Doctor’s Orders: Why the Physicians of Tomorrow Need to be Cooks Today
Maggie BordenMaggie Borden
October 07, 2015
The 2015 JBF Food Conference will explore the future of food, from farm to kitchen to table. Featuring experts and thought leaders from across the industry, we'll examine how the choices we make and the steps we take today will impact what we eat, drink, and grow. In anticipation, we're talking to some of the men and women on the cutting edge of our collective food culture.
Dr. Tim Harlan may be best known as Dr. Gourmet, the on-air wellness expert and author of multiple books on healthy living, but his main vocation is changing the way American doctors approach diet and health. When he’s not writing or seeing patients, Harlan spends his days as executive director of the Goldring Center for Culinary Medicine at the Tulane University School of Medicine, where he shapes the practices of future physicians and teaches them how to cook. We sat down with Harlan to find out why all doctors should take a turn behind the stove.
JBF: It’s currently recommended, although not required, that medical school students receive 25 hours of nutrition training. What kinds of resources are currently available for students outside of Tulane’s program?
Tim Harlan: If you just Google nutrition education in medical schools, it’ll give you a pretty good sense of what isn’t there. Before the Goldring Center, the folks at UNC-Chapel Hill probably did the most with a program called Nutrition in Medicine. It’s an online repository of educational materials and modules that they started back in the early part of the century. It’s very nutrition-focused and not very food-focused, per se, which I think is the big distinguishing factor from what we’re trying to do. There is a difference between the science of nutrition, i.e. metabolism and biochemistry, and physiology and nutrition in terms of what we actually put in our mouths. That’s the real distinguishing factor that, in our opinion, has been missing in medical school education.
JBF: The Center has an exchange program with Johnson & Wales—what do the culinary students learn when they come to the Center, and how do your medical students interact with J&W?
TH: We do, and that’s actually been running since before we started teaching med students. They have a culinary nutrition program there—it’s the only program of its kind at a culinary school. When the students graduate, they can complete a dietetic internship program and then sit for the registered dietician exam. So they become chef-RDs, and the majority of the students that we host for 11-week externships are in that program. The culinary students absolutely form the backbone of our ability to get as much accomplished as we have, and that’s the cool part of this: that our programming is so student-driven. Students have written the content and the curriculum. They revise it. They deploy it. They teach the community. It’s just amazing. We also send a dozen medical students to their program each year for a 28-day rotation. They spend a month in the kitchens, and then they have some of the same responsibility to teach the culinary students as the culinary students have here in teaching our medical students.
JBF: And that’s on top of the curriculum you’re doing in the kitchen in New Orleans?
TH: The exchange is actually a pretty small part of what we do. The core of our program is an eight-module curriculum for first- and second-year medical students. Each module is about three hours, hands-on, in the kitchen. All the lectures, readings, etc., are done online before you come to class. Then once you’re at the kitchen, we divide the students up into the groups and do some case-based learning, such as “a 38-year-old woman comes into your clinic with X.” They then spend about an hour with hands-on cooking. Each team that does their piece of the case or their question set for the case, and they all cook something different. The modules are thematic, and the cases fit the theme. Once they finish cooking, there’s an interstitial piece where everything gets plated up for presentation because we’re very big on portion size and serving sizes, and making sure that people understand what that should look like. Then they all sit down together at a family meal, and they eat what they cooked together, and each team presents their piece of the case. That discussion group is led by a Tulane faculty member, a fourth-year med student, and one of the culinary nutrition interns.
And then in addition to that eight-module series for medical students, we have about five or six disease-specific, condition-specific modules for third- and fourth-year medical students. We’ve got celiac disease, congestive heart failure, food allergies, and more. We’re hoping to develop about two to three dozen modules over the coming years. Most people think of nutrition and diet in the context of medicine as just focused on eating healthily, but our patients have all these different issues. We have patients with Crohn's disease, irritable bowel syndrome, and acid reflux. It’s not just all about diabetes and hypertension.
JBF: Do you have to be a good cook to be a good doctor?
TH: Definitely! I might not have said that five or six years ago, but part of what I do in my day job now is what’s called population health management and chronic disease management. It’s the idea that we, as physicians and in the healthcare profession in general, are changing how we practice medicine very rapidly. For two millennia, we have done episodic and acute care that goes like this: Maggie comes to see me with a problem. I deal with her problem with some sort of intervention, and then she goes away, and I don’t think about Maggie again until three months from now when she comes back for a follow-up visit. That’s how we’ve practiced medicine, and that’s also how we have taught medicine. Due in part to changes from the Affordable Care Act, and partly from the fact that the personal computer gives us better access to data, we are now able to think about this a little differently. I’m going to think about Maggie all the time now, and think “Am I doing everything to not only help her be as healthy as possible right now, but to keep her as healthy as possible in the long run?” And that entails a completely different set of tools that, as doctors, we’ve never had. The sum total of the conversation about nutrition, diet, lifestyles, food in the past was, well, lose some weight. All your problems are because you're overweight. But that’s not a very good tool. So we see ourselves in the collective of all these medical schools now as creating those tools and the training methodologies for physicians, both present and future.
So should doctors know how to cook? Of course they should, because if you know how to cook, then you know what those challenges might be for your patient in terms of access to food, the time investment in preparing food, the skills needed, and what great food tastes like that just happens to be healthy for you. This is not about “health food.” This is about tacos, spaghetti, and blackened redfish—it’s about real food.
There’s really interesting data that says that when physicians walk the walk, our patients actually listen to us at a much higher rate. So if we know about food and we know about what it takes to go to the grocery store and shop economically for great tasting food that is not as calorie-dense, but is much more nutrient-rich, then I think we can have the ability to have a better conversation with them.
JBF: Tulane’s curriculum has been licensed to fifteen schools, and you offer continuing education modules to help practicing MDs. What are your hopes for the future of the Center?
TH: This past spring semester, we began integrating our modules fully into the overall curriculum. We’ll continue to expand that footprint over the coming years probably to at least three and maybe as many as five or six modules that will be a required part of the curriculum, so you won’t be able to get out of Tulane Medical School any longer without doing at least three hands-on modules in the kitchen. Beyond Tulane, when we get any sort of press, local or national, my phone does not stop ringing. We were part of a nice article in the Wall Street Journal, and that’s when other medical schools started calling and emailing and asking to come see what we’re doing. I think that it’s very possible by the time October rolls around this year we’ll be in pretty close to 15 percent of medical schools. I think it will become absolutely a codified part of the medical curriculum in the next five to seven years.
JBF: You’ve talked about all of the outreach that comes from the press that you get, but is there anything else that you would recommend to people who are interested in pursuing this, either for personal or professional reasons?
TH: I think that having that conversation with your own physician to raise his or her awareness of what we’re doing is always beneficial. Tell him or her that you can come and do CME (continuing medical education) with us. If you have any friends, family, or colleagues at medical schools across the country, we are happy to engage with those folks and help them working on this type of programming. We’ll do everything we can to show them how to do it. Our call to action is really just to call us.
For folks personally, probably the simplest advice that I have is to stop eating in chain and fast-food restaurants. If you’re going to eat out, go eat with good, honest chefs, because you’ll be healthier. But really, I want you to go to the grocery store and cook for yourself at home. That’s probably the single best thing that you can do for your health, and it’d be even better if you walked to and from the grocery store.
JBF: Finally, are there any specific medical conditions that you think people should ask their doctors about diet-based treatments for a first line of defense?
TH: You know, I do. I think it should be everything. Monsieur Brillat-Savarin was right: tell me what you eat, and I will tell you what you are. Food affects everything. What you put in your mouth is absolutely the core of how healthy you are or are not. So it seems like a simple question, but it’s actually a really broad one, because if you’ve got irritable bowel syndrome, there’s probably something that you’re consuming or eating that is contributing to that. Or, if you’ve got a lot of gas and bloating, something as simple as chewing sugarless gum could be causing that because of sorbitol. The vast majority of Americans over the age of 45 have not a little bit, but a lot of, lactose intolerance. There’s a lot of food allergy out there. But the real challenge is asking your physician. I know that the vast majority of them will not know how to respond right now, and that’s a shame, but that’s what we’re trying to fix.