It’s a common scenario: a patient shows up to my office lugging a bagful of over-the-counter supplements, defiantly informing me that they “don’t believe in prescription drugs.” In the very next breath, they present a lab slip with a list of bloodwork that their alternative medicine doctor wants me to order to help diagnose their myriad symptoms.
I’ll admit, my initial natural reaction in this situation was a feeling of annoyance and frustration. Patients like this may make us feel that they don’t trust our medical expertise and are rejecting evidence-based medicine, and are promptly labeled “non-compliant.”
But after having honest discussions with folks about the root cause of this behavior, I have come to a different conclusion. Now, I realize that maybe we are failing our patients.
We are failing them by not getting to the bottom of their distrust of Western medicine or “Big Pharma.” Many times, they’re concerned about taking too many prescription medications. They’re worried about adverse reactions and drug interactions. And rightfully so: studies show that nearly 50 percent of older adults take one or more unnecessary medications. We know that there are negative clinical consequences to polypharmacy, and the probability of adverse reactions increase with each additional medication.
We are failing them by not spending enough time emphasizing the need for lifestyle modifications. By purposefully increasing my emphasis on healthy eating and weight loss, I have been successful in helping patients wean off PPIs, diabetic medications, and anti-hypertensives. It always blows my mind to discover that so many people don’t understand that many of their chronic conditions are treatable and preventable through improvements in diet, nutrition and physical activity.
Is it because physicians are not comfortable with leading these conversations? Because we spent more hours studying pharmacology than nutrition in medical school? Because we simply are not given enough time to spend with patients to have these conversations? Because our quality metrics dictate that we must prescribe statins, beta blockers and ACE-inhibitors, so we feel that we have no choice but to prescribe, even if a patient is already on 15 other medications?
Then maybe we physicians are being failed as well by a broken fee-for-service health care system that squeezes us with 10-15 minute visits, which does not allow us the necessary time to have these crucial conversations with our patients and does not reimburse appropriately for this preventive service. We’re being failed by a system that forces us to choose the fastest option to treat a problem — the prescription pad.
We are failed by our medical education that has not equipped us with the knowledge and tools to comfortably tackle the conversation of nutrition, diet and weight loss, although we know that 80 percent of chronic diseases can be prevented or reversed by lifestyle modification. Studies show that 75 percent of U.S. medical school curricula don’t include the minimum 25 hours of nutrition education hours recommended by National Academy of Sciences. Most physicians admit that their knowledge in nutritional education is woefully inadequate.
In turn, we are also failed by a society that values instant gratification with a pill for every ailment — reinforced by every new infomercial that touts the latest magic capsule that cures every ailment without any need for personal accountability or inconvenient lifestyle changes.
However, since many people equate “natural” to “safe,” they feel more comfortable ingesting a host of vitamins, supplements, and herbal teas but refuse to take their statin. Because they have a (healthy) fear of overmedication. Because we haven’t helped them get to the root cause of their poor health. Because their “other doctor” has more time to actually talk to them, and are comfortable recommending non-pharmacologic therapies (whether or not they are evidence-based or safe is a whole other issue).
It’s time for physicians to get at the forefront of this problem. We need to advocate for a more comprehensive, holistic education to the treatment of chronic disease. We need to fight for more time with our patients, and for better reimbursement for our efforts. We need to become leaders in the fight for health care policy changes that make it easier our population to have access to healthy food. We also need a take a step back, and analyze our reaction to patients that we deem “noncompliant.”
Trust me, I know this is an oversimplified and by no means a comprehensive analysis of an incredibly complex issue. But we have to start somewhere, and maybe that initial change needs to come from within.
Kimberly Rogers is an internal medicine physician who blogs at Prescribe Me an Apple.
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