Holy hell balls, only 2 weeks of class on obesity? (Or, why I really shouldn’t read stuff on Huffpost)

Medical school is full of stuff to learn. A lot of stuff. Every day is a new day of a massive volume of information. It’s like trying to take a sip from a fire hose.  Residency is even more. The AMA has voted to classify obesity as a disease. An interesting move, for sure, that will ignite debate and discussion for years to come.

This has triggered a bunch of blog posts from a variety of parties who ask the obvious question: how can doctors who receive less than 2 weeks of class on obesity be adequately prepared to treat it?

To this, I have three rebuttals:

1) Two weeks is way more than you think it is in medical school time.

The volume of information that needs to be transferred in medical school is enormous. Every speciality laments the fact that they have so little time in the curriculum to teach the basics of their field. Two weeks in a medical school curriculum is actually massive. My entire cardiac eduction took place in a single month. Lungs? 4 weeks. Brain AND nervous system? 8 weeks. All of the musculoskeletal system? 6 weeks. I’m obviously biased here, but medical students aren’t stupid. They have and are selected for the ability to learn, process and absorb information fast.

So can/should physicians treat ‘obesity’? Here’s a list of some of the things I had class for less than 1 week in medical school that physicians DO treat/manage; and there’s no Huffpost article on why we shouldn’t be:

-hypertension
-diabetes
-depression
-lung cancer
-acute life-threatening electrolyte imbalances
-advanced cardiac life support (ie. what do to when someone’s heart goes life-threateningly wrong)
-childbirth (technically, this isn’t a disease)
-anemia
-septic shock
-asthma
-allergies
-high cholesterol
-arthritis (all forms)
-breast cancer

Here’s a list of some stuff I had just a 2 hour lecture on in residency:
-melanoma (all of it)
-breast reconstruction (all of it)
-brachial plexus reconstruction
-rhinoplasty
-lower limb reconstruction
-how to put a face back together after practically every bone is broken
-cleft lip AND palate reconstruction
-advanced burn life support
-microsurgery
-breast augmentation and reduction
-tendon physiology and repair
-rheumatoid arthritis and reconstruction
-Oh wait, there weren’t any MASSIVE topics on which we spent more than 2 hours in a lecture format.

Realistically, how much of those short lists were learned in a classroom, or even a structured learning format? Not a helluva a lot. Why do you think residents have no lives?

The same limitation of classroom/structured curriculum learning applies to trainers, nutritionists and other allied health professionals. If we’re going to paint with the broad stroke of “bottom of the pile”, how long do you think it takes to be a trainer? How much training and class does a trainer get on obesity? One weekend. Oh wait, that’s for the WHOLE certification. What does it take to be a CSCS? An undergraduate degree in ANYTHING, and an exam. No classes.

By the “hours of class” argument, two weeks of medical school class is about 80 hours (5 days a week, 8 hours of class per day.) If a weekend-certified trainer didn’t sleep and  actually managed to learn for the entire weekend, that would still be just 60 hours (if they started at noon on Friday.)

So let’s not play this divisive game that has no good outcome for anyone, especially for the folks who don’t need any more confusion as to who to turn to for help. We’re in this together. Divide and conquer is for your enemies, not your allies.

2) If you’re a physician and you stopped learning the second classes in medical school stopped, you should have your license revoked.

Becoming a physician is a commitment to lifelong and independent learning. There’s no way you’ll learn everything you need to know from classes. That’s a ‘spoon feed the helpless hatchling’ mentality that has no place in physician education (“When I was in medical school, we studied on tables made of broken glass and rusty scalpel blades. We acquired tetanus immunity the hard way. Poor Joe complained about no one teaching us anything. He stopped complaining after his jaw locked.”)

Physicians take initiative and responsibility for their own learning because when you don’t learn, people don’t just fail to lose weight, they can die and you can, in fact, hurt them; Well, that, and most of us are in this gig because it’s interesting and we actually do want to help people (not all learning is motivated by fear.)

Learning how to treat any disease starts in medical school. It develops as a physician interest develops. The expertise needed to treat obesity is one that many physicians will acquire out of interest. Not all doctors are “equal”. We all have our own specialties and clinical interests to which we devote our “learning time”. Will obesity be a specialty disease? There will probably be some cases that will call for more specialized expertise, just as there are now. I can’t fathom how a trainer would treat a patient who was so overweight that they could’t sleep lying down because it restricted their breathing; and couldn’t sleep in a recliner because their pannus claudicated (i.e. cut off the circulation to) their legs. There’s no diet or training program for that.

The idea that learning stops at the door of the classroom is laughable at best.

3) By and large, physicians don’t like being alone.

“Who should treat obesity?” is like asking, “Who should treat influenza?” Sure, physicians make decisions on how patients should be treated. Sometimes, as in surgery, it’s more hands-on. Sometimes, as in post -surgical rehab, it’s more hands-off. Physicians don’t generally dispense medications. We don’t actually do the physical therapy sessions. We don’t do the calculations for IV infusions (except in some specialties.) We might not work directly as a team, but physicians count on everyone (like nurses and therapists and pharmacists and dieticians) to make good things happen for people who want to get out of bad places.

There’s plenty of work to go around. Voting for a construct to be a disease just explicitly makes physicians a part of the discussion, and acknowledges the importance of the issue. Sure, there’s a lot to learn. Give a med student a learning mission and they’ll learn the frig out of it. No matter which occupational position you’re coming from, there will be knowledge to learn from the others. This applies for practically all knowledge fields in which we don’t know everything.

The answer to “Who should treat ‘obesity’?” is easy. It’s all of us.