Talking to a patient about the role of food in causing and curing disease seems like the least a doctor could do.
A bill being considered by the D.C. Council would help make that happen. It’s a modest proposal, but don’t laugh; it’s better than nothing. Doctors and nurses would be required to complete two hours of nutrition study over a two-year period.
The hope is that they would then be better positioned to counsel their patients on how to better care for themselves.
A poll commissioned last month by the D.C.-based Physicians Committee for Responsible Medicine found that 73 percent of physicians surveyed think “patient visits should include nutrition guidance” but that only 15 percent are “totally prepared” to provide it. It was a small sampling of doctors — just 40 — but the study pointed out that doctors need to understand the causes of their patients’ illnesses and have the ability to help them get better.
“Doctors will tell you that they should talk to their patients about nutrition, but they feel inadequate,” D.C. Council member Mary M. Cheh (D-Ward 3) told me.
“On the other hand, doctors have the option to take nutrition courses that are available, but too few do,” added Cheh, who sponsored the bill. “So, this legislation would make the courses mandatory.”
“There is no indication that ill-prepared medical school graduates usually make up for deficits in their medical school education later on through extensive additional nutrition instruction and skill building opportunities,” the report said.
Not everyone is on board.
Andrea Anderson, who chairs the D.C. Board of Medicine, said at a recent council hearing that she opposes the bill. Among her reasons: Two hours for studying nutrition is too much.
“Two hours might not seem like a lot, but it can be burdensome when physicians are trying to keep up on the vast breadth of all the things we have to keep up on in a medical practice,” said Anderson, a family doctor whose organization oversees the licensing of 14,000 health care professionals in the city — 11,000 of them doctors.
“I do agree that nutrition education is important,” she said. “But with the 15 minutes I have to see a patient, I think the patient would be better served if I could refer them to a dietitian who would spend an hour with them. I don’t have the time when I’m trying to take their blood pressure and deal with postpartum care and other patients.”
Meedie Bardonille, who chairs the D.C. Board of Nursing, also opposes the bill. Among her reasons: Two hours is not enough time.
“Just having two hours doesn’t give us the time to make a huge impact,” Bardonille, whose board oversees the work of 24,000 registered nurses in the city, told the council. “There is more to nutrition than just telling you to change your diet. It’s way more than reading a nutrition module online.”
Neal Barnard, a physician and clinical researcher who heads the 12,000-member Physicians Committee for Responsible Medicine, spoke in support of the bill.
“At our primary care clinic, our doctors also see patients for 15 minutes, and if they have a patient who smokes cigarettes or someone with a bad diet, we recognize it. Spending two or three minutes talking with a doctor can make a difference. By the same token, two hours for a nutrition course is not a lot, but it can make a huge difference.”
It turns out that 90 percent of 930 cardiologists surveyed for a 2017 study cited by the American Society for Nutrition agree with Barnard. They believe that their roles include providing patients with basic nutrition information. And 90 percent of them also said they had received little or no training in nutrition during their medical fellowships.
In the District, the heart disease death rate is 239.7 per 100,000 residents, compared with 178.5 nationally, according to the D.C. Department of Health. And death rate for African Americans in the city is nearly triple the rate for whites — at 333.0 per 100,000 compared with 116.6.
“Nutrition is a cornerstone of cardiovascular health,” according to a 2017 study published in the journal Current Cardiology Reports, “yet the training of cardiovascular specialists in nutrition has been called into question.”
The District already requires physicians and nurses to complete 50 hours of continuing medical education every two years to get their licenses renewed. Participants get to choose from a list of approved subjects. Only two are mandatory — one is LGBTQ sensitivity training and another deals with pharmacology. Nutrition would make three.
“You can get a lot done in two hours,” Cheh told me.
A 120-minute course — with 730 days to complete.
That might be just enough to jump-start a lifesaving conversation.