Why your doctor might not be the best nutritional resource
I am happy Mr. Talens wrote this- even though I only half agree with him. I do agree that in general, physicians are not very good at counseling someone on making what most well trained coaches/RD's/etc would consider "useful" dietary changes. I define "good" as represented by the ever-changing evidence based medicine combined with clinical experience, e.g. "evidence based behavioral practice". Additionally, the motivational interviewing skills could likely be improved for a large percentage of primary care physicians. Finally, the way most primary care practices are setup in such a way that it precludes physicians from being good resources for patients on exercise or nutrition due to the "fee for service" model and the need to see a lot of patients per day who are NOT their for dietary or exercise counseling primarily?Originally Posted by Malpeg
I would argue that a very real problem is that the importance of lifestyle changes, e.g. exercise, nutrition, sleep quality and quantity, and interpersonal relationship health, are neither heavily emphasized nor adequately rewarded in most medical practices and educations unless the practicioner has self-educated and/or personally/professionally experienced benefits from optimizing these avenues in themselves or in their patients. Similarly, for a clinician who wishes to have a more substantial fund of knowledge and more treatment recommendations for, say, nutrition- the "cost" is very high in that a lot of research needs to be done on their own time to be able to adequately know the current clinical landscape with respect to nutrition, while keeping track of emergent research and treatment options.
Let's use hypertension (high blood pressure) for an example here. Most physicians have watched the treatment recommendations and guidelines change over the time they've been learning and practicing medicine. They've changed significantly in the past decade, such that if a person comes in and has met all the criteria for hypertension- the treatment recommendations will get a once-over by a physician before initiating the current evidence-based treatment unless the physician treats this issue so often that he or she is very familiar with the current recommendations and any update to those recommendations automatically gets added to their fund of knowledge. Contrast that with nutritional recommendations for a particular patient population. Not only are there NO CURRENT EVIDENCE BASED recommendations, more or less, but there does not exist any sort of unified resource for the primary care doc to reference to often to keep them in the loop for emerging research, treatment options, etc. So what's the best step in rectifying this situation? More pre clinical education about nutritional principles? Maybe. How about more clinical experience with trained nutritional professionals (e.g. nutritionists and RD's)? Maybe. The answer is complex, certainly, and I think indicting physicians as no-nothings about nutrition and exercise, while likely not the goal of Mr. Talens' post, is both unfair and untrue. I think a lack of evidence based recommendations in an easily accessible- both in physical and a cerebral sense- is likely a bigger problem. So I guess we need a Barbell Medicine Treatment Algorithm for exercise and diet, eh?
