Are You a Real Doctor Too?

I love it when I hear patients say: “I didn’t keep my appointment with you last week doctor because I was sick.” Or when they describe their other medical problems and I start making comments, if they say “Are you a real doctor, just like my doctor?”

I guess I can’t blame patients for their confusion. Most physicians who deal with weight loss--and there aren’t that many of them--do nothing else. Dr. Elhag and I are somewhat unique in that we have kind of a dual practice. We are primary care physicians who have done extra training in weight loss medicine. We still practice primary care internal medicine.

I know that we are all specialized these days, and perhaps patients like the idea of seeing a doctor who does nothing but weight loss medicine all of the time. However, from my standpoint, I think that primary care physicians are the best physicians capable of dealing with weight loss issues.

First of all, we see all the complications that come from obesity. I first became interested in this because for many years I’ve been treating people for diabetes, coronary artery disease, sleep apnea, hypertension, breast, prostate, and uterine cancers, back pain, knee and hip arthritis, infertility, and many of weight related illnesses. You get tired of treating each problem independently with a plethora of medications. Eventually you’d like to treat the root cause of all these problems and make them go away.

We also get to see the side effects of many medications prescribed by other physicians. I don’t know how many psychiatrists that I’ve had to inform that our mutual patient has gained fifty pounds because of the medications that that doctor has used, only to have the shrink deny that their medication was the culprit. Now there is an increased awareness of this in the psychiatric community but it took years. The same can be said for estrogen replacement therapy, many blood pressure medications, seizure medications, and a host of others. As PCPs we are aware of what medications can cause these problems, what may perhaps be a better alternative, and how to coordinate these issues.

Another issue is how to deal with the favorable effects of weight loss. For example, diabetics on insulin make dramatic improvements in their blood sugar with small amounts of weight loss. Since as PCPs we prescribe diabetic medications constantly, it is easy for us to advise the patient what to do as they lose weight. The same can be said for the cholesterol and blood pressure medications.

Many times I’ve had a patient in for their routine weight loss checkup with a bad cold, or asthma attack, or some other acute problem. It is both gratifying and amusing to have them realize that we aren’t just “weight loss doctors” when we treat that other problem as well.
Our weight impacts our entire health. I think that primary care physicians are in the best position to deal with that whole person.