Consumer Focused Health

The NYTimes has an interesting article on the range of advice given to pregnant women looking to exercise– and the takeaway is that much of the advice given is completely arbitrary.

“I had a woman, she was huge, and she was running seven-minute miles up to Week 39,” Dr. Pivarnik said. “It looked like she had a basketball under her shirt.”

It was, he said, close to the pace she had run before her pregnancy.

He was worried, but not about the baby. Dr. Pivarnik was concerned about the woman’s abdominal muscles and whether they would be pulled with all that jostling. “But she claimed she was not uncomfortable, so who was I to argue?” he said.

Both the baby and the woman’s abdominal muscles turned out to be fine. Dr. Pivarnik’s nonchalance about the effects of strenuous exercise on a fetus might take some women and their doctors aback.

But his was an educated response, he said. He based it on his research and on what he and his colleagues found by surveying published studies and case histories of pregnant athletes who continued to train.

“We looked at training patterns during pregnancy and postpartum,” Dr. Pivarnik said. “And we asked, ‘Was the amount of training related at all to adverse events?’ The answer was no.”

Dr. Pivarnik is one of the few that has actually looked at the primary research. Sadly, many doctors who have no idea “err” on the side of “caution”, creating arbitrary markers for their patients that have no basis in science.

The best way to learn how much exercise is safe is with studies in which pregnant women are randomly assigned to exercise regimens. Such studies, though, “can’t be done,” said Dr. Mona Shangold, the director of the Center for Women’s Health and Sports Gynecology in Philadelphia. No researchers or women would want to take a chance that the exercise might injure the fetus.

As a result, said Dr. Shangold, an expert recommended by the American College of Obstetricians and Gynecologists, doctors tend to play it safe.

But the advice often varies by doctor and can be based more on hunches than science, she said. Dr. Shangold says she tells women to limit their exercise time to 30 minutes a session, which she said was arbitrary advice.

“The problem is that we don’t know yet what the safe limit is,” Dr. Shangold said. “We are probably more conservative than we need to be.”

It is pretty clear that many doctors don’t know how to tell their patients that they have no idea. While meaning well, they are making significant decisions for their patients where the patient would likely make a different decision if they knew what their doctor did or did not know.

As doctors, how should this function in a consumer-focused world? I think there should be three principles of conduct:

1) If you don’t know the answer, make it clear that you’re not sure– and if you’d like to research it follow up.
2) Try to find someone else your patient can talk to that might have an expert opinion
3) Stop making stuff up– you’re abusing your professional bully pulpit and giving arbitrary advice that the layperson could make up just as well

Physicians imposing their views and biases on patients (without scientific backing to reinforce a truly professional opinion) create a damaging divide that compromises the trust in both the physician’s knowledge and the use of the scientific process.

When in doubt, why do we physicians have the arrogance to feel we have a better answer than the consumer’s own default choices/common sense?