Isn’t it a funny thing when you spend time on a given project (like, say, a blog post) only to find when it’s done that an intriguing new angle shows up in your line of vision? Take last week’s post on health check-ups and how they might be more effective with some strategic re-envisioning. The next day an article on culinary medicine got me thinking about medical training and the myriad of possibilities for physicians who want to enhance their understanding of nutrition, exercise and lifestyle change (and for patients who would prefer a doctor who has this everyday health knowledge).
We’re looking at two sides of the same coin here really: how “basic”/preventative health care (for most people, ideally the span of insurance qualifying/tax deductible services) can evolve to effectively serve more relevant preventative purposes AND how physician training (particularly for family physicians and general internists) might enhance doctors’ effectiveness in promoting healthy lifestyle and behavior change. In the spirit of this latter point, I wanted to highlight a few unique programs that are breaking through old academic impasses and forging the way toward a new view (and practice) of med school instruction. We the public, I think, may have something to gain here.
There’s the adage, which is thankfully growing in public awareness and research support, that food is medicine. That said, only 25% of medical schools offer their students the 25 hours nutrition science instruction suggested by the National Academy of Sciences. It’s even possible to go through intensive cardiac specialty programs and not receive any instruction on the influence of diet. Meanwhile, the prevalence of obesity, diabetes and heart disease keep rising….
Interestingly, we’re seeing the advent of something called culinary medicine – the study of not just nutrition science but the actual practice of incorporating nutritional principles into hands-on cooking.
The study of culinary medicine is slowly taking root in official and unofficial collaborations between med schools and cooking schools. At Tulane University, for example, med students are required to take a culinary medicine course through Johnson & Wales University. They learn to put healthy cooking into practice while also offering a medical dimension to the culinary science studied by chefs-in-training. Similar collaborative programs exist in other parts of the country, including Chicago.
The med students for their part get to see what healthy and creative cooking look like first-hand. The instruction becomes personal as well as practical. They come away with actual recipes to offer to patients but also with an understanding of what these patients will need to know to make healthy eating happen in their kitchens.
With the decline of food prep in this country, cooking skills are at an all-time sorry state. With programs like these culinary medicine collaborations, nutrition recommendations don’t have to sound from the abstract chamber of book science but can be inspired by real life experience in a gourmet kitchen.
How long have many of us known this – exercise is medicine. Studies have demonstrated its efficacy for countless conditions, including depression. Yet, it’s the most underutilized lifestyle choice out there. Perhaps even more than nutrition, fitness gets short shrift in health check-ups. According to CDC data, only one-third of people who met with a health care provider over the course of a given year received any counsel regarding physical activity.
Most doctors I’ve met know little about exercise science and even less about coaching patients toward an actual, workable plan. One big reason? A large number of doctors don’t exercise.
That’s why I was heartened to read about a fitness instruction program for med students at Case Western University’s Urban Area Health Education Center (and disappointed that it’s no longer running). Dr. Susan Wentz, a trained family physician, directed a program that encouraged exercise as medicine for med school students, noting that students who personally experience the benefits of fitness more often go on to counsel their patients to use exercise for their own health and well-being.
The med students in the program received a 12-week university health club membership as well as initial assessments and partner and class exercise options. Wentz considered it a model for other med schools across the country despite the program’s folding at Case Western.
Exercise science education in med school is extremely limited, and a program like this model can help fill in a bit of the physiological picture for students. More importantly, however, it connects science with practice and makes it personal for these physicians in training. As the American Council on Exercise article notes, not only will they be more likely to help their patients embrace an active life, but they’ll see a more integral connection between their medical services and those of physical therapists and trainers.
This one begs to be included. Ask anyone who’s dealt with a rude, insensitive doctor, and you get a pretty clear picture of how much physician sensitivity matters for a patient’s experience and even outcome.
If you think the talk of bedside manner is simply overblown fluff, consider that a variety of studies show that physician empathy results in better compliance with physician recommendations, fewer complications (for diabetes treatment) and stronger patient immune response. Patients with physicians they deemed responsive and empathetic also were twenty times more likely to consider surgical outcomes as favorable.
In other words, you can know all the book science you want (and should), but if you can’t communicate it in such a way that your patient feels like a human being with dignity and decision, your knowledge won’t get you as far as you think.
Experts have long suggested that a significant element of the placebo effect in health care settings is the attentive time and perceived care of an expert. The more personable and extensive the interchange, the more potential there is for detailed sharing by the patient, for better explanation by the physician, for a more effective and comprehensive plan that feels personalized to the patient him/herself.
Enter some unique programs that attempt to bolster doctors’ ability to emotionally reach their patients.
In addition to the mindfulness programs that seek to reduce physicians’ stress to build emotional resilience as well as enhance emotional regulation, the University of Medicine and Dentistry of New Jersey offers an elective class that allows medical students to work with horses. As a result of their close interaction, the students learn to attune to the body language behind the animals’ fear response and to learn emotional and physical approaches that reduce fear and build trust.
These are critical skills, according the instructor who is a clinical psychologist, particularly because doctors are often working with admitted patients who are anxious given their lack of physical autonomy and confusion about their circumstances. In learning to become aware of the horses’ body language, students then learn to transfer that focus to nonverbal communication with their fellow human patients.
The result? More sensitivity to patients’ situations and pain experience as well as more effective communication opportunities that can lead to better care – and ultimate outcomes.
These are only a few of the new programs cropping up to respond to cultural impetus around lifestyle counseling and patient support. What do you think of these models, and have you heard of (or participated in) others along these lines? Share your thoughts, and have a great end to the week, everyone. Thanks for reading.
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