February 17, 2011
I wear lots of hats. Over the years, I have developed analogies for most of the things I do and for the things I want my patients to do. Analogies help people conceptualize the complexities of medicine in a way that makes sense.
Today, I had my chef’s hat on. I was actually treating a young chef and found myself talking about food and medicine. There is a direct correlation. My office medicine cabinet is no different than my home spice cabinet. As each spice has a specific taste and texture and effect on your body, each medication has a different personality and effect.
Cooking is all about getting just the right mixtures of taste and textures and sensation to put a smile on your face. No matter how many times you make a recipe, you have to season, then simmer, then taste, then season, then simmer, then taste, then season until you get it right. Once you’ve gotten it right, you have to let your guests taste your version of what you believe is perfect but it may not please them. I make an amazing chile con carne! At least, I think it is amazing. If I fed it to ten different people, I might get ten different opinions. Some may think it is perfect. Some may complain I use to much chili powder. Some may complain I do not use enough chili powder.
When I cook with medications, I know exactly what results I am looking for. Today, I was treating a case of newly diagnosed hypertension. I went to my drug closet (spice rack) and picked out my favorite medication (seasoning). I have made this recipe thousands of times but never for this unique individual. I picked my favorite spice. It is my favorite because it is often successful and rarely causes any adverse reactions. I sent him home on one tablet a day and asked him to see me in 2-3 weeks. In this case, 2-3 weeks is the simmer phase and the follow up visit is the taste test. If his blood pressure is controlled and he has no distasteful problems, the recipe is good and I will let him simmer for 3 months before I take another taste. If his pressure is not controlled or he does not like the recipe, I will adjust the mix by adding or removing medication. Sometimes the recipe is so bad you have to throw it out and start from scratch. Eventually, if my patient is compliant and works with me, we can achieve perfection.
As a chef, I take great pride in being the best on the block. I am very particular when it comes to choosing ingredients, using the best quality available. I like to taste frequently and adjust spices often in order to find perfection. When I serve you chili, I don’t mind you adding some chopped onion, cheese or even salt. When I am cooking up a recipe for hypertension, I mind the addition of salt and prefer that you not add any other medications or neutriceuticals without my knowledge. You know the old adage of too many cooks in the kitchen!
So, the next time you are in your physician’s office, imagine him wearing a chef’s hat. Decide whether you are willing to settle for a mediocre dish or you want the gourmet version. If you want perfection, go home and simmer and then follow up and let the chef taste and adjust. You really should demand the best in your food and your health.