Friday, June 14, 2013

Hospital Cafeterias: They should be a place of rehabilitation and teaching, not serving junk food

Hospital junk food
It always amazes me that hospitals have a "tobacco free campus" program but in their cafeteria they sell junk food
Hospital Cafeterias Should Be Used for Rehabilitation and Healing
Every hospital  has a shortage of space, and every hospital uses its space to maximum ability to help patients.  But the most under utilized space for patient health is the hospital cafeteria. While hospitals have dietitians, which they use to help determine patients nutritional status, I've never seen a hospital use their chef to teach people to cook. 

But what I do see in many hospitals is junk food in their cafeteria.
Teaching patients to cook is the one simple thing we can do to help patients avoid the hospital again. 

A chef can teach a patient with heart disease how to cook a meal with less salt. A chef can teach a cancer patient how to make tasty vegetables that have the phytochemicals in them that help fight cancer. A chef can teach a patient how to portion meals, and fill the plate with healthy alternatives.

But these chefs are not utilized in hospitals for health, for rehabilitation, for preventive teaching. Hospital chefs are well trained, most love to teach, but instead are relegated to making meals for some patients, and the staff.

The Current Reality of Most Hospitals

I've had more meals in hospital cafeterias than I care to. In training, living in the hospital for days at a time meant that hospital food was all I had.  On days when I operate on patients, the hospital is where I take my lunch. Now, I am on the board of a couple of hospitals and here is what we really face with hospitals: they have no clue about the power of positive teaching and the message of junk food in a place of healing.

The Hospitals Have no Idea that the Best Resource for Helping Patients is in their Cafeterias

The hospital governing board meeting was getting started when a new item was added to the agenda, to make the hospital a junk-food free campus. We had, several years before, and with a lot of work, made the hospital and the campus a tobacco free campus, but it was time to go after the next major killer in America- obesity. You would think this would be a "slam dunk" for the hospital - but it wasn't.

As a physician I was shocked - how could we, as a hospital and health-care system, preach health and yet in our cafeteria was the very food that was causing the rising epidemic of obesity that came with a rising incidence of diabetes. They then told me something shocking, "we need guidelines, as to what food is classified as junk food and which isn't." Imagine a hospital dietician not knowing simple guidelines about healthy eating!

The hospital CEO asked for time to work with this and come back with a plan.

The next meeting the hospital dietitian showed us a new "energy drink" that would take the place of cola. While she was presenting this drink I did a quick on-line search of it: it had the same numbers of calories as coke, it had slightly more caffeine.  I raised my hand, again, in shock as to how a dietitian would think this was healthy, when, a quick internet search as she was presenting the data, showed it was no better than cola, and perhaps a bit worse.

Utilize this Space and These People

One hospital in Phoenix, Good Samaritan,  boasts that it has a physician cafeteria with a wonderful chef who makes their doctors great meals. When the hospital was trying to get me to bring my patients there the "business vice presidents"  told me that this was one of the "benefits" of bringing my patients to that hospital. I asked if their chef would be available to come to group meetings with my patients to teach them to cook, or if my patients could meet in that cafeteria and have the chef make food and teach them how to do that. This vice-president looked at me with a blank stare, "I have never once been asked that."

Food Should be Therapy

On the very ill patients hospitals are great at getting dietitians involved to help sort out the therapy they need for feeding patients through an iv, or through a tube. But when it comes to teaching patients what to eat, what to avoid- hospitals fall short, and the hospital is the best place to teach a a patient.
Hospital classrooms are used for support groups for cancer, for weight loss surgery, for cardiac rehabilitation classes, for AA meetings. Hospitals are generous with their space- but one of the single best uses could be cooking classes.

We Spend More Time Teaching Cooking than Operating
More and more physicians are teaching patients how to cook. We spend more time teaching patients to cook than operating on them. It is time for hospitals to assist in this effort.  Today when hospital performance is measured by re-admission rates acutely, but tomorrow hospitals will be defined by who keeps them out not just in 30 days but longer.

Teaching patients how to cook, and what to cook, and what to eat- is the best step modern hospitals can take.

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