Why your ER Doc won’t shut up about Prevention
“Is this bad, doc?”
I hear some version of that question almost every shift. Chest pain at 3 a.m., a blood pressure of 220/110, a glucose so high the lab can’t read it, a teenager who can’t breathe.
By the time people land in the Emergency Department, the house is already on fire. My job is to keep it from burning down completely.
But here’s the part nobody sees: so many of these emergencies started years ago. High blood pressure that never got checked. Sleep that was sacrificed for emails. “I’ll start exercising when things slow down.” A diet that quietly shifted from food to food-like products.
That’s why an emergency physician—whose entire career is built around “sick today” problems—is here to talk to you about prevention and longevity.
What are we actually trying to do?
Let’s define the game we’re playing.
Longevity isn’t about living forever. It’s about:
• Fewer bad days – fewer strokes, heart attacks, ICU stays.
• More good decades – being able to walk, think, laugh, and do the stuff you care about deep into your 70s, 80s and 90s..
From the Emergency Room side of the glass, the “big four” we see over and over again are:
• Heart disease
• Stroke
• Complications of diabetes
• End-stage lung disease
The risk for all of these is shaped (not completely controlled, but heavily shaped) by the same boring-sounding things:
What you eat, how you move, how you sleep, how you handle stress, and how you work with your doctor.
Which is what I refer to as Tier 1.
Then there’s a bunch of shiny, fun, Instagram-friendly stuff:
• Supplements
• Protein powders
• Creatine
• Saunas
• Cold plunges
That’s Tier 2. It’s not useless, and some of it is genuinely helpful. But if Tier 1 is on fire, Tier 2 is like rearranging the cushions on a burning couch.
The Tier 1 vs Tier 2 framework
Think of your health like building a house:
Tier 1: Foundations & frame
• Diet – what you put in your body 3–5 times a day
• Exercise – how often you ask your heart, muscles, and lungs to do something useful
• Sleep – whether your brain and body get a nightly reset
• Meditation and tools for managing stress – how good are you at switching off the “fight or flight” response
• Working with your doctor – do you have someone in your corner, checking your blood pressure, your labs, prescribing and managing your meds, and screening you for disease.
Tier 2: Fixtures & upgrades
• Supplements – vitamins, minerals, a few specific compounds
• Protein & creatine – targeted tools for muscle, bone, and potentially for the brain
• Cold plunges & sauna – thermal stress that has interesting effects
The internet often reverses these tiers. You’ll see a reel about a 3-minute cold plunge before you see someone calmly walking through how to actually lower your blood pressure.
This series will intentionally flip it back the right way and we will walk you through the blueprint for healthy living, without the sensationalist fluff. So that you don’t have to see me on your worst day in the Emergency Room.
30,000 ft view – Why an ER doc cares
From 30,000 feet, three truths show up again and again:
1. Most of what kills and disables us in wealthy countries is slow, not sudden. “All of a sudden he had a heart attack” almost always sits on years of blood pressure, lipids, smoke, sleep, and stress.
2. Small changes, repeated, are more powerful than big changes, abandoned. I would rather you walk 10 minutes every day than run 10 km once a month.
3. You don’t have to be perfect, just consistently “pretty good.” The body is incredibly forgiving if you give it half a chance.
As an emergency doctor, I’m never going to tell you that lifestyle fixes everything. Genetics, trauma, bad luck—these are real. But from what I see at 2 a.m., there is a huge middle zone where different choices, over time, mean different futures.
How should this modify your life?
For now, I don’t want you to overhaul your entire life. I want you to see the map.
1. Adopt the Tier 1 / Tier 2 lens.
Any time you see a health hack, ask: “Is this fixing my foundations or adding a fancy light fitting?”
2. Pick one Tier 1 area that feels most changeable.
Easiest to start with? Diet / walking / bedtime / breath work / doctor check-in. We’ll dive into each of these over the coming weeks.
3. Make this one commitment:
“For the next 4 weeks, I’ll focus on building one Tier 1 habit, not chasing Tier 2 hacks.”
This series will build you a practical playbook. By the end, you’ll be able to say, “Here’s my plan for diet, movement, sleep, stress, and medical care—and then here’s how I’m choosing to layer in supplements, sauna, or cold exposure.”
Extend yourself – Where we’re going next
Over the next few posts, we’ll walk through:
• How food behaves like a first-line drug in your body
• The minimum effective dose of exercise for long-term health
• What to do about sleep when your life does not look like a wellness retreat
• Simple tools for turning down your stress system
• How to use your doctor as a teammate, not a judge
Then we’ll talk about the “fun toys” with a clear, honest evidence lens.
If you want to go deeper, bring one question to mind: “If I keep living exactly like this for the next 10 years, where am I likely to end up?” We’ll start answering that together next week, with food.
