It’s the first day of fellowship, and everyone’s getting to know each other.
“Oh, you won’t have time to work out here.”
I’m not the small, scrawny kid I was back in high school anymore, even if that’s the person I still see in the mirror. I’ve added roughly 50 pounds since college, and it shows with the things people say. Being told I won’t have time to work out has been a common chorus throughout my training.
What always amuses me is that these are physicians. The exact people that are supposed to be safeguarding, encouraging, and promoting health. Yet, here, outside of the confines of a clinic, when the white coat is off, they are actively opposing a universally agreed upon healthy habit, trying to take care of my health. I couldn’t wrap my head around this behavior until I came to one critical revelation: Doctors don’t care about health, doctors care about disease.
Not that doctors don’t care about their patients, because we do. But health is an ambiguous concept and is more than just “the absence of disease.” As the medical field becomes more and more specialized, physicians are turned into the proverbial hammer. If there are no nails, what is a hammer to do?
I was a freshman in college when I realized that life is short and that I need to start taking care of myself and my body. As one of the many kids in my class that pledged to be premed, it made logical sense (to me, at least) that I should take care of my body before even attempting to take care of someone else’s. It didn’t make sense to pay for so much education (average is ~$300K) to help other people find their health and lose mine along the way.
Because I bought into this so strongly and put time and effort into working out and healthy eating, I was floored when doctors and aspiring doctors alike would turn around and tell me that I shouldn’t be working out or that I work out too much, that I should be doing something more productive with my time (i.e., studying).
But eventually, it started to make sense. The medical system cares more about the medicines they can prescribe, the surgeries they can perform, other things the system can bill for. We care more about preventing death than we do about making life better. The acute issues are more pressing than long-term chronic issues.
In a way, disease is easy. It’s more concrete in our minds. The profession of medicine was born out of treating illness and disease. As healers, we develop clot busters to treat strokes. We produce stents to keep blood vessels open to stop chest pain. Antibiotics were created to kill infection-causing bugs. If there is a virus and we research vaccines. The pattern is simple. There is a problem, and we fix it. This is the foundation of medicine, and it worked. The physicians that have come before us have eradicated polio, tamed AIDS, and fixed dysentery.
In a sense, medicine is easy. And medicine is what most people want. All you have to do is take a pill, grit your teeth through a shot, or get nervous about a surgery. It’s a relatively quick, painless fix. At least, in theory, it is easy. Somehow patients still forget to take their medicines. It’s hard enough to get people to take their meds. Sometimes it feels like we spend a lot of time begging and pleading patients to take their meds. After giving patients another lecture about the medicines they have to take, we have enough bandwidth for like one other thing, which is usually getting people to quit smoking or vaping or doing other hard drugs. With the rest of the time in our mandated fifteen-minute visits, when do we have time to build and praise healthy behaviors?
Being healthy, on the other hand, is much more abstract, and we have difficulty thinking about the abstract. In medical school, we are not taught much about what to do for the healthy patient. Other than asking about eating “healthy,” exercise, and cancer screening, we are not taught much else. These few things that we are taught are often neglected under the mountains of diseases, Latin phrases, unpronounceable drug names, convoluted drug mechanisms of actions, and other buzzwords that we have to memorize.
Part of why we can’t talk about a good diet and exercise is because physicians don’t eat healthily and rarely exercise.
Physicians are steeped in a noxious culture that seems to be averse to creating healthy physicians. We ignore mountains of evidence that show exercise, sleep, and healthy eating is beneficial for cognitive function, learning, and performance — all aspects that physicians should optimize. But the current medical training system pushes physicians, residents, and students to the brink of their physical, emotional, and mental capabilities and leaves little room for much else other than work. The culture of medicine forces us to ignore our health. I’ve done it too, but it’s time to focus more on our health, not just patients’.
Vybhav Jetty is a cardiology fellow.
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