I do what I know is harmful for my body

For the last 3 weeks, I’ve been working as a sub-intern on the family practice inpatient service in one of the local hospitals. It’s been quite a time! I’ve sure been kept busy, but learning a lot and seeing a lot. With a moment of downtime, I wanted to share a reflection I had yesterday.

We’re all familiar with the glamorous “saves” in medicine. It’s the car accident victim that undergoes helicopter evac, immediate surgery and whose life is saved. It’s the acute peanut allergy that receives the almost magical dose of adrenaline and is almost instantly better. The list goes on. We’re often very successful at treating these conditions, though sometimes they do die. What I think is a common misperception, though, is that this is the norm in medicine. That most illness is out of the blue, is something that just “happens” to people, that there was nothing you could do. But most medical problems are not caused by being in the wrong car on the wrong day.

What I see day in and day out is complications of simple, easy to manage problems like diabetes, high blood pressure, asthma, etc. These are things that we know how to treat. We know how to prevent complications. And yet, I just had a man last week who required half of his foot to be amputated as a complication of untreated diabetes. I had a woman this week who came in seeing snakes on people’s clothing, because her blood pressure was so high it was affecting her mind. Last month, I saw a man who had large amounts of yeast growing in his mouth and groin because his blood sugar (and thus urinary sugar) was so high.

This morning, I’m caring for a truly pleasant gentleman with COPD (bad chronic lung disease usually caused by smoking). He hasn’t smoked in the last 15 years, but he smoked quite heavily before that. Even though he’s been doing things all right as far as his lungs are concerned for the last 15 years, he has to live with the consequences of his actions prior to that. For the last several days, I’ve seen him decompensate and gasp for air, feeling like he’s drowning, because he can’t get the air to move through his lungs like he should. How did this kind old man get to this point?

Day after day, I see patients on dialysis because diabetes has destroyed their kidneys. The treatment of diabetes is simple. Some pills once or twice a day, sometimes insulin is necessary, diet and exercise. These are not miraculous innovations. But are they hard to do.

“Physician, heal thyself” haunts me. As I tell my patients about the importance of eating well and getting regular exercise, I think about how I’m going to grab a Big Mac and a large Coke as I race from the hospital to the clinic. I think about how I’m working 60+ hours a week and have no time to go on a run. I know I’ve gotten 4-6 hours of sleep per night, most every night for the last several years. I think about all the bad habits I have, and how I have full knowledge of the right thing to do, and what the consequences are if I don’t. But sometimes, it just doesn’t matter. I do what I know is harmful for my body, anyway.

And this makes me think of three things:

1. It makes me compassionate, and humble. There’s no point in me lecturing someone about not following the obviously right path. Yes, it’s simple, yes it’s straightforward, but life isn’t always that easy.

2. It drives me to keep encouraging them. Sometimes, we just need that external voice to nudge us in the right direction. We know what’s right, but we need a little kick in the seat to push us down that road. I’m happy to be that benevolent kick.

3. It pushes me into trying to make at least one extra right choice today. Maybe I’ll grab a salad in the cafeteria before I leave the hospital, instead of a Big Mac. We’ll see.

“Doctor” Matt is a medical student who blogs at “Doctor” Matt’s Musings.

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  • http://bit.ly/gwalter gwalter

    It is so hard – especially with the dysfunctional demands put on our schedules.  Working nights, sleeping days, never enough time to sleep, let alone family, exercise, or good meal prep.  However, there are some things we can change.

    When I was a young paramedic, 30 years ago, I rode my motorcycle without a helmet, after drinking copious amounts of beer.  I smoked, I ate whatever I wanted, and participated in any number of “bad” things.  I was young – I was invincible.
    Now, although I haven’t smoked in two decades, I have chronic bronchitis, I’m 20+ pounds overweight, and I struggle with developing a heart-healthy diet and exercise plan.  But, back in EMS after a 15 year hiatus, is not helping.  Even though most of the patients we see, are not “emergency” patients – they are like the ones you describe above.  They suffer from hypertension, COPD, diabetes complications, dialysis issues, and obesity.  They call 911 because they have no other resources – not because it is the best choice for their primary care.

    Often, as I write my chart on the way to the hospital, I think – that’s me unless I make some changes.  And then, three hours later, after having missed my last meal, starving, with no good places open at 3am, I drive through McD’s and get a cheeseburger and fries.  And the cycle continues.

    • Anonymous

      So true, one tip is to plan-ahead, boring and a pain it may be, but it works. I travel with my work, not too often these days, but a few years ago it was often and I found I started to gain weight. No time to exercise, sitting for long periods of time in the plane or at a desk, too many restaurant meals and pre-dinner drinks and functions – something had to change…
      I make sure I’m never caught short and try to avoid the food at the airport – I have a selection of healthy options I take from home and when I’m too busy to shop, get a local deli to make me a chicken salad to go…I make a habit now of spending some time in the gym when I’m overseas or walking/swimming…at home I park my car a couple of blocks from my meetings and use the stairs. I also limit intake of wine – no more than 2 glasses a day and 3 wine-free days per week.

      Business class is a trap, all the delicious champagne – you can end up having 2 or 3 glasses with no trouble at all. Now that I have rules that can’t be broken, I make better choices – skip the wine at a work lunch and enjoy the french champagne in business class. I know it’s one OR the other…
      I also go for two entrees rather than entree and main and skip or share a dessert…that way you don’t feel like you’re missing out and get a couple of mouthfuls of something sweet.
      I found this was the only way I could turn around something I could see might become a big and weighty problem. I know some work schedules make it very difficult – my sister is a busy vet and often finds she’s snacking on the gifts from her patients, usually chocolate, at 10pm, exhausted and hungry after a long day.
      Now she tries to take in soup – she wasn’t gaining weight, but was feeling sluggish and unhealthy.

  • Anonymous

    When people knowingly make bad decisions that adversely affects their health, our society will bail them out with free health care (assuming inability to pay). By doing this, we take away CONSEQUENCES for bad decisions. And like any good parent knows, consequences are needed to change bad behaviors. This is how we become responsible adults. For example, if I (who pays a lot of money for health insurance) don’t take care of myself, my health will deteriorate, my expenses will increase, and I won’t be able to make ends meet. As a result, I make every effort to live a healthy lifestyle. Unfortunately, our current government has encouraged generations of irresponsible citizens, and therefore I don’t see this realization of yours changing any time soon.

    • Anonymous

      Your analysis is based on the assumption that people who have bad health habits cost society more.  Not so, or at least not proved.  People who die young save society money in overall costs, including health care and retirement costs.  So quit bagging on the unhealthy.  Perhaps the healthy should have to pay the CONSEQUENCES of their selfish, anti-social behavior.

      • Anonymous

        Not proven? Are you serious? Did you not read this gentlemen’s article? You must not be a physician, because this is what you see everyday. That’s OK though, because lamens can blissfully float through life ignorant to any real knowledge. All you will do is sit back and quote “studies” from academics to prove your point. But, no matter, because eventually this mess will work itself out, regardless of what you or I say. Keep smoking those cigarettes Buzz Kill, I guess the selfish, hard-working, responsible citizens will save you for now.

  • Bobby Title

    Thanks for #3.

  • Anonymous

    Thanks Matt for this reassuring yet paradoxically discouraging perspective.  While your entirely human Big Mac attacks may make you more empathetic towards your future patients’ unhealthy decisions, these same patients will be generally leary about following your ‘do what I say, not what I do’ advice.

    But let’s not just pick on Big Macs here.  Dr. Søren Holm, writing in the Journal of Medical Ethics, for example, responded to recent debate in the U.K. on whether precious and scarce health care resources should be limited in non-compliant patients (or smokers, alcoholics, the obese – those whose medical conditions might be considered to be self-inflicted). His take on this:

    “Participating in a number of sports
    and leisure pursuits, even at amateur levels, increases your risk of
    sustaining significant ankle or knee ligament damage, requiring surgical
    reconstruction. This is also true of alpine skiing, squash playing,
    soccer, and many other sports.
    “Should we expect guidance to orthopaedic surgeons that they
    are only to reconstruct sports-induced ligament injuries if the patient promises never to play that sport again?”

    More on this at “Did You Bring This On Yourself?” -  http://myheartsisters.org/2009/11/14/bring-this-on-yourself/

  • http://www.facebook.com/people/Lezlee-Maupin-White/100000077693322 Lezlee Maupin White

    yep, that’s what I saw 30 years ago in a hospital. Nothing has really changed. I just talked with a guy who has multiple health problems tell me that he didn’t really want to know all the technical stuff about how the body works. He said he wasn’t interested in that subject. What if we only got one car for the rest of our lives when we get our drivers license and we were told that that was the ONLY car we could have for the rest of our lives. We would take precious care of it, learning everything we could to make sure it runs good and lasts.
    We make damn sure that we keep up our maintenance on the cars, but our bodies……we can’t even trade them in and we act like there disposable.

  • http://www.facebook.com/profile.php?id=1676290779 Joan Miriam

    As a Certified Diabetes Educator and registered dietitian, I can attest to the fact that it is challenging for many people to make lifestyle changes to improve or maintain their health.  In fact, many patients do not even show up for their appointments.   This has been very troublesome for me personally, as it has resulted in my work hours being reduced a number of times, my position being eliminated at one hospital, and one diabetes education program closing altogether. Some health insurance plans do offer financial incentives for their subscribers to participate in exercise programs.  Maybe there should be some similar incentive for attending appointments with the dietitian or Certified Diabetes Educator . . . or perhaps there should be some consequence from the health plan for not doing so. 

  • Anonymous

    Dr. Matt, you are correct.  Personal choices and ‘lifestyle’ are overwhelmingly important in controlling the human damage brought on by these common diseases (diabetes, copd, CV disease).   Without patient adherence to diet, weight management and exercise (REAL exercise), there is little hope to reduce the human toll (and attendant costs) of these common conditions.  The reality is that, for most people, it’s always tempting to ask: “Don’t you have a pill for that?”
    As Pogo said: “We have met the enemy, and he is us.”

  • John Smoot

    I have to praise j551wright for bringing up a huge thing in my eyes, REAL exercise. Walking around the block twice a week for 20 min is not enough. You have to really work to stay healthy and its not easy but its worth it!  

  • Anonymous

    “Your analysis is based on the assumption that people who
    have bad health habits cost society more. Not so, or at least not proved.
    People who die young save society money in overall costs, including health care
    and retirement costs. So quit bagging on the unhealthy. Perhaps the healthy
    should have to pay the CONSEQUENCES of their selfish, anti-social behavior.”

     

    I have read studies about those who smoke, who are morbidly
    obese, who because they die younger, save society money.   And for every study like this, there a two
    dozen showing the insidious and horrible consequences and escalating costs of
    the chronic preventable conditions caused by an unhealthy diet, not just on the
    person but on society.   You choose not to
    read those or are in denial about the reality of the US eating
    culture.   Even if we had a cost effective
    healthcare system in the US
    and stopped all unnecessary costs especially futile end-of-life costs, we could
    still not bend the healthcare costs curve.   Further, those who do maintain a healthy
    lifestyle DO pay for the consequences of others unhealthy lifestyles.  It is especially unfair when an unhealthy
    person develops a disease that is not caused by an unhealthy diet but can’t
    afford care and or goes bankrupt.

     

    The US
    was a leader in decreasing tobacco smoking. 
    It has gone from 65% to 17%, as the latest statistic I heard.   This is quite remarkable.  It took a long time, the political will of
    Congress to fight Big Tobacco, and imposing an appropriately directed tax and
    message on tobacco products.  Deaths from
    COPD and lung cancer will decrease (unless our polluted air will become the
    leading cause).  Also, subsidies were
    dramatically reduced.  

     

    There is no such model to address the destruction caused by
    an unhealthy diet.  It is now know that
    sugar, fat and salt (and recently wheat) are the substances that have an effect
    as strong as  the nicotene in cigarettes or processed coca leaves on human brains.  Now the biggest pusher of sickness is Big (unhealthy)
    Food, like Big Tobacco was – subsidized, highly advertized, pervasive, creating addictive products and able to sell them cheaply.

     

    I empathize completely with the author.  He knows the consequences of his behavior –
    it is an individual choice what one puts in his or her mouth.  But, what is out there for him to eat that is
    healthy, inexpensive, tasty and easy to find? 
    And, what is he going back do after his burger and soda.  Yet, another person who will require his care, not because of something that “happened” to them but
    something that could have been prevented by achanging to a culture of healthy eating in the US.  

    • Anonymous

      References please.  I’ve given you one.  You owe me 24. In the medical literature.  Peer reviewed.