Medical Waste

27 Comments

Guest post written by: Anonymous

 

In my third year of medical school, I nearly failed one of the notoriously easier clerkships: family medicine.   My preceptor – a morbidly obese, overworked woman – had urged me repeatedly over the course of the six-week rotation to speed up my office visits.  She insisted that I cover the patient’s medication list, discuss their current problems, make sure that their chronic conditions have not worsened, do a focused physical exam, then get the heck out of the room.  Success in optimizing my life through food and exercise was the reason I was pursuing a career in primary care in the first place, as I hoped I could bring the same satisfaction to my patients, so I certainly had to say something to each of them about diet and physical activity.  Indeed, I felt it was my duty as a physician to address a patient’s health in a minimally invasive, cost-effective manner. Lifestyle modification fits that bill.

Despite this daily struggle, I figured that even she would have appreciated a bushy-tailed, bright-eyed medical student taking time to simplify the advantages of a gluten-free diet or the complications of adrenal fatigue.  Unfortunately, at the end of the rotation I opened her evaluation, and I was discouraged to find a near-failing grade and comments that read something like this:  ”He is friendly in patient interactions, but he spends too much time advising patients who clearly won’t benefit from diet and exercise recommendations.”

Patients who clearly won’t benefit?  Says who?

I will spare you the details of my thought process, but eventually, after a few more rotations, primary care was beaten out of me.   I decided to specialize.  I also started my own health coaching company which would give me an outlet to work with patients in a setting outside of my medical practice.  I realize that this is an unreasonable solution, and if every budding primary care physician (PCP) chose to the do the same preventative medicine would fly out the window.  The state of our health care system may require a solution developed outside of primary care in order achieve real change in the lives of patients, but getting physicians and other health care professionals on board will continue to pose a challenge.

The problem described in my story is multi-factorial:

1) Lifestyle modification is given little focus in medical school education.  

This is forgivable to some degree as the breadth of information that we are required to learn in medical school is tremendous.  I do not know where best to fit it into the curriculum.  However, there have been experiments nationwide with shortening the medical school curriculum to three years by eliminating the basic science courses for those planning to specialize.  Likewise, it has been suggested that the more specialized rotations be omitted for those who enter medical school intent upon a career in primary care.  We could alternatively re-direct the basic science courses to focus on the application of biochemistry and physiology in weight loss or disease management as a means of priming young physicians’ minds to think critically about these concepts.

2)  Physicians are pressed for time in office visits.

Doctors who do have the insight to look beyond the American Heart Association or American Diabetes Association for dietary recommendations may not have time to dedicate sufficient attention to the topic in the office.  The state of primary care mandates that PCPs overload their schedules daily in order to make ends meet.  This necessitates shortened visits, leaving little time to explore the reasons behind patients’ non-compliance and persistent illness.

3) Preaching lifestyle in an outpatient setting will not make you rich.

There is no billing code for teaching patients about the dangers of wheat.  Recent changes in our primary care model are responding to this issue by providing additional compensation to physicians who improve health outcomes, but the system is financially broke.  Many years of catch up will be required before such incentive programs will ever actually increase the appeal of drawn-out patient interactions.   Perhaps an incentive program based on health markers will lead to an increased demand for specialists in behavioral change and who have a good understanding of more effective nutritional principles  (e.g. health coaches, personal trainers, etc.).  These specialists can afford to spend the time with patients, neutralizing point #2 above.  Kicking some extra dollar signs to physicians that take the necessary steps to get their patients to lose weight or reverse their diabetes through healthy lifestyle modification will take some time, but it will probably help if we can devise a way to afford it.

4) Failure is becoming the norm.

Many patients have not found success in reducing their sugar intake.  Likewise, many physicians have not been successful in assisting patients in reducing sugar consumption.  Both of these assertions are partially to blame for the assumption that lifestyle modification can not work for the majority of patients.  Despite years of failure to help people lose weight or eat healthy, many physicians continue to push the same recommendations:  eat less, exercise more, count calories, etc.  Dieting is not supposed to be a daily battle between you and a slice of cake.  Anybody who has tried to simply eat less knows that it is not sustainable.  You will lose weight, but you will also feel like crap.  When patients are so used to failing at diets while their physicians are accustomed to seeing patients fail at adopting their recommendations, the topic seems to simply take a backseat at physician office visits.  That long heart-to-heart conversation about lifestyle modification is not happening.  My preceptor’s attitude suggests that she has tried and failed with many patients, and she no longer sees it as a valuable use of her time.  Maybe her approach failed because it was wrong all along?  It is time to find something that works better and then to revisit the conversation with patients that have failed in the past.

5) We give up too easily and blame others.

In line with item #4, we tend blame others when we fail.  Patients blame their physicians for not helping them.  Physicians blame their patients for not complying.  If a game plan fails, you have to scrap it and try something new.  The person to blame is the person that assumes that lifestyle modification is not useful in optimizing a person’s health.  Instead of pointing fingers at the health care industry, food industry, your physician, your patient, “that blogger guy”, or your mom, take a step back and consider what can be done to carry things forward.  Maybe one of these resources failed on your first shot at weight loss.  You can reliably blame your upbringing for the preconceptions you have about the world or many of the barriers to healthy habit formation that exist  in your life, but it is certainly 100% your fault if you choose to do nothing about it.  This goes to both dieters and health care professionals.

6) Health professionals can be hypocritical.

I used to live near a dialysis clinic in Pittsburgh.  Without fail, there would be at least one white coat standing out back smoking during all operational hours.  Likewise, physicians in my hospital regularly take the elevator down two floors to more expeditiously slam a piece of pizza down their throats.  I am generalizing, of course, but this behavior is certainly alarming.  Physicians claim that their stressful lives and difficult working hours prohibit healthy food choices and exercise habits.  If physicians can not develop healthy habits, how can we expect anything better from our patients, many of whom work the long hours without the big paycheck?

Human beings are adaptive organisms, and it is irresponsible for medical professionals to assume that our patients are incapable of adopting basic lifestyle modification.  If you casually tell a patient to “lose weight, start exercising” during their six-month office visit, it should be no surprise when they show up at the next visit heavier and sicker than before.  Take a step back and reconfigure your strategy.  There are volumes of clinical and anecdotal evidence out there to draw from in recommending specific foods and routines that could improve the life of a patient.  Unfortunately, the powers that be do not yet support many of them at an institutional level.  As a health care professional, patients look to you for guidance.  You are the role model for patients and future generations of medical professionals, thus it is your duty to use your extensive training in pathophysiology and biochemistry to weigh the evidence and explore all options rather than accept failure.

Lastly, for the love of Pete, do not give a failing grade to a budding physician for his efforts to initiate conversations with patients about diet and exercise.

 

The author prefers to remain anonymous.  He is a fourth year student at an accredited U.S. allopathic medical school.  He is currently in the process of applying to residency training programs in obstetrics and gynecology.  He is also a firm believer in the Paleo diet and primal lifestyle in general as a means of managing and preventing his patients’ and health coaching clients’ chronic ailments.

Leave A Comment

Comments

Comment using Facebook

Comment using RobbWolf.com

  1. Raphi
    September 26, 2013 at 5:51 am

    4) Failure is becoming the norm.

    Things is achingly true. I have come to conclude that except for miracles – like finding a smart paleo type doc – the laymen must genuinely becomes his own doctor, quite literally. The usefulness of 99% of docs I’ve met and heard of essentially comes down to the fact that they can get you ‘access’ to tests & drugs. They can be so much more though – frustrating to say the least.

  2. Amy B.
    September 26, 2013 at 9:30 am

    This is awesome! Thank you, soon-to-be Dr. Anonymous, for your honest perspective.

    About specialization — if anything, I think there should be *less* specialization in medicine. How can you be an effective cardiologist without understanding the fundamental influence the endocrine system has on the heart and vasculature (mostly via blood glucose & insulin dysregulation). How can you be an effective OBGYN without knowing more about estrogen, cortisol, & testosterone than the average endocrinologist? How can you be a great gerontologist without being steeped in how the modern food supply is a recipe for Alzheimer’s and arthritis? It’s all connected, and I’m discouraged that so many physicians (through their own volition or simply as a product of modern medical education) see only the trees and forget about the forest. (And don’t get me started on standards of care and treating numbers on a lab printout rather than treating unique human beings…)

    Your points about failure and blaming others are powerful. I think you’re right — yes, failure *is* the norm, but from what we know about ancestral health, it’s more likely that the *information* being dispensed and the recommendations being parroted are failing us as a population, rather than the individual doctors and patients failing. If you follow the specified guidelines and “fail,” does it mean YOU are a failure, or were the guidelines incorrect and the endeavor was doomed to fail from the start? I think we can answer that pretty well when it comes to the last 60+ years of dietary recommendations from “the experts.” I guess it’s just a shame that we, as a society, didn’t question this approach sooner. We’ve got a lot of time to make up for.

    I give the doctors who are trying a lot of credit. It can’t be easy to work within a system that you know is broken and try to really effect change when your hands are tied in so many ways that you probably never expected when you first considered going into the healing arts. I think this is why some physicians eventually break away altogether and set up cash-only and/or concierge practices. Obviously not something you can do if you’re a brain surgeon or something like that, but a PCP or family doctor? Doable.

    I think a lot about going to medical school, but sometimes I think I can have a better influence going a different route…that is, unless and until medical education changes radically.

  3. Cody Rice
    September 26, 2013 at 10:07 am

    Wow, Amy and Squatchy. It has been an ongoing battle inside my head as to how to make the biggest changes long-term, and both of you do an amazing job summarizing a great deal of my thoughts, including my perspective on medical school.

    To expand, our healthcare system and physical education system is broken. PE should consist of education, as well as movement. Using nutrition as an example, imagine an grammar student being given examples of solid nutrition. As the student enters middle school, they are then taught how to approach nutrition. High school begins the exploration of why it is important. By the time a student enters college, they now have a basic understanding of nutrition and can make educated decisions.

    Think about it, by using movement, nutrition, biological, genetic, and other markers, we can truly start to predict and prevent a multitude of issues. A new specialization of GP’s should be educated that rely on a general approach to health, including a basic understanding of musculoskeletal, endocrine, digestive, etc dysfunctions. By addressing the dysfunction early, we can reduce the sequelae and create a proactive solutions to health.

    Preventative medicine is possible. Unfortunately, the current approach seems to focuses on cost effectiveness as opposed to health. Which is a better approach, to have 1 out of 100 pay $750,000 for cancer treatment, or have all 100 pay $10,000 each to have no incidences of cancer.

  4. Colleen
    September 26, 2013 at 10:32 am

    I find this a depressing story that one potential doctor “who got it” gave up on primary care (we know there are a few out there in various areas disseminating this info).

    However, I’ve got news, from my view as a patient, OBGYN is often like a primary care doc. Often you will be the only doc your patient sees. You will have the same and may be even better opportunities if practicing in this area to educate women who are pregnant or about to be same or who are suffering female problems from poor diet. My one regret about coming to learn about paleo was that I knew nothing about it when I was pregnant and looking back am sorely disappointed about the lack of guidance about nutrition from either OBGYN or pediatrician.

    Anyway, my view is that OBGYN is a great platform to educate patients about benefits of diet.

  5. Surgeon Sucka
    September 26, 2013 at 10:49 am

    I had similar experiences. But the thing I’ve come to realize are that it is NOT a physicians job to counsel EXTENSIVELY. Thats why we have coaches, nutritionists, chiropractors, nurses, and extensive health care teams at our disposal. A physician is akin to a CEO. The patient is the customer, and the low-midlevel providers are there to institute the plan that you develop or to continue the metaphor…conduct day to day business. If you want more of a role in interaction and working with patients then you chose poorly giving up Primary care because you will only distance yourself from those interactions. Patients need to become more involved with their own health care, I can’t even begin to count the times I’ve told people to lose weight, stop smoking, sleep more, eat better etc. One ear and out the other. I tell them, “this will help you, do you understand that”. Nearly 90 percent will say they do and choose to continue in their ways.

  6. charity
    September 26, 2013 at 11:45 am

    As a nurse, I see it everyday that the docs just offer a pill for this or that, never taking the time to really get to the heart of the issue- usually something diet related (or lack of activity). I feel like I am the only one who cares on a daily basis what these patients eat or do and I get flack like “Oh, why bother, they are just going to do whatever they want when they get home anyway”…really? Don’t we have a moral obligation to educate and try? I dont care what they say, I will plant the seed in their brain and do my best to help. And help the docs too so they can see how all of these things are connected- diet and health.

  7. Karl
    September 26, 2013 at 2:02 pm

    Thanks for the post. You mentioned that Dr’s often use the American Heart Association as a diet reference. One thing that I’ve often wondered is, why does the AHA, which presumably has an interest in minimizing heart disease, promote a diet that is heavy in whole grains? Are they looking at different science, or is there some inherent bias on their part (a la USDA)?
    - See more at: http://robbwolf.com/forum/viewtopic.php?f=35&t=8564#sthash.eouUevDB.dpuf

  8. Swanny
    September 26, 2013 at 5:18 pm

    I agree with Surgeon Sucka. 90 percent of the population will reject lifestyle counseling, I see it everyday. Something as simple as a hip flexor stretch to fix their crippling back pain, they will not comply. So the next step is to get some type of opiate derivative from their “family doc”. Then to see pain management once they are hooked. Then maybe the surgeon.

    Once it becomes the individual’s fiscal responsibility for their healthcare choices will they seek providers that are invested in prevention and common sense solutions. The pain of paying for crappy repeated solutions will cause people to become invested in prevention.

  9. Mike F
    September 26, 2013 at 9:12 pm

    I didn’t read though the whole post yet but it did get me thinking about how to get people motivated who don’t feel any urgency. I think this may be a side-effect of insurance. I think having insurance gives people a false sense of safety. I think free insurance is probably worse.

    I think nothing would motivate people more than if they had to physically make the monetary transaction.

    A corollary to this would to have lawsuit reform around doctors liability. It would free doctors from a ‘standard of care’ that restricts what they can prescribe.

    • Amy B.
      September 30, 2013 at 9:40 am

      AMEN, Mike!

      If people had to pay the full cost of their medical care, rather than just insurance premiums and copays, they’d probably be much more motivated to get themselves back to health and keep those costs DOWN.

  10. Audrey
    September 26, 2013 at 9:45 pm

    Very well-written post. I can relate- I maintain a paleo lifestyle, and I am also an OB/Gyn doctor. There are certainly difficulties trying to fit all the required stuff, addressing the concerns the patient is seeing you for, plus trying to talk to patients about diet and exercise all in a 15 minute visit. I wish I could convince everyone to go paleo in one visit, but most people are so far away from that point. So one has to slowly plant seeds to help the patient make small doable changes.

    Clearly that preceptor has a few things to learn, and perhaps has unfortunately become jaded by the system. On the other hand, being on the other end of medical school and residency, I can relate to her frustration of being slowed down by a well-meaning medical student who may not quite understand the pressures to keep the clinic pace moving.

    There is no easy solution in our current medical system. With that said, I do think there is value in figuring out the most effective way to counsel patients in what little time we have. Motivational interviewing, which involves figuring out what changes that particular individual could realistically make, and what motivates him or her, is more effective than just telling people they should stop eating sugar and starchy foods.

    Hopefully our medical culture will eventually move towards focusing more on lifestyle and prevention, and also accepting the paleo lifestyle as much more than a fad diet.

  11. Christy
    September 27, 2013 at 3:21 am

    Here’s the thing: allopathic docs are not in the business of health care. It is misnamed. They are in the business of disease management. It’s an important business. When my bone is broken, I want a highly trained expert to be the one cutting me open and drilling pins into my bone. Nothing makes me more upset than taking a NORMAL time in life – pregnancy, child birth, child rearing, etc. and saying we need ‘an expert’ to navigate this time. Yes, I do believe in preventative care, sonos that look for holes in hearts, spines and guts, etc. Beyond that, there’s not much need for PCP except an artificial need created by a bankrupt system that has to keep generating income to fix past failure. I sure dont need an MD or a DO to tell me my well child is well. (And I will keep him well by not vaccinating!) Did I mention I come from a ‘health care family’ where we all have degrees qualifying us to work in medicine and I married an MD, ranked top in our state year after year? He knows the limit of the letters behind his name and doesn’t cross the line or put his self esteem in a bunch of letters.

    A naturopathic doc is one that has ALL the basic medical education plus a strong foundation is nutrition and wellness.

    We don’t see a PCP and we pay for the insurance that doesn’t require a gatekeeper. We buy the medical care we need, just like we buy any other product we need. I realize that liberty is on the way out if HHS Obamacare isn’t repealed!!

    Go to the dr if u need drugs, tests or surgery. Although there are more and more labs popping up that dont require a dr order. And who (novel) release lab results to the person whos body is being tested.

    I hope you find a little niche in the system that works for you. But I dont want to hear nutrition advice, pusing-a-baby-into-the-world advice, or especially parenting advice

  12. George Helou
    September 27, 2013 at 7:44 am

    I think doctors need to be either allowed to evolve into providing health care or categorised accurately within their parameters of only treating effects not equipped to address causes.

    I wrote this last week and think it adds value to the struggle for doctors: -

    Why Some Doctors Think Life Coaches Can Be Dangerous

    I recently had a client who was warned not to see me by her physician. He recommended she go back on antidepressants despite her explaining to him that she has improved remarkably over the past 3 months. Her attempt to also explain she was only feeling down due to a recent circumstance at work and needed a couple of days to implement some personal development exercises that will reduce the stress and get centred was greeted with disinterest.

    I get a lot of clients who are caught between following a doctor’s medical advice and wanting a drug free solution to addressing their personal challenges.

    Firstly, it’s important to clarify that you are personally responsible for your health. When you visit a doctor, they can advise and write you a prescription, but it‘s your personal responsibility and choice whether you follow that advice and purchase and ingest that prescription. Most people do not feel they either have this choice or believe they’re being irresponsible if they don’t follow it.

    Coincidently, I had a coaching session with a very experienced doctor recently who explained that one of her biggest challenges in her profession was the expectation to have the answers and be 100% responsible for a client’s well being. From discussions with doctor friends and several doctor clients, I have come to learn that they do their best with great skill and impeccable intentions, but are pressured by pharmaceutical corporations and society to solve problems they are not fully equipped or trained to adequately handle.

    The temptation for some doctors to enjoy this increased power also should be considered for the potential problems this can cause. When it comes to mental health, doctors can only view your body and brain as a biochemical neurochemical machine that is ‘out of balance’ because of your genes. They are not trained to address how diet and attitude can be root causes of your stress, mood swings and overall lack of confidence, eventhough many of them use common sense and do a decent job bringing this to their patient’s attention.

    To attempt to understand why a doctor would view a life coach as dangerous is to appreciate the pressure expected of them to find urgent ways to manage the patient’s thoughts and mood in order to keep them from harming themselves. This is a legitimate concern, which can pressure a doctor to desperately want to err on the side of caution simply because it’s the only way they know how to care for their patient.

    Most people are depressed because they simply are missing the tools that would help them address the circumstances that give them a reason to feel depressed. If mental health drugs were kept as a last resort, then motivation to learn and apply the tools can be intensified. This would increase their chances of applying themselves and improving their mental and emotional state as well as connecting with empowering new ideas and developing habits that create lasting change.

    The risk of becoming dependent on medication can mean that their only option is finding the next drug that will replace the one that is gradually losing its’ effect on maintaining their even mood. This is a very disempowering and risky road if you talk to the countless people already on it. They explain that as you are transitioned off one drug and onto another, your desperation to escape the emotional and mental anguish reaches dangerously new highs. Many attempt suicide in this terrifying phase – I have witnessed this struggle first hand.

    For anyone stuck in this predicament, seeing an inexperienced life coach who is not capable of providing effective personal development coaching, can make the doctor’s fear more than justified. There is not a cut and dry solution for anyone. One thing is clear though; the independent adult in emotional pain is the best person to decide what course of action to take given they will have to experience the full brunt of their consequences.

    Additionally, one must appreciate the cause and effect nature that determines our moods and shapes personal experience. How we relate to ourselves and our relationships can make them empowering or toxic. We can address sabotaging beliefs that were learned and can be unlearned, that will instigate much needed breakthroughs and establish lasting change.

    From my 15 years experience in the coaching field, I have formed the view that it’s important to seek life coaches who address confidence and personal empowerment as a foundation of their coaching program. Having success-based goals is one thing, but reaching the core issues that affect your confidence, clarity, motivation and lack of resilience is where the focus needs to begin. Being able to address them is profoundly more important than the achievement of the goal itself.

    The journey can be as sweet as the destination. You ought to find a way to feel great about who you are and enjoy going about doing the very things that lead you to personal success in a natural way. When you’re in emotional pain, this is feedback to suggest your ideas need re-evaluating because some of them are simply incompatible with well being and will continue to sabotage your efforts to succeed.

    ———–
    George Helou is a Mind Power Life Coach based in East Perth, Western Australia. He developed EP7, an Empowered For Purpose Coaching Program. George also trains life coaches to add the EP7 process to their life coaching service.

  13. Sara DeFrancesco
    September 27, 2013 at 11:34 am

    Hi Future Doc,

    Thank you for sharing your experience in such a thoughtful and non-inflammatory way. I’m sorry you had that experience and for the doctors and patients stuck in this vicious cycle.

    I’m a Naturopathic and Chinese Medical Student in my 6th and last year of training, so I can’t say that I can identify with #1. My training has provided me with the same biomedical science and diagnosis as medical schools, but also with:

    1) The philosophy that the body is never wrong and that treating the root cause to resolve and prevent illness means treating based restoring physiology, not simply hammering down pathological symptoms with therapies that are really just temporary band aids.

    2) An overabundance of treatment options including nutrition, botanical medicine, homeopathy, musculoskeletal medicine, acupuncture, lifestyle modification, counseling, and pharmaceutical intervention when absolutely necessary. This allows me to individualize treatment and use the least invasive means necessary.

    Being a soon to be doctor, I haven’t yet tackled the financial aspect. Because of the points you mentioned related to time needed to assess, bond with, and counsel patients I will charge by the hour. Insurance reimbursement varies by panel for this type of care, although it sounds like the new healthcare system will make “alternative” practioners more available to the public. I know many NDs who do very well with insurance and others who choose to require full payment at time of visit and give the super bill to the patient so they can file from reimbursement.

    Bottom line is: patients need better care which requires more time spent with them, because it’s clear that counseling and coaching is just as important as diagnosis and treatment to set people up for success and empower them to get involved in their own care.

    I’m with you 100%! I’m so sorry you had to go through that and I wish you had come to Naturopathic Medical School, you would have loved it here!

    • Sara DeFrancesco
      September 27, 2013 at 11:36 am

      PS – Meant to say “the same biomedical science and diagnosis as *conventional* medical schools,” in the second paragraph – as opposed to a naturopathic medical school.

  14. Laura
    September 27, 2013 at 11:54 am

    Great post! As a nutrition student, I am amazed at how little attention is paid to lifestyle factors such as good nutrition and physical activity when treating a patient. As a future dietitian, I know that my primary job will be to spend the necessary time with patients teaching them about how to eat and move while simultaneously motivating them to do so, rather than just popping a pill or getting cut open. It’s a demanding job that is poorly respected in the medical community. I understand that most conventional dietitians aren’t necessarily making huge changes in patient outcomes but I sincerely believe if patients are given accurate information and helpful action steps to making changes, their health will dramatically improve. We’ve all seen it in the countless success stories posted around the internet.

    I’m glad to see that there are med students who are thinking about this, and I’d like to argue that this just goes to show how crucial it is to have intelligent and properly trained nutritionists and dietitians who are able to sit down with a patient for 1-2 hours and really promote lifestyle change. And it would be great if we were covered better by insurance… but that’s a whole ‘nother story!

    Thanks for bringing the plight of medical professional students to the forefront. While I may not be in the same boat as you, I certainly empathize.

  15. Stephanie
    September 27, 2013 at 12:48 pm

    About failure. I’m curious if the rate of compliance for people who start paleo is higher than the rate of compliance for a typical low calorie diet. Personally, I find it easy to stick to paleo once I got over the initial cravings. Things that used to tempt me don’t really appeal to me anymore. When I did weight watchers in the past I found it really difficult to eat sugary stuff “in moderation” to remain in my points allowance. I would eat one and then have trouble stopping. Plus paleo is so satiating compared to just eating less of my former “healthy” vegetarian diet.

    So, the failure of standard CICO is probably a combination of the diet itself being inherently inferior to paleo even as prescribed combined with being really hard to follow because it basically prescribes hunger. Plus even if you succeed and lose fat, you have to really work hard your whole life to keep it off or you only end up worse off in the end since most people end up with more body fat if they gain weight back. If paleo is really easier to maintain in the long term, as I suspect, that makes it even more compelling as a lifestyle modification to have people pursue, even if it didn’t have the other health benefits it has compared to CICO.

  16. Kim
    September 27, 2013 at 7:59 pm

    Your married to an MD…and you don’t vaccinate toTake care of your kids…obviously he didn’t marry you for your brains!

  17. Victoria
    September 28, 2013 at 11:31 am

    I’m so sorry this was N’s experience. I had the exact OPPOSITE experience in my family med clerkship- which is probably one of the main reasons I will be doing a residency in Family Medicine.

    The physician I worked with not only liked that I talked to patients about lifestyle and nutrition, she encouraged it. She had me write down names of books and blogs for her patients, and even included them on patient handouts for her patients to take home.

    As almost grads (we’re at the same stage of our education, both applying to residency now) we’re both fighting upstream to use evolutionary/ancestral principles in clinical practice, but it is doable- in some specialties more so than others. It’s certainly nice to know we’re not alone as we travel this road!

  18. Gail
    September 28, 2013 at 11:48 am

    We have a downward spiral going here. Doctors don’t bother with advice on diet, etc because patients won’t follow it. When patients do get advice, it often is bad advice (avoid meat, eat grains..) so it doesn’t work and they quit. Maybe if the advice worked, patients would be motivated to follow it. It’s much easier for me to eat Paleo and drop meds than to eat grains and low-fat foods and take meds that don’t work well. I avoid nutritionists because they stick to the standard advice and I don’t need to be hassled. I have a doctor who lets me do my own thing because it works. I wish she were more knowledgeable and could actually offer more information.

  19. Nick
    October 2, 2013 at 4:56 am

    I am an MSTP student, and although I can empathize will your points, that primary care should be preventative care, I don’t believe you get the point of your clerkships. You are being evaluated by a set of criteria set by your preceptor. You are not a doctor yet, you don’t have that degree of autonomy that comes with the MD after your name. If this woman counseled you mid-clerkship on what you needed to improve on, it is your fault you received a near-failing grade. That is the same idea behind your point in (5) (Okay troll part over).

    What I see as the biggest step in the improvement of patient care is making the patient an informed consumer. Telling your patient the cost-benefit analysis of glucose monitoring for T2 diabetes (which is practically nill benefit…if I remember right, its an improvement of .2% of hbA1c at 120 days of management) is one of the better examples. Is the cost of the monitor, test strips, and time necessary to monitor glucose going to improve ones life? Not at all. The same is true for angioplasty and coronary artery bypass grafts for any patients outside of late-stage disease or actual heart attack (but this comprises about 20-25% of total hospital revenue, so you can bet there are other motives). This goes to your point that that talking about diet and exercise is commendable, it is down right necessary in a primary care setting. Trying to change the paradigm from “eat less fat and more plants” to risk maybe the future of this type of counseling. “At this bodyweight, with these comorbidities, you can expect these risks for complications, this life expectancy and this for your medical expenses”

    Just my thought, good luck on the match and your 4th-year clerkships.

  20. Retired RN
    October 12, 2013 at 5:45 pm

    Anyone can take charge of their own health by reading great books about paleo, and primal eating. I am reading Grain Brain now and have read The Paleo Solution, The Paleo Answer, and Primal Blueprint. All are so full of very sound information.
    Read, follow directions, and get healthy. You are the boss of you!
    Take charge of your own health people.

  21. Sara
    October 23, 2013 at 2:12 pm

    As a Med 3 who just had my first day of my Family rotation today, I found the timing of this article to be serendipitous. One of our patients today was 621 lbs. 621 lbs! Naturally, he was tying to lose weight the SAD way so that he could have gastric bypass! A language barrier (and my preceptor) prevented me from suggesting he look into a paleo way of eating, unfortunately. Outpatient medicine has never interested me, but since having discovered the ancestral diet/lifestyle I continue to scheme about how I can best work this approach into caring for my patients in the specialty of my choosing.

    • Robb Wolf
      October 23, 2013 at 5:08 pm

      Ugh. Well, just muscle through and be one of the docs we desperately need going forward.

Leave a Reply