As I’ve alluded to in the past, the study of medicine can be overwhelming. We’ve simply discovered too much for one person to master completely. This is the challenge medical educators are tasked with – what’s so important that it must be allotted time in the brief 2 years of dedicated book learning doctors-to-be receive?
Students face a similar time-management challenge – first, we must decide what’s important enough to focus on, but the real question I think we wind up asking ourselves is this: is it worth it to study this if no one will test me on it? We quickly learn that things not emphasized in a particular course are typically not represented on the exams administered (at least not in a way that can hurt us).
Nutrition is, and will continue to be, a controversial and evolving aspect of medicine – but I also consider it to be one of the most fundamental. So, why then, don’t doctors know about nutrition? Because no one is teaching us. The approximate time devoted to nutrition science over the first two years of my medical education is a measly 6 hours – that’s only two hours more than an average day of lectures at my institution.
A 1985 report commissioned by the National Research Council concluded the following:
“The teaching of nutrition in most U.S. medical schools is inadequate. . . All students should be given a course or its equivalent in the fundamentals of nutrition during the same years in which other basic sciences are offered.”
I’m afraid the commission would reach the same conclusion today.
During the brief period of my education dedicated to diet, we were instructed to use an online food log for a day and analyze the results. It had a clumsy, cumbersome interface that was difficult to navigate – this is coming from someone who’s not bad with computers. Most people didn’t even complete the exercise – now, do you think they’ll use that tool with their patients in the future? I recommended FitDay.com & NutritionData.com, which I’ve written about in the past, as alternatives for this exercise in the future, but the instructor wasn’t interested.
I have a friend who is a medical student and I joke that he can barely manage to feed himself – he goes for days without adequate calories, then binge eats; and I assure you, the type of food he eats is as bad as his pattern of eating. I have another friend who thought there was the same amount of sugar in a serving of vanilla yogurt versus plain.
And even when we do know what’s right and wrong, we often make poor choices ourselves – why should our patients listen to us?
We may study biochemistry and what happens to the components of food we eat, but we study very little about dietary choices and how to advise our patients. In the hospital, we consult the dieticians when we need to make decisions about what exactly to feed our patients. When patients ask us questions about diet and nutrition, we often deliver vapid, cookie-cutter answers that (rightfully) go in one ear and out the other.
This is absurd. We are in the middle of an obesity epidemic that’s not only making us sick as individuals, but weakening us as a nation. Nutrition is intimately involved in the pathogenesis, and sometimes (but not often enough) treatment, of chronic disease. I hope this is one aspect of medical education that is reformed in the near future, because I feel it’s hurting us in ways we may not even recognize.