How Much Health Should Flow Through Your Smartphone?

We at KBGH get pitched a lot of apps. Apps for blood pressure, apps for blood sugars, apps for lab and imaging pricing. Lots of apps. In the roughly two years that the current staff has been at KBGH, I think pitches from outside companies have covered most of medicine in apps, save a few small nooks and crannies. I don’t think we’ve been pitched a fertility app yet, for example, but I might be mistaken. And this isn’t an ivory tower problem for us; we’re in on the creation of apps as well. We’re working with WSU’s College of Innovation & Design on a Rural Health Challenge to, in part, help connect rural patients with their doctors via technology. That technology may include smartphone apps since, according to a Cochrane review, there is “low-certainty evidence of the effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of [cardiovascular disease].”

But, as we’ve blogged about before, your computer or smartphone may not be the most direct route to a healthy, happy life. Excess time on devices, particularly that spent on social media, may be bad for us and may paradoxically exacerbate loneliness and isolation. So how much of our medical care should run through our phones? I’m generally optimistic about the future of telemedicine, but I’m pessimistic about the attention economy, in which companies are incentivized to grab increasingly big chunks of our time.

Regardless of my opinion, though, people have thought hard about what should go into a good medical application. Here are four elements paraphrased from Swiss investigators Kenny R. Lienhard and Christine Legne:

1. Mobile medical apps should guide a patient through every step of instruction, setup, clinical measurement, and analysis and feedback. Imagine that you just downloaded an app to your smartphone to help communicate blood pressures to your doctor. The app shouldn’t just tell you how to send the blood pressure. It should give you instructions on the technique for where to place the cuff. It should provide feedback if it senses your technique is wrong, like if different readings get very different results. It should help you analyze the numbers; if your blood pressure is consistently high or low, it should prompt you to talk to your doctor about it.

2. The user interface should be adapted to cope with patients’ physical and cognitive restrictions. This goes without saying. The American Medical Association (AMA) recommends that health care materials be written at or below a sixth-grade reading level. But the interface should also account for people with impaired vision or hearing or differences in dexterity, to name a few.

3. A mobile medical app should build on a robust medical knowledge base, ensuring an evidence-based approach to mobile app design. This one is tougher because most of us–present company included–don’t necessarily know the ins and outs of app design. But manufacturers can search out the best medical advice for many circumstances and account for those in the testing of the app.

4. Mobile medical apps should facilitate both patients’ and physicians’ routines. This is crucial, and it applies directly to work we’ve done at KBGH. It is great to get blood pressure results to your doctor. But it’s even better if the app, upon seeing those blood pressure results, can make a treatment recommendation to your doctor. We call this “decision support.” The app may give bad advice once in a while, like recommending a thiazide diuretic for a gout patient, but making more sophisticated decisions is what the doctor is there for.

What experiences have you had with medical apps? Let us know!

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.

Can We Trust Information on YouTube?

Once upon a time, in my academic career, I worried that inaccurate mass media depictions of, say, diabetics would cause people to make bad care choices. If you’re thinking of Julia Roberts in Steel Magnolias right now, trust me: Julia Roberts in Dolly Parton’s hair salon is the tippy-tip of the iceberg. Now I worry more about YouTube, the modern-day Library of Alexandria of instructional videos.

In the past year or so I have watched YouTube videos, off the top of my head, to learn to: change a blinker bulb in my car, fix my thermostat, learn to run specific reports within Quickbooks, refresh my memory on how to do certain math problems for helping with my daughter’s homework, and shut off the “move to wake” feature in my iPhone. And dozens more.

But I’ve also used YouTube in the past to remind myself how to reduce my son’s dislocated elbow (my son’s orthopedic history gets more complex by the year). There’s an old saying in medicine: “see one, do one, teach one.” I needed to “see one” again before I subjected my son to it. The procedure was successful, for what it’s worth. (Being a doctor’s kid is weird. I digress.) Are you scheduled to have your thyroid gland removed? YouTube can show you the procedure. Are you a new type 1 diabetic who wants to practice carbohydrate counting for insulin dosing? Boom. Starting chemotherapy and interested in using cooling therapy to reduce hair loss? Look no further. Recently we talked about the reliability of physician rating sites (spoiler: potentially useful, but with major caveats). How do YouTube videos stack up for general medical information? For the purposes of this post, I’m mostly ignoring obvious conspiracy-mongering about COVID vaccinations, cholesterol medications, and whatnot. Like pornography, I trust that you’ll know those when you see them.

To get an answer on the accuracy and utility of YouTube videos for medical inquiry, I looked not to YouTube, but to PubMed, the search engine of the National Library of Medicine. Here’s what I found:

YouTube contains so much information that investigators tend to categorize it by learner, generally either medical trainees or the general public. Videos for medical trainees seem to be relatively generously reviewed by researchers. Using our example of thyroid surgery from above, one study found that most YouTube thyroid surgery videos were posted by surgeons operating in academic institutions, which they took to mean the intentions of the videos were purely educational and not promotional. But the researchers also noted that surgeons who had no history of traditional academic publications–i.e., not necessarily the most respected people in the field–posted the majority of surgeon-sourced videos. This led the authors to conclude that “Trainees and educators alike should critically analyze the quality of video content,” which is the academic equivalent of throwing shade. A systematic review of studies of YouTube videos aimed at medical learners backed this up, concluding that “While videos authored by academic physicians were of higher quality on average, their quality still varied significantly,” and “Video characteristics and engagement metrics were found to be unreliable surrogate measures of video quality.” That is, a video’s slick production and millions of views did not mean it was accurate.

Videos aimed at the general public tend to be more harshly judged. One study by two emergency room doctors investigating the quality of videos pertaining to the management of low blood sugars went so far as to say that “health videos should only be uploaded by physicians,” a statement hilarious in both its confidence and its wrongness. Surely someone without a medical degree somewhere, at some point, has been filmed saying something accurate and helpful. But, in general, the quality of public-facing YouTube videos does appear to suffer in comparison to professional learner-directed videos. A systematic review from 2015, admittedly ancient history in internet years, concluded that “YouTube contains misleading information, primarily anecdotal, that contradicts the reference standards and the probability of a lay user finding such content is relatively high.” But, on the bright side, they also found that “videos from government organizations and professional associations contained trustworthy and high-quality information.” We at KBGH, who have produced and posted videos of our own, hope that we fall into that category.

Let’s bottom-line what we can take from this research. First, beware of any video that makes claims that seem extraordinary. Someone who says that removing a food from your diet is as powerful as taking cholesterol medications for preventing heart attacks, for example, better have good evidence to back that statement up. Second, pay attention to the source. Videos from academic centers, government agencies, and professional associations appear to be the most reliable. But they’re also, I suspect, the most conservative. Few such organizations are willing to put themselves out on a limb compared to their peers. Finally, beware of using the number of views or shares as a marker of the reliability of a video’s contents. As we’ve discussed before in this very blog, the internet is set up to make sure the most radical statements get the most eyeballs.

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.

Is “Social Media Hygiene” The Next Frontier In Workplace Wellness?

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH:

Social media takes up an inordinate amount of our time. A recent report by Activate Consulting found that, when multitasking with consumer internet and media activities are accounted for, the new “normal” day is 31.5 hours:

The amount of time we spend on these platforms is not likely to go down. According to that same Activate Consulting report, the number of social media networks an average person participates in is projected to almost double in the next four years, from 5.8 to 10.2 per user.

And in spite of snarky comments—many of them, yes, on social media—about the habits of millennials or Generation Z, it is Gen X workers in their forties and fifties who are the heaviest social media users, at almost seven hours per week, rising about 17 minutes per year.

All this virtual communication may be bad for us. Studies that are now several years old show that the more Facebook you use, the worse you are likely to feel. As anyone who has ever been accidentally pulled into an email argument that could have been solved with a single two-minute face-to-face conversation can tell you, in email and on social media in particular, we may abandon social norms in response to feedback from other users, since the algorithms that drive the platforms reward content that is highly emotionally charged. Tweets that use the greatest amount of moral-emotional language are the most likely to be retweeted or liked. Facebook posts that display not only disagreement, but indignant disagreement, are more likely to be liked or shared.

Why is this?

Researchers believe that virtual conversations lack the “advanced analogue cues” that in-person, video, or phone conversations have. Without clues like body language, tone of voice, and facial expressions, we have a hard time discerning the true intent or meaning behind innocuous statements.

What can be done?

A randomized trial by Stanford investigators showed that people who were paid to deactivate their Facebook accounts—as compared to people paid to continue their usual activity—were happier and reported increased well-being, decreased political polarization, and increased time spent with friends and family. And, presumably because of the drug-like effect of social media platforms, people who were paid to discontinue Facebook experienced apprehension at re-starting, just as a former smoker may be nervous about going outside around other smokers at break time.

But because of the strong network effect of social media, asking employees to cancel their accounts is probably unrealistic. Instead, we should look for healthier ways to use the platforms. After sifting through the mainstream medical literature, here are some of our tips:

1. Encourage your employees to use social media as a bridge to in-person connection and real experiences, preferably outdoors and definitely away from screens. Using social media this way to connect to other people you’ve lost touch with may even have profound professional benefits.

2. Create this bridge to in-person connection by changing the way you approach social media. Do not seek “likes.” Do not like other people’s posts, even though that may seem rude at first. Instead of passively scrolling through your Twitter, Instagram, or Facebook feed and hitting the “like” button, intentionally reach out to people. One study found that even one week of increased composed, directed social media posts to friends and family increased happiness. Another study compared this strategy to simply “liking” or sharing posts on Facebook. People who received targeted, composed messages from friends or family felt better; those who simply got “likes,” status updates, or shared posts experienced no change.

3. Encourage employees to enforce “sacred spaces” where no devices are used, in order to reclaim conversation and non-verbal advanced analog cues. At home this may mean the kitchen, the dining room, and the bedroom, since even the presence of a device on the table may alter conversations, and looking at bright screens before bed can disrupt sleep (to say nothing of sex). As technology researcher Sherri Turkle famously said, “The greatest favor you can do to your sister, mother, lover, professor, student, is put away your phone.”

4. While you’re at it, encourage employees to delete all social media apps from their phones and use social media only on a device they have to seek out, like a desktop computer. If that seems too severe a step, encourage them to go to their phone’s settings and kill notifications from all social media.

Are there strategies you’ve tried, either at home or in the workplace?  We’d love to hear them!

Links for Thursday, October 11, 2018: British cowboys, kickers so white, email owns us, and the heart of your toilet paper

British Rodeo Cowboy Association, you say?

Don’t mind if I do.

Damn near every kicker and punter in college football is white, even at historically black schools

The average user spends 5.6 hours per day on email

Close this window, turn off your device, and go ride your bike or take a walk or read a book or go to the library or call a friend or volunteer at a charity or write a letter or…

There’s not really a heartbeat inside that toilet paper roll. It’s just….science!

I still think fitness devices are overrated, fwiw, regardless of what the Community Guide says.

Links are back! (for now, at least): Tuesday, August 15, 2018

The Gravel Boom Could Save Road Biking's Soul

This is true, and mostly for the reasons Aaron Gulley lays out: fewer cars and an attitude of adventure rather than competition. None of the assholery that turns up at road races is present at the majority of gravel races, unless you count a few people trying to change it for the worse.

Gravel Rides Are Saving Small-Town America

I guess gravel riding is "saving" a lot of things today. "Saving" is too strong a word for the effect of gravel races on small towns; a couple hundred riders one or two days a year is nice, but I doubt if it pays for that new school library. But no doubt I have traveled to and spent money in a dozen towns over the last few years I would have completely bypassed if not for gravel racing.

Med students don't go to class. This is not a new phenomenon

I don't mean to pull any kind of hard work card, because people work hard in every imaginable job. But it's hard to overstate how precious your time is in med school. The volume of information is overwhelming, and even a good lecturer can't typically deliver the material in a time-efficient way. It's much easier just to look at other people's notes (as in note service in my day) or to watch the lecture via podcast or webcast at double speed later. And most professors just aren't good lecturers. Not even Nobel laureates. Maybe particularly not Nobel laureates; the skill set that makes a good investigator is far removed from the skill set of a good teacher.

What's interesting here is that the move to pass-fail grading systems--which I completely agree with--has made performance on the national "step" exams that much more important. This, according to Orly Nadell Farber, is what is driving the further diminution of attendance at lectures. My response to this is for NBME to stop giving step scores to residency program directors.

Doctors are pulling their hair out trying to get parents to limit screentime

U.S. kids get an average of over 7 hours daily in front of screens, almost all of it because increased use of smartphones, tablets, and other devices. Not that anyone who has seen a kid in a grocery cart at the store lately needs to be told that. Why is this important? Because the more time you spend zonked out in front of a television, the more fat you tend to have (what we five-dollar-word types call "adiposity”). And adiposity means bad things later on, like heart disease and diabetes.

So the American Heart Association is recommending--again--that children and teens to get no more than 1–2 hours of recreational screen time a day. They also warmed my heart by continuing to recommend against having screens, including phones, in bedrooms and while eating.

Riding is the answer

I own zero articles of Rapha clothing. But I love one little part of this video: at 48 seconds, the group rides by a couple staring at their phones. The contrast between life lived through a screen (like you're doing right now, probably) and life lived behind bars (the bars of a bicycle, that is) is brilliant.

Oh, and the song, Catamaran by Allah-Las, ain't too shabby, either. Happy Thursday. 

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. 

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*

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 20-23

Well. That did not go well. My Saturday was fine. I raced in the first race of the Rage Against the Chainring series, and finished 16/55 in the "B" race, about as good a result as I could have hoped for:

I spent precious little time on my phone Saturday, but I can't prove it since I deleted Moment over the weekend. I just couldn't handle the notifications, and I couldn't justify having the app without having it remind me to stay off my phone. So it's gonzo. 

Sunday, though, was tough. I started strong and left my phone in an inconspicuous place, and I did well staying away from it through the morning and early afternoon. I did fun things with real people, per Catherine's instructions. I didn't even get any Rubicon consults. Come evening, though, the seeding for the NCAA men's basketball tournament came down the tracks like a locomotive. And I just. Couldn't. Stop. Myself. from looking to see where my beloved Kansas State Wildcats ended up. I didn't even consciously cheat. I just walked by my phone and casually picked it up and tuned into the NCAA website:

Answer: on a collision course with a first-weekend exit. 

And once I'd peeked to see where the 'Cats were, I couldn't resist looking to see where the rest of the Big XII ended up, and then where Wichita State was seeded, and then a bunch of posts on The Ringer and ESPN about how easy the Xavier/UNC bracket was. I killed an hour, easy. On a day I was supposed to be phone-free. Sigh. 

But yesterday (Monday) was a new day. It was the first day of My New Relationship with my phone. Catherine told me to answer a series of questions she calls "See/Think/Feel/Wonder."

What did I observe (see) about myself and my behavior and emotions during my twenty-four-hour trial separation?

When I actually managed to keep away from my phone, say before and after the hours of 4-6 pm CST, I felt great. I did meaningful work around the house, I asked my kids questions, and I did the laundry in silence (sans podcast). I was a better person than I am with my phone distracting me. 

What do these observations make me think about? When I reflect back on my experience, what thoughts come into my mind?

I feel like, even after three weeks of conscious effort and months or years of half-assed behavior modification before that, I still have work to do. 

Now that i've made it through the Trial Separation, how do i feel about my phone itself, as well as my relationship with it?

I still feel like my phone is very, very valuable for specific tasks, like my to-do list, my calendar, and podcasts. And being a phone, of course, And texting, to a smaller extent. But the rest of my phone is an elaborately designed distraction device. It is definitely expendable for large swaths of the day. 

Now that I've completed the Trial Separation and begun to deeply observe my relationship with my phone, what do I wonder? What questions do I have? What do I want to know more about? What would I like to investigate further or look into more?

I wonder if I could really go back to having just a home phone and a paper planner, or if I could at least revert to a flip phone. I know it would cause me to carry a paper planner around, which would be a drag, but I already carry a notebook and pen most places, so it wouldn't be a big deal. I'd miss being able to coordinate my calendar with my wife. I'd miss getting my kids' school calendars automatically through Google on my phone. I'd like to investigate more how I could handle those issues through my work computer. 

What was the hardest part?

Finding the results of NCAA tournament bracket seeding in a house with no cable subscription, obviously. 

What was the best part?

I had several Beyblade battles with my son without the threat of phone interruptions. 

What surprised me?

I was surprised that I fell back into phone use so easily. It really disappointed me that I was so weak.

What did I learn from the experience that I can use once my official breakup is over?

If I really want to stay away from the device, it needs to be in a different room. It's that bad.

Day 23, Tuesday, today, was to Phast. Catherine said to pick a time today to take at least a half-hour break when my phone would be either unavailable or turned off. This was easy. I knew I had a couple high-level tasks to complete this morning before going to lunch and then going to KUSM-Wichita to teach at one pm. So I silenced my phone at 10 am and stuck it in my briefcase. I used a desktop computer to order Chipotle for carry-out. Then I sat down and ground out a couple hours' work on the use of the Diabetes Prevention Program for osteoarthritic pain. It felt great to work without interruption or distraction from my phone and to have something to show for the morning. 

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. 

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? Um...no. 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."

News

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

Blogs

• 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? 

FREEDOM was more like this:

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. 

Sincerely,

Justin