I encourage us to take our mental models regarding sugar into our hands and recognize that we are all looking at this question regarding the use and impact of sugar through our mental models. Can we suspend them, and can we open up our discussion by asking if high fructose corn syrup is a toxin and the major cause of fatty liver disease? Can we examine the epidemic of fatty liver disease that we are seeing, as well as the potential impact of high fructose corn syrup on metabolic syndrome. Both fatty liver disease and metabolic syndrome are underwhelmingly recognized. It is amazing to me that this is the case. I look at my patients in the hospital and 90% of them have metabolic syndrome.  No one has that diagnosis attached to their chart—to what is happening to them in the hospital.  As a result, I am changing what I talk about with my residents, and I am changing my mental model. How could this have been going on for so long and we are unaware of this? And now I am looking at it differently. It is everywhere in the hospital.  The heart attack patients have metabolic syndrome.  The stroke patients have metabolic syndrome.  All the diabetics (except type one) have metabolic syndrome. Actually, most of the type one patients have this syndrome too.  I am just blown away that it is so prevalent. It is causing major problems. If we just limit out analysis to fatty liver disease, this is still a horrible thing. But high fructose corn syrup is probably causing a whole lot more problems. What is keeping us from seeing the outcome of this chemical in our foods?  That is our trigger topic. I’m curious to hear your comments.

Jeremy

Let me offer an example regarding the impact of mental models in health care. Mitch and I helped establish protocols at the County Hospital to help prevent Pulmonary Embolism, which at the time, was the #1 unrecognized cause of death in hospitals (in the 1990’s).  We met with lots of resistance, skepticism and “that never happens here” type stuff. However, we eventually instituted important new ways to prevent those blood clots from forming by providing leg compression devices and subcutaneous injections of a blood thinner as routines for at risk hospitalized patients. Laying down in a hospital bed for days on end is a risky thing—walking around is lifesaving, as are compression devices and blood-thinners.

I can remember being coached by faculty not at the county but at my medical school (which was a perfectly fine medical school). “Jeremy, don’t you dare write anything that would imply pulmonary embolism unless we have diagnosed it yes or no, because I don’t want to get sued for even thinking about it.” I thought “that seems really strange.”  You are telling me that I shouldn’t put our discussion about pulmonary edema in my notes, because we are going to get sued. So, the fear mongering and the dogma is part of the mindset. We are there to diagnose stuff only that we can treat.  I think that is part of physician mental models.  I only diagnose that which I know how to treat.  Everything else I don’t want to see it.