Medicine causes just as much disease as it solves. We must adopt the lifestyle to get through college, medical school, residency, and fellowship is nothing close to a healthy lifestyle. Previously, we discussed the long hours and the lack of exercise, but our food inhibits our desire for health.
This begins with what the hospital cafeteria sells. Despite promoting healthful eating, hospitals instead profit from diabetes-inducing food like Coke, cookies, and cake. Instead of focusing on heart-healthy diets and avoiding high glycemic index foods, cafeterias often cause the diseases that the rest of the hospital aims to fix.
Unfortunately, the laws of economics still apply in the hospital. Cafeterias need to sell food that people buy. If people do not buy the food the cafeteria offers, the cafeterias will not make a profit. Continued losses would drive the hospital cafeterias out of business. Therefore, the cafeterias have to stock their shelves with food patients and their families will purchase.
Hospital cafeteria food can be fine for patients and their families, but for residents and staff who live and work in the hospital, eating hospital food day after day insidiously leads to diabetes, weight gain, coronary artery disease, and other disease associated with poor eating habits.
Despite the focus on health, medical school neglects nutrition training. I remember one, maybe two lectures that focused on healthy eating and living. Between these lectures, our noon conferences often had chicken tikka masala and saag paneer from the local Indian restaurant, two dishes exclusively seasoned with cream and clarified butter. When our student meetings were not incentivized with fatty Indian food, we would get extra-large pizzas.
We spend our lives focusing on health. We tell our patients to develop healthy habits, yet we neglect to develop them ourselves and end up a few pounds heavier over the course of our training.
This continues in our residency training. One variable ensures timely medical student and resident attendance to our noon conferences: free food. In my residency program, free food, holds strong predictive power for timely attendance. The control can be seen without food. Without free food, trainees leisurely stroll to our noon conference, usually 10-15 minutes late. But with free food, like Chick-fil-A, the line begins at 11:40 am. Residents quickly learned the rule and adapted: show up on time or risk not getting free food. Even though our program director often repeats to deaf ears that prompt, timely attendance is important. He still has not learned that few residents are late on Chick-fil-a days.
We know academically we should avoid unhealthy food. We advise our patients to avoid such food, yet we actively provide it and seek it.
The food helps financially too. Trainees welcome free food as a way to stave off paying for food. With mountains of debt, a small resident’s salary, and long workhours, free food offers one less meal to worry about. We say we are too busy with our residency to cook our own food. Like in the general population, it becomes easy, too easy, to say that we’re too busy being residents to keep eating restaurant food.
We justify it further by saying that we are residents, the time when we are supposed to be working ungodly hours. Because we are doctors and work too much, we feel justified in saying that we are tired after a long day’s work and eat whatever is easiest to come by. It may be justified but the calorie counts remain high.
Our work hours have as much to do with resident weight gain just as much as the trash food we eat. Shift work and insufficient sleep lead to increased incidences of diabetes, weight gain, coronary artery disease, strokes, and cancer. Health care relies on night shift work despite the growing body of evidence linking the practice with worsening health. Medicine causes these diseases with systems that create an environment where these diseases can propagate.
Primum non nocere, first do no harm. We forget this principle that lays the foundation for the rest of ethical medical care. We forget this principle when it comes to dealing with our fellow physicians and physicians in training. We continue to insidiously promote disease in our co-workers by keeping our sleep-deprived physicians in hospitals full of calorie-dense food. The system needs to change, and yet the administrators remain resolute in old, outdated ways.
Vybhav Jetty is a cardiology fellow.
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