Thursday Born

The everyday life of a psychiatry resident (who was born on a Thursday).

The widening gap between doctor and patient

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I was standing in Walgreens one day when a somewhat overweight teenage girl approached me and asked me if I exercise.

“No, not really.”

“Well do you know anything about this acai berry thing? Oprah says it helps you lose weight.”

… “I don’t know anything about it, but you know, none of that stuff works. You just need to eat right and exercise.”

“But it’s hard!” And she wandered off in search of someone else to tell her that yes, she should buy that supplement and yes, it will magically help her lose weight.

It’s funny though, because she was looking for people who exercise to tell her about this. She was targeting skinny people because she assumed they must exercise and must know about health stuff, and yet she also believed that she too could be slim not by exercising, but by swallowing a few pills.


My medical school class is surprisingly athletic and healthy. Never before have I been with a group of peers who complained about free pizza and soda. Free pizza and soda!

This worries me a little, in a roundabout way. I worry about their ability to empathize with the every day American, the “common folk,” and also the poor who never had the resources to even think of trying rock climbing or ultimate frisbee, who think they can’t afford anything but pizza and hamburgers and soda. My class seems open minded and empathetic, and over a third of us did a Public Health pre-orientation program to introduce us to our new city and it’s myriad problems.

Still. I worry. The obesity/diabetes/high blood pressure/etc problem is, well, it’s a serious one, but there’s a huge gap between the way doctors see it, and the way the people with “the problem” see it. It’s a health issue, but I’m not sure tackling it as a health issue is the way to go. It’s also a psychology issue. A socio-economic and cultural issue. A government subsidized crops issue. A society drenched in consumerism issue (try this diet! No, this one! Buy my book! Buy my supplements!). The one approach I have seen that I think could really work is the Health At Every Size movement (not to be confused with the Fat Acceptance movement; they share some roots and the cultures mix a bit, but they are not one and the same), but it’s not marketable. It’s not flashy and it doesn’t promise to “fix” your body; all it claims is that it can help you be healthy, and maybe that will mean losing weight and maybe it won’t.

So as idealistic and hopeful as my class is, I worry that when the time comes, we all will fall victim to the culture at large, and despite our intentions to be a positive force, we will simply become a new part of the problem. Unable to connect with our patients who don’t understand that juice is not healthy,  and who take elevators when they need to go up one floor. Unable to connect with the patients who don’t have time to cook because they’re holding too many jobs and they can’t afford the ingredients anyway, or the patients who actually are eating right and exercising but have a disorder that’s causing the weight gain.

I worry that we will become the doctors who just  say, “You need to eat right and exercise,” as I did to that girl in Walgreens. It doesn’t matter how true something is if it doesn’t work. I hope at least that none of us will be the doctors who actively alienate their patients, who treat the overweight ones with contempt and ridicule. Shame is not a positive changing force for the majority of people.

Written by Aba

August 29, 2009 at 10:28 am

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