Sunday, December 6, 2015

The Negative Placebo - Why Fitness Buffs Avoid Doctors

My personal trainer never visits a doctor. Neither do many of the weightlifters at the gym where I go. Part of it probably has to do with unease about appearing naked in front of a near-stranger, as well as a dislike of needles and other painful features of medical treatment. But fitness buffs have more fundamental reasons for their negative view of doctors.

     1.  They anticipate that the doctor won’t respect their values.

Fitness buffs are people who have spent years of their lives studying and fine-tuning their bodies. They have learned exactly how far this muscle will stretch and how much weight that one will lift. They know what foods and supplements work best with their particular body type. One of the rewards for this hard work is a precise sense of what and how the body is doing (proprioception). If something starts to go wrong, they usually sense it. Fitness buffs believe that proper diet and exercise can keep most people healthy most of the time.

Doctors aren’t taught much about diet and exercise in med school and they don’t learn more afterward. Many don’t exercise themselves; some are overweight. Ads for hospitals and medical practices frequently display photographs of these out-of-shape physicians, a good indicator that they haven’t gotten the message about diet and exercise either.

Doctors tend to give more credence to test results than to the patient’s own intuition about how she is doing. Some believe that patients are actually better off taking an FDA-approved medication or than trying to exercise. “People who can take statins are the lucky ones,” an MD told me once.   
 
2.  They don't want to be exposed to a doctor's negative attitudes.

The pursuit of fitness is based on hope and aspiration. The workouts I do each year are harder than the ones from the year before. The increased strength, flexibility, and versatility have enhanced my confidence and sense of well-being. In spite of scores of studies to the contrary, many doctors believe that exercise doesn’t work. I smiled when I read a post on Kevin MD by an orthopedic surgeon expressing appreciation for personal trainers and surprise that they could make a significant difference. 

Some doctors worry about injury; they recommend moderate exercise and advise people to “know their limits.” Fitness buffs believe that gently but persistently pushing against your limits is the path to better health. Each person needs to discover what amount and intensity of exercise works for him or her.

Doctors also believe that patients won’t follow a serious and consistent exercise program so they don’t even suggest it.

          3.  Doctors do crisis intervention, not health maintenance.

Although orthotics for problem feet can prevent devastating knee, hip, and lower back injuries in later life, this painless and inexpensive treatment is seldom recommended. Protein supplements and proteolytic enzymes can help older patients retain muscle but they are usually dismissed, along with supplements in general. If there were personal trainers in doctors’ offices, they might be able to implement some of these useful therapies and broaden a few minds in the process.
  
          4.    Doctors are relentless in their search for disease, sometimes finding it where it     doesn’t exist.

Fitness buffs like to think of themselves as healthy people. Doctors are trained to discover illness and to empathize with those who are suffering. Many fitness buffs don’t have annual physical exams because they fear that a misapplied test or misinterpreted test result will redefine them as sick, setting off a cascade of unnecessary interventions. I don’t have the option of staying away because I need renewals of the two or three medications I take and occasional blood tests to monitor my thyroid. Every year my doctor suspects me of harboring a different illness; every year I have to prove that I am healthy.

Heart disease and stroke are the major killers of people in the US. Stress can be a significant contributor to these illnesses. A recent study showed that women who had false positive mammograms had a greater risk of developing invasive breast cancer in future years. The researchers thought that the radiologist might have detected some subtle feature that anticipated the change. I would like to know whether these false positive women also had a greater risk of heart attack and stroke in future years. Perhaps the anxiety associated with the repeated tests contributed to future illness of several kinds. For fitness buffs, the stress involved in visiting a doctor may be too high a cost for any possible benefits.

The truth is that both fitness buffs and doctors have important information to contribute. If those insights could be shared in a context of openness and mutual respect, everyone would benefit.


Note: After following @RogueRad on Twitter, I realize that I should have called this The Nocebo - but some of my readers probably haven't taken Latin in school.

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