Joe Lightfoot, a last year medical student, wrote a guest article named Just Because A Doctor Said It – A Response on Tony Gentlicore’s blog, and its popularity has been spreading like this year’s strain of the influenza virus. You should definitely read that blog post; it’s a good piece with some thought-provoking points, and you’ll probably need it to understand my arguments fully.
I’m constantly bombarded by stories of people’s “stupid doctors” who said X,Y and Z about fat loss diets on my Twitter and Facebook news feed. This bashing is getting tiresome, and if you ask me, it’s based on completely the wrong premises of what I do as a medical doctor versus what I did when I worked as a personal trainer, or what I do currently with my online consultations.
As a physician working with real patients on daily basis, I do have a few opinions which I’d like to share. Joe Lightfoot and I agree on many points, but there are a few aspects that I believe needs to be added to the discussion. So far, the discussion seems solely focused on two parties: the health practitioner and the trainer. We have completely forgotten to include the third, and biggest party: the general population.
Point one: the misconception about what doctors do
Question: As a doctor, do you know I do on a daily basis?
Answer: I see ill people (also called patients). I sit by their bed, I comfort them, listen to their stories, examine them, use the x-ray to get under their skin so I can give them a diagnosis, plan their treatment, prescribe the right medicine and do a follow up.
Doctors need more education on everything to do with lifestyle advice, particularly exercise and nutrition. That is indisputable.
That is an interesting point by Joe Lightfoot, and in a fantasy world where you could ride the rainbow, shower in moonbeams, and do wand-wielding magic, that could probably be feasible. Reality however, is a cruel mistress. In most countries med school is six years long, and that is before any kind of specialization comes into play. In the real world, there is just not enough time to learn everything. Specially if it is not going to be a part of what you will be doing on day-to day basis because to become a good clinician, we need to get students out of med school as fast as possible and get them to start building real world experiences.
Sure, doctors need to understand human physiology and the effects of lifestyle on the pathological processes, to a minimal degree. This is a very important point, which is why I will repeat it: they need to understand it, to a minimal degree.
What often comes to light in these discussions is that the advice given by your idiot doc was not the “optimal” advice. Nor was it in accordance to the latest paper published in the British Journal of Nutrition (which you have probably only read the abstract of). That’s considered talking about expert opinions, not general guidelines. I repeat once again: doctors need to understand human physiology and the effect of lifestyle on the pathological processes to a minimal degree, as a way to understand ILLNES and the treatment thereof. Because THAT is what doctors do. There is just no time to learn all that other stuff, unless that’s something you are genuine interested in (and even then, people will still call you an idiot because you don’t follow the same nutritional cult as they do).
This brings us to the next point
Point two: The reason doctors give advice on fitness and nutrition even if they shouldn’t
So if doctors really don’t have a clue about optimal nutrition or exercise physiology (the two weeks spent touching on that during med school just aren’t enough) – why the hell do they give you advice about it?
Just like Joe Lightfoot said:
Whilst some are motivated by money and titles, the vast majority of people became doctors because they want to help their patients.
They will give you advice because of the very same reasons anyone gives advice about nutrition or fitness. With a few exceptions, your doctor wants to help you, and will say what he or she truly believes will do so. So does your mom, your neighbour and your personal trainer. That does not mean they know what they are talking about, and YOU are the misinformed one who thinks that’s what they are supposed to know. If you’re not smart enough to know who to listen to, then you’re just as “dumb” as they are. Don’t blame others because they tried to help your ass out.
Point three: Your doctor is not the idiot. You are.
Nutrition and the education on lifestyle and preventive medicine during med school was minimal. And like I stated above: I don’t necessarily think that including more lectures and adding years to med school is the solution, since that is not what we work with on day to day basis once school’s out. When you ask anyone on the street what you should eat to lose weight, you’ll get the answer this person happens to have, which is usually influenced heavily by external factors. This could be yesterday’s magazine, some random documentary or from last week’s episode of The Biggest Loser. Understand this: Your doctor has the SAME source of information as the general public. It’s you who thinks that just because your doctor said it, there should be some validity to it. In a way, calling doctors stupid because of the nutrition advice they give, tells more about the knowledge of the audience than the doctor.
The focus needs to shift from the doctors being stupid and not knowing shit, to the general population who are the misinformed ones about what they can expect from their physician. Give your doctor a pair of strange sounding lungs and you should expect him/her to diagnose pneumonia and prescribe you with the right antibiotics. However, don’t expect him to know which the optimal diet is for fat loss, even if he does think he knows, and there is a stethoscope hanging around his neck.
In the perfect world, doctors would stop giving advice about areas outside of their expertise (so would the general population). In the meantime, the general masses need to get their facts right about what a physician’s job is and most importantly, what it’s NOT… before they start hating for the sake of hating. On the same note, trainers need to shut up with advice about how much water people should drink to reduce risk of kidney stones, how sleep deprivation causes cardiovascular disease and why gluten is the most evil thing since dairy.
Finally, I want to get back to the original question:
Is it true because your doctor said so?
I’d say it depends on the initial question you asked your doctor. If your physician is trying to explain what bacteria caused your pneumonia and how you should go about treating it – the yes, you should expect your doctor to know, because THAT is what we do. When it comes to nutrition, preventive medicine, or exercise physiology? No, not any more that you trust your mother, neighbour or favourite columnist – they all get their information from the same sources anyway.
The takeaway is this: Stay critical and ask for people’s sources, never ever trust people blindly just because of their title – be it your doctor, mother or columnist.
Trust me – I’m a doctor
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