Friday, April 28, 2006

Dietary counselling

Today I saw John Belushi in clinic.

Not really of course, since John is dead, and this guy was ten years old, but the point is, the obesity epidemic is real. The problem is that he came in because his mom was concerned about a rash, and so my preceptor didn't want to touch on the issue of the kid's weight.

So I acceded to her direction, and dealt only with the guy's rash, but it broke my heart to see a ten year old sitting on the exam table playing with his minature beer belly while his mom and I discussed his treatment. I should have spoken up about his diet anyway, but my preceptor's point was "that's a job for his primary care provider." Next time, I'm going to talk about diet anyway.

I'll probably be seeing little JB in my cardiology practice in 30 years, when his lifestyle and habitus catch up with him. But I'd rather not, for his sake.

1 comment:

S. Lee said...

I think that you will learn as a physician how open the Hippocratic oath can be at times. Preventative medicine sure beats that heart surgery later.

It's also important to remember that most people trust doctors implicitly. This gives you a priviledge that I could not reasonably exercise by sauntering up to the kid's mom in the grocery store and telling her how obese her child is.

And finally, exercise your ignorance, or at least your right to it, as a doctor-in-training. :) You can pretty much say anything to the patient and shrug and say, "Gosh, I didn't know I wasn't supposed to say something."

And sometimes you'll be wrong to the eyes of your colleagues, but always make sure you have the conviction I think you might have in this particular case to act and truly make a difference.