Not every Friday brings doctoring bliss. Sorry.
Some Fridays, the wrongness of our healthcare approach squeezes you like a vice-grip.
The medical news of the week can hit you hard.
–This highly tweeted report on how Overweight is the new normal speaks to the futility of asking people to help themselves. That our strong, vibrant, and proud citizenry is succumbing to fatness saddens me deeply. Building wider doors, heavier toilets and restaurant seats without armrests is the wrong approach to fighting obesity.
–We also learned this week that the advancing fury of medical therapeutics cannot counter high rates of obesity, smoking and inactivity. The WSJ health blog reports life expectancy in some Southern US counties trails that of El Salvador and Latvia.
–The nation’s chief doctor prescribes prevention over treatment, and no one retweets her. Silence.
–And the final egg on the face of wellness was this warning from the FDA: The popular anti-smoking drug, Varenicline (Chantix) might increase the risk of adverse heart events. Would it surprise you that a drug which can cause hostile behavior, agitation and depressed mood increases the risk of heart problems? Though I concede that the heart-related data against Chantix is weak, the message that pills are not the answer to wellness is consistent: In obesity, pills do not work; in raising HDL, pills might make us worse; and in Arthritis, NSAIDs clearly do make us sicker.
As a heart rhythm doctor, I see a variety of patients each day: young, old and middle-aged. I witness the evolution of trouble. The overweight young patient with high blood pressure and poor sleep habits is followed by the middle-aged patient with heart rhythm problems, who is then followed by the elder with a weak heart, from the cycle above.
Like a Dad tries to tell his teenager, you try to tell younger patients where their poor choices are leading them. But in the real world, Olive Garden builds wider seats, doctors prescribe more pills and hospitals build bigger beds and wheelchairs.
We are adapting, accepting, succumbing to our fatness, rather than addressing its root cause.
John Kennedy famously said, “Ask not what you country can do for you, but what you can do for your country.” Ronald Reagan reminded us of the value of reaching down and pulling ourselves up by the bootstraps.
Is it mean to ask patients to help themselves? Shouldn’t we as a profession stand up and recommend that people take more ownership of their own health?
We need more truth. More bootstraps.
And less pills.
JMM
Now I am going riding. Hopefully that will uplift my mood to something more heart-healthy.
frank says
dr. please don’t get to down on all of us that know better but just cain’t seem to find the way that’s best for us. you do your best, put us on the right road then how we drive it is up to us. i always look for your blog and am always glad to hear from you. thanks
PGYx says
AMEN! We do need more personal responsibility. My heart swells with joy when one of my patients shows me s/he understands this point or has even already changed some unhealthful habits. It’s just not typical of my generally sick patient population.
Jackie Fox says
This is so true and so important. I agree Frank has a point that we don’t want to be judged and that’s a fine line for doctors to walk. But I also think doctors would be remiss if they didn’t point out what we can and should do. I always had a healthy weight until I hit my 40s. My family doc had the “creeping weight gain” talk with me more than once until my husband and I got serious, dropped 30 pounds and started exercising, but that took awhile. So don’t give up on us. Thanks for this post and thanks for caring!
P.S. I was tempted to skip exercise today but now I won’t, so thanks for that too.
Dr John says
Thanks for sharing JF. I will keep trying to convince people that they can help themselves more than any doctor can.
And I am glad that exercise has “stuck” for you.
Thank you for taking the time to write.
mgeek says
Excellent points. I have a question: do patient charts (in family practices / hospitals) have a field for physical activity, such as they do for “smoke” / “alcohol”?
It could bring doctors to investigate more on lifestyle habits and stress more the crucial importance of this.
Dr John says
Some forms do. But most do not. And more importantly, there is not a lot of time to discuss the importance of exercise in a 15 minute visit.
When I try to discuss obesity, sedentary-ism or other lifestyle issues, it is often perceived as punitive or judgmental rather than medical. You have to start these conversations so gently.
Jaynie Martz says
I feel the Xtreme drag too Dr. John. This cute 10 minute RSA Animate (The Secret Powers of Time) explains a lot. ‘Hedonistic/Doesn’t pay to plan’ piece of the pie is maybe a far larger proportion of national mindset than realized. + Human brain doesn’t fully mature until approx. age 25. Future oriented thinkers are already boot strapping it, eyes on ‘goals gold’. The rest are ‘carrot & stick’ types…My loved ones watch me nibble veggies (while dreaming of the next lap lane interval sets) as they wolf down ribs, pizza, fries and talk about the next meal. (while I’m counting the minutes until I can dolphin my spine deliciously back and forth underwater with H2Audio itunes headset cranked up).
Very different heads = very different inner worlds.
Dr John says
Fantastic, Jaynie. Thanks for sharing.