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According to Nagi Maehashi’s recipe website, you should never soak, or even rinse, basmati rice before cooking because doing so “makes it waterlogged and makes a mushy rice problem”. And use a rice-to-water ratio of 1:1.5—more water makes the mushy rice problem even worse. Finally, “do not fluff with fork since this will break the long grains”.

On the other hand, Suzy Karadsheh’s website says, “Rinse basmati rice very well before cooking. This will help remove starch from the surface of the grains, which is what makes the rice sticky and gummy.” After cooking is complete, “fluff the rice with a fork and enjoy!”

And the BBC cooking website goes even further than Suzy in challenging Nagi Maehashi. It says that not only is it essential to soak basmati rice for at least 30 minutes prior to rinsing, but to use a rice-to-water ratio of 1:2. And it agrees with Suzy that the rice should be fluffed with a fork. All three websites say that following their recipe is key to producing a tender, non-mushy product.

So here we have directly conflicting instructions on how to make a perfect pot of rice. To soak or not to soak? To rinse or not to rinse? To fluff or not to fluff? What’s a poor cook to do?

This recipe discrepancy is, of course, just one example of the contradictory advice we’re offered every day:

• Ice a sprain. No!–not a good idea. Icing decreases blood flow, which retards healing.
• Rinse dishes before putting them in the dishwasher. No!–they get cleaner if you don’t rinse them since the dishwasher detergent is activated by food residue.
• Wait at least half an hour after eating before swimming. No!–at least an hour. No!–that’s an old spouse’s tale. It’s totally fine to go into the water right after a meal.
• Stretching before working out prevents injuries. No!–stretching before exercise in fact increases the chance of injury; you should stretch after the workout is completed.
• Take a shower first thing in the morning to set yourself up for the day. No!–it’s really better to shower before you go to bed so that you deposit less skin debris and bacteria on the sheets.
• Paint the wall before you paint the trim. No!–it’s absolutely better to paint the trim first.
• Floss before you brush. Actually no–Good oral hygiene requires flossing after brushing.
• Drink at least eight glasses of water a day. No!–drinking that much water is unnecessary, and can have deleterious side-effects.

What are we to make of such discordant advice? Each recommendation seems authoritative. But is it really based on credible evidence? Or is the person offering their wisdom simply carrying forward what they were taught by their grandmother?

What we are told sticks. As the Nobel prize-winning psychologist Daniel Kahneman said, “A reliable way to make people believe in falsehoods is frequent repetition, because familiarity is not easily distinguished from truth.” So the more we hear a piece of advice, whether actually true or not, the more we’re apt to heed it.

To cite an example, despite what we were all taught about the dangers of swimming on a full stomach, there are no documented cases of anyone drowning as a result of entering the water immediately after eating. Even the conservative Mayo clinic says that there’s no need to wait after a meal. Yet, because this belief has been so widely repeated, I suspect that after hearing the facts even the most rational parent might feel a little queasy telling Jimmy that it’s fine to hit the waves right after the picnic lunch.

Of course it’s not harmful to require a respite before swimming, except for having to deal with postprandial pediatric impatience. And in most cases, it probably doesn’t much matter whether we consciously drink lots of water, or not so much. And it seems unlikely that there would be serious hygienic consequences from showering at a suboptimal time of day.

But maybe, for at least some things, it actually does matter. I really do want to know how best to treat a sprain so my recovery will be as quick as possible. And in my view, there’s no doubt that following the admonitions of anti-vaxxers could have harmful consequences.

So if we really want to know which advice is best, what can we do? In most cases, not much. Even though a great deal of my professional life has been devoted to designing randomized clinical trials to determine whether one treatment is better than another, I’m unlikely to floss before brushing for six months, ask my dentist to rate my oral hygiene, then reverse the procedure for the next six months. And I’m certainly not going to intentionally sprain both ankles, ice one and not the other, and compare outcomes.

There’s little motivation to change longstanding ways of doing things. I’ve always painted the walls before the trim—if it wasn’t my grandmother who told me that this was the right sequence, I guess someone else must have. But I recently read on a seemingly authoritative painting website that it’s actually best to do the trim first. So will I try it when I paint the small bedroom next week? I doubt it.

We simply have to accept that we can’t live all aspects of our lives optimally. Figuring out how to do that would be too costly. And anyway, in most cases we probably wouldn’t gain enough to make the effort worthwhile.

So what about the basmati? Well for no particular reason I borrowed from each of the recipes. I rinsed the rice, but didn’t soak it. My rice:water ratio was 1:1.5, And after cooking I didn’t fluff it. How’d it turn out? It was just fine. Would it have been even better if I hadn’t rinsed it, or if I’d soaked it for 30 minutes, or added more water, or fork-fluffed? Could be. But next time I’ll probably make it just the same way.

I kept in touch with only a few of my college buddies. But no matter where we were living, fifteen years after graduation I was still in regular contact with Jamie. One day when I was living in North Carolina and he was in Chicago, I got a letter from Jamie—this was before the days of email. He wrote that his mother had been diagnosed with colon cancer. By then I was a gastroenterologist. So my reply focused on technical questions related to the diagnosis: What was the cell type? What imaging had they done? How had it been staged? Though I don’t recall, my guess is that I said little in the way of condolence or support. Naturally, Jamie’s news resonated with my mother’s cancer death when I was fourteen years old–it was uncomfortable to face.

Several years after she underwent surgery and chemo all his mother’s tests were negative. We both breathed a sigh of relief. But later, about five years after her initial diagnosis, I got a letter from Jamie saying that his mother’s cancer had returned. Not long after that he wrote that she had died. Even though this was now decades after my mother’s death, it triggered very unsettling feelings, which I tried to shut down by not thinking about Jamie’s news. When I did consider replying I couldn’t figure out what to say that would be sensitive and helpful. Whatever I came up with seemed trite (“Dear Jamie, I was saddened to hear of your mother’s recent passing…”). So I kept putting off a response. And putting it off. Finally, after about six weeks of silence I sent him a tepid letter. But I felt intense shame for the long delay–as one of Jamie’s closest friends, as well as a physician whose own mother had died of cancer, I was in a special position to give him really meaningful support. And I hadn’t.

Jamie never responded. I presumed it was because he was justifiably angry that I’d taken so long to acknowledge his loss. And I was too humiliated to write again. So we lost touch. For the first time in many years I didn’t know where Jamie lived, or what he was doing. I really missed him.

This lack of communication went on for ten long years. During this time my wife and I had a child, I changed jobs, and we moved to London, and later to France. So much had happened; I longed to be in touch again. By then email had come into wide use. So one day I took a deep breath, and after a quick internet search tracked him down.

I sent a short note to his email address, expressing regret that we’d lost touch and said I’d like to resume communicating. He responded right away. It was a bit awkward at first, but soon we were friends again, and together mourned the missing decade. There was of course a lot of catching up to do. Now, years after our reconnection, we’re still uncovering things we didn’t know about each other during that time.

What I learned from this painful experience changed my life. I vowed never again to let anyone down the way I’d let Jamie down. So now when I receive a message of loss or any other kind of distress–which is happening more and more as I get older–I endeavor to reply promptly. Even if my sentiment isn’t perfect, I know that the person who reached out to me will appreciate that someone is thinking of them and, however awkwardly, recognizing their pain.

If I’m in the middle of something else, or need time to gather my thoughts, I still try to answer quickly and say something like, “So sorry to hear your news! I’m thinking of you and will get back to you soon.” And then I do. That very few people acknowledged my loss after my mother’s death led me to feel isolated and ignored. And I’m sure that Jamie felt the same way when I, one of his best friends, didn’t get back to him. It’s now clear to me that simply making a timely connection and expressing concern is much more important than crafting perfect sentences.

Lately I’ve generalized this philosophy: I now try to rapidly get back to everyone who contacts me, even if there’s no particular pain or trauma motivating their communication. Putting off answering means that the email is apt to get buried in my inbox and forgotten. I believe that people who have taken the time to contact me are on some level wanting to connect. It’s heartwarming to see how meaningful a quick reply can be to the recipient—I think it helps people feel valued.

By promptly responding to people who reach out to me, especially those who are in distress, I’m honoring Jamie, honoring my mother’s memory, and perhaps especially honoring my 14-year-old lonely self. It’s a good feeling all the way around.

Note: Some unimportant details were changed to preserve Jamie’s privacy.

After my morning shower I grab the squeegee and carefully scrape down all the surfaces. The theory is that this will lead to less water spotting and perhaps prevent mold growth. But as I scraped away the other day (an activity I find quite burdensome) I wondered if I was actually doing anything useful. On rare occasions when I don’t squeegee, say because I’m running late for a ferry, I have to admit I don’t notice any water spots the next day. And since we have a good vent fan, the shower room seems to dry out pretty quickly. Do I really need to worry about either mold or water spots?

And speaking of showers, is it really necessary to take one every day, as I’ve done for many years? I recently read a commentary by a dermatologist who said that daily showering is quite unnecessary, and in fact is probably a bad idea since it tends to dry out the skin. And besides, it wastes water. And I recall a provocative commentary by another physician who said that he never takes a shower unless he’s visibly dirty. Yikes! He claims that he remains in excellent health, has supple skin and non-greasy hair, and doesn’t broadcast any unpleasant odors, at least according to his wife.

Despite the lack of evidence that daily showers with post-shower squeegeeing are appropriate, I continue with this ingrained routine. Perhaps for no better reason than that I enjoy showering (though not squeegeeing). I certainly can’t defend my behavior on any rational grounds. But I do it anyway.

Now that I’ve admitted my culpability in behaving irrationally, I feel I’ve immunized myself against being accused of being judgmental when I cite examples of things other people do without good reason. I might start by mentioning folks who are grimly determined to drink at least eight glasses of water a day. This, despite that apart from unusual circumstances (for example, hard exercise when it’s very hot outside) there’s absolutely no evidence that drinking fluid, other than when you’re thirsty, is of any benefit. In fact, there are several studies that suggest that drinking extra water is actually not wise. Some water guzzlers believe that inducing more frequent urination is useful since it “flushes toxins” out of the system. Such people should know that it’s well-established that peeing more does not eliminate more toxins. It just dilutes the same amount of toxins that the kidney excretes regardless of fluid intake. But will I tell all this to people I see schlepping around those huge Nalgene water bottles wherever they go? Of course not. That would have about as much effect as someone suggesting that I change my unnecessary and wasteful showering behavior. They’ll do it anyway.

On the other extreme, there are people who refrain from drinking any liquids at all during a meal because of their belief that doing so will “dilute the enzymes” in their stomach, impairing the digestion of their food. I won’t go into all the reasons why this is simply not true but will just say that it’s a quite unnecessary restriction. As opposed to glugging eight glasses of water throughout the day, drinking some liquids during a meal can be pleasurable, helps the food go down, quenches thirst, and, if anything, is likely to enhance digestion. But would I ever try to convince believers that they are needlessly limiting themselves by foregoing liquid while they eat? Of course not. They’ll do it anyway.

Then there’s gluten. Only one or at most two percent of people actually have “gluten-sensitive enteropathy,” as we in the GI biz call it, or as it’s better known, “celiac disease.” But a far higher proportion believe they have adverse reactions to gluten (“non-celiac gluten sensitivity”). Symptoms include not only abdominal pain and nausea but diarrhea (for some), constipation (for others), brain fog, headaches, anxiety, depression, fatigue, joint pain, and rashes, to name a few. As opposed to celiac disease, there are no blood or tissue tests to confirm the presence of non-celiac gluten sensitivity. It’s a do-it-yourself diagnosis depending simply on the person’s belief that they’re sensitive to gluten. I won’t go into all the reasons why non-celiacs who say they are sensitive to gluten are very likely actually not. I’d just point out that people who claim gluten sensitivity generally experience symptoms only when they know that they’ve eaten the stuff. In “blinded food challenge studies,” subjects are randomly given either regular bread, or similar-appearing bread made without gluten. Almost without exception, people who are certain they are sensitive to gluten can’t distinguish which version of bread they’ve eaten based on subsequent symptoms. Despite all the evidence, I’d never suggest to a person who eschews gluten to give it a try. They’ll continue to avoid it anyway.

Continuing on the food theme, we make rice two or three times each week in our beloved Zojirushi rice steamer. It makes great rice. Along with other fans, we affectionately refer to our appliance as “The Zoji.” When we first got it I watched a Zoji video about how to prepare rice for cooking. After putting a carefully measured portion rice in the special pot, you are to quickly rinse and drain it three times. Then stir the rice vigorously with your clawed fingers (ten circuits clockwise, then counterclockwise, then again ten clockwise), then rinse it, and repeat this finger stirring a total of three times. But you’re still not done—this sequence is followed by three more non-stirred rinses. The idea, say the Zoji mavens, is to wash out as much of the husk fragments as possible, which enhances the quality of the cooked rice. So even though it’s tedious, I’ve followed this recipe for years. Occasionally I’ve heretically wondered whether such a carry on is really necessary. Indeed, when my wife makes rice she’s much less compulsive than I am, just giving it a quick rinse once or twice, then chucking it into the Zoji. And I have to admit, her rice doesn’t seem at all inferior to the rice I so carefully prepare. But does this alter my rinsing behavior? Alas, no. If the Zoji pros tell me how I should wash rice, how can I defy them? I do it anyway.

So there’s copious evidence that I and many—probably most—of my fellow humans do things that are unnecessary, irrational, or both. I wonder how much time we waste over the course of our lives, and how much aggravation we self-inflict, by adhering to such needless routines. But alas, the combination of belief and habit is very potent–they work in concert to sustain behaviors, no matter how irrational. Moreover, I do appreciate that there’s a place for rituals in our lives. They help stitch the day together, and can give order and comfort. But if they aren’t altogether pleasant, and if they involve unwelcome time and effort, there’s reason to examine them and see if they’re really worth continuing.

The good news is that occasionally such behaviors are actually changeable. Here’s one tiny example: for years before starting a fire in our wood stove, I opened a window. The theory was that doing so increased ventilation into the stove, making the fire start more readily. But a few months ago, in my haste to warm up the house on a particularly cold morning, I forgot to open a window. Nonetheless, the fire started just fine; in short order the house was warm and toasty. So guess what? Now I never open a window before firing up the stove. This is not only a little time saver, but it means I don’t have to remember to close the window once the fire is blazing, which I often forgot to do, letting lots of precious warm air escape.

Eliminating behavior that’s irrational, or simply unnecessary, can save time, and sometimes really improve the quality of life. Maybe we should all examine some of the things we do that are bothersome or time consuming, and consider whether there’s really good reason for us to persist. And then make a change and see what happens: Dare to eat a slice of toast. Leave that Nalgene home. Drink a nice glass of water with dinner. Speaking for myself, I’m not yet ready to stop showering daily, but maybe I’ll try cutting down the squeegee use to every other day. And even rinse the rice a bit less assiduously. No telling what I’ll do with all the extra time.

“Why do anything at all?” my daughter asked. Though it was a very reasonable question it still startled me since I’d not considered that option. We were standing at the bottom of the set of steps that led to the upper garden area (“the back forty,” we called it). The twenty steps were made of old railroad ties in the front with gravelly soil overgrown with weeds behind them. My idea was to dig out the soil behind the ties to a depth of about 5 inches, lay down landscaping fabric, then fill the holes with fresh gravel.

As Emily aptly pointed out, this scheme would involve a great deal of work. A much easier alternative would be to simply pull the weeds. But as we agreed, that would be a very temporary fix because the weeds were embedded in hard dirt and gravel. Thus they couldn’t be cleanly removed and would begin to grow back as soon as they were plucked. My plan of deep excavation-and-replacement would be a more satisfying long-term solution. But still, the weeds would inevitably return. So why do anything at all? Particularly since despite the luxuriant crop of weeds, the steps were quite easy to negotiate.

Emily shrugged and wandered off. Simply doing nothing seemed the rational and appealing course. While contemplating doing nothing, I picked up my shovel and gave it a few hefts. Then I idly poked at the dirt and started digging into step number one. I found myself getting into a pleasing rhythm. There was something unexpectedly satisfying about biting into the gravelly dirt, extracting a little weed village, and chucking it into the nearby wheelbarrow with a resounding thunk.

Then, to my surprise, I decided to activate my initial plan, and resolved to do two steps a day. The more I did, the more compelling the process became. In fact, after finishing the big dig behind the railroad tie of the second step, I found I couldn’t stop. Up came the weedy soil of step number three, then four, then five. And in addition to the digging, I found unexpected pleasure in maneuvering the loaded wheelbarrow into the woods and tipping out its contents to fill a convenient depression in the earth. I thought about how the foreign material would settle into its new home and become a breeding ground for the adherent weeds, soon becoming indistinguishable from the earth around it.

So I dug and I dug. After several hours of steady shoveling, I suddenly realized that all twenty steps had been mined. But I still couldn’t stop. Now it was time to begin filling in the pits behind the railroad ties. First, I had to put down the landscaping cloth to prevent weeds from creeping up from below. So I unrolled the cloth on the front deck, and with a chalk stub sketched out the area I wanted to cover. It was so quiet that I could hear the scratch of the chalk as I drew it across the black fabric. Then, as I cut along the line, a gentle puff of white dust was thrown up, which delighted me. The scissors made a soft honking noise, which rhymed with the sound the Canada geese down by the water. As I drew and cut, I felt a deep sense of peace.

Reverently, I placed the fitted cloth at the bottom of the first step. Then I grabbed two plastic buckets and filled them with ¼ minus basalt gravel, which was waiting for me in the driveway, in the bed of my pickup. With some effort I lugged the heavy buckets back to the steps, poured their contents into the hole, and repeated the process until the gravel was level with the wood in front of it. Carrying those buckets back and forth reminded me of my time doing medical work at a refugee camp in northern Uganda. Throughout the day there was a steady procession of people transporting incredibly heavy buckets of water for several kilometers, from a well back to their tents. Of course, the buckets were far heavier than mine, only women did this work, and the women often carried them on their heads. While toting the gravel I was somehow communing with those hard-working women. And felt in awe of them.

I cut more cloth, carried more gravel, and filled more holes. After finishing step number six I was getting pretty hungry, so finally stopped. The waiting dinner, made by my sweet wife, was delicious, and I went to bed feeling quite satisfied.

The next morning, after a quick breakfast I was back at the steps. The routine was now very familiar, and the rhythm of the work even more pleasing. By midday the job was done. The weedy steps had been transformed into smooth, gray gravel behind dark wood. I marched up and down to test them out—lovely! Were the sleek, unform steps any easier to navigate than the former weedy ones? Well, no, not really. But was I still glad that I had done all the work? Absolutely.

So it turns out that my response to Emily’s question wasn’t rational. Doing nothing would have saved time, money, and blisters. But still. The work was very satisfying. It gave me good exercise and allowed me to commune with things I might otherwise have missed. I will long remember the sensations and feelings I experienced—the subtle sound of the scissors cutting the landscape cloth, and the puffs of ejected chalk dust as it was severed. Becoming aware of the honking geese. Feeling connected to those heroic Ugandan women toiling with their heavy buckets of water. And the sense of accomplishment as I regarded my twenty beautiful steps. Sometimes I think, it’s reasonable to do things that are completely unnecessary.

I’m a Woofer! Two years ago I took an intensive 5-day course to become a Wilderness First Responder (WFR), or “Woofer” as we affectionately call each other. We Woofers are trained to deal with injuries and illnesses in a “low resource environment,” such as a backpacking trip in the boonies, where proper medical care is a long way away. We learned what to do about fractures, heatstroke, third degree burns, dislocations, near drowning, spinal cord injuries, massive bleeds, and allergic reactions. Not to mention back country heart attacks, spider bites, and anaphylaxis.

In addition to classroom learning, the course included lots of simulations, culminating in a late-night final exam. In the exam we dealt with an MCI (mass casualty incident, just in case you didn’t know), in the deep woods of Fort Ward on Bainbridge Island. Turns out that a group of campers were peacefully sleeping in their tents at the base of a cliff when, in the middle of the night, there was a major rockslide. We Woofers-in-training were rushed to the scene. In the dark we had to locate the victims, who, despite their grave injuries, had somehow been able to leave their tents and scatter throughout the woods. Once we found them–their wounds highlighted by the fake blood that glistened in the light of our headlamps–we had to diagnose and treat the grisly injuries they had sustained. Fortunately, the patient with a spinal cord injury that I ministered to survived, and I passed the course.

Then just a few weeks ago I took a three-day refresher course to maintain my Woofer credentials. (Technically, I’m actually a “Wumper”—WUMP stands for “Wilderness Update for Medical Professionals”—but it comes down to the same thing.) This time the MCI was a serious earthquake. My poor victim was a 91-year-old woman (both in the script and in real life) who, while trying to escape a collapsing building, was impaled in her right chest by a three-foot length of rebar. She heroically, but unwisely, yanked out the rebar. Thus, when I found her, she was experiencing severe bleeding, shortness of breath, and a nasty sucking chest wound. Once again, I was fortunate to be able to stabilize her (and, along the way, confirm that her real pacemaker was still working properly), and passed the course. So I’ll continue to be a certified Woofer for the next two years.

Why, you might ask, did I decide to become a Woofer in the first place? No, I’m not planning to scale Mt Everest, or even do the Pacific Crest Trail. But I live well within rumbling distance of the Cascadia Fault. We’re told that a massive earthquake (Richter 9 or so) is overdue, and reasonably likely to occur sometime during the next fifty years. That is, The Big One could happen long after I’m gone. Or tomorrow. (Or, as in the simulation, a few weeks ago!) When it comes our island will be completely cut off from medical care—the ferries won’t be running, the bridge to the mainland will be in shambles, and there won’t be electricity, or even cell service. (That’s why a year ago I earned a ham license; now I have to get around to learning how to use my transceiver!)

So in anticipation of The Big One I joined the Bainbridge Island Medical Reserve Corps, and became a Woofer to boot. After the shaking stops, I’m to report to our local “disaster hub”, one of twelve on the island. My hub is at the Seabold Church, about 0.8 miles from our home. It should be an easy walk, assuming I’m able to hop over all the fissures in the earth en route. At the church, where there’s a big trailer stocked with all sorts of medical supplies and emergency gear, My fellow Woofers and I should be in a position to treat earthquake-related injuries as well as chronic health conditions.

But even if the hubs are activated in my lifetime, the things I’m likely to deal with compromise only a small part of the skills I was taught in Woofer Academy. What about all the other things I learned and was tested on? The chance of my ever needing to care for a scorpion sting is about on par with the chance of my having to treat someone struck by lightning. So I wonder: what was the point of spending so much time, energy, and money learning stuff I’m very unlikely to ever use?

Here’s my answer, or perhaps rationale, for becoming a Woofer: First of all, it’s quite possible that a disaster, natural or man-made will in fact occur when I’m in a position to help. As a physician I’d feel terrible if I had no relevant skills and just stood around helplessly while people were suffering. So even if most of my Woofer learnings won’t be called upon, and even if I recalled only some of the useful ones, I might be able to help someone who otherwise would receive no assistance. Second, there’s pleasure in learning new things, or relearning old ones, even if they aren’t of practical use. Third, ya never know! Though I doubt that I’ll ever find myself trekking across the desert and encountering someone with heatstroke or strolling atop a glacier and stumbling over a person with frostbitten toes, other situations may arise where what I’ve learned could help. In fact, just a few months ago there was an announcement on the ferry for any medical personnel on board to report to the second mate’s office. I did, and was led to the bottom of the staircase that went down to the car deck. A man had tripped and fallen, sustaining some nasty facial lacerations (this time the blood was real). I was able to help check him out and, when a crew member appeared with a medical kit, stabilize him until the boat docked in Seattle and the EMT crew came aboard and took over. It felt good to be able to give my sudden patient help and reassurance.

The Big One might not occur in my lifetime, and the hubs may never be activated. Thus, I may never be called on to apply a tourniquet to stop a radial artery bleed, or start an IV to treat serious dehydration, or splint a fractured tibia. But there’s still a great deal of satisfaction in knowing how to do these things, whether I’ll ever use them or not. I’m glad that I’m a Woofer