Are medical students learning enough about prescribing advice on physical health and nutrition? The campaign Move-Eat-Treat weighs in

Anahita

Anahita Sharma is a 3rd-year medical student at the University of Manchester. She became interested in global health work after noting that access to surgical treatment for her congenital defect, a cleft lip and palate, varied worldwide, and with income level. She loves mountain biking, reading, and people’s idiosyncrasies.


The docs going to tell me to quit smoking and do more exercise.

They dont even live my life or do my job, so how could they understand what this means to me?

I already know this is bad for me – but it makes me feel better.

Ive tried before and it didnt work, so whats the point of bothering?

If Im going to have to give up everything I enjoy in life, is that life even worth living

Does this discourse sound familiar?

Do we tell our patients what they expect us to, and do our patients relay to us us what we expect them to? Can this parody of a conversation turn into a meaningful exchange of trust, rather than regress into, over time, a relationship where neither party addresses causes, but rather, consequences?

Is this even a conversation we should regularly be having in secondary care? If patients can be medically discharged, but still have to wait for the physiotherapist to verify their ability to climb the stairs at home, I would certainly think so.

Dr Joseph Lightfoot set up the campaign, Move Eat Treat2, as a medical student.I learnt about disease, but I didnt learn about health,’, he reflected, alerting us to the coarse distinction between ‘proactive’ and ‘reactive’ medicine, and to the paradox of the hospital setting as an environment that does not especially inspire wellbeing. He prompted us to consider the fundamental gaps between our own agenda as healthcare professionals – to meet targets, to clear waiting rooms, to encourage our patients to take responsibility for their health, and that of the patient – who seek attainable resolutions, an allaying of fears, and an impetus for changes in their lives. The campaign itself is refreshing in its simplicity and clarity, outlining three goals:

GOAL 1: Reform healthcare education to include lifestyle as a core theme

GOAL 2: Provide education to healthcare professionals about lifestyle advice. – A study by Weller et al. in 20123 demonstrated a ‘widespread omission of basic teaching elements’ with regards to guidance on physical activity.

GOAL 3: Provide a platform for collaboration and connection 

I would argue that medicine is largely a social rather than a scientific profession. We have a duty to bridge the biomedical community with our patients – and the literature has unequivocally demonstrated the effects of modifiable risk factors on health. These have been recognised by their formal incorporation into cardiovascular risk calculators such as QRISK2 and JSB3. So, when was the last time you asked a patient about changes they wished to make in their lives during a clerking, and do you remember how they responded? Did they mention how they wished they could fit into an old pair of skinny jeans? Or that they wanted to be able to play with their children? What does the patient care about? If you remember to ask these questions, that is half the battle. Rather than pushing your own, identify the patients agenda and what he or she is willing to change and work from there because they will be more receptive.

Personally speaking, a patient once mentioned that she didn’t feel like she was athletic enough to attend a leisure centre. I go to a leisure centre regularly and suffer through push-ups with people of all ages, sizes, and levels of fitness,  so I knew this belief was erroneous. She had consequently been denying herself of the immensely health-protective effects of exercise. Should we begin to lay out these thought patterns? Should we draw on our own experiences and those of individuals we know?

Any healthcare professional will acknowledge that behavioural change is obviously important, but is this put into practice? How can we succeed in demonstrating to patients that their behaviours have tangible and cumulative effects on their health across their lifetimes? Patients are not privy to the lucid, cross-sectional, view of society that working in healthcare provides. Outside the hospital, it can be difficult to make the ‘right’ choices. For example, fresh produce and healthier options are often priced higher than processed foods are. Precisely how much much agency do we exert over our own choices when our pockets come into question? Are social gradients in health all that surprising?

This leads me onto a tangent – why are we often surprised by statistics when they actually reflect the world we live in? For instance, the ‘Fairness on the 83 campaign interviewed pedestrians in Sheffield across the longitudinal section of society traced out by the 83 bus route1, and asked them, ‘Do you think we live in a fair society?’. Granted, this was a small and random sample, but the question was generally met with a ‘more-or-less’ type answer, before the interviewee was informed that:

On average, women born in Ecclesall and Millhouses will live around ten years longer than those born in Burngreave.

So, as it turns out, Sheffield conceals concrete disparities within its confines. I speculate that statistics surprise us because we do not live a uniform existence. And why is this unfortunate? Because we miss important  signs and developments. We cannot translate what has been generalised on a population level to ourselves, until, perhaps, after the damage has been done. Daniel Kahneman describes this as the tension between the ‘outside’ and ‘inside’ view, in Thinking, Fast and Slow, a review of the psychology of decision-making. Statistics elucidate key relationships where they are otherwise confused by the chaos of everyday life.

Dr Lightfoot underlined that there is no formulaic solution. Is there a perfect diet or a perfect exercise regimen? What is the ever-elusive magical pill to our modern ailments? There might a magic pill for one, but what works for one might not for another. This adage is as old as time, and continues to stand in its wisdom. And what motivates us? Is it a pep talk, the sense of making progress, the fear of negative consequence, or our physical and social environments? If we consider that all of these have effects, we can begin to understand the heavily weighted roles public health education, civil engineering, and our social environments, play in our health.

To round off the session, we discussed motivation, perception of ability, the use of triggers, and the importance of consistency, in establishing a habit. We shared our own personal goals, and  attempted to provide one another with lifestyle advice. When consciously attempting to provide lifestyle advice, I found myself awkwardly trying to trace the root of my ‘patient’s’ problem, but this was not simple. I found it helpful when a lens was placed on my own habits, and to break apart the various factors that made changing them difficult. Our group found that we had a tendency to separate activities into those that we deemed essential, and those that simply didn’t seem as important. Can we, therefore, re-frame good nourishment and exercise as everyday priorities?

The resources available on Move Eat Treats website are designed for us, for easy reference. They are beautifully succinct summaries – spanning physical activity & sedentary behaviour, nutrition, sleep, smoking, alcohol & substance misuse, stress & mental wellbeing – and signpost the length of time it will take to read any externally referenced documents. A quick peruse reveals insightful rules-of-thumb that can be immediately be put to to the test. For instance, check out the the Positive Hunger Scale on the ‘Nutrition’ page, the important distinction between ‘physically active and ‘sedentary, ‘How to take an exercise history, and the suggestions of apps that might be useful for patients.

Anahita Sharma

PA-matrixPostivie-hunger-scale


Citations

  1. “Fairness on the 83.” Fairness on the 83. N.p., n.d. Web. 24 Oct. 2015.
  1. “Move Eat Treat.” Move Eat Treat. N.p., n.d. Web. 24 Oct. 2015.
  1. Weller, Richard, Stephen Chew, Ngaire Coombs, Mark Hamer, and Emmanuel Stamatakis. “Physical Activity Education in the Undergraduate Curricula of All UK Medical Schools. Are Tomorrow’s Doctors Equipped to Follow Clinical Guidelines?” Physical Activity Education in the Undergraduate Curricula of All UK Medical Schools. Are Tomorrow’s Doctors Equipped to Follow Clinical Guidelines? British Journal of Sports Medicine, 30 July 2012. Web. 24 Oct. 2015.

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