Obese patient gets mad after I tell her to fast.. page 2

[Jac]

You make some good points. I wasn't telling these patients to immediately jump into a fast, but rather come up with a plan to gradually introduce elements of fasting into their routine with the necessary adjuvant care. But I see what you're saying about them not being my patients. Still, it's frustrating because if these patients do what my attending says, they'll get sicker and be back more often to get more powerful drugs and more invasive operations. A resident friend of my calls it medical masturbation, and although I don't believe doctors have any ill-will, a lot of what they do harms more than it helps.

I wish we could rearrange the entire training scheme for health professionals - and then force the current workforce to get with the new programme. But until then, it's an exercise in frustration and patience. You're absolutely right about the trajectory these patients are on. You do need to consider your own ongoing mental health though - it's not healthy in any way to spend the next 4 years in a state of frustration! I agree that you need to pick your battles. As you get further through your training you'll have more influence, but even then aim for small steps, leading them to the next level and showing them how to stay there. Sometimes the sum total of what we can do for a patient is to make them feel OK about seeking help next time.

[Urban Forager]

What about just printing up some cards with MDA site on it and like Eric said highlighting the success stories? You could say something like here's a site that has a different approach to weight loss and many have had good results with it. Letting them know that this way of eating is based on eating whole unprocessed foods.

I understand how frustrating that would be to be around those that clearly need help and not be able to do something. I think you have to have faith that if you pass on the info some will find their way. My husband is a teacher and he also has constraints on what he can tell his students, there are times when he feels he's not able to reach the kids in a way that he'd like to, but then every now and then he has former students that contact him and tell him how much they got out of his classes.

[Hedonist2]

I'm sorry there isn't a good answer. The serenity prayer (non-sectarian in this example) is all I can suggest.

May I always have the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.

(Non-sectarian. Add a religious flavor if you want.)

[goneprimal]

Somehow the paleo concept is more convincing if you don't phrase it as such.

"Eat only nutrient-dense foods because they are naturally filling"

...stands a better chance of acceptance than:

"Eat only raw fat from warm carcasses you murder with your bare hands"

...which is what people seem to hear after I explain the finer nuances of the paleo concept.

[Syracusedoula]

I offered this patient my personal cell phone number and my services as a weight loss coach.

This is sweet, but probably not a good idea. Until you are practicing, it may be good to have solid work/personal boundaries.

[katemary]

I haven't read all the other posts so sorry if this is duplication, but how about something that offers food for thought and isn't entirely inconsistent with your senior, like:

A number of researchers are concerned about the growing rate of obesity, despite increased education, particularly in the last couple of decades. There is an emerging group of scientists who have gone back to the studies that precipitated the low fat edict,and they are convinced those studies are wrong, and sugar is the problem. But by removing fat in EVERYTHING we have actually increased sugar. I am personally convinced this is right and I ditch the grains and sugars - I mean whole foods we ate 20 years ago can't be wrong. I can give you some key words for your own research or show you a good website - they show success stories. Based on this, I think you should trial for 2 weeks - no processed food, no grains, no sugar - and see for yourself how it makes you feel after you spent 2 or 3 days adjusting.

That way, you acknowledge it against CW but hopefully patient can acknowledge the temporal connection you describe.

[Damiana]

I know it is frustrating, but just play it safe for now. You're at the bottom of the ladder, stick it out until the end of your residency, then you can preach what you believe. It's not a good idea to piss off your attending.

[magnolia1973]

I remember one patient with a BMI of 50 telling me: "I will do absolutely anything to lose weight. I have tried everything. Nothing works. You seem confident you can help me to lose weight; I will do anything you say. I am willing to try anything."

I told this patient to fast. She became incredibly angry and demanded to see the real doctor.

Send her to MDA and have her try primal or paleo. There is a lot of "buzz" going around that fasting can really mess more with women than men. Straight up primal works great for so many people without needing to tell them to fast.

If I came to you 5 years ago and you said "fast" with no additional information.... I'd be annoyed.

FYI, why fasting doesn't work- the woman fasts, gets hungry, binges, fasts, gets hungry, binges. Gonna bet she has done this before. She needs the other 90% of the equation.

[drssgchic]

Honestly, start them off with avoiding refined sugars and encourage them to expand their vegetable options. Meat, veg and starch for dinner? Sweet potatoes could be a stand in for the "starch." If you happen to have a pile of delicious-looking (and tasting) recipes on hand- how terribly convenient, right? And if they just happen to be primal . . .

Just those two things alone will start them feeling better. Once they start feeling better, they will stand a much better chance of starting to find their own options. It's also in no way a contradiction to anything else they will be told. Makes you look smarter than if you, the med student, are spouting off about stuff that "everyone" knows is wrong.

Oh yeah- about the fasting? Dude, you did NOT want to see me when I was hungry before I was adjusted to the PB. Three squares a day was stretching my blood sugar- skipping any of them would have resulted in dead bodies. Most people, particularly people with food issues, need to discover fasting on their own. That way it will happen when they're ready- leading to a better result.

[PrimalWannabeGirl]

I'm a physician with 35 years of experience and I can tell you you can't accomplish much of anything with most people without having a trusting, empathic relationship with them, something harder and harder to do in today's health care system. About the only thing you might try is to give your attending MD a copy of Primal Blueprint and with all humility say, "I found this interesting and had some good results for myself with this program. I'd like to know what you think if you have time to take a look."

You'd have to have some humility, though, and be prepared to thank him/her for reading it even if s/he comes back and says, "That's crap."

But really----take it easy on those patients. Upsetting them and then not having the relationship to support them isn't kind or effective. And kindness in a CAREgiver is really, really important.

Pea