Assessing the risk of diabetesBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4525 (Published 03 September 2015) Cite this as: BMJ 2015;351:h4525
All rapid responses
Two articles in this week’s BMJ have confirmed my suspicions that we are losing our sense of direction in medicine. McCartney1 implies that we should not share stories about patients. Shah2 says ‘ask him if it is OK to talk about his weight’.
I often assess patients for ill health retirement with unexplained shortness of breath and fatigue preventing them from working. They have typically been fully assessed by cardiologists and respiratory physicians over several years who have been unable to find any cause, cardiological, respiratory or otherwise, and there is no clue anywhere in the notes or reports. Their morbid obesity has somehow been completely overlooked. Doctors seem perfectly capable of providing objective data about everything else, but the best you will get for a BMI over 40 is ‘slightly overweight’.
The risks from obesity far outweigh the risks from smoking and alcohol. Why is it OK to talk to patients about smoking and alcohol, but not obesity? Since we stopped overtly criticising obesity as a lifestyle choice, and instead damned anyone who suggested a person’s weight was related to the amount of food they consume, the rates of obesity have risen substantially and the most common comment from patients in my clinic is ‘my obesity can’t be a problem because none of my doctors have mentioned it’. Why haven’t they?
Behaviour change is inevitably a balance between ‘carrots and sticks’. Just using carrots clearly isn’t working. I see patients who go for years unable to lose weight, until their daughter’s wedding, when 25kg seems to be the typical amount of weight loss prior to them facing the photographer. There is a message here; what is the key motivator? Maybe for many the most effective motivator is stigma. Is that really such a bad thing if for many people it is the only thing that works?
When I discuss obesity with patients, I use stories about other patients to help illustrate the risks, the ways to change lifestyle, and the successes. Is this really so wrong? Maybe I am a traditionalist, but for me the art of medicine is having those difficult consultations not avoiding them, and using narrative and personal experience in teaching. Political correctness has been immensely damaging to society in recent years; is it about time we spoke up for common sense?
McCartney M. The power of patients’ stories. BMJ 2015;351:h4259.
Shah R. 10-minute consultation: Assessing the risk of diabetes. BMJ 2015;351:h4525.
Competing interests: No competing interests