The two questions that every doctor should ask

Where were we? Oh right. The American Heart Association (AHA) has finally admitted that doctors should be counseling their patients on physical activity.

As you could probably predict, I find this recommendation…amusing. Especially since many physicians and other health care providers simply don’t exercise themselves.

Not that I don’t get what they’re up against, here. Doctors are busy. We’re trying to balance family with a career that is increasingly filled more with paperwork than with actual patient care.

And, well… it takes a lot more time to counsel a patient about lifestyle changes than it does to write a prescription.

As my patients know, no one gets out of an appointment with me without answering two basic questions:

1.) What did you eat in the last 24 hours?
2.) How much are you exercising?

Everyone gets these two questions. Everyone.

But you know what? I have time to ask these questions. Because I’m not forced into seeing a dozen patients an hour by the insurance companies or a hospital that I work for.

Unfortunately, practices like mine have become the exception. And it’s sad to watch my profession become something that I don’t even recognize.

These changes would be fine if healthcare outcomes were getting better. But they’re not. In many respects, they are getting worse. The system is broken, simple as that. And even I don’t know how to fix it.

What I do know is where I would begin. And that’s by taking Big Pharma, Big Insurance, and the massive food industrial complex down a few pegs.

But enough about me. Let’s get back to what the so-called experts have to say about exercise–you know, that pesky “physical activity” that they just now realized might be important for us.

Allow me to paraphrase parts of their recent statement for the sake of illustration. (Fair warning: This is some crazy stuff.)

According to the AHA, doctors haven’t been relying upon physical activity levels in their assessments. At least, not as much as other traditional heart disease risk factors.

Why, you ask? Well, according to the committee chair behind this new statement, “there is a lack of knowledge and understanding of how to effectively assess this behavior.”

I wish I was joking. Sadly, that’s an actual quote.

I’m sorry, but either you’re exercising…or you’re not. It’s not rocket science, people.

And besides, last time I checked, there were standard exercise guidelines. And they had been around for years. (Constantly changing, of course…but they’re there, nonetheless. We’re hardly shooting in the dark here.)

So I fail to see where this “lack of knowledge and understanding” lies, quite frankly. But there you have it, by way of explanation.

And then, of course, there’s this:

“For a cholesterol screen, blood-pressure screen, glucose screen, it is very cut and dried on how to gather the information and how to interpret the information. This is not the case with physical activity.”

Another revealing quote from the folks in charge. And all you have to do is read between the lines to figure out the real reason behind the medical establishment’s lack of interest exercise.

Just look at that list of risk factors–cholesterol, blood pressure, blood sugar. Now what do they all have in common?

We have drugs to control every single one of these factors. But we don’t (and never will) have a drug that can substitute for exercise.

There’s so much more to say about this. But unfortunately, I’m running out of space. So stay tuned for some frightening statistics tomorrow… because I’m just getting started.

“Guide to the assessment of physical activity: clinical and research applications: a scientific statement from the american heart association.” Circulation. 2013 Nov 12;128(20):2259-79.
AHA Recommends Regularly Assessing Exercise Habits. Medscape. Oct 17, 2013.