By Pauline W. Chen, M.D.
Excerpts from New York Times
Within days of being accepted into medical school, I started getting asked for medical advice. Even my closest friends, who should have known better, got in on the action. “Should I take vitamins?” “What do you think of this diet?” “Is yogurt good for me or not?” Each and every time someone posed such a query, I became immediately cognizant of one thing: the big blank space in my brain. After all, even with medical school acceptance in hand, I was no more a doctor than they were. But I also soon realized that many of their questions had nothing to do with medications or operations, or even diseases. With all the newspaper and television reports about newly discovered carcinogens and the latest diets and miracle nutrients, what my friends and acquaintances really wanted to know was just what they should or should not eat.
Years later, as a newly minted doctor on the wards seeing real patients, I found myself in the same position. I was still getting a lot of questions about food and diet. And I was still hesitating when answering. I wasn’t sure I knew that much more after medical school than I did before. One day I mentioned this uncomfortable situation to another young doctor. “Just consult the dietitians if you have a problem,” she said after listening to my confession. “They’ll take care of it.” She paused for a moment, looked suspiciously around the nursing station, then leaned over and whispered, “I know we’re supposed to know about nutrition and diet, but none of us really does.” She was right. And nearly 20 years later, she may still be.
Research has increasingly pointed to a link between the nutritional status of Americans and the chronic diseases that plague them. Between the growing list of diet-related diseases and a burgeoning obesity epidemic, the most important public health measure for any of us to take may well be watching what we eat. But few doctors are prepared to effectively spearhead or even help in those efforts. In the mid-1980s, the National Academy of Sciences published a landmark report highlighting the lack of adequate nutrition education in medical schools; the writers recommended a minimum of 25 hours of nutrition instruction. Now, in a study published this month, it appears that even two and a half decades later a vast majority of medical schools still fail to meet the minimum recommended 25 hours of instruction.
Researchers from the University of North Carolina at Chapel Hill asked nutrition educators from more than 100 medical schools to describe the nutrition instruction offered to their students. While the researchers learned that almost all schools require exposure to nutrition, only about a quarter offered the recommended 25 hours of instruction, a decrease from six years earlier, when almost 40 percent of schools met the minimum recommendations. In addition, four schools offered nutrition optionally, and one school offered nothing at all. And while a majority of medical schools tended to intersperse lectures on nutrition in standard, required courses, like biochemistry or physiology, only a quarter of the schools managed to have a single course dedicated to the topic. “Nutrition is really a core component of modern medical practice,” said Kelly M. Adams, the lead author and a registered dietitian who is a research associate in the department of nutrition at the university. “There may be some pathologists or other kinds of doctors who don’t encounter these issues later, but many will, and they aren’t getting enough instruction while in medical school.”
Eventually, practicing physicians may even be able to earn continuing medical education credits, a requirement of many hospitals, state licensing boards and specialty boards. “It’s extremely difficult to get people to change their diets and their habits around food,” Ms. Adams said. “Anything that improves a doctor’s confidence and skill set will go a long way in helping patients. You can’t just keep writing out script after script after script of new medications when diet is just as important as drugs or any other treatment a patient may be using."
Bonnie - I applaud Dr. Chen's honesty in writing this piece. Most doctors would not admit to this, especially in a public forum. This is an issue I have harped on for decades and little has changed. While increasing the amount of nutritional education for doctors is priority number one, the second issue is to teach them the right kind of nutrition. If educators are just re-hashing the food pyramid and dietary guidelines, then it is a complete waste.
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