A stick save and a beauty from JoanieL in prevention of this thread taking the bullet train to crazy town. Well done.
I will interject 2 big things that I think do play a factor for a lot of doctors. They are what I had to overcome to do what I do, which is to actually have "consult patients", or people that I spend a good deal of time just talking to, either through me or my nutritionist.
1) Lack of time.....Joanie's story about getting told to lose weight with no idea how is typical, and the main driver is the simple economics of being a doctor. Many work in hospital or managed-care clinics, well over 80% are not private, so this means you are essentially a very well-paid employee. In the view of a hospital or clinic, you are the engine of the entire business, the producer. Everyone else is only there, from staff to patients to janitors, because you are there creating fees for services.....this means that you have a schedule that is often BUILT for you to fall behind, as the managers have realized that you will usually find a way to carry it out.
2) The problem with telling the truth....the reality is that, just like most any other professional, a doctor wants his patients to LIKE him/her. You want to have a good relationship with them, and a big part of that is that many patients are looking for validation, not confrontation. I have seen a lot of patients that come to me after years of getting regular care, and they are constantly shocked by what I tell them. More so than that, a lot of them get very angry or defensive. I am used to this by now.
What if all doctor's started telling people the truth?
Here is a quick summary of what I tell people several times a week. I have a binder I give them which lays all of this out in more detail, but here is how it typically goes. My typical patient is upper 40's to low 50's, at least 40 pounds overweight, diabetic, and almost always only has an interest in making sure they don't go blind (I am an ophthalmologist). Once they realize that I am in for changing much more than that, and have often been given a Carte blanche by their overloaded PCP to do whatever I want, it is a big shock to them.
Patient: "So where are we at doc?"
Me: "It doesn't look good. All of your metabolic markers point toward worsening disease, and this combined with your cholesterol numbers show increasing risk for a heart attack. On top of this, you are carrying an extremely excessive amount of visceral fat which surrounds your vital organs. Your feet are bad from years of not enough walking or using Martian shoes, the disks in your back are collapsed due to years of carrying too much weight, with bad posture and no back strength. Your knees are bad because of the same issues, along with a completely sedentary lifestyle over decades.....your blood sugar is diabetic of course, but this is masking a much bigger problem of metabolic disease. It makes you feel hungry even when you have plenty of glucose in your system, feel lethargic and foggy due to the food that you eat, and your gut is perpetually inflamed, giving you acid reflux, constipation, along with your poor digestion.
Patient has stunned look on his face. I wait for a question but it never comes.
Me: "Given the fact that you have developed all of these habits, from poor eating to bad posture to no exercise, over decades, all combined with an appetite tuned for hyper-palatable industrial pseudo-food, turning this around will be incredibly difficult. Would you like to hear how?"
Patient still has jaw down.....mutters "Uh, sure?"
Me: "First, you need to go home and take all of the food in the house and give it to a homeless shelter. I want it empty, to the point that a mouse wouldn't find food there. Next, you need to go to the store and buy only 6 categories of food: Meat, vegetables, fruit, rice, olive oil, and buy some coconut oil or ghee. This will be all that you eat, even if you go out. This will be an overhaul of your entire diet that must happen at least 95% of the time......next, I want you to walk, run, or hike 4-6 hours a week. You will start a strength program, based on compound movements with a lot of compensations for your joint problems, and you will begin seeing a flexibility coach. You will lift 3 times a week, do the others 2 days a week. With me so far?"
Patient now staring at my shoes. They are minimalist dress shoes that took an act of God to find, BTW.
Me: "You will no longer eat breakfast, ever. At best you will not eat solid food until at least noon, but eventually we will be doing about 16 hours without food, every day. You will buy some BCAA shake to make before you workout, fasted. No alcohol but small amounts of wine, no sweets, no bread, no caffeine once you start your eating window. Set an alarm for when you will go to bed, and let the sun wake you up if possible most mornings. You sleep like hell, and that needs to change before any of this will be possible. I will see you in 3 months. If markers have not changed, I will no longer be seeing you and will be transferring your care to someone that is fine with letting this happen. Any questions?"
Now, I operate with losing about 25% of the patients that are sent to me.....seeing as I am private and get more referrals than I could ever possibly handle, this is not a problem, but if were to work for a hospital or network clinic this would be seen as completely unacceptable. I am fine with what I say being too much for some people, and I see it as proof that I am not diluting my message too much.
One could make an argument that #2 is the fault of individual doctors, but that is not entirely accurate. We are forced to operate in a system that SOCIETY setup, seeing patients using a food system that THEIR elected officials setup.
"They now look to a single and splendid government of an aristocracy, founded on banking institutions, and moneyed incorporations under the guise and cloak of their favored branches of manufactures, commerce and navigation, riding and ruling over the plundered ploughman and beggared yeomanry." - Thomas Jefferson, 1826