“Americans don’t lose weight.” This was the favorite tagline of a gastroenterologist I shadowed as a second-year medical student. In the few hours I spent with him, he seemed to have a defeatist attitude towards the potential that patients have in caring for themselves. Unfortunately, I do not believe this physician is alone in his thoughts.
The allopathic medical education culture lends itself to treat people with medications and surgeries. Each fresh crop of students is taught by seasoned clinicians and are informed about the latest drugs and procedures, the studies showing their efficacy, side effects and even costs. A significant portion of our class time is devoted to this, and ultimately, as students, this is what we take away when we see patients. While our curriculum also includes a fair amount of psychology, counseling, nutrition, public health and lifestyle modification information, the application of these lectures is significantly less than the purely scientific medicine we are taught. The reason for this cannot be attributed to the lecturers, as they are equally enthusiastic and clear in their delivery. Rather, I believe there are two major causes why doctors apply preventive medicine far less:
- The allopathic community prides itself on evidence-based medicine (read: pharmacotherapy) and would rather refer the “touchy-feely” aspect of medicine to others (psychologists, social workers, dietitians, and so forth).
- So much of our education and doctoring style come from watching other physicians who halfheartedly delve into the patient’s lifestyle. “Eat low fat and exercise a few times a week.”
While this is the status quo of medicine, there are physicians who approach patient care in an alternate way. One such physician, Dr. P., is a doctor who I have recently shadowed. Dr. P does the usual primary care physician thing: listens to the patient complaint, goes over labs and reviews the chart. The unique aspect of his care is that in the 10 to 15 minutes he spends with a patient, 50 percent of it is addressing diet and exercise. His tactics include helping the patient develop a diet (carbs, fat, protein, calories and example meals), downloading a fitness app on their phone, printing them out an allowed foods list, writing an exercise prescription (heart rate, times per week, duration), and even shares his own experiences in lifestyle modification.
What is even more intriguing is that his time is well spent. I see the patients at their follow-up appointments, most showing marked empirical improvements in labs and yes, even weight loss. They rave about their health care provider, saying their lipid panel and HbA1c has never looked this positive, and they show real optimism in the future, inspired by what they have accomplished. I want to note that Dr. P is not a hippie doctor; he prescribes the necessary medications, refrains from weird supplements, and orders labs and imaging. He simply tackles lifestyle head on, something that many of us are embarrassed to do or are not prepared to do.
I grew up in an environment where naturopaths and homeopathy were scoffed at and “science,” particularly drugs and surgical procedures, were the way to health. As a technologically mindful chemical engineer, I could not be more in favor of these advancements and in no way am undermining the use of these interventions in modern medicine. Even now, I do not see myself becoming one of those alleged “alternative health” doctors, but I am attempting to give the intervention of diet and exercise the respect it deserves as a future allopathic medical professional. I feel very lucky to have shadowed a physician who practices what the community preaches.
I understand the hurdles of little time, modification familiarity, and skepticism in value that doctors likely feel when approaching lifestyle discussions. Nevertheless, this is an area in which the medical community could improve. In the educational setting, the classroom curriculum is up to the mark, but experiencing it in clinical practice is necessary for students to start incorporating the ideology in the real doctor-patient setting.
Americans may or may not lose weight, but they most definitely have the ability to make a positive impact on aspects of their health. As future physicians, we have the knowledge and the respect to guide patients to a more healthful life.