I just finished Whole30.
The diet eliminates everything except meat and vegetables for 30 days.
Whole30 worked well and felt like death.
Doctors promote diet and exercise, all the time.
Dieting takes discipline. Discipline is a virtue. Ergo, doctors promote virtue.
Virtue is good. The lack of virtue is bad. Thus, doctors dictate morality on unsuspecting patients.
How dare they!
Doctors do it all the time. In fact, special billing codes pay doctors to promote health. That is, government pays doctors to promote virtue.
Wait a second! That is not true.
Doctors give behavioural advice, based on scientific evidence that promotes improved health. Physicians support patients finding their own ways to change behaviour.
Change comes through many means: medication, cognitive therapy, group support, and healthy coping mechanisms.
Behavioural change in the clinic does not demand virtue… But it often does.
Victorian Virtues
Virtue includes restraint, self-discipline, prudence, delayed gratification and much more. Dictionaries define virtue as “behaviour showing high moral standards.”
This rankles modern minds. But moderns rankle at the wrong end. The point of virtue is behaviour, not what it shows.
Regardless, virtue evokes morality. I dare you to go on Facebook and suggest that self-restraint leads to lighter patients and fewer babies. It will guarantee death by social media.
Modern minds really rankle at Victorian Virtues because virtue smells religious. Religion tops the list of intolerable things to modern minds.
But if the Pope tells parishioners to do push-ups for health, that does not make push-ups Catholic, popish, or even Christian.
It only makes push-ups more popular with Catholics.
Push-ups are still a good thing on their own.
Push-ups and propriety are good, in and of themselves, even if we do not recall, or care about, the philosophy on why they are so. In the short term, it does not matter.
Modern ignorance reaches climax when moderns shun fasting because it might be Muslim; or jettison food guides because they look Jewish; or slam social behaviours because they evoke Victorian Virtues.
Promote Performance
Doctors used to investigate behaviours and examine outcomes:
Will my patient’s diabetes improve with culinary self-restraint?
That is science.
Ruling out behavioural change because it looks Victorian, or ethnic, or religious is unscientific.
Closed minds harm patients.
Doctors should promote what works, whether it’s Whole30, mindfulness, or monogamy. And if supported by evidence, that means Victorian Virtues too.
Bring on death by social media!
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Ha Ha good points. I stay away from it all including telling pts how to live healthy lives! The science and government says I should do it but I dont! I dont care if you are fat and I will ask once if you want to quit smoking. You can exercise like me which is like a slug and if you drink like me then who’s complaining? The reason is simple. I grew up with a patriarch who told me constantly what to do. It was the saddest part of my life and made a lasting impression. Now I can do what I want ( but the echoes are still there). I only tell patients that they MUST have more fun, they MUST love life, they MUST stop working so hard, and they MUST take vacations. And their homework is to watch a movie or read a book or go to a gallery. Who cares about virtues because if you want to leave a legacy behind then the length of life is irrelevant. It is the quality. And those that remeber you however few.
Pat, I love this.
Whatever happened to supporting patients? Why has medicine become such a list of rules? But only the socially acceptable rules get shovelled onto patients…telling them to avoid having babies until they are married would guarantee a complaint to the college.
I focus on supporting patients. If they want to change, I try to share evidence. But all this talk about diet, discipline, and self-denial seems dubious at times.
Thanks for taking time to read and post a comment!
Cheers
“ Moral fibre” was promoted in the Victorian and Edwardian era schools ( and of my era until the late ‘50’s) ….with sport such a rugby ( a “hooligan’s game played by gentlemen”) emphasized as a character builder…perhaps ice hockey played the same role in Canada in that same time frame….today the promotion of “ moral fibre “ would probably be regarded as a “social construct promoting masculine toxicity” and condemned.
Where eating is concerned , a prominent endocrinologist recently stated during a CME on diabetes that we should all “ respect satiety”…we should eat until we are three quarters full and the put down our knives, forks, spoons and chop sticks.
The peoples of the Ryukyu islands of Japan enjoying a long longevity eat sweet potato rather than rice and practice practice “Hara hachi bu” , the self imposed habit of calorie restriction eating until 80% full…there is a Japanese proverb “ eight parts of a full stomach sustain the person, the other two sustain the doctor”…it takes a certain amount of moral fibre to maintain such self discipline.
“ Respect satiety”.
Love it! Never heard that before, Andris: respect satiety.
Having said that, I cringe a bit at all the advice I’m supposed to tell patients. I am comfortable with a focus on disease and how to avoid it. But many articles on clinical medicine sound more like lifestyle counselling than science.
Thanks again for taking time to read and comment! Now if only I could find a way to know when I’m 80% full…
while Hara Hachibu has become a popular phrase to explain Okinawan longevity, other factors like the temperate weather also play a factor. In Japan with the millions of centenarians , there are more the further west (south) you go.
When your young is good to eat well, exercise and practice restraint so that you can be in shape to party like a demon in your old age. 😉