Health promotion needs to start in medical school

I recently took an exam focused on the pathophysiology and clinical risks factors of cardiovascular disease, the number one cause of morbidity and mortality in the developed world. Atherosclerosis, hypertension, and smoking were all there, front and center. Ironically enough, since it was the final exam of our first year of medical school, the instructors decided to reward us with dozens of Krispy Kreme donuts to enjoy during the exam. I tried my very best to see this for what it was, a well-intentioned congratulatory treat, but I could not get past the hypocrisy.

As I interpreted ECG’s with ST-elevation and discussed clinical management of acute coronary events, I looked around the room to see many of my classmates going for second and even third helpings of the donuts. Talk about an innovative way to provide early clinical experience—self-experimentation with risk factors!

I often wonder how the very essence of health can get lost on the front lines of health care. At its very core, medicine is about health promotion whether this happens upstream via disease prevention or downstream via treatment.  It would only make sense that physicians and allied health professionals embody and exhibit the same health behaviors that they strive to instill in their patients.  Shouldn’t those in the health care field be the healthiest employees around? Wouldn’t you think that health care institutions would prioritize wellness? Isn’t the culture of medicine would be rooted in the tenets of healthy living?

The unfortunate reality is that the culture of modern medicine often breeds, perpetuates, and exacerbates unhealthy habits. True, there are the unavoidable periods of sleep deprivation, IV-drip levels of caffeine consumption (although this may not be so bad based on recent studies!), limitations on social life, and hit to one’s love life. Many of these are unavoidable consequences of the intensive, yet necessary training. Certain sacrifices come with the territory.

However, it seems that even in cases when a choice is available, the unhealthy option often prevails.  Even though we pay lip services to the detrimental health consequences of poor diet and physical inactivity, we often do not heed our own advice.  We are trained to ask patients about their smoking habits, alcohol intake, and stress levels. We inquire about their dietary habits (even though we lack adequate knowledge to provide follow-up suggestions). And we encourage them to get exercise on a daily basis.

Meanwhile, we spend nearly all of our waking hours in a stressful setting, living a rushed existence that is inherently imbalanced. The “grab and go” diets reflect this hectic bustle as we hoard, guzzle, and inhale any and every piece of sustenance that we get our hands. Often, this is the birthday cake for a colleague, the soda from a vending machine, or a bag of chips from the cafeteria. We are too busy to sit and eat like civilized folk much or strategically plan well-balanced meals. Time to prepare meals, eat at regular intervals throughout the day, exercise, meditate, and rejuvenate the soul are all luxuries in the medical profession.

My own struggle to maintain a healthy, balanced lifestyle this past year leads me to believe that this imbalance starts at the very outset, in medical school. Now that I am living it, it is clear why medical students demonstrate more significant reductions in wellbeing, and higher levels of depression and burnout than those in other academic disciplines. I feel very fortunate to attend a medical school that is committed to its students’ physical and mental health. I live in one of the most health-conscious areas of the country and this has successfully penetrated the medical culture.

We have access to farmers markets, a med-student only gym, free personal training sessions, a wellness coach, top-tier athletic facilities, and outdoor adventures. The students here take their personal health very seriously, and many can be found exercising at lunchtime, standing and stretching during lectures, and tossing the football at any free moment. The administration has taken note of this and responded in kind by instituting a Wellness Committee and creating a WellMD newsletter. Although I feel very blessed, I feel for and speak on behalf of those at other institutions who do not have access such facilities and opportunities. Given our mission and the message we carry, this should be the bare minimum, and even here, we could be doing better.

Please do not misunderstand this message. In no way is this an incrimination of or a crusade against those who do struggle to maintain a healthy lifestyle. And in no way am I proposing low-carb, no sugar diets with mandatory Iron Man training in medical school. I am simply voicing a concern on behalf of the many medical students out there who are health conscious, yet feel frustrated by the absence of health promotion in medical training. For those of us who have even the slightest inkling towards the healthier choice, it does no good if that choice is not even on the menu.

Most of the time, our brainpower is solely focused on the task at hand—trying to cram in as much information as possible to pass the next exam. It is unreasonable to expect us to devote our valuable mental resources to seeking healthy options, cooking meals, planning workouts, etc. Healthy living is a commitment that requires dedication and energy.  Yet this commitment should be facilitated by an environment that provides an unconscious nudge in the direction of the healthy choice. Medical schools and medical facilities in general should have workout facilities onsite with locker rooms and showers. Cafeterias, kiosks, and vending machines should provide ready-made, well-balanced, and portable meals and snacks. All medical students should be provided with sample meal plans, simple recipes, and tips for cooking in bulk for maximal efficiency. All lecture halls should have areas with standing desks or even treadmill desks so that students are not sitting for 8 hours each day. If I am expected to spend 10-14 hours of my day in one building, I think it is fair to expect that building to support my lifestyle and provide the comfort and amenities of a home.

Medical schools are the settings in which the new cadre of physicians is currently in training. Health promotion must start here. Healthy lifestyle is not s skill set that can be transmitted didactically in a few lectures on nutrition and cardiovascular health sprinkled here and there in jam-packed curriculum. Healthy lifestyle is learned through experimentation, trial and error, goal setting, competition, and hands on interaction, and direct participation. My challenge to the medical schools of the 21st century is to design ways to create unconscious, simple nudges towards healthful choices as part of education process.

Rich Joseph is a medical student who blogs at Progress Notes.

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