By Shantika Bhat, VRG Intern

Shantika Bhat is interested in the intersection of ethics and medicine so she decided to ask Jay Lavine questions about his experience as a doctor.  Dr. Lavine, a retired opthamologist, answers questions about promotion of healthy diets and the medical system.

The current medical system

The current medical system focuses a lot on trying to fix people, which can be problematic in the long run, said Lavine. Prevention of diseases and solving them at the root cause should be the main focus of the medical system. However, according to Lavine, he thinks that the medical system is too focused on giving drugs. Thirty-seven percent of all deaths in the United States are attributable to four health behaviors: smoking, unhealthy diet, lack of physical activity, and problem drinking according to an article in the Journal of the American Medical Association. To Lavine the healthcare system has turned to more of an economic standpoint of trying to gain profit rather than doing what’s in the best interest of the patient. According to Lavine this is why patients he had were scheduled for unnecessary surgeries and given drugs when they could’ve fixed their problem by simple diet changes. However, when focusing on the diet aspect often doctors don’t have time to follow through with such lifestyle changes. A study titled Time Allocation in Primary Care Office Visits found that doctors spend a median of 16 minutes with patients age 65 and older, which isn’t enough time to explain diets, answer questions or concerns, and more. Lavine says the systematic approach to earning the most money for the medical industry has been to make doctors see more patients in less time to maximize profits which has hindered many physician and patient relationships. Relationships are key for trust between the patient and doctor so that positive change can be made, but the system needs to be changed to allow for more productive time.

Educating and Advocating for Vegan/Vegetarian Diets

Note from Shantika: I discussed several of the following topics with Dr. Lavine. From all the books, shadowing experiences, and more that I have experienced, I have seen that implicit bias, patient autonomy, and cultural competency have always been a huge struggle and influence in the medical industry. These three factors all come into play when it comes to lifestyle changes such as diet. Implicit bias is when we have attitudes towards people or associate stereotypes with them without our conscious knowledge. Patient autonomy is about patients’ ability to advocate for their self-interest. Cultural competency is about where doctors understand different cultures and can advise with that in mind.

In Lavine’s description of medical school he believes that one’s perspective and exposure plays a huge role in the way they treat their patients. For example, doctors who are vegan/vegetarian themselves have more tips and advice to give patients because they are themselves vegan/vegetarian; however, a non-vegan and vegetarian will only learn those tips from exposure in medical school. If doctors who don’t follow a vegan or vegetarian diet don’t get exposed well enough during medical school about implicit bias and effective diet teaching, then their way of explaining to patients about diet change might be less well rounded. From what Lavine witnessed he saw that everyone gets different level exposures to different procedures in medical schools. This is why he saw peers with negative biases about suggesting vegetarian and vegan diet change. Since there is no standard that each gets, bias can seep through when the doctor advises the patients. Jay Lavine once attended a lecture and it was about the prevention of heart diseases and the speaker was only talking about different medicines. Lavine asked about diet changes and then the doctor made jokes about the diets with negative connotations. Overall that action highlights that different doctors may say negative comments like that because of their own dietary preferences or they believe that the patients won’t follow through. This is where better training on bias and preventive techniques should be taught more.

“My adoption of the vegan/vegetarian diet symbolized to me the philosophy that one should conduct one’s life in a way that doesn’t cause harm to other beings both human and not human,” said Lavine. His perspective and exposure to a vegan/vegetarian diet helped change the way he treated patients to a more preventive route compared to other colleagues who didn’t have the same lifestyle. “We should all be for ourselves but that shouldn’t be at the expense of using others,” said Lavine. In terms of education, there could be much done to improve the way doctors educate patients on diet changes. Jay Lavine would explain and suggest dietary changes and give recipes to help patients figure out a plan to adopt it. He thinks the best way for doctors to educate is to 1) repeat terms a lot so that the patients can internalize it; 2) give handouts and articles that the patient should read because it allows patient autonomy to choose what’s best for themselves; and 3) give people the benefit of doubt and not assume that they will not change. Those are his three tips to start when suggesting a change to a patient. In addition, patients have the responsibility to try to understand what the doctors say and go for the change if they can do so.

It’s good to acknowledge that not everything is easy when it comes to switching to a healthier diet, says Lavine. One is the fact that many Americans in poverty may not be able to access healthy options, which is why social history, follow-ups, and support programs should be implemented. Health disparities are a huge issue that society needs to fix for healthier communities. Another fact is that cultural differences can cause some conflicts between the diet change if the doctors don’t educate themselves about their patients. There needs to be more diversity and cultural competency training in medical school as well. “You can turn any cultural foods vegan/vegetarian if the knowledge is applied,” said Lavine. Finally, the topic of the younger generation of kids wanting to change diets can cause conflicts in the household if parents don’t agree. Each parent responds differently but, highlighting the parents who may think a vegan/vegetarian diet can cause a lack of nutrients;  Lavine suggests giving parents literature and tips to read to help mediate between kids and parents.

“I think that there is too much judging and the lack of open mindedness in seeing things in the way that patients might see them,” said Lavine. He believes that doctors should try to understand how patients may feel and try to help them rather than quickly assess that patients will not follow through on diet changes.

“Nutrition is the main determinant of health,” said Lavine. Prevention and the focus on changing diets should be more advocated in the healthcare industry. Overall, training on implicit bias, patient autonomy, and more exposure in medical schools are ways to improve doctors’ ways of educating patients’ healthier diets.

Dr. Lavine is author of the Eye Care Sourcebook. See https://www.amazon.com/Eye-Care-Sourcebook-Jay-Lavine/dp/0737303956