Last week I wrote a simple post on eating yogurt with fresh fruit for lunch. It wasn’t until later that I realized why it’s a medical lesson.
It happens that yesterday morning I was up and out early. I saw a former colleague walking along the street. He’d gained weight, and walked slowly. I thought about how hard he works, and what a good doctor I know him to be. And yet any citizen or patient might size him up as heavy, maybe even unhealthy.
The problem is not that he’s uneducated or can’t afford nutritious foods. He knows fully about the health benefits of losing weight and exercise. The problem is the stress and long hours of a busy, conscientious physician’s lifestyle.
When I worked as a practicing doctor and researcher at the hospital, I rarely ate a nutritious breakfast or lunch. My morning meal, too often, consisted of a gobbled muffin and coffee. A weekly lunch conference provided faculty, fellows and students with Domino’s pizza and soda. (To the best of my knowledge, these were not pharma-sponsored; otherwise the food would have been better quality.) On other days, we’d get take-out sandwiches from a nearby deli.
There was a salad bar in the hospital cafeteria. I took from it occasionally, but that involved time (long lines) and risk: You never knew who’d coughed over the lettuce, or swiped her hand too close to the chick peas.
Dinner was usually at home with my family, but I didn’t have much time for cooking then. Sometimes my husband prepared dinner, which was a huge help. Still, we sometimes ordered in Chinese (American-style), from diners, and other local sources of high-fat, low-vitamin, low-fiber “junk” meals.
It wasn’t until I stopped working at the hospital that I learned to eat three healthy meals on most days. Preparing meals with fresh foods takes time and effort, besides access to ingredients and a kitchen.
Med school can be stressful and involves long hours and late nights of study. The same goes for residency, and then for clinical practice in some specialties. Grabbing a slice or an over-sized sandwich is satisfying, and easier than packing lunch.
Maybe part of the curriculum for first-year students, even just a session, should focus on staying healthy as a busy doctor – on maintaining a good diet, keeping physically active and getting sufficient rest.
Perhaps this seems patronizing: Students in med school typically learn what to tell their patients about exercise, stress and weight control; it’s assumed they know how to take care of themselves. But maybe we shouldn’t wait until there’s a problem (a student with an alcohol overdose, or an overweight doctor with a heart attack) to take note and address the fallout of long workdays and stress in physicians’ lives.
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I’m trying! After 7 years of surgery residency and 20 years in practice, it was clear to me that we needed to do better. I’m using my platform as a medical educator (Vice Chair of Education Dept of Surgery, Associate Dean of Student Affairs) to teach what I wish someone had taught me. http://www.wellnessrounds.org. I’d love to use this as a guest post or have you submit more!
Mary, Thanks for writing in. The work you do sounds very valuable. I’ll check out your site. Best, Elaine
Don’t think your idea of teaching medical students about healthy living is crazy — in fact, many schools probably already do it! At my school, for example, we have an Associate Dean for Wellness that curates a wellness center full of healthy recipes, organizes occasional runs around our neighborhood and events that encourage humanities related reflection (i.e. we read Kafka and Faulkner and discuss it with some of the leading thinkers on the literature at my university). Would be really interested, actually, to hear what other schools do as well!
Hi Emily, It sounds like you have a well-rounded curriculum. Still, at most med schools the focus, if nutrition and lifestyle are included in the curriculum, is what doctors should advise patients to do. The assumption/arrogance? is that, of course, doctors know how to take care of themselves, that we don’t need this sort of advice or training.
I just found this site, and am mesmerized. Teaching medical students healthier lifestyles isn’t only to their benefit, but such a curriculum, if vastly expanded, could absolutely reform healthcare itself.
I make it a practice to ask colleagues, “What proportion of your patients are you treating for disorders that arise from pathogenic lifestyles?” I’m not just asking about addiction to McGutbusters and the sedentary life, but the whole spectrum: toxic exposure, adverse self-image, poor stress management, unfulfilling work, deficient support, and dysfunctional relationships. They uniformly answer , “Most.” Since a huge proportion of illness arises from ways we’ve chosen to behave, prevention must involve more than regular checkups, mammograms, and colonoscopies. Unfortunately, though, we docs haven’t been trained to intervene in ways other than physicochemical.
Maybe help is on the way. One feature of the Affordable Care Act is funding of experiments in low-tech interventions, such as sending nurses’ aides or trained volunteers into the foci of illnesses Atul Gawande describes in his 2011 New Yorker article, “Hotspotting.” Patients involved in these interventions wind up using 40% less healthcare. I suggest these folks benefit not so much from medical as social effects–they simply learn how to live more healthily.
Anyway, Dr. Schattner, keep this wisdom of yours flowing. It’s a pleasure to read.
Jeff Kane MD
healthcareasthoughpeoplematter.blogspot.com
Jeff, Thanks for your comment and kind words. Yes, there’s a lot that could be done in the way of prevention, besides what comes in the form of tests and formal medicine. Best, Elaine