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Dr. Daniel’s Top 5 Reasons for Fatigue

I am blessed to care for a lot of young adults in my Endocrinology practice. I enjoy hearing their goals and aspirations. From teaching, to engineering, athletics, and healthcare careers, I love getting updates on their progress. I typically address their thyroid disorders, diabetes, obesity, and PCOS but there is one complaint that I hear from majority of my patients:

There must be something in the water these days because everyone seems to complain of fatigue. For those prehealth students and professional school students out there, this can really impact your chances to be successful. It’s tough to do well when you always want to fall asleep all of the time. I’d like to share with you my S’s of fatigue.

1. Sleep: Never underestimate the power of sleep! I would easily guess over half of Americans either suffer from inadequate amounts of sleep or a specific sleep disorder. It is estimated that 1 in 5 adults has sleep apnea. This disorder can result in a number of problems with fatigue being a primary one. Sleep apnea tends to affect obese patients at a greater frequency although I have seen it in thinner individuals as well. It is always difficult for me to get my patients to actually be evaluated for sleep apnea despite how common it is. Some patients suffer from insomnia, restless leg syndrome, narcolepsy, or circadian rhythm sleep-wake disorders. It is recommended we get 7-9 hours of sleep daily. Don’t be that superman or superwoman character saying you need only 2 hours. There are a number of important physiological activities taking place during the hours of sleep. For students, many have erratic sleep patterns disturbed by long late-night cramming, work, noisy roommates, and (let’s be honest) partying. Working on sleep hygiene can really make a huge difference. [Message me if you need a list of Do’s and Don’ts.]

2. Stress: We all face stress but the medical training path intensifies this. Some handle it well and others don’t. We often underestimate what stress can do to us and we push it to the side. Amongst the many symptoms stress can cause (headaches, chest pain, muscle aches, anxiety, depression) fatigue is certainly high on the list. If I could write a prescription for rest and vacation for my patients I would. Some countries have built in a siesta or mandatory stress relieving techniques. In the United States this is not very common. I highly recommend taking time out of the day to untangle and for many of us this may mean cutting back on activities. It is very easy to overcommit yourself as a student.

3. Sedentary: Get up and move. God did not design our bodies to sit around all day on the computer or couch. This will only lead to deconditioning. It truly disturbs me when I ask my younger patients if they are physical active and they respond by saying they walk around the grocery store. Maybe this is just a Texas thing. It is recommended that all adults get at least 30 minutes of moderate-to-vigorous aerobic exercise at least 5 days a week (or total of 150 minutes per week). Many of us fail to do this. The question I get is, “How can I do that when I am already so tired?” Start small and build up. Use the exercise as a relaxing tool so you can kill two birds with one stone. The benefits of exercise are tremendous. If there was a drug out there that offered this benefit it would be worth thousands of dollars.

4. Substance: Sometimes it is what we consume that is contributing to us feeling tired. This may be in the form of drugs (prescription and illicit), foods, and beverages. Some medications designed to treat allergies, hypertension, cough, seizures, and pain can all contribute to fatigue. Excess caffeine and alcohol may also be a factor. A poor quality diet may lead to nutritional deficiencies and blood sugar dysregulation which may cause fatigue and mood disturbances. Some may also have food allergies. Make sure to get a well-balanced diet with adequate amounts of fruits and veggies. Try your best not to depend on anything to keep you energized.

5. Sickness: Well this is the big one. There is a huge list of medical conditions that can contribute to fatigue. Majority of the time, we are convinced we have a serious disease and often ignore the above issues I have discussed. It is important to address the other S’s above if there is something else going on. The more common illnesses I find in younger individuals include anemia, psychological disturbance, thyroid disorder, obesity, mononucleosis, fibromyalgia, or autoimmune disorder. Other less common diseases can be diabetes, adrenal insufficiency, chronic kidney disease, heart failure, lung disease, cancer, liver failure, low testosterone, infections (viral, bacterial, fungal), multiple sclerosis, chronic fatigue syndrome and chronic pain. Let me offer some reassurance, it is very unlikely that you have one of these less common conditions. These conditions do happen and it can be extremely frustrating trying to get to the bottom of why we are tired but what tends to happen is we lose sleep, become less active and take substances to fight the stress of worrying about what we may have. See what I just did there? We can enter a perpetual fatigue cycle and end up being our own worst enemy. It is best to address what we can while we search for diseases.

So there are a ton of reasons why we are tired. Fatigue is very troubling and frustrating for many of us. My final advice is to address the top 4 S’s. If the fatigue doesn’t resolve then see your primary care physician to investigate for the 5th. Try not to simply place a bandage over the issue. If you have any thoughts or suggestions I’d love to hear from you. Feel free to share with your friends and family.   

Now, I’ve got to go to sleep. Let me know if you yawned at all while reading this.. lol.

Related Article: Eating Wise as a Premed

Be accountable for your own success!

Week 47 of  the PreMed Mondays book covers personal accountability.  This is a tough episode.  Students need to understand that at the end of the day, whether they succeed or not is due to their own performance.  You can’t blame anyone else or life’s circumstances.  If you want to be successful, you have to figure it out.  Life will throw curveballs and the bat is in your hand.  You have to swing it!

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Premeds, find affordable services designed to help you get accepted into medical school at

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Overcoming Unforseen Obstacles 

I haven’t been on here in awhile as I was focusing on finishing up my clinicals for Surgical Technology. To my surprise we have a new site it’s no longer PreMed Star. I just wanted to give an update on what’s going on in my world. While finishing my clinicals and preparing to graduate in May. On March 18th, I was involved in and car accident where my car got totaled and my wrist was broken. Due to my injury, I had to put my clinicals on hold and my participation in graduation was in question. I have cried many days and nights, been dealing with PTSD from the accident and in alot of pain. However through this tumultuous time I thank God for sparing my life it could have been a lot worst but he is bring me through this test day by day. I can now say on May 17, 2019 I will be earning my second degree. Sorry for the long post I just really wanted to share my story and hope that it may touch someone else to not give up and to keep fighting for what you want and deserve. 

Five ways to make the most out of summer school

When I came upon the realization that I was going to have to spend my summer at my undergraduate college taking courses in order to graduate on time, I was worried that I would be wasting a summer I could spend improving my CV through programs like SHPEP or studying abroad in a foreign country. However, there are still so many great things to do during the summer that’ll also be good experiences to reflect on and possibly talk about in an application or interview.  Just because you’re taking summer classes does not mean you can’t go out and gain new experiences.

1: Shadow a physician- this one may seem a bit obvious, but when isn’t shadowing a good idea for a premed to do? Students get the luxury of having the summer off but unfortunately, doctors do not. An advantage of students being gone during the summer is that the doctors will have fewer premeds trying to shadow them, so it would be nice to take advantage of the opportunity and try to shadow two or three physicians during the summer months, just remember that nothing has changed for the doctor, so shadow them as you would shadow any other physician.

2: Summer research- Similar to doctors, research professors don’t get to pack everything up and go home after the school year ends. If you already have a lab, the summer can be a good time to get some extra hours in, as you will probably have more free time that can be spent working with your primary researcher and can get ahead on projects. If you don’t have a lab, this could be a good time to find one! Plenty of research professors will lose assistants as they graduate and move around the country so new lab openings will appear. Some schools also have summer poster sessions where students can showcase their work over the summer, not to mention the possibility of getting paid.

3: Going to a conference- While schools may not have as many conferences at this time of the year, there are still plenty of opportunities such as CME medical conferences happening all summer. Not only can you learn things about different diseases, medications, and contemporary news in medicine, but you can also network with various doctors and officials at different schools. If you can find a conference close to you this summer, it wouldn’t hurt trying to make a trip.

4: Volunteering- While I don’t have any statistics to back me up, I’m sure volunteer organizations are in need of more staff over the summer with students leaving, and with summer school typically taking less time out of the day for school, that’s more time that can be spent helping out in the local community. While the hospital is a popular choice for pre-meds, there’s also homeless shelters, soup kitchens, food banks, and plenty of other opportunities to help the less fortunate during the warmer months. Don’t just do it to check off the box, it’s legitimately a really kind thing to do.

5: Get involved in the community- Sometimes we get so wrapped up in our work that we forget about all of the opportunities around us that can be valuable and just plain fun. While you’re at your school’s town, try to find interesting things to be a part of. Join a community soccer or basketball league, join a local band, get more involved in a church or any of the other countless local organizations that are there all year around. While these experiences can be beneficial to put on a CV, they will also be fun moments you can look back on fondly. Just because you’re in summer school doesn’t mean you shouldn’t enjoy your summer.

5 Things to do After the Interview

Week 46 of  the PreMed Mondays book covers 5 things to do after your interview!  Here’s the deal, your job ins’t complete after the interview is over.  You’ve got a few things left to do in order to keep on impressing the school as well as making sure your can stay on track moving forward.  In this episode, we’ll cover 5 of those things!

Click HERE to register for our 3rd annual Application Boot Camp Webinar Series in partnership with SNMA

Premeds, find affordable services designed to help you get accepted into medical school at

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A Day in the Life of an AQuity Scribe – Aislinn

I have had the opportunity to scribe for Dr. Grace Lee in endocrinology and Dr. Kenneth Mancher in family medicine. Working with these two doctors has allowed to me learn about two interesting specialties and learn about different providers’ preferences.

I am no longer working with Dr. Lee, but I had a great experience scribing for her. I would prepare the patient’s chart through pulling forward the previous note, deleting the interim history, and updating the labs section. Dr. Lee preferred that I log onto Fluency for Scribes about 15 minutes before the shift in order to ensure additional pieces of information, such as recent surgeries, DEXA scans, and ultrasounds, were included. During each visit, I would input the HPI (history of present illness) and ROS (review of systems). Dr. Lee liked to provide thorough instructions for her patients, and I would often enter these into the Patient Instructions section. After the visit, we would review the physical exam, and Dr. Lee would dictate the assessment and plan.

With Dr. Mancher, I do not prepare the charts until the patient arrives. The notes are created using NoteWriter and the CPE (complete physical examination) or Return Visit templates. I add in the most recent labs and apply the default ROS and physical exam if applicable. During the visit, I fill in the HPI, enter the visit diagnoses, update the ROS and physical exam, write down EKG results dictated by Dr. Mancher, enter orders, and include detailed information in the Patient Instructions. There are also smart lists relating to health maintenance in the note, and I make selections based on what was discussed during the visit.

With both doctors, I have found it important to ask questions. They are usually more than happy to answer your questions, and it allows you to record the correct information. Working as a scribe for AQuity Solutions has allowed me to learn a lot about medicine, patient-physician relationships, and the electronic medical record.

(Aislynn lives in California and currently scribes remotely for a family medicine physician in Connecticut.) 

Finding Joy in Medicine

If you’re like most premeds, you’re a little concerned about what your lifestyle will be as a doctor. Surely, you’ve heard all the horror stories about doctors getting divorced, being unhappy, working 80+ hours a week. You love the idea of caring for human life but hate the idea of being miserable outside of the hospital. Can you have your cake & eat it too? To tell you the truth, I never understood that phrase. If I have some cake, of course I want to eat it! Well, I’m hear today to tell you that yes, you can have a great lifestyle and practice medicine. I’d say that most of my doctor friends are very happy with where they are in life. I know I am!

Media perpetuates negativity. It’s only been in the past 10 years or so that we’ve been hearing stories about how horrible it is to be a doctor. That lie is probably spreading so much because of social media. My reality is that being a physician is great. I wake up everyday excited that I get to care for patients. It’s one of the greatest joys of my life. However, as a doctor, that’s not all that I get to do, there’s so much more.

People ask why I chose to stay in academic medicine. “Don’t you want to make more money, why didn’t you take the private practice gig???” For me, it’s about so much more than the money. You can be happy in private practice or academia, you just need to find what fits you. My professional mission statement is to “Develop tomorrow’s leaders in medicine.” Achieving that brings me joy. While I can do that in private practice, it’s much easier for me to accomplish it when I’m surrounded by students and young doctors on a regular basis. It’s also important to understand that I am more than a doctor, and you will be too. I’m a person of faith, a husband, a dad, a son a sibling, a friend, a teacher, a coach, an innovator, an author, etc. It’s the culmination of all these things that make me wake up every morning excited to take on the world.

So, when considering if medicine is the right career for you, the first question to ask yourself is, “What is my professional mission statement?” Identify your professional purpose and find a career that will allow you to accomplish that purpose. Start with the end in mind. Don’t stress about the work hours, or medical school loans, or politics of medicine. There are ways to address all of those things. Your primary job is to identify your God-given mission. Once you know what that is, THEN figure out how you’re going to take it on!

For those of us doctors who have a clear understanding of our mission, being a physician is a dream come true, however it’s still just a part of who we are. We are more than doctors and know what we want out of life. To be happy, you must tend to all areas of your life that need attention.  That means finding a way to spend time in those areas.  Money is NOT everything.  I make the trade between money and time everyday.  Understanding the importance of spending time with people will make you happy.  Understanding that medicine is about helping people, will make you happy.  To find joy, your mission must focus on other people!  That’s the secret!

Do you have a professional mission statement? If so, please share it with us here. If not, spend some time thinking about it then share.

Five Questions to Ask Your Interviewer

Week 45 of  the PreMed Mondays book covers 5 questions for you to ask your interviewer.  A great way to really impress your interviewer is to be prepared to answer their question, “So what questions do you have for me?”  In this episode, I’ll go over 5 key questions that you can ask your interviewer.

Click HERE to register for our 3rd annual Application Boot Camp Webinar Series in partnership with SNMA

Premeds, find affordable services designed to help you get accepted into medical school at

Click HERE to subscribe to this podcast on iTunes!

Do not let people tell you  other wise 

I often been told that I cant docertain things because I’m not smart  enough. I started  to believe  them . I told my self that I would never get to my dream and I was nothing. one day I woke up and talked to a friend and told them  how I felt and they told me you wont know until you try. I thought about it and thought about it and then it hit me I came a long way a lot of up and downs. I am smart and strong enough to follow my dream. I maybe discouraged sometimes and it may take me a while to get back on the right track to reach my dream but that ok. I will get there and I will succeed. I wont stop and I wont give up till I get to the top.  Don’t let people tell you other wise you are smart and talented person. done let people get to you there are people out there that want to see you succeed and they are rooting for you. we are here to talk premed star has helped me believe  In myself and its a great way to meet people who is passionate about the same thing as you. I hope this encouraged you. 

Getting into Med School with Subpar Scores

It doesn’t seem very fair when you look at it on paper but there is a lot more to an applicant than numbers. So how does John get into medical school with a 3.2 GPA and 500 MCAT while “Mr. 4.0 GPA”, Chris over here doesn’t get in? There are many reasons why this may be the case but at the end of the day, John likely was vouched for while Chris was lost in the 50,000 plus applicant pool. This is all about the “N” in Dr. Dale’s Premed G.R.I.N.D. technique. It is very easy to get stuck on the numbers but sometimes schools see something in a student which makes them confident that that student will be a great physician. In fact, sometimes it only takes 1 person to believe in you and vouch for your success. Because some schools will only interview students above a certain GPA cutoff, it is important that students with low scores find a way to present themselves to schools. These are a few tips, John used to get the edge over the higher scoring Chris:

The applicant pool. It is not always those with top scores who are selected.

1. Attend National Conferences

I personally missed out on this one. As a premed, I was so focused on my books and extracurricular activities that I didn’t take time to attend any national conferences. I didn’t know that there were scholarships one could get to attend and present at these conferences. Some students had sponsors assist them with their trips. I have since been to a number of these conferences and have been amazed by the growing number of premeds that attend them every year. I have yet to hear a premed student tell me that attending a national conference wasn’t one of their best experiences. It is not good enough to just attend the conference and hang out with your friends. Use these conferences to spark connections with physicians, recruiters, med students and your peers. I’ve met a number of students on this site at conferences and many have stayed in touch.

2. Befriend Med Students

Medical students can be your biggest proponents on your premed journey if you allow them. As a medical, student I had a few premeds who slowly became my friend. I supported those that I genuinely liked and a couple of them eventually made it to medical school even with poor grades. I was able to give them advice that helped them tremendously. I informed them of the right staff to talk with and important functions to attend. A few premed students would show up to our soul food Sunday brunch held by our SNMA organization (which I served as Vice President) and some would show up to our annual “meet the faculty” event held at the home of an attending. There was no better way to network than this.

3. Attend Mission Trips

I never took advantage of this as a premed student but I rank this towards the top on my list of premed extracurricular activities. This is an amazing way to gain clinical experience and also a great way to network with a medical team. The best way to learn about yourself and for others to learn about you is when you are placed under stress working with those who are less privileged. There are few ways to get hands on experience and really feel like a doctor than going on a mission trip. It will hopefully reinvigorate you and allow you to form unbreakable bonds. The doctor you work with will be an excellent person to write a solid letter of recommendation.

4. Speak to Recruiters

Recruiters want to hear from students. They want to chat with students of diverse backgrounds that fit well with their program. After years of mentoring premed students, we witnessed way too many awesome premeds fail to make it to medical school. Many times those students could not make it to conferences to meet with recruiters and network with doctors. This is why we put in the blood and sweat creating this website so students can connect with recruiters, showcase themselves and learn about their schools. Many students have taken advantage of this and I hope others do the same. Whether it is at a conference or online, recruiters want to be reached. They don’t bite. They just may offer you amazing opportunities you could not get elsewhere.

5. Visit Schools

Would you believe that a student on this site contacted a recruiter and landed a personal tour date? The student was able to visit the campus and learn about it before applying to medical school. It was a great experience and that student left a strong impression on the recruiter. Why not sit in on a grand rounds session, attend morning conference or even a med student lecture if you are allowed. This is the way some premeds go above and beyond. This is how John made it to medical school while Chris spent his time in the library all day.

Whether your scores are stellar or not, as a premed you are in a pool of 53,000 applicants with amazing credentials. These tips can be the difference between getting into medical school and being buried in the pile. Don’t just sit back and expect your numbers and experiences to get you in. Be proactive, make the connections, and start today.  

Do you have any other tips for your peers? I would love to hear from you?


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