Man, I clearly need to get back to writing more ‘What Your Doctor Doesn’t Know’ articles.
I’m offended, annoyed, and disgusted at all the apologists who say that we shouldn’t expect docs to know about nutrition and exercise. In a sense, you’re right. After all, I shouldn’t know as much about nutrition as a nutritionist, I shouldn’t know as much about musculoskeletal injury assessment and treatment as a physical therapist, nor should I be able to handle speech, language, and swallowing disorders as well as a speech therapist. But I’m pretty sure I should know the basics. And anyone who thinks their doc shouldn’t clearly doesn’t want to be treated optimally.
The doc’s job isn’t just to treat you when you get sick, it’s also to keep you healthy. How the hell are we supposed to do this if we don’t know the science of being healthy? If we don’t have at least a solid grounding in functional anatomy, exercise physiology, and nutrition? Moreover, how are we supposed to help you recover from illness without knowing that. ‘Oh, I’ll just do your shoulder repair surgery, but I don’t know the first thing about the exercises you’ll need to do to get back where you want to be.’ ‘Oh, I don’t know how to assess your lifestyle to help you prevent a heart attack or stroke, here’s a statin and let’s hope for the best!’
What a bunch of garbage. Especially when the literature shows that for almost any condition we can think of, from osteoarthritis to nerve damage to heart attacks to strokes to depression and anxiety (yes, depression and anxiety), it’s the lifestyle stuff that has the biggest, most efficient effect both in prevention and in treatment/recovery?
Look, the reason our education is so freaking broad (despite being a psychiatry resident, I’ve nonetheless ran codes, treated asthma, sepsis, worked up cancer, cracked chests, done significant portions of surgeries, and stitched up lacs) is because we’re supposed to at least have a handle on whatever walks through our door. And some people think we need know nothing about nutrition, exercise, and functional anatomy? When in many cases it’s the most important area to pay attention to? This is me laughing.
I spent much of the first two years of my med school education learning all sorts of garbage that just isn’t that relevant to practice. Learning stupid anatomical points of interest that dead guys who never saw living patients wrote about, but which I’ve never needed as a real-life doc treating real life people. On the other hand, everything about functional anatomy and MSK diagnosis I’ve had to teach myself. Learning about an irrelevant and esoteric pathway for a whole week when ‘too much uric acid is bad’ would have sufficed, and had to memorize the structure and synthetic/degradation pathways of all the amino acids, but not actually why they matter. I’ve spent the last 4 watching docs run around using meds like crazy but failing to understand and implement the behavioral/exercise/nutrition changes in their patients that would have obviated the need for the mad dashes, the crying families, and tons of money crapped down the toilet.
I’ve had orthopods tell me that the reason my bench was down over 100lbs was clearly because I was getting older…at 25. I had another doc tell me that at 203lbs (BMI of 30), I had substantially increased my risk of diabetes (I had a six pack). I had another doc tell me I needed a low-fat/high carb diet since I have a very very strong family history of diabetes. And this is leaving out the travesty that has been my journey through nerve and spine damage–and the fact that every bit of progress I’ve made has been by doing exactly what the docs told me not to do.
Trust me, yeah we are the most broadly-educated people in all of healthcare. And we have to know a crapload. But there is room for the stuff that matters. And plenty of stuff that doesn’t matter we could get rid of in our education.