Physicians do not receive adequate training in nutrition

As an MD, nutritious and healthy cooking and eating are very important to me.

We as physicians do not receive adequate training in nutrition, healthy lifestyle choices, and disease prevention in general while in medical school or in residency.  On top of that, we work long and difficult hours, often overnight shifts during which we consume processed, fatty foods, void of any nutritious value and we find ourselves suddenly with an extra butt cheek and elevated cholesterol levels and we ask, “how did that happen?”

I remember being the resident in the intensive care unit.  I always carried around about 3 snack bars, a pack of Swedish fish and those hospital graham crackers in my pockets.  Making rounds on each critically ill patient seemed to go on forever and when the attending physician (my boss) wasn’t looking, I’d shove an entire snack bar in my mouth praying both that he/she wouldn’t notice and that I avoided aspirating any contents into my own lungs which would put me in a similar position as the patients I was caring for.

Throughout the day as a resident, I would receive innumerable texts, “it’s Bobby’s birthday today, cake in the treatment room” … or “a patient’s wife dropped off fresh baked cookies on 7, come by quick” … or “drug rep lunch, gnocchi in the conference room.” And so every day, I would make multiple stops to “re-fuel” at these “stations” losing sight of the numbers and types of calories I was allowing myself to ingest.  I would justify my careless consumptive behavior by telling myself I was too busy tending to sick patients and trying to decide what tests to order next or what medication to discharge them on, and too busy amidst the constant pages from nurses and my interns and too tired having been up since 5:30 am and now it being 2 pm with another full 17 hours to go.  So, it was okay that at 3 AM on call in the intensive care unit, I was shoveling (literally with a fork in one hand and a spoon in the other) buttery noodles drenched in marinara sauce topped with a crispy chicken parm delivered from across the street straight into my mouth.  But it wasn’t okay.  It was the opposite.  I, like the majority of my colleagues, was a hypocrite.

I spent the bulk of my day, “educating” my patients both in and out of the hospital that the key to longevity and fighting preventable disease was making healthy decisions with respect to lifestyle, diet and exercise.  And yet, there I was, making the unhealthiest decisions myself.  I was almost as bad as the cigarette smoking pulmonologist who would reek of tobacco and counsel his patients on smoking cessation.

Preventive medicine should be a critical component of medical school and residency training and it is not.  We as doctors focus so much of our effort and energy in this area when educating our patients, which our training so desperately lacks.  And add to this the lifestyle that a resident is expected to lead; with 24-36 hour workdays, under monstrous pressure with people’s lives at stake.  We are just mere mortals after all and at some point like other humans need to fulfill basic human functions like eating, sleeping and using the bathroom.  So how can we be expected to educate our patients on making healthy lifestyle choices when our training has deficits in these exact areas and our own lifestyles are not conducive to practicing what we preach?

These questions motivated me to find answers during my training and led me to take a great interest in nutritional medicine.  As part of an initiative to incorporate nutrition into the internal medicine residency training program, I applied and was selected to partake in a course for resident physicians designed to provide doctors with the tools and knowledge we need to guide patients to make healthy decisions about their lifestyles, specifically how to plan and cook nutritious meals.  In addition to education on nutrition as a medical science and with respect to evidence based research, we participated in kitchen sessions in our city’s culinary institute with instructor chefs who taught us culinary techniques as well as tips for developing nutritious meal plans, the importance of serving sizes and the health benefits of balanced and wholesome food preparation.

I further pursued my great interest in nutrition and preventive medicine by undertaking an extensive research project on the Mediterranean diet specifically deconstructing specific components of the diet, the impact of adherence on mortality, the impact of each element on cardiovascular health and its implementation in a clinical setting.  I delivered this medical conference to my department of internal medicine in New York City as well as the department of endocrinology at the United States Air Force Base.

To me, there is nothing more peaceful or rewarding than creating a healthy meal with fresh ingredients and enjoying it with friends and family.  My blog is part of my effort as a doctor to promote healthy eating.  My hope is that my food-related experiences with respect to my cultural background, and my medical knowledge will serve as a source of information to empower you to make the right decisions when it comes to dietary habits so that you can play an active role in fighting preventable disease.

Solmaz Amirnazmi is an internal medicine physician who blogs at Of Pomegranates and Saffron.

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