Last week marked a personal milestone: I retired from clinical medicine after 35 years. If you were to count the years I spent as a child rounding in hospitals with my late father, I will have spent over five decades seeing sick people in hospitals and other clinical settings. In that time, so much has changed about the practice and process of medicine and medical care.

In this blog entry, I will first speak of the not-so-positive aspects, and then next month, the more positive side of the changes I’ve seen. As always, these observations merely reflect my own experience. There are solid trends that I’ve witnessed as well as great developments that have helped patients. However, some of the more disturbing things I’ve seen are:

1. Doctors don’t know as much as you think. There’s a pervasive perception among non-medical people that doctors know it all. After all, don’t they train for years, speak a secret language and deal with fancy equipment and life-altering pharmaceuticals? While all of that may be true, doctors still, in many ways, are not perfect. They make mistakes in diagnosis and treatment. Just look at the opioid crisis. Yes, a large part of that was due to pressure from the drug makers, but doctors had to buy into that. Without doctors prescribing, the crisis could never have happened. Doctors have long been put on a pedestal, and that’s not really a good thing. Doctors do do great things, but they are human.

2. Patients rely too much on medication. I have a great friend. He has been so for 35 years. He is smart, sensitive, educated and a consummate professional. And yet when he was diagnosed with coronary artery disease and told by his physician that, after his angioplasty and statin therapy he could “do what he wanted,” he reverted right back to his terrible diet of refined sugars, starches and saturated fat. His mentality was “as long as I take the medication, the doctor said I can do as I please!” This dangerous and backward attitude is all too present among patients. Instead of wisely changing his lifestyle for the better, he chose to rely on medications, with their potential for side effects, to clean up the mess left by his bad habits. This is a dangerous attitude.

3. Doctors don’t listen to their patients as much as they used to. Doctors more than ever are under time constraints. Because of demographic changes, doctors need to see more patients in less time with greater efficiency. The art of medicine has become the corporate business of medicine. It was not so in my father’s day, where he would actually talk with his patients, eye to eye, and attempt to understand the whole person. Today, the “clinician” is clacking away on the keyboard as she listens to you, barely making eye contact. A lot is lost in that approach, but I have no answers as to how to fix it.

4. Patients are rapidly leading to their own demise. I’ve beat this dead horse to death, and I will preach it again whenever I can: the obesity epidemic is the most dangerous threat to public health since smoking cigarettes became widespread. Perhaps even more so. In blog after blog, video after video, I have warned patients that obesity and its sister conditions are so very detrimental to health that its importance cannot be overestimated. I often quote that the average American male in 1965 weighed 150 pounds and today weighs 200, and that the rate of overweight and obesity is an astounding 72%! Patients are truly digging their own graves with a knife and fork, adding high blood pressure, diabetes, joint disease, cardiovascular disease and cancer to their list of obesity-related maladies on their diagnosis list. And it gets worse with each passing year. If I were a presidential candidate, I would beat the warning drums about this major American disaster, which costs us all over a trillion dollars a year, and make attacking this scourge a top priority.

In next month’s blog, I will discuss the good changes I’ve seen since I first donned the white coat. Until then, eat better and keep moving!

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