Why Don't Doctors Get It???

I’d love to know what world doctors live in. Is it all sunshine and lollipops? All they do is lecture adults to watch your weight, quit smoking, and limit/quit drinking. Don’t doctors get it? For cheesecake sake, doc! Living causes stress! What does your ivory tower text books recommend we do!?!?!

Why do doctors think they have all the answers?

'Cause they went to medical school and you didn’t?

I’m with ya, but my pet peeve is insomnia.

Yes, I’ve done a sleep study.

Yes, I’ve been through therapy.

Yes, I have several sleep disorders and have so for 30 years.

No, Benadryl or TylenolPM do not work. In fact, they have the opposite effect and wire me for seven or eight hours.

No, meditation and chamomile tea before bed do not work.

Yes, Lunesta is the only thing that works, and that means maybe five or six hours of semi-restorative sleep.

I’ve had to “break-in” a few new doctors at the family practice I go to and it’s very frustrating to try and relay to someone who has obviously never experienced real insomnia what a life-killing, debilitating problem it is.

Maybe they just think you should look at other ways to relieve stress aside from eating, smoking, and drinking.

How about some yummy brightly-colored pills instead?

Telling people to quit doing fun stuff is what doctors and preachers do. Lawyers come in to the picture for people that get caught doing stuff doctors and preachers told them not to do. Such is life.

Doctors live in the same world you do. Maybe turn it around on them and ask them what they do to avoid or limit those things?

But do not ask a skinny female doctor how to avoid night-time bingeing. Her answer was to have a few carrot sticks or suck on ice chips. She couldn’t understand why I was laughing at her.

I generally loathe it when knuckleheads quote the entire first post, and I apologize for doing so, but I ask you to take a step back and re-read it, Jinx.

I really do apologize for sounding snarky, but what do you expect doctors to do? Tell you to just give in to the stress and do things they believe are bad for you? They’re just doing their job. They can’t change the world.

Full disclosure: I am exceedingly obese, and I don’t blame my poor doctor for encouraging me to work on saving my own life, even if he is unsuccessful.

What do you think they should say? go ahead and keep smoking/drinking/overeating and die of lung cancer, liver disease, or a massive heart attack at 40?

The fact is, drinking, smoking, and overeating are very unhealthy. In fact smoking and obesity are by far the biggest causes of preventable death in the united states and drinking is a (very distant) third. Added together they cause damn near 40% of the deaths in the United States (smoking alone is almost 20%).

Since a doctor’s whole job is to keep you alive and healthy, of course they don’t want you drinking, smoking, and overeating.

I’m no paragon of health virtue, but I seriously have never gotten any lecture on healthy eating and exercise from a doctor. I think they should state some facts but not be judgmental.

For a little levity, at my recent physical my doctor did ask if I exercised. I said “a little.” She laughed and said “at least you’re honest.”

Well speaking as an pretty damn overweight all my life Med student, I’ve been on both sides of this coin.

All my life I felt the way you did, I enjoyed my Doctor’s visits and all, but I hated the checkups and the inevitable conversations that would always occur- “You need to consider loosing some weight…”- EVERY visit. As a kid, I always ignored it, or I said I’d try, or even had a few doctors just give up on me for it. I hated it and I hated them for it.

Now in med school, it kinda sucks- because the one telling me I should lose some weight is myself pretty much. And the textbooks- well they pretty much all spell out the same thing. Diabetes lowers your life span, and has plenty of complications. Hypertension is a killer in the long term- the big three irreversible organs to go are Kidneys, Heart and the Brain. Acute MI’s, Heart Attacks, aortic stenosis, clogged arteries, pulmonary HTN (hypertension), reversible steatosis (for the drinkers out there) that progresses to fibrosis and then irreversible cirrhosis. Getting to read about Wernicke-Korsakoff syndromeand the crushing toll it can take on family members, to learn about the costs of medications, the strokes, the MI’s, the feel of cutting into a Cadaver and feeling a person’s yellow fatty tissue…

It really really brought it all home to me. It was and is graphic and on going. So many problems are created in the long term with these and many other pathological conditions which all list common causes that can lead up to them: being overweight and all the complications that arise from it pretty much lead up to a TON of crazy things that can do you in, or if not even that, can REALLY make the end stages of life not a happy place to be.

So I feel for you, Sir/ma’am. Because I know had I not gone to med school I never would have cared about these things, I was stubborn about it, and I believed that sure I might be cutting a few years off my life, but why sweat it, when I could enjoy the now?

And now, I have to be on the other side of the coin, being an overweight doctor trying to explain to his patients to do the very same things that I myself can obviously been seen as not having done? Not cool. It feels hypocritical. But in the end, the Doctor-patient relationship should be FOR the patient. The patient comes first. Their health should be #1, that’s why they’re here to see us, and we’ve got to do the best we can to take care of their current problems. If they’re sick, medical professionals should do their best to help solve their problems or if not that, then to improve their quality of life the best we can with our knowledge, our training, and our tools.

But should we as health care professionals stop there? Would you want us to?
I believe now that health care professionals should also try to do some measure of preventative measures as well- if we can advise or advocate to the patient ways that can help THEM out in the long run from hitting more severe or complicated illnesses, I think that doctors and other health care providers have an obligation to try to prevent that.
We cannot force you to change, nor do I believe that is the role of a doctor.

But if there’s a bad end down an unhealthy path, I feel I should try to educate and advise my patient the best I can on ways they can avoid that end. Life is certainly stressful and terrible right now, but if we only focus on a patients’ CURRENT medical health, then I think I would be doing you a grave disservice.
If a patient came in with a growth or suspicious lump, the doctor would be doing them a terrible disservice if they merely stated “well, it’s not bothering you right now, we shouldn’t worry about it right now. Let’s wait and if it gets worse, THEN think about coming in” (yes, I know this does still happen though- it’s not a perfect world).

That’s my idealistic views as a medical student. And I know how much a 15 year old me would have hated the current me saying these things. But… I still think it’s the right thing to do. Dieting isn’t fun, cutting back on alcohol isn’t fun, and I certainly don’t blame anyone for feeling frustrated at all- I know what it’s like to constantly have doctors remind me about it over and over. And I also know what it’s like to go to the doctor, and have them look at my weight and simply not say anything, even though they knew it was out of control. That one hurt more- when it hit me that he had nothing left to say and he’d given up on me. I don’t want to do that to my patients. You’re not alone though.

And I’m sorry I don’t have all the answers at all. :frowning:
The only thing they give me is the fact that I get to learn all the various ways I can die, all the various ways my life can slow down, and watch others who’re currently suffering through those problems.
All the books tell us is “it could have been prevented.”

As to HOW to get someone to cut back? How to explain to someone for the 400 and first time that he’s got to cut back or else it could kill him but to do it in a way that connects and makes sense- there’s nothing on that. How to get someone to figure out that they’ve got to take a look in their life and see what’s more important to them their current lifestyles or the ability to have a similar one in 5 or 10 years- nothing on that either.

I don’t think it’s something that’s teachable really- they just teach us that to prevent these problems it’s best to prevent them from starting in the first place, and to recognize the unhealthy behaviors when they’ve got a fighting chance to not go down an even worse road.

But getting someone to MAKE an important lifestyle change just because a doctor has pointed out it’s got an unhealthy consequence? That’s not something that they can teach us. That’s where the doctor-patient relationship now requires help form the other side. The doctor can only point out the bad outcomes, and he can only be an advocate and warn the other half that it’s not a fun road… :shrug: The doctor can only give forth the knowledge, and perhaps (if they’re really knowledgeable) some ways to help or places to turn to for support and help, but the rest? The rest is up to us patients to deal with.
Bummer on the bad news, but good luck to you in your journey. We each have our own to bear and it’s not a fun or easy path. But I certainly do wish you the best.
A journey of a thousand miles begins with a single step. - **Confucius **


I don’t see what caused the laughter either, and I’m not a fat hater with an ax to grind.

I keep my fridge full of healthy and low calorie foods. All the fruit and veggies I can eat, plus some low-fat yogurt, whole wheat pasta, almonds, and the like. If I ate absolutely everything in my fridge in some wild binge tonight, I could probably gain 1.5 pounds. I probably wouldn’t make it past the whole bowl of apples, but there are foods you can binge on all you want and not get fat.

If everything you keep in the house is healthy and reasonably low-calorie, you can have a night-time binge and have it not affect your weight. If she wasn’t addressing the emotional component behing your binging, fine … but until that is addressed, why not follow her advice?

Have you been to a nutritionist?

Seen from the other side, it’s equally frustrating. My wife is a cancer doctor, a radiation oncologist, to be precise. When asked, in social occasions, about the “secret” to avoiding cancer (you know, the one that doctors jealously guard to themselves to avoid loosing business), my wife is alway glad to let them know there actually is one. Tons of research shows there is some things you can do to hugely reduce your odds of getting cancer, and that it’s relatively cheap: stop smoking, control your weight, exercise, and eat many kinds of vegetables. For some reasons, they go away all disappointed. Then, they come back in 30 years with a growth. Or a heart attack. Or a stroke.

As for relieving stress, I alway suggest vigorous exercise, preferably hitting or breaking something, like a heavy punching bag, or splitting logs. Splitting logs is wonderful & cheap therapy. Kinda like bubble wrap on a ginormous scale.


Eat fruits and vegetables.

Socialize. Communicate and problem-solve with your SO. (Therapy if necessary.)

Pet kittens. Plant gardens. Read a book.

Praying may reduce stress for some. Meditation might work for others. Biofeedback is available, but doesn’t work for everyone.

That’s the typical list.

Because binge eating, true binge eating, isn’t about having an occupied mouth, or a full stomach. It’s not about nutrition. Nor is it about weight loss, as binge eaters don’t have to be overweight. It’s a psychological problem with a physical manifestation. Suggesting ice chips or carrot sticks to combat binge eating is like suggesting an anorexic buy some pretty clothes and smile more. It misses the point so immensely, it’s not even in the same universe.

A good doctor, upon hearing the word “binge” should have stopped and asked more questions, and investigated further and made a recommendation for someone qualified to treat eating disorders. Glib recommendations of carrot sticks are about as useful as telling the person with a compound tib-fib fracture to just not walk around for a while until they feel better.

Did you explain that this was/is a psychological problem and that you weren’t talking about sneaking back to the fridge for a few spoonfuls of leftovers ?

Ha! I would suggest the carrot sticks. I keep a bowl of veggies all cut up and ready to go in a little tupperware container full of water so that when I need something to munch on… there it is.

Also: air popped popcorn with a few sprays of zero calorie dressing and your favorite spice sprinkled on top.

I could go on and on :wink:

Although your comment does make me ask something that I’ve experienced both online and off (and I swear I’m not accusing you, it’s just the right time for me to ask): why do a lot of people seem to discount the advice of people who are thin? I’ve gotten “you wouldn’t understand!” from overweight people who are looking for diet/exercise tips. Why wouldn’t I understand? It works!

PS: I would also suggest not visiting the fridge in the middle of the night for pie :wink:

Good answer.

My doctors have all told me to lose weight and quit smoking. What else are they supposed to tell me?

Their jobs are to keep us alive and healthy. AND HEALTHY. It must fucking suck for a doctor to be treating a guy with emphysema who is still smoking, or a woman with high cholesterol who won’t quit the fried chicken. It’s like constantly having to clean up someone’s computer who won’t stop clicking on questionable links.

They’ll either make their money by you staying around longer to have you as a patient longer, or by you needing them more as you deteriorate faster. So money is not a driving force for them. Health is.

In my opinion, our role as physicians should be to advise patients what choices will improve their health and diminish their dependence on medications. It shouldn’t be to tell them what to actually do. Not everyone’s greatest good is living longer or healthier. The patient should decide what to actually do.

We should also help patients rank their choices. Sure, more exercise is a good idea, but not as good an idea as stopping smoking, for instance, if you are a youngster. On the other hand if you are 60, stopping smoking probably won’t increase your longevity, but exercise might…

Finally, we should be a good source of how to actually do something. “Stop smoking” is not very worthwhile advice.

Tell em what they want to hear, then live your life. If your doc does not get the message after a certain amount of visits, I would shop around for another one and have a interview where you tell him what you want out of the visits and what you dont want.

I remember the last time I went to a doc in the box, i got the same speech bout smoking , but the doc had this expression on his face that said , I gotta do this , nothing personal.