Can I have cheese on my ham sandwich?

BMJ 2016; 355 doi: (Published 09 November 2016) Cite this as: BMJ 2016;355:i6024
  1. Kaustubh G Joshi, associate professor of clinical psychiatry
  1. Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC 29203, USA
  1. kaustubh.joshi{at}

“Can I have cheese on my ham sandwich?” My patient asked me this question several times during the first few weeks of my employment at a state hospital. Although dieticians provided recommendations, I was ultimately responsible for entering dietary orders. Like most patients on the ward, my patient was prescribed psychotropic drugs that resulted in metabolic complications. As a result, she …

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