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Thread: Patient education

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  1. #1
    Join Date
    Oct 2012

    Patient education


    new here. Not sure if this is the right forum, and it's a bit of a long read, but bear with me.

    Background: I am an ER doc and changed to a paleo diet to cope with shift work. More often than not, I don't get a chance to eat during my 10 hour shift. I used to do the 2 am junk food run on the way home from work, eat in my car, and feel terrible. Now, my shifts at work are planned intermittent fasts and going paleo has helped the quality of my sleep and work a lot.

    Since afew months I have started incorporating nutrition advice to my patients. Not surprisingly, the vast majority of my patients are not in optimal health: diabetes, overweight, hypertensive, smokers. Most are not particularly motivated to change their lifestyle, or are in denial ("I only ever eat fish and vegetables, doc" ... you'd be surprised how many - morbidly obese - people tell me this). Most patients will ask me what supplements I recommend for weight loss. The general philosophy on health in this Western society seems to be that the solution for all health problems comes in the shape of a pill, and this is what most patients request. My impression is that most people frequenting this forum are not representative of the general population that sees their doctor for health issues.

    Occasionally, though, I do see a patient who is interested and motivated in nutrition and lifestyle changes. I spend some time talking about the basic principles of paleo. At the moment, I think I am the only doctor in the department who advocates paleo, or who gives nutrition advice at all (it's an emergency department - poor diet is not an emergency).

    I'd like to make it a more formal Patient Education process, supplemented with written documentation and referrals to websites and other sources of information. However, I am a little concerned trying to roll it out on a larger scale, because of a lot of the rhetoric of the paleo diet. By rhetoric, I mean the argument that "our paleolithic ancestors didn't eat this, therefore we shouldn't either" or worse "Grok didn't eat this". It makes me cringe. My feeling is that this has done the dietary recommendations more harm than good. The evidence of what life and health were like ten thousand years ago, is highly debatable and not that relevant to the world we live in today. It simply is not an solid argument and too easy to refute and ridicule (our ancestors also did not have clothes, cars, computers etc and what was the under five mortality rate at that time?). I sometimes recommend this website, but add a qualifier that the name paleo/primal makes no sense and people should just ignore this, try out the dietary recommendations instead and see how they feel. I am also hesitant to convince my colleagues of the benefits of a lifestyle, when the scientific evidence is peppered with such debatable historical and irrelevant arguments.

    So, for now, I'll stay semi-closeted. I am interested in hearing your thoughts on this. Also, if there are any paleo friendly doctors out there with experience on formalizing patient education, that would be great.

  2. #2
    Join Date
    Nov 2011
    I can say that as an ER doc you probably are going to face more challenges rolling this out that many others. Heck, I'm a chiropractor and the people who come to my office are suppose to be the demographics more interested in holistic treatment or nutrition, but I haven't really found that to be true either. Everyone is basing their decisions on putting out fires rather than preventing them....Anyway you may consider reaching out to Doug McGuff. He is an ER doctor also and the author of Body by Science. He is also a big proponent of the paleo approach and has several on youtube Paleo Diet | Doug McGuff MD | Biochemistry of the Paleo Diet and Strength Training - YouTube. Personally, I have Mark's book, Robb Wolf's, and a few others in the office that I loan out regularly to those who seem genuinely interested in making significant lifestyle changes. I also printed out and made copies of the old Kurt Harris ten steps type program Archevore - Archevore Diet. I just feel that if someone is really going to make a change then they have to go "all in" and really own the information for themselves. The ICA council on wellness (chiropractic) has a great program, but it really is a full years worth of follow ups and questionnaires for the patients to determine significant changes and adherence (most studies indicate new habits need to be maintained for a year to be conducive to real change). I don't actually do this program...I stick with lending out books and provide the one sheet explanation, but this is the best I've seen from my profession. Again, not something your likely to be looking for in an ER department. Either way great to hear that your looking into it! I wish you the best!
    Last edited by Neckhammer; 10-20-2012 at 05:25 PM.

  3. #3
    Join Date
    Sep 2012
    Hey doc,

    you have a split audience - your patients, for many of whom the "Grok didn't eat this" logic makes perfect sense - and yourself and other medical professionals for whom such non-scientific perspectives cause cringing.

    The truth is that people remember sound bites. "Grok didn't eat this" is a much easier shorthand way of framing the lifestyle than understanding the chemical and physical interactions of particular nutrients. Grok is in the literature because he works for the lay audience. If you're going to remove him from your recommendations you'll need to come up with another, all-encompassing, shorthand soundbite to replace him with.

    If I were you, I'd start with the idea of "non-processed food eating" or "food with only 1-3 ingredients." I expect just that would help most of your patients. Then you're also not taking sides in the low fat/low carb debate.

    Of course, you'll also have to deal with patients like me who know how to eat primal/paleo, have done it enough to know we feel better when eating this way, and still persist in eating poorly most of the time. Don't make the mistake of assuming a lack of knowledge is the problem! Adherence is a problem.

  4. #4
    Join Date
    Apr 2012
    Alberta, Canada
    I'm impressed the ER contingent is willing to listen to this, considering just last week I saw someone who had advanced COPD, lost 1 leg and was about to lose another one to peripheral artery disease, and was STILL SMOKING. Reasoning was "it's too stressful not to smoke." Evidently, NOT HAVING LEGS is somehow less stressful.

  5. #5
    Join Date
    Aug 2012
    Christchurch, New Zealand
    Hi NaLi

    Good on you!! I say keep on trying with the patients. I'm a Nurse on a busy surgical ward and I honestly cringe when I look at some of the meals that are served up to patients. The one that sticks out was a Diabetic Diet offering of Macaroni Cheese served with a large portion of mashed potatoes. No. I am not joking. There was not a vegie in sight and could someone please explain how that is carbohydrate controlled?? Beats me - it looked sad.

    As I'm so new to this new lifestyle I don't feel that I know enough about the science behind it and need to do way more reading before I would recommend this to others.

    But please don't give up - read more, explore the web, gather some evidence for yourself and go for it!! I plan to do the same.

  6. #6
    Join Date
    Jan 2013
    Central Illinois
    Thank God I'm not alone! I registered here today because of this thread. As a home health nurse I struggle with the "official diet teaching" and what I know to be true. I have settled with teaching the commonalities: eat a whole foods diet. Even if they gorge themselves with fruit and beans at least it's a start. I also throw in that all those "whole grain" products are only LESS processed. If I'm dealing with colleagues, I find Gary Taubes book and the studies in it to be very helpful... although, I've found that the overweight smoking nurses are really not that interested anyway and would be more interested in the truth or even in the massive changes they've seen in my body. I compare it to sharing my faith-- people really don't care about things that even work for you until they want it for themselves. You should have seen the questioners that were interested once the "biggest loser" contest happened

    As for patients, they are individuals. I tailor my teaching to whatever I think they'll understand best and what I think they can do.

  7. #7
    Join Date
    Jan 2013
    this is a very inspirational thread!
    I think this hasn't been suggested so if I may: LCHF for beginners |

    although it doesn't have a forum or everything you're looking for, I found this website quite convincing for explaining the diet in a "neutral" way...if you want to check it out.

    hope this can help a little

  8. #8
    Join Date
    Apr 2011
    How much of an issue is this going to be for your hospital? I know last time I was in, the ER doc said I needed more fiber, like whole grains, but he also wasn't surprised when I said I didn't eat grains. I'm not sure if he was just teling me what he was supposed to or really thought fiber was going to help me out (I'm much better off without it).

    I really think it's going to be tough. Unless people can see that it's something directly related to food, I don't see them getting much out of the visit other than "I'm still alive" and maybe "I need to be healthier", then turning around and doing it the old CW way. It might be too much to mentally digest at the time.

    It's going to be a lot easier if it's obviously something intestinal/obesity related. I really like the website. Very helpful in my case. I hope you have some success!

  9. #9
    Join Date
    Mar 2012
    Southern California
    I also have a problem with the rhetoric of going paleo/primal. If asked to explain my diet, I'm sure as heck going to feel silly trying to explain who Grok is and what he ate, much less trying to fight off the critics of the lifestyle beyond those that argue that one cannot live a true Paleolithic lifestyle these days. It's true, if we were striving to live as our ancestors do, we'd all be foraging for wild game and eating insects and whatever we could get our (literally) grubby paws on. Therefore I just tell people that I eat little to no processed foods, a lot of vegetables, meats, and natural fats because dietary fats are not the sole cause of atherosclerosis. It's a hard sell, and I'm not even a doctor trying to convince people. You have my respect for having an open mind and I wish you luck with convincing your patients and fellow doctors.
    F 28/5'4/100 lbs

    "I'm not a psychopath, I'm a high-functioning sociopath; do your research."

  10. #10
    Join Date
    Feb 2012
    South Carolina
    When I first went low carb I so wanted to get diabetes educators to understand that there was an alternative approach. But then I learned that they are required to teach the American Diabetes Association approach in order to get insurance reimbursement. Since it isn't your job to teach nutrition you can probably get away with saying whatever you want, but the hospital in general is stuck with best practices. My experience is to take the approach: "This has worked really well for me--you might want to explore it." Yes, you would like your authority to come from science rather than personal experience, but you aren't going to be able to convince outsiders that the weight of scientific evidence is in your favor. And I think recognition that different things work for different people will both improve medicine and is an effective argument to get people away from conventional wisdom.
    age 56, type 2 diabetes, swimmer
    low carb since 2006 thanks to Jenny, primal since Jan. 2012

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