Letters

The future of medicine

To the Editor:
I really enjoyed "Building a New Health Care System" [Editor's Page, January 2002, page 12]. It resonated with my own thoughts on medical school curriculum changes that I see as inevitable as we prepare our future physicians.

We will have to expand our current focus from acquisition of knowledge (i.e., cramming young minds full of medical facts and principles) and broaden our curriculum to include concepts of systems thinking, communication and teamwork.

The old concept of "captain of the ship" no longer always applies in our current milieu of complex, integrated, multispecialty medical care. Rarely is one person ever totally in charge. Nurses, pharmacists, consultants, laboratory and radiology technicians, as well as clerical personnel are involved in most patient care. In fact, the concept of single control and supreme command stands in the way of effectively resolving or improving medical outcomes, if we persist with a "blame and shame the responsible party" mentality. Instead we must begin to teach our medical students a culture of safety, teamwork, patient empowerment and involvement, as well as systems thinking if we are to truly build a new system of care.

Glen Couchman, MD
Temple, Texas

Treating obesity

To the Editor:
I would like to applaud you for the thorough and sensitive article "Toward Sensitive Treatment of Obese Patients" [January 2002, page 25]. As a clinician who has worked with high body weight or obese patients of all ages for over 25 years, I have heard from countless patients (particularly adolescents, who are already being ridiculed and shamed at school) how they have been avoiding preventive care, how they blame themselves for their medical problems and, most of all, how humiliating many of their encounters with the medical profession have been.

I appreciate that your article was presented in an educational rather than accusatory manner. Hopefully, this will result in a kinder, more accepting view of these patients. Often, we are unaware of our own personal prejudice toward obese patients. Your article helps us put ourselves in their shoes.

J. Abbott, DrPH, CEDS
Clackamas, Ore.

To the Editor:
I am amazed that you published "Toward Sensitive Treatment of Obese Patients." The article could have been written in one sentence: Obesity is a disease and we should treat it as such, with the care and sensitivity we give all our patients.

Advocating that we cater to the disease so we don't hurt people's feelings is something this country would do well to avoid. Advocating not taking someone's weight or not telling them they need to lose weight is fantastically idiotic. How about we not measure a diabetic's HbA_1c or a hypertensive patient's blood pressure? Restructuring your office to cater to the needs of the obese? Hold on. I'll also have to set up a cash mini-bar and a crack den. And where should I put those grow lights?

Either obesity is a disease or it is not. We need to treat obesity the same way we treat other medical maladies. We do not live in Goody-Gumdrop Land on Peppermint Lane. Patients can see through superficial nonsense, so don't publish more of this drek.

Ryan C. Crim, MD
Loysville, Pa.

Author's response:
Dr. Crim missed the point of this article completely. The focus of the article is to encourage physicians to be proactive and sensitive in managing patients with obesity. Yes, obesity is a disease, but as the National Heart, Lung, and Blood Institute (NHLBI) expert panel on overweight and obesity in adults noted, "Obese people are often recipients of scorn and discrimination from strangers, and sometimes hurtful comments from previous health care professionals" (The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults. Washington, D.C.: NIH Publication No. 00-4084; October 2000; available online at rover.nhlbi.nih.gov/guidelines/obesity/practgde.htm).The same is not true for patients with hypertension, diabetes mellitus or most other chronic diseases.

The article never advocated that physicians encourage patients not to lose weight or that they not address the issue of obesity. Rather, it encouraged the establishment of a positive, mutually respectful patient-physician relationship that would help make patients with obesity feel welcome.

This article was co-authored by Sandra Birt, a patient who helped us see the plight of obese patients more clearly. She felt that if physicians could see what obese patients see, we could do better in addressing the issue of obesity. Indeed, the NHLBI expert panel advises that, "A positive, supportive attitude and encouragement from all professionals is crucial to the continuing success of the patient."

Syed M. Ahmed, MD, MPH, DrPH
Milwaukee, Wis.