Rewiring the Healthcare Hard Drive.

I believe nutrition is the key to health.

And yet, as I was working in the hospital, an establishment dedicated to improving the health of our patients, I listened to a nutritionist who was making her rounds. She entered the room of my overweight, diabetic patient and the following conversation ensued:

Nutritionist: “Hi, I am the nutritionist and I was asked to come speak to you about your diet. Is now a good time?”

Patient: “Sure”

Nutritionist: “Okay. Are you eating okay?”

Patient: “Yes, I’m eating.”

Nutritionist: “Great. Well just make sure to eat lots of fiber and protein, and focus on fruits and vegetables.”

Patient: “Yeah, I know. I try to avoid bread and grains too. You know, because my diabetes.”

Nutritionist: “Good. Also, try to fill half your plate with vegetables. Here is a packet about eating a cardiac diet.”

Patient: “Okay. Thank you.”

Nutritionist: “You’re welcome. Any questions?”

Patient: “No.”

Nutritionist: “Okay. Have a good day.”

How does this conversation sound to you? It might sound adequate. The necessary information was given to the patient, after all. But to me, I think this conversation was worthless.

Eating styles and habits are formed over years. Obesity and diabetes are epidemics that cannot be altered by a two minute conversation and a packet of instructions. That nutritionist’s job duties should be so much more. She should have pulled up a chair with a writing pad, psychiatrist style, and asked, “What does a day of eating look like for you? How do these foods make you feel? Are they fueling an inner battle or emotions? Does your family or life at home hinder you making healthier choices?” These are the questions that need to be asked and the problems that need to be addressed. Meanwhile, I have witnessed diabetic patients munching on chocolate mousse on their diabetic lunch trays and sick patients washing down their 500-calorie pumpkin pie (Yes, 500 calories in one slice of our hospital pumpkin pie) with Coke. How does this make any sense? Our hospitals claim to be promoting health but stand as disguised contradictions. Our patients don’t get adequate sleep, because we poke and prod them every hour during the night. Our patients aren’t pressured to eat healthy foods. Our patients drink soda and sugary juices instead of water. Our patients don’t get enough physical activity. Our patients lay in bed all day watching television, maybe working with physical therapists for 30 minutes before slumping back onto the mattress.

I have witnessed a group of doctors telling a morbidly obese young woman that she was on too many sedating medications, treating her depression, anxiety, and pain. Her body was rampant with infections, bed sores, early organ failure, and the list goes on. She looked at them and told them she refused to comply with their recommendations, and to continue with her previous regimen. So they left, and she was discharged later that day.

Health care is not invasive or comprehensive. We apply bandaids to the surface of problems, then hand our patients discharge orders to go home and continue their daily lives until their deteriorating health wheels them right back into our doors.

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