The idea that nutrition is the foundation of health is a given. Then why does medical care so rarely focus on food? 3 obstacles and 3 solutions:
1. Education Gap
The unfortunate truth is that doctors learn very little about nutrition. In medical school, an average of only 20 hours total over 4 years (often focused on biochemistry and rare disease states) and 0 hours in most physician training after medical school, including internal medicine and cardiology.
2. Time Pressure
Doctors are already pressured for time. Clinic visits are getting shorter. How much time can realistically be devoted to nutrition with acute problems to deal with in a clinic visit of only 15 minutes? In addition, many physicians believe that nutrition counseling is not in their job description.
3. Lack of Financial Incentives
Insurance providers offer very little (if any) reimbursement for physicians to deliver nutrition counseling.
1. More Nutrition Education
Add practical nutrition and counseling education to all phases of medical training, including specialization. Clinical nutrition should also be a part of all board exams to further encourage learning in this area.
2. Align Incentives to Value
The wind is already shifting in this area but the fact remains that writing a prescription still takes less time than nutrition counseling. Insurance payers need to realize the importance of effective nutritional counseling and to provide fair reimbursement for it. Imagine how many fewer prescriptions and procedures would be needed if what we applied what we already know about nutrition.
3. Leverage Time
Sadly, the 15 or 20 minute return clinic visit isn’t going away anytime soon. Nevertheless, even a brief and informed mention of the value of nutrition, discussed in as few as 2 or 3 minutes, is certainly better than the status quo that approaches zero attention to nutrition. Its enough for physicians to convey to patients that nutrition is a high priority item for wellness (equal to that of other medical interventions) even if they don’t have the time to delve deeply. That’s the beauty of a team including dietitians, nutritionists, nurses, and many others.