Thoughts and insights from medical students
A 22 year old male presents to the emergency department in a great deal of distress. His heart rate is close to 110bpm, he looks well perfused but he is agitated. Close observation of his visual fields shows he is indeed looking up at the TV screen in the waiting area...and watching the Olympics. Specifically, the Men’s 10,000m final. Infact, his partly cut finger is wrapped in Olympic-themed kitchen roll, he’s proudly wearing a Team GB T-shirt and his only real problem is one which has become pandemic – ‘Olympic Fever’. No doubt the aetiology of his injury is related to making dinner whilst watching the women’s heptathlon final.
Of course, our patient is hypothetical. The country is currently on the edge of their seats to see what Team GB can offer at, what I must say, is a pretty impressive show going on in our country’s capital. I used to be a real cynic about the Olympics. It seemed to be a lot of hype. Jennifer Saunder’s summed up my views in the Ab Fab Olympic special ‘...it’s been like tinnitus for five years’. However, when I forced myself to watch the opening ceremony my opinions completely changed and seeing how much the country has united to support our athletes has been inspirational. I too have symptoms of Olympic fever.
Ironic, therefore, that just as the Olympic games starts, I find an interesting article in the British Journal of Sports Medicine (Weiler et al, 2012) that seems to suggest that we, as medical students, are not educated enough on the topic of ‘Physical activity education’. Findings show that the approach to physical activity education (the old, “do some exercise” advice) is varied across UK medical schools – with very little, if any, dedicated teaching time on the topic. Worryingly, I found myself nodding my head as I read. I feel completely un-educated as to how to inform my future patients on this simple instruction – “do some exercise”.
In the past few years I’ve had lectures in cardiology, cardiovascular physiology, respiratory physiology etc (the usual pre-clinical spiel).In almost every system of the body, a clinician has lectured us and used a phrase somewhere like ‘lifestyle modification’ or ‘exercise regime’. Equally, the danger of a ‘sedentary lifestyle’ has been emphasised in almost every module. Yet, no one has stopped to tell us how we might address this issue. If I had an overweight patient who was quite clearly putting their health at risk, using a phrase like “you need to do some exercise” is probably not helpful – it simply doesn’t ‘prescribe’ what to do.
When I hear the word exercise I instantly get an image of the keen beans I see on the walk into the University. The sort that deliberately takes the rush hour route to make a bold statement of “I am so healthy, I even jog into work” (Whether they in fact live around the corner is yet to be ascertained...). The word exercise instantly makes me sigh a bit – so what do patients who need the advice think?
It’s quite clear that exercise is good for you – no one disputes it. It’s dubbed as the wonder drug, something that benefits every part of your body. Yet, do too much and you run the risk of suppressing your immune system, ruining your joints and potentially making things a lot worse for yourself. How do I avoid this happening to future patients? The honest answer is – I don’t know. No one has told me.
Clearly, there’s a balance. One man’s 4 mile run may be another man’s hell. Perhaps many patients would have the same image as me – a runner, jogging and yet exercise can be a lot more enjoyable! What about walks? Walking the dog, walking to a place your visiting etc similarly, cycling – I think it’s best to consider all things patients might be able to do.
I recently saw a fantastic speech at a TED Conference by Atul Gawande, a general surgeon based in America (his books are well worth the read!). In that speech he emphasised that the best healthcare is not the most expensive. So it’s well worth considering exercise - something that has been dubbed a ‘miracle drug’ and is completely free. Yet, clearly we need to take steps to address its delivery both in education and in clinical practice.
At the moment, it’s rather easy to bring up the topic of exercise with patients, just ask them “Have you seen much of the Olympics?” You never know, that question might just end up saving their life.
“Physical Activity education in the undergraduate curricula of all UK medical schools. Are tomorrow’s doctors equipped to follow clinical guidelines?” can be read at bjsm.bmj.com
Atul Gawande’s talk “How do we heal medicine?” can be viewed here: http://www.youtube.com/watch?v=L3QkaS249Bc