In medical terms, the kitchen must be as crucial as the clinic, and the doctor needs to be a chef, writes JOHN McKENNA
LATE LAST year I read a fascinating article about Dr Preston Maring, a gynaecologist and obstetrician working in California, formerly physician-in-chief at the Kaiser Permanente medical centre in Oakland.
Maring has enjoyed a distinguished career in medicine. But, strangely enough, what has made him especially celebrated as he nears retirement age is not his medical work, but the fact that he established a farmers’ market at the hospital, as long ago now as 2003.
If that seems like a curious fix – are the patients going to get up from their beds to go down to buy a head of cauliflower and some organic cherries? – then consider why Maring did it: “In the health professions,” he says, “the kitchen must become as crucial as the clinic.”
Wow! Maring sounds like someone who practises Chinese medicine, not a veteran doctor steeped in Western medical practice, where what a patient has been eating, or not eating, is not regarded as an essential part of a health diagnosis. His statement reminded me of the ancient Chinese poem:
Is he a chef or a doctor?
Is this a pharmacy or a restaurant?
Fish, meat, vegetables, spring onions and leeks:
Delicious dishes banish tablets and pills,
Nourishing food is the drug for all ills.
And Maring goes as far as the Chinese: food is at the centre of health and illness, he contends, so doctors must make all aspects of it – growing, buying, cooking and eating – a mainstay of their medical education, their own lives and their medical practices.
That seems like rather a tall order: food must be at the centre of doctor’s education and practice, as well as their own lives. But given what we know about the pressures doctors often work under, especially young doctors, it really seemed to me to be pie-in-the-sky thinking.
So, I asked a young doctor, Jenni, my nephew’s wife who practises in Belfast, just how Irish doctors shape up when it comes to growing, buying, cooking and eating food. Is food a mainstay of their lives? The answer, unsurprisingly, is that it kind of depends on where you are working.
“In busier hospital attachments such as medicine and AE where there is shift work and a lot of on-call,” says Jenni, “then during these attachments our diets would tend to deteriorate. You rarely get time to eat and, when you do, it’s usually from the hospital canteen, unless you have been extremely organised.
“If the canteen is open at the time you manage to get a break, then the most edible solid food is usually chips, although that really depends on which hospital you are in. If the canteen isn’t open, eg on a night shift when the hospital is supposed to provide food for oncall workers, then in my experience this has consisted of microwave chips and kebabs – not very healthy or tasty!”
Well, in the land of microwave chips and kebabs, we are already a long way from Maring’s ideal place, but we are in the place where so many young doctors find themselves, whether in Belfast or in New York or in Oakland.
And, as Jenni points out, you are so exhausted at the end of the shift, “then I am afraid that the day will often end with a takeaway meal, unless you have a lovely family or partner at home who have stocked the fridge or have dinner waiting for you”.
Do the dietary habits of young doctors matter? I think they do, for the simple reason that obesity is now the biggest issue in healthcare, nationally and internationally, and so it’s one in which the doctor has to be able to ask the patient a blunt question: “What did you eat for your last meal?”
And it’s one where the doctor then has to be able to understand the answer, and know how to respond to it. But the young doctor living on takeaways, whose culinary skills extend no further than pushing the button on the microwave, isn’t in the right position to ask that question, or to deal with the answer.
It isn’t all as bad as the AE situation, however. When Jenni and her colleagues worked in psychiatry, “we had quite healthy diets. From those I asked, their general diet would be cereal and fruit juice for breakfast, sandwiches, fruit and yoghurt for lunch or, in my case, soup. And then dinner varies, however, I did find that most people cook a meal for their dinner, and they say they rarely use ready-made meals and would have on average one takeaway per week. This is a phenomenon, however, that I think is confined to psychiatry as the hours are more sociable and therefore we have more time to plan, shop and cook meals.”
That’s good news, but it’s still a long way from Maring’s ideal of food being at the centre of the doctor’s life. As Jenni points out, even the doctors in psychiatry, “feel that they would rarely manage to eat five portions of fruit and vegetables per day: at most it is probably around three portions”.
In an interview with the Washington Post, Maring identified the US problem as beginning with the fact that tertiary medical care is where all the money gets spent, while primary care never gets properly funded. “Unless we put a focus on a healthy food system . . . and prevent disease rather than treat it, we’ll never have enough money to pay for it.”
Doesn’t that sound so familiar, the medical equivalent of closing the stable door after the horse has bolted? But Maring has shown that there can be solutions, and that they begin with the basics. Patients need to be well fed, but hard-working doctors need to be well fed too, and hospitals need farmers’ markets. In medical terms, the kitchen must be as crucial as the clinic, and the doctor needs to be a chef.
JOHN McKENNAis author of the Bridgestone Guides, bridgestoneguides.com
