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During a recent urgent care shift, I encountered a man in his mid-50’s who had presented to the center with complaints of sinus pressure and cough. After I gathered more history and conducted a physical exam, the patient went on a tangent, asking me numerous questions about healthy foods. A commercial construction foreman, he was accustomed to being on site during the day, and insisted that his daily lunch was quite healthy and acceptable. As he prepared to tell me about this daily meal, he beamed with pride. What was it? Several slices of ham from the refrigerated section of the supermarket, a few slices of cheese, and a handful of pickles. He truly believed that the meal he consumed daily was incredibly healthy and nutritious. He even stated that he was consuming a high protein meal with produce (the pickle). The patient went on to tell me that when he was done with work, he often stopped at Arby’s to pick up a sandwich for dinner, and felt that the animal protein from these sandwiches wasn’t harmful in the least.

I shake my head in amazement when I encounter patients who have completely convinced themselves that somehow, their eating habits are completely clean and healthy, when they are actually abysmally deficient in nutritional value. What is more surprising is how insistent these people are on continuing their unhealthy habits, even when they ask for advice. The patient I mentioned above listened to me discuss the power of food as fuel, as sustenance, and nodded when I suggested he visit the fresh produce section of local grocery stores, select uncured meats, and avoid frequenting fast food establishments like Arby’s. I also mentioned that his blood pressure readings of 181/125, 179/127, and 185/122 (non-symptomatic) were rather alarming, especially since he stated that he had “forgotten” to take his blood pressure medications that morning. Was it fair to shake him out of his fog and inform him that with malignant hypertension, and a diet sure to compound the problem, he was on a short course to an unfavorable event like a stroke or heart attack? Did he even care if he was at high risk?

This is the kind of situation which I as a physician must often dance around. I have to determine how receptive a patient is to advice, and I also have to figure out the best way to speak to the patient without offending or discouraging him or her. It can be very tricky to reason with someone who has most likely gone through his entire life somehow believing that ham, cheese and pickles constitute an acceptable daily meal in anyone’s life!