This is a question asked by patients who want a doctor that advocates for whole-food plant-based nutrition using the latest scientific evidence to promote its health benefits.
There are 3 main reasons:
1. The Economic Factor
We are led to believe that each disease has a specific cure, therefore taking a single pill will easily cure our complex disease. However, most chronic conditions are influenced by lifestyle and astoundingly account for 75% of healthcare costs in the US. Healthcare systems are financially motivated and providing lifestyle counselling at low reimbursement rates is not very profitable. In addition, physicians may fear losing patients if they promote healthy lifestyle changes over writing prescriptions.
Meanwhile, the financial interests of Big Pharma and food manufacturers influence healthcare practices and public health policy respectively. For example, instead of providing recommendations that are evidence-based, national dietary guidelines are watered down out of a concern over the economic interests of the meat and dairy industries. See my blog post “Should We Be Following US Dietary Guidelines?”
2. The Training Factor
Patients routinely seek physician’s guidance about diet. However, many practicing physicians continue to rate their nutrition knowledge and counselling skills as inadequate. Disappointingly, only one fifth of US medical schools require students to take a nutrition course. Moreover, in those that do have a requirement, students receive less than 25 hours of nutrition studies over 4 years.
Having earned my certification in nutrition studies, nutrition coaching, and as a certified professional plant-based cook, I can confidently teach my patients the connection between poor diet and many preventable diseases. I love to get them excited about home cooking and trying out plant-based recipes.
3. The Time Factor
The predominant fee-for-service model rewards physicians for high patient volume to counteract low reimbursement rates. Consequently, a 15-minute appointment leaves little time for physicians to discuss nutrition with their patients. Even if they could, it is unlikely to be reimbursed by insurance companies. A 2017 study of cardiologists revealed that more than 50% of those surveyed spent less than 3 minutes discussing nutrition during an average patient appointment.
In fact, counselling patients on how to adopt a healthy lifestyle change and successfully switch to a plant-based diet requires time and more than one visit. For this reason, at Clarity Health & Wellness, my practice is intentionally smaller in the number of patients that I see daily. Most importantly, this allows me to spend time addressing medical issues AND have detailed conversations about nutrition with my patients. As a result, they feel empowered to change their eating habits and set new goals for their health.
Ultimately, most physicians are honest and ethical people who care deeply for their patient’s wellbeing, but the system is letting them and their patients down. Essentially, a radical shift is needed to incorporate plant-based nutrition and more broadly prevention-based lifestyle medicine into mainstream medical care.
By Maryam Salehpour, M.D.
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Ref:
Devries S, Agatson A, Aggarwal M, et al. A deficiency of nutrition education and practice in cardiology. Am J Med 2017 Nov; 130(11):1298-305. DOI: https://doi.org/10.1016/j.amjmed.2017.04.043
Storz, MA. Is there a lack of support for whole food plant-based diets in the medical community? Perm J 2019; 23:18-068. DOI: https://doi.org/10.7812/TPP/18-068
Bodai BI, Nakata TE, Wong WT, et al. Lifestyle medicine: A brief review of its dramatic impact on health and survival. Perm J 2018; 22:17-025. DOI: https://doi.org/10.7812/TPP/17-025