The irony of the “sick” caring for the sick


“Why do you eat so healthy?” or “Where’s your kale today?” I would hear regularly.

For as long as I can remember, my colleagues and friends have often smirked at my lunch choice. To me, I always ate what I enjoyed (even if it was the occasional french fry), and my diet and lifestyle were all about balance. Growing up, I played competitive soccer for 10 years and knew my performance was equivalent to the fuel I provided my body. Additionally, I could directly feel the benefits of the constant exercise on my mood and physical capacity as well as the negative effects when I had exceeded my limits, both mentally and physically. I attempted to find that balance within my life at an early age so I could create lifelong habits that I deemed to be “healthy.”

Then, when I began medical school, I noticed that many of my colleagues did not share the same values as me and that diet and exercise did not play much of a role in our education (as I believed it deserved). While I pursued medicine for a number of reasons, I thought there were many facets to healing that were adjunctive to medications, non-invasive therapies, and surgeries. Anecdotally as well as literature-based, we know that diet plays a large role in the management and prevention of chronic disease. However, only 29 percent of U.S. medical schools receive the recommended nutrition teaching. Most medical schools do not even have nutrition in the curriculum anymore, so that leaves graduating physicians empty-handed, without the tools to educate patients. And if nutrition is not a doctor’s passion, he/she will likely not pursue further education on the topic.

In addition to the lack of nutrition education, we had a lack of healthy options for meals. The abundant availability of pizza in my pre-clinical years and of McDonald’s in the hospitals in my clinical years definitely made a statement of the lack of importance of nutrition in the medical field. This culture of eating on-the-go (if you even had time to eat) often created unhealthy habits that left my colleagues and myself full of empty calories and devoid of energy to take care of patients that needed us most.  If physicians weren’t taught to be healthy or were healthy themselves, how did we expect our patients to be healthy?

Yesterday, one of my colleagues, admitted to me that she could not list with confidence most of the high phosphorus foods to instruct her patient with chronic kidney disease to avoid. While that information is easy to find, it is also simple nutrition education that can be provided during medical school. Luckily, innovative programs, such as the Goldring Center for Culinary Medicine at Tulane, have started to pave the way and recognize the need for knowledge about healthy eating.  But we need more than that; we need a drastic culture shift in medicine.

While there will always be so much to learn in medicine and not enough time to do it, we need to further educate about nutrition and highlight the importance of a balanced, healthy lifestyle. We need to act as role models for our patients both in and out of the exam room. But if we aren’t taught how, how can we?  Now, I know that being healthy is not just about nutrition and exercise; sleep, mental health, stress reduction, and overall “well-being” are also crucial.  And we have made substantial progress in changing resident duty hour restrictions to aid in decreasing physician burnout to promote overall wellness.

Again, we need more than that. I’m not blaming the 36.5 percent (according to the CDC) of Americans that are obese on doctors because individuals need to take responsibility too. But if we, as leaders in healthcare, do not take a stance to demonstrate the value of nutrition and a healthy lifestyle, obesity and the chronic diseases’ burden will continue to worsen.

Farrell Tobolowsky is an internal medicine resident.

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