This Is About Brussel Sprouts, Not Broccoli (And It’s Not What You Think)

Bradley Flansbaum

Posted 4/12/12 on The Hospitalist Leader

There is a lot of talk these days of personal responsibility.  Obesity, lifestyle choices and any untoward consequence of either are usually attributed to the individual, and the cost—both financial and in quality of life—are duly theirs.

As you will discover, this post will not deconstruct the literature base behind that sentiment.  It will however encompass some parts anecdote and intuition, as well as a few life lessons.  On the latter, if I convey by half a bit of my own takeaway, I will have achieved just rewards.

For framing, early in my training, I fervently believed that obesity, poor food selection, and lack of exercise were a choice:

–No gym membership?  Hit the pavement.

–Dearth of fresh vegetables?  Buy frozen.

–Have lower back pain?  Look in the mirror.

That was long ago.

It stemmed from inexperience, adverse sway in residency (still rife in programs today), and a shortage of familiarity with the forces behind one’s life options.  These outcome-shaping lifestyle choices are not availed to all.  And as a sobering gut check, just when I think I comprehend the determinants of health that allow individuals to pursue these alternatives, life imparts a new lesson.

In that vein, we all make the usual assumptions—suboptimal education, ethnicity, place of residence— are consequential and produce the disparities in society with which we are familiar.  However, these influencers, while real, are in the abstract and it is not until we challenge ourselves, do we see the sometime expansive distance between our patients and us.  What we discover on probing can be surprising.

Continue reading “This Is About Brussel Sprouts, Not Broccoli (And It’s Not What You Think)”

Primary Care Physicians and the Goldilocks Principle

Kenneth Lin

First posted 10/10/11 on the AFP Community Blog.

recent national survey of internal medicine and family physicians published in the Archives of Internal Medicine found that 42 percent of physicians felt that their patients were getting “too much” health care, while only 6 percent thought that patients were receiving “too little.” These opinions contrast with multiple previous studies showing that primary care clinicians fall short when it comes to providing guideline-recommended care; a 2007 study, for example, found that children received less than half of indicated care.

Continue reading “Primary Care Physicians and the Goldilocks Principle”