Monday, November 14, 2011

The Elephant in the Room

If you are an NPR listener, you may have caught today's piece on Morning Edition on doctors  who don't directly address weight issues with their patients, even though it is standard practice to weigh each patient on arrival and to record their weight in their chart. 

In many cases, patients would welcome support and advice on how to shed their excess pounds, but family physicians typically face a number of barriers which lead to them skirting the issue.

Some of the barriers mentioned include the following:
  • The reimbursement system is typically based on treatment, rather than prevention.  It is based on treatment of specific medical issues, like hypertension or diabetes, even though these are usually weight-related.  So nutritional counselling might not be reimbursable.
  • Doctors typically lack training to provide weight counselling and nutrition is not something that is covered in detail in their medical training. 
  • There is often too little time in a typical doctor's visit (an average of 8 minutes was mentioned), to address weight issues.
These are all valid points that are worthy of further discussion, but I would add a couple of points of my own. 

Some patients are easily offended when their physician addresses their weight.  They may be in the office for something they don't believe to be related to their weight, and with visits being undeniably brief, there might not be enough time for their physician to explain the relationship of weight to health.  More complex issues like the relationship of excess weight to the risk of wound-healing complications when it comes to surgery are even trickier to cover.  The linkage between fast and processed food consumption and health is another touchy one, and it doesn't take much for some patients to feel their doctor has crossed over into interference in an area of their lives that has nothing to do with them.

Another barrier many doctors face, ironically, comes from the nutrional profession.  Almost all the official nutritional guidelines from Canada's Food Guide, the USDA's My Plate, the Heart & Stroke Foundation, the Canadian Diabetes Association, as well as all the other governmental channels promote a "balanced" approach to nutrition that involves eating "more healthy grains." They never advise people to radically restrict carbohydrates, not least if they have diabetes.  They prefer to tell people instead, erroneously, as it happens, that carbohydrates are essential for health.  These organizations often enjoy hefty financial support from big food corporations, and the potato and grain lobbies, and they can't bring themselves to say an outright NO to sugar and starches that cause blood sugar to spike.  This is in spite of a growing body of credible evidence that excessive sugars underlie our society's weight and health problems.

In our litigious society which allows patients to make College complaints whenever they feel their doctor is out of line, doctors have to be careful when they offer opinions or advice that don't enjoy mainstream support.  Having been married to a doctor as long as I have, I have heard enough stories of shoddy patient treatment by some of his less competent colleagues to believe very strongly in the complaint process.  On the other hand, I do understand very well how stressful and time-consuming it is for doctors to answer the College when a complaint is made, even if it is trivial or unjustified. 

This is why it is perfectly understandable to me why risk-averse doctors with busy practices choose not to address weight issues and nutrition with their patients, even though they may be fully on board with the literature and increasing number of peer-reviewed studies that support carbohydrate restriction as the key to losing weight and improving long-term health. 

They are simply too busy, many patients are too easily offended.  Avoidable unjustified College complaints are the last thing they want to deal with.

No comments:

Post a Comment