measure that in a way that can be comparable between patients. We have the subjective scale. Usually, the ways that we qualify that are, you know, the number, which can be hard, the words which to say mild, moderate, severe, mild being kind of a 0 to 3, moderate being 4 to 6, and severe being 7 to 10. And then the other way we use this is the scale called the Wong-Baker Scale. It has this . . . you know, starts with a smiley face at zero and like a very unhappy face at 10. I usually think of 2 out of 10 as being a place where there's still maybe a little bit of a smile if you have a really good game, but definitely there's some grimacing if things get bad. And if you start to get to the place where there's no longer a smile on your face, then probably it's too much.

Interviewer: And that's during. What about pain afterward? How long until that pain would go away for kind of the average player?

Dr. Chalmers: Well, usually what I tell people is that you should be able to do what you're doing in a reproducible way every other day. So if you feel like I could pitch like this every other day, then that's a right amount. If you feel like, "Ah, I need four days to recover from this pitching outing because it was so painful or took that much recovery," then what you're doing is too much.

Interviewer: And you said, you know, the saying is, "There's no crying in baseball," and sometimes pitchers tend to be a little tougher than the rest. If somebody is having elbow pain above the threshold you described, what are some of the downsides to not having that looked at?

Dr. Chalmers: Yeah, there are definitely downsides to just pitching through significant pain. The significant pain can be a sign of a substantial injury to the elbow. So, for instance, if you do have ligament tear and you're trying to just work through it, I've definitely seen players that years later have developed arthritis in their elbow or they have bones spurs that have worked to kind of help the elbow to stabilize even though the ligament is not functioning properly. So there's definitely a downside to thinking, "I'm just going to push through this."

Interviewer: And then, what about the repair? Some of these elbow surgeries can take a long time for patients to recover. Do you think that plays into why perhaps sometimes pitchers choose to play through it, because they don't want to be out of the game for any period of time?

Dr. Chalmers: Yeah, I think that's definitely part of it, is that pitchers think, "Oh, I can't afford to take 12 to 18 months off." So, if you know that there's a solution that can get you back in six months, that's the length of the offseason, and I don't think you need to worry so much about, "Oh, I'm going to lose next season." So it's definitely worth if you're having pain thinking, the very least get it looked at the end of the season, to see maybe if there is something that can be done that could still you get back in time for next year.

Interviewer: Yeah, and new procedures are coming along all the time that have shorter recovery periods. So even if you are of the opinion or if you've heard, "Well, if I get this done, I'm going to be out for 24 months," that might not be the case anymore.

Dr. Chalmers: Oh absolutely. And not only that but if you're listening to this and it's two years from now, let me tell you, it's going to be even better, because we've got all sorts of things coming down the line that will help to bring down recovery periods for pitchers in the future.

Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.

Interviewer: We all know someone that sleeps six hours or less each night and then they claim that doesn't bother them. Actually, they say they thrive on little sleep. Is that really the case, or is it really not good for their health? Paula Williams is an associate professor of clinical psychology at University of Utah. And Brian Curtis is a clinical psychology PhD student. And they are part of a research team that is researching a phenomenon called "short sleepers," and these are people that sleep six hours or less a night and report no ill effects.

So the first thing I think we need to do, and Paula, would you please define what a short sleeper is? I kind of summarized, but did I miss anything there?

Dr. Williams: Well, at the broadest level, it is someone who sleeps six hours or less a night on average. The recommendation is seven to nine hours. The people we're interested in, though, are also habitual short sleepers. That is, regardless of the work schedule or vacation schedule, these are people who tend to sleep six hours or less.

Interviewer: Yeah. And we all know, maybe, you know, you are one. Are you a short sleeper?

Dr. Williams: I am not.

Interviewer: How about you? Are you a short sleeper, Brian?

Brian: I'm an insomniac, but that's a whole different . . .

Interviewer: Oh really?

Brian: Yeah. I've had insomnia. My mother has insomnia. My three older brothers have insomnia. So it's in the family.

Interviewer: Sounds like it, yeah. I'm definitely not a short sleeper. But about 30% of the United States are short sleepers the way you define them. But then there's a 10% subset. Explain what that group is like.

Dr. Williams: Right. So about a third of the population report they don't sleep more than six hours. And within that group, however, there is a small percentage, maybe 10% we think, that feel fine on six hours or less. They don't feel the usual negative effects that most of us would. That would include fatigue and irritability, etc.

Interviewer: And they claim they're different almost. It seems like.

Dr. Williams: Yes. For some it's a badge of honor that, "I can, I feel fine. I don't need much sleep. I feel good." And so they're a fascinating subgroup of people that we want to understand better.

Interviewer: And it can be concerning because the question is, is that really the case? Or are they just as susceptible to the detriments of lack of sleep that the rest of us are?

Dr. Williams: Right. At a minimum, we can say that they feel better. And so that's something in and of itself. But there are lots of other questions about whether cognitively, objectively they are functioning as well as they perceive themselves to be. There is a whole area of psychology that is looking at the discrepancy between self-assessments and objective assessments. And that's something that's of interest to us.

Interviewer: And, Brian, short sleepers think that they function just as good as somebody who's gotten the seven to nine hours if not better. Why do they think that way?

Dr. Williams: That's the million dollar question.

Dr. Brian. That's why it took me aback. I mean, that's just how they feel. I mean, they are reporting that in fact they feel just as good and in my experience, talking to these individuals, often better. I mean, these people they tend to be almost the flipside of what you would expect, at least what they're reporting, of somebody who has been sleep deprived or who's sleeping six hours or less. In other words, instead of having less energy, they report having more energy. Right? So this concept of behavioral drive, these people are always on the go it seems.

A couple of these participants have told me that their idea of hell is just nothing to do. Like what if we put you in a room, you don't have your phone, you have nothing to read, right, that to them is very, very off putting.

So this high degree of stimulation, behavioral drive and they just feel fine. They've been told by many, many people that something is either wrong with them or, you know, there are a bunch of negative health consequences, but they just feel fine.

Interviewer: So I would love to be able to get two extra hours a day, right? So is there a way I can become a short sleeper? Are there strategies that they're using to actually survive on less sleep, or are they just genetically different than you and me?

Dr. Williams: Right. We don't know, and that's why we're researching this question. It's a question that we get a lot because everybody wants to do more in less time, to have more time, etc.

But, you know, there's too much research out there on short sleep duration and health consequences that we need to look at this subgroup more specifically.

Interviewer: To see if that applies to them.

Dr. Williams: Exactly. So it's possible that someone is feeling fine, but they're not fine. So we just need to know more. And we need to know how their partner perceives them as well. So part of what the research would look at is, what do other people report in terms of their behavior and their functionality.

Interviewer: How could a person determine if they or a loved one are a true short sleeper? I mean, is it just simply cut and dry as they're not getting the seven and nine hours of sleep that they should?

Brian: I think the most important thing there is, if you take away societal obligation, you take away needing to wake up early for work or to stay up late to study, whatever it is in your environment that's dictating your sleep schedule. If on the weekends with a lot of opportunity, right, you're still getting six hours or less a night, if you're on vacation, that's still the case, often with these individuals this isn't something that started in college or when they got a high pressure job. A lot of these people report that they've kind of always been this way, reaching far back, even into childhood.

And it's also not uncommon to hear that they may not be the only person in their family that tends to have this sleep pattern as well. So there seems to be a familial pattern of short sleep. And that's been borne out at least in one study that our research colleagues, Chris Jones and his geneticist collaborators, they found a mutation in a mother and a daughter. And when you put that human mutation into mice, you now have short sleeping mice. And not only short sleeping mice, but these mice run more on their running wheels during the day. So you have a behaviorally driven mouse.

So this was back in 2009. That's almost a decade old. And since that time, we haven't found a similar slam dunk mutation in families. So it does appear that these genetic short sleepers may be very, very rare. But assessing them objectively into the lab and getting more of these people is the goal now.

Interviewer: I would be a little scared if I was a short sleeper right now, because of all of the evidence that's out there that says, "If you're not getting seven to nine hours, you know, it could be detrimental to your health." And we don't know a lot about whether or not it is. So if I am a short sleeper, do I worry? What should I do? Should I try to get more sleep?

Dr. Williams: No. These are important questions. But the reason we don't know is that the vast amount of medical research is epidemiological. It looks across the population and looks at associations. What we're trying to get at now are individual differences. That is, are there differences between people in the effects? And we know that at least in perception there are.

Interviewer: But as far as behavior changing, if I'm a short sleep or have a loved one, really, at this point, nothing you should do. I mean, if it's true short sleeping, that you're not, you know, getting up because you have responsibilities, you're not sleeping because of stress, but you just naturally do that, just get up after six hours.

Dr. Williams: You know, a question I would ask somebody is, what are they doing to stay awake, for example, because one of the things we think about some of these short sleepers, given what Brian just said about behavioral drive is that they are seeking out stimulating activity in the night. And what I would recommend is pulling all environmental stimulation. You know, what we should be sleeping in is the equivalent of a cool, dark cave. If you put yourselves in that kind of situation, do you still not sleep? Right?

Interviewer: Yeah. So that might be a good thing to check.

Dr. Williams: Yeah.

Interviewer: A good experiment to do.

Dr. Williams: I would do that. And all kinds of things we know, like having a routine, trying to sleep at the same time, not having in a hot environment, noisy environment, all of these things, light blocking shades. Try all of those things. And then see how your sleep is.

Interviewer: And you might discover, it turns out, you're a regular sleeper.

Dr. Williams: Right. Or, I mean, part of what I study is personality and so that's part of what we see is that people are behaviorally different around sleep. In fact, sleep might really be part of personality.

Interviewer: So if somebody is concerned that maybe they should take a look at some of their sleep hygiene things or some lifestyle things. Ultimately it might end up that they're just sleeping six hours, because that's just how they're wired, and at that point, I mean, at this point, what do you do then?

Brian: They get in touch with us.

Interviewer: And become part of your research study.

Dr. Williams: Part of the research.

Interviewer: Okay. And how would they do that?

Brian: So our laboratory has a website. It's restlab.psych.utah.edu. And on that website there there's a section for the short sleepers study. They can go there, read up a little bit about the background. And if they're still interested, there's a quick questionnaire that they can complete online about eligibility criteria. And then a member of a research team will get back into and go forward from there.

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Dr. Jones: So you live longer if your doctor is female. That's what the research suggests. Well, let's look at this a little more carefully, okay? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Healthcare and full disclosure, I'm a female physician and this is The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health," with Dr. Kirtly Jones, on The Scope.

Dr. Jones: It seems as if every major news outlet brought forth the research that people live longer if their doctor is female. Okay. That sets us up for some controversy and some potential bad feelings. But let's unpack the numbers and take a closer look.

The study was published in JAMA Internal Medicine. This is a well-respected journal and it looked at medical billings for hospitalizations around the country for people over 65 with a number of common medical problems such as pneumonia, heart failure, or urinary tract infections, to name a few. They analyzed over 1.5 million admissions between January 2011 and December of 2014. Wow, that's a lot of hospitalizations. But in fact, they just picked a random 20% of all the admissions in the US to study.

They specifically looked at the outcomes of death in the 30 days after admission or readmission to the hospital. Those are just the two things they looked at. And then, they looked at whether the physician who billed for the admission was a female or a male. It's amazing what you can find on the internet.

Of course, they had to look carefully to see if the patients of male physicians were sicker than those of women. They had to look at the age of the patients to see if they were older in the male doctor group than the female doctor group. Then, they looked at the doctors to see if the females were younger. And they were, on average, about five years. And if they had had more recently finished their training, which women physicians had by about five years. Then, they had to control for all these factors in their statistical analysis. They chose hospitals where the doctors who provided care tended to work on shifts, so the admitting doctor was not by the choice of the patient.

Well, it was pretty good study and with really big numbers. And the envelope, please. Patients who were cared for by female physicians were less likely to die in 20 days. Now the real numbers. Patients cared for by female physicians had an 11% chance of dying in the 30 days. You should know that the average age of these patients was 80. Compared to the rate of death within 30 days of 11.5% in those patients cared for by male physicians, that is one-half of 1% difference.

Now, because the number of patients is so large, one-half of 1% is statistically different. However, if you're thinking of changing your doctor, that's a pretty small difference for any one person. To save one death in 30 days, you had to have 233 people cared for by women for every one cared for by men.

Similar numbers were found in the rate of readmissions for hospitals, and the females compared to males was slightly less. Some people argue that the difference is very small for any individual patient. But if you look at hospital admissions for the elderly over the entire United States, there are over 10 million hospitalizations among Medicare patients annually. And one-half of 1% of 30-day mortality could add up to a lot.

So, what's this about? Physician sex doesn't make a difference in outcome. It isn't the extra x chromosome or the estrogen level that makes the difference. It must be some behaviors in female physicians that are just a little different than men. We call that a gender difference, not a sex difference. Sex is the chromosomes in the biology; gender is the behavior.

Studies have found that female physicians are little more likely to adhere to clinical guidelines in care and practice more evidence-based medicine. Women tend to use more patient-centered communication and provide more psychosocial counseling to their patients than males. It's hard to know exactly what is the difference in practice that accounts for this small difference in patient outcomes.

Of course, to me, it may all boil down to a factor that all women know. Women are more likely to stop and ask for directions, right? In fact, we are trying to teach more protocol-based and evidence-based medicine to all our medical student these days, men and women. And we are teaching patient-centered communications more.

So maybe our women and men graduating from medical school will be more comfortable asking for directions. And everyone, patients and doctors, will get where they're supposed to go.

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Interviewer: When is a fever bad enough that you should go to the ER? We'll examine that next on The Scope.

Announcer: This is "From the Frontlines," with emergency room physician Dr. Troy Madsen, on The Scope. On The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health Care. When is a fever bad enough to go to the ER? Dr. Madsen, shed some light on that for us.

Dr. Madsen: Yeah. You know, it's interesting you bring that question up because I've had people ask me even recently. They've said, "At what point is the fever just going to cook my brain and how high does it have to be to cook my brain"?

Interviewer: That can't happen. Right?

Dr. Madsen: I can't say I've ever seen it happen and I told them that.

Interviewer: Okay.

Dr. Madsen: And it's something that's out there. I remember hearing that too, like people saying, "Wow, you got to keep your fever down, or you're just going to fry your brain." I can't say I've seen that. So when I think of fever I don't think of the absolute number with the fever. We define a fever as being 100.5 degrees Fahrenheit or greater. So I think of fever more in terms of what are the symptoms that you're having or what kind of medical problems do you have.

This is a child, a young infant, less than, say, 12 weeks old, and they have a fever of 100.5 or greater, you got to go to the ER because there, we get concerned about a serious infection. If this is someone who has an immune system problem, who's on chemotherapy, or maybe has HIV, or something that's affecting their immune system, again, another reason to go to the ER. I'm not concerned about is it 105, is it 100.5, if they have a fever, they need to have testing done.

Interviewer: If they are in that particular group?

Dr. Madsen: Exactly.

Interviewer: Okay.

Dr. Madsen: If they have immune system problems, if they're very young, and then, of course, if they're very old, people who are very old also. It's interesting because very old people really don't get high fevers like someone in their 20s might. So in them, a fever or a temperature of 100.5, that's pretty significant. And again, potentially a sign of something going on that's very serious. Whereas the average person walking along, who's healthy, who has really no medical issues, maybe they have a cough, maybe they have a fever up to 102, even 103, in my mind, that's not so concerning.

So when I think of fever, I think of more the whole person, what kind of medical problems do they have. And then, beyond that, I think of "Okay, what else is going on?" If it's someone who has a fever, who says the light bothers my eyes, my neck is stiff, I'm confused, or someone is reporting to me that they're confused, then I think of meningitis. Fever with a really severe cough, or a cough that has been going on for a week, and won't go away, I think of pneumonia or a sinus infection. Certainly, fever is with your unary symptoms, back pain, we think about kidney infections and issues there.

So again, you're taking that whole picture. So I think the big take home point would be that I don't even own a thermometer at home. I don't check my own temperature. I know if I'm hot, or I'm cold, or family member is hot or cold. I've heard some pediatricians say, "Get rid of your thermometer. Just don't use it on your kids unless they're the very young kids less than 12 weeks old," Because there, you are again looking at the whole picture. It's not just the fever.

Is the child lethargic? Are they feeding well? Are they eating? Are they still urinating, meaning that they're still having adequate fluids in their body? You're looking at everything there in addition to the fever.

Interviewer: That's kind of a tough paradigm for me to wrap my head around because I think a lot of people are just driven by "Oh, 103 fever. That's burning up. That's a major problem." But it sounds like you're saying to take that as an indicator to maybe assess, are there some other issues going on and those other issues are actually the reasons why you'd probably go to the ER?

Dr. Madsen: That's exactly it. You could have 103 fever with kind of a run of the mill cold, and you could feel absolutely miserable, but it doesn't mean you have to rush to the ER.

Interviewer: Okay.

Dr. Madsen: And you can. If you're at all concerned, never hesitate to call your doctor. Never hesitate to go to an urgent care or an ER. But in your mind, I want to think of it as like, "Okay. This absolute temperature means you're sick or something less than temperature means you're not." Like I said, some people with 100.5-degree temperatures who have other problems, that's really serious. Whereas another person on 103-degree temperature, probably very well, just could be a viral infection, and it isn't that big a deal.

Interviewer: So this could be probably tough information for somebody to hear because I'm imagining if they're listening to this, they're concerned about somebody in their life with a fever. If they don't fall in one of those two groups, the very young, the very old, they're going to want to do something. But it sounds like what you're saying is a fever should only indicate that maybe you should look and see if there are other symptoms?

Dr. Madsen: That's exactly it.

Interviewer: Yeah.

Dr. Madsen: Yeah. I won't rush to get into the hospital based on a fever alone. Look at the whole picture. Look at all the symptoms. Look at how the person is acting. If they're acting fine, and they're eating well, and drinking well, and they're alert, and they're not confused, and they've got a temperature of 102, they're probably okay. You can give it some time. You can take some Tylenol, some ibuprofen, to bring the fever down and see how they're doing.

Announcer: We're your daily dose of health, sciences, conversation. This is The Scope, University of Utah Health Sciences Radio.

Interviewer: The general perception is that we all need eight hours of sleep. True or false? That's coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialist you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We're talking today with Kyle Bradford Jones family physician at the University Utah. How important exactly is sleep?

Dr. Jones: Boy, sleep is huge. You know, if you get too much, too little, it severely impacts your health for the negative. It's been a big debate for years. How much sleep do we need? Currently the average American gets a little bit less than 7 hours. And so the question is, is that enough? Is that too much? Is that too little? So the National Sleep Foundation got together a bunch of sleep experts. They reviewed all of the scientific literature on sleep and came up with some recommendations for certain age groups.

Interviewer: And what are those guidelines?

Dr. Jones: So first of all for adults 18 and over. They give the range of seven to nine hours. So I mean that kind of fits the perception that we've had of roughly eight hours. But the nice thing is they give a little bit more of a range, because sometimes we need more sometimes we need a little less.

Interviewer: Right so there's that seven to nine buffer zone.

Dr. Jones: Exactly.

Interviewer: How about elderly people?

Dr. Jones: It's a similar amount. However with the elderly they tend to sleep a little bit less at night and nap a little bit more during the day. And that's okay. That's more of a natural rhythm for them. And so that's healthy for them.

Interviewer: So my grandma, bless her heart, always comes up with these crazy myths in the world. She always told me that the older you get, the less you need. I guess her way of saying that you can't sleep as much as you used to. That seems to be the case with this review.

Dr. Jones: Absolutely. As you get more into those elderly years like we said, it's a little bit less at night and then a little more napping during the day.

Interviewer: My grandma is not that crazy then.

Dr. Jones: Not on this aspect anyway.

Interviewer: And what about school age children? How much sleep do they need?

Dr. Jones: So this has been a big topic for years as well. How much do they need? We're talking about nine to 11 hours a night. Many kids don't get that. But it really impacts how they do in school. If they get that amount of sleep, they're going to do better, they're going to behave better and they're going to learn it better.

Interviewer: Does bedtime and waking up time have a difference or does that matter?

Dr. Jones: As long as it's consistent and you're getting the adequate amount, that's the most important thing.

Interviewer: Does school age children also include teenagers?

Dr. Jones: No. So for teenagers it's slightly different. We're looking at 8 to 10 hours. Parents of teenagers know that they like to sleep in. They like to do those things. Getting 8 to 10 hours is important because they are growing their bodies are changing, they need that rest in order to optimize their physical health.

Interviewer: What if you are a mother caring for a newborn, let's say?

Dr. Jones: So with a newborn its 14 to 17 hours a day.

Interviewer: More than half the day.

Dr. Jones: Exactly. They are growing so rapidly. Their brain is developing so rapidly. They really need that much rest in order for their body to grow.

Interviewer: So I'm not a mother yet, so I don't really know the answer to this, but is that in one nap or is it separated?

Dr. Jones: It's separated. So getting as much sleep during the night as you can which is easier said than done as any parent knows. But also includes a few naps during the day and letting them get their rest as much as they can really.

Interviewer: Does that also apply to adults as well, like little naps in the afternoons or something like that when we're free. Does that add up to the seven to nine buffer zone?

Dr. Jones: Actually for adults naps can be detrimental because it actually can worsen your sleep during the night. So ideally you want the seven to nine hours all in one chunk overnight.

Interviewer: Any final thoughts?

Dr. Jones: Just try to individualize this to yourself. So some people do better with seven some might do better with nine. You know you want to try to get within that range as much as possible to optimize your health. But the most important thing is making sure you get enough rest.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.

Announcer: This is the show by med students for med students. It's The Med Student Mentor on The Scope.

Interviewer: Balancing work and extracurriculars can be difficult at best, but we're here today with Tim Muvihill, a nationally ranked cyclist and a pre-med student. Tim, welcome to the show.

Tim: Hi, nice to be here.

Interviewer: You're a very impressive young man. You balance this incredible cycling with med school. Really, where do you find the time?

Tim: You just have to kind of squeeze things in. If you really love to do something, I think you can always find a way to make it work and find a way to get out there and do what you want to do.

Interviewer: Do you have a lot of late night studying finishing problem sets?

Tim: I actually go for the early morning.

Interviewer: Really?

Tim: I try to get up early and get most of my work done. It frees up the rest of the day and I feel a little less guilty about sneaking out on my bike for a couple hours.

Interviewer: So what is an average day like for you? Walk us through your work day.

Tim: A typical day during the first year, I had class in the afternoons, so the morning was the time to get most of my studying and obviously riding done. So I'd be up and studying by six every day and study for about three or four hours, and then try to sneak in a ride before I'd go to class. A quick ride, go to class, and then in the afternoon finish up the rest of the studying I have to do and any errands that I might have to run for normal life like a normal person.

Interviewer: Do you find that to be sort of an abnormal schedule? Do most students have the depth and breadth of non-medicinal interests that you have?

Tim: I think pretty much everybody has their interest outside of medicine. People will develop more or less time to it and obviously the way people like to study is a lot different. A lot of my classmates really like to study at night, so they'll be up, you know, 1:00 in the morning still cramming or doing whatever it is they do. That never worked for me.

Interviewer: They're not getting up at 6:00 a.m. to study [inaudible 00:01:44].

Tim: Probably not.

Interviewer: What do you think makes you so accomplished then? What differentiates you between you and another med student who maybe is interested in cycling, but is not a nationally competitive cycle?

Tim: I'd like to say that it's really drive to be the best and competitive, but really I think of it, I just love cycling. Any chance I get I want to be out on my bike riding. And kind of a byproduct of that is that you get fast and then you win races.

Interviewer: It's passion for the sport.

Tim: Yeah, I'd say so.

Interviewer: Well, have you always had that passion? Where did it come from and do you think that that bleeds over into other aspects of your life?

Tim: Definitely in the sense that you want to be good at things and that you're interested in them, and you want to do them as well as you can. I am honestly interested in school and medicine, and it's something that I feel very passionately about. So I'm willing to do the work to study in order to get to where I want to be career wise. As far as cycling, it's just enjoyment of riding a bike. It's like flying. It's one of the most wonderful things in the world, I think.

Interviewer: Was there ever a time that you thought that maybe you couldn't do both where you thought you might have to give up one dream for another?

Tim: Maybe when you start med school it's that kind of transition period where you think you won't have any time, that you're going to be all consumed by exams and studying, and that everything else in your life is going to kind of fall away, that you won't have time for those activities that you love to do. Thankfully, that turned out not to be the case. I'm not trying to be a professional cyclist at this point. I am just loving to ride my bike and I'm thankful that I can still get out and compete at a pretty high level. I don't think I ever considered giving up cycling just because even if I wasn't racing, I'd still want to get out and ride as much as I can.

Interviewer: When did you decide to go to med school?

Tim: I started college with no intention of going to medical school. I wanted to go into business. I actually studied economics mostly the first couple of years. I decided to go to med school, I guess, my fourth year of college really. I ended up stretching college to five years.

Interviewer: Really?

Tim: But I was pretty late when I finally made the decision that I wanted to go.

Interviewer: Bio-chem and economics, a double major. Why?

Tim: Again, it's just two things that I'm interested in. I don't really feel the need that you have to choose one or the other regardless of whether it's medicine and cycling or economics and chemistry. If there are two things you really want to do, I say go for it. Don't give up one for the other.

Interviewer: Okay. Well, do you think that your background in economics is giving you a different take on someone who maybe just went pure biology? What sort of advice would you give to a pre-med student who's trying to decide between biology and economics?

Tim: Do the medicine prerequisites that you have to do and then major in whatever you want. There is no advantage of being a biology major or a chemistry major and taking physiology or anatomy, or anything as an undergrad. You're going to get everything you need in med school.

Interviewer: Really? So maybe would you say there is even a disadvantage? I don't want to push you into anything. That was a very leading question.

Tim: It's not a disadvantage. I won't call it a waste of your time. I'm just going to say that if it's something you're not interested in or if there are other subjects you want to pursue, undergrad is definitely the time to do that.

Interviewer: You do seem very invested in exploring your other interests.

Tim: Yeah.

Interviewer: I think that's good advice. I think that's great advice. So then just being a pre-med is stressful enough, how did you work in cycling during studying for MCATs and volunteer hours, and your last minute of pre-med requirement classes? How did you balance that?

Tim: Again, it's just making time for the things you want to do. I like routines. They help me be a lot more productive. So like volunteering, I went to the same place every week and spent four hours volunteering at a hospital, and it just becomes part of your week. You don't question whether you can squeeze in the time to go do it, it's just that's what you're doing. And so if you kind of partition your time in advance, it's a lot easier to squeeze things in.

Interviewer: So you spend about four hours a week volunteering. How many hours a week did you spend cycling?

Tim: I probably average about 20 hours a week on my bike.

Interviewer: Really? I got to ask, why is cycling important to you? Why are you willing to devote 20 hours as an undergrad to it?

Tim: Well again, it's not out of really any dream of taking this to another level. It's something that I really like to do. It's like some people like to play video games and I'm sure there are plenty of undergrads who spend 20 hours a week with their Xbox. Cycling is just kind of a more unusual pursuit, I guess.

Interviewer: But certainly healthier than video games.

Tim: Potentially, yeah.

Interviewer: I don't think I've ever worked up cardio playing video games.

Tim: I don't know. Some Halo sessions get a little intense there at the end.

Interviewer: So tell me, how did you first get into cycling then? We've talked about how you got into medicine a little bit.

Tim: A little bit, yeah. So cycling, I guess, I grew up swimming and running a bit. And so when I went to college I thought it might be fun to race triathlons, so I started biking. Pretty quickly decided I liked training for biking more than triathlons and gave up the swimming, and mostly the running, and from there I kind of started racing, and I guess that's the story.

Interviewer: Talk to me about med school. You've done a full year of it. You're going into your second year. What's been the most surprising thing?

Tim: Really just how interesting everything is. It's like you go to med school and you think it's going to be this intimidating thing. It's going to be super challenging and hard, but you don't really understand going in just how interesting the material is. It's fascinating.

Interviewer: What's been the hardest part so far?

Tim: Hardest is definitely the exams. You know? It's like dealing with the stress. The first year I had a test every week. And so that is something that you're kind of always being evaluated and you have to get used to that. I think learning to cope with stress is a big part of the first year for everybody and thankfully I have cycling that makes that a little bit easier for me.

Interviewer: So then do you think there is a specific kind of person who can go to med school and one who can't or do you think it's really just a matter of hard work?

Tim: I definitely think it's a matter of hard work. No matter what kind of background you come from there is a path to medical school. And if it's something that you're passionate about and really want to do, I'd encourage anyone to give it a crack. I think it's the greatest job in the world and I'm super privileged to be here.

Interviewer: All right. Well, thank you so much for your time.

Tim: Thanks for having me. I appreciate it.

Announcer: The Med Student Mentor is a production of The Scope, powered by University of Utah Health Sciences. For other shows check out thescoperadio.com.