Dr. Peter Attia thinks about his former patient often, the woman who came to him in the emergency room at Johns Hopkins Hospital one night seven years ago.
She was obese and suffering from a severe complication of Type 2 diabetes, a foot ulcer, which required an urgent amputation. At the time, Dr. Attia admits, he silently judged her. If she had only taken better care of her health, maybe exercised more and eaten less, he thought to himself, this never would have happened to her.
But a few months ago, in a TED talk, Dr. Attia stepped onto a stage and offered a few words to his former patient: “I hope you can forgive me.”
“As a doctor, I delivered the best clinical care I could, but as a human being, I let you down,” Dr. Attia, his voice breaking, said in his talk. “You didn’t need my judgment and my contempt. You needed my empathy and compassion.”
For many, Dr. Attia’s talk, delivered at a TEDMED conference in April and opened to the public on the TED Web site in June, has struck a chord, in part for its unusual candor.
Dr. Attia admits to something he believes many doctors may in fact be guilty of. That compassion for overweight and obese patients often is not quite as deep as it is for those who are sick for other reasons – the “unlucky” ones, for instance, who develop cancer or another disease through no apparent fault of their own.
“I probably spent a lot of my time in medicine judging people who I thought brought conditions on themselves,” he said in an interview on Thursday, “without thinking, ‘Maybe I need to walk a mile in that person’s shoes. There’s probably a reason this person lived the life that they did, and maybe I have a privilege that they didn’t have.’”
Dr. Attia’s insight was informed, in part, by the startling discovery a few years ago that despite paying close attention to his diet and exercising frequently, often for hours at a time, he had developed metabolic syndrome, a precursor to Type 2 diabetes. He had made all the right lifestyle choices, he thought, and yet he was overweight and on a fast track toward obesity and diabetes.
The revelation, Dr. Attia says in his talk, forced him to make drastic changes in his life. And it led him to question whether the conventional wisdom about obesity that has prevailed for decades may be fundamentally wrong. Obesity itself may not be the cause of disease, he suggests, but one symptom of an underlying metabolic problem.
“We have this paradigm that says that if you eat too much, you don’t exercise enough, you get diabetes and you die,” he said. “With that belief in that paradigm, we’ve been treating people for 40 years, and things are getting worse dramatically.”
Dr. Attia eventually left clinical practice and became the co-founder of a nonprofit nutrition organization, the Nutrition Science Initiative, which funds experiments and medical research on the causes of obesity and Type 2 diabetes. The group expects to launch several major studies at universities around the country this year.
Since the talk went public two weeks ago, Dr. Attia said, he has received hundreds of e-mails about it daily. Many are from doctors who express regret about their judgment of former patients.
“I remember getting one the other day from a retired physician,” he said. “He was saying, ‘I’m a retired internist and I’m just ashamed to say I spent my entire career doing the same thing and I wish I had the opportunity to apologize to some of my patients as well.’”
Countless e-mails have poured in as well from people who have been on the other side of the examination table. Many are from people who are overweight or obese with diabetes, who feel they have been dismissed by doctors and looked down upon as deliberately ignoring their health, even when they struggle to make good choices.
“I’ve had many from people who say, ‘Even though you weren’t my doctor, I’ve accepted your apology to that woman, and I’ve forgiven my doctor who treated me poorly,’” he said. “It’s really moving and it humbles me to get literally dozens of these e-mails a day.”
Dr. Attia, however, has not heard from the woman he described in his TED talk, and he suspects he never will.
“The sad part is that my fear is this woman probably isn’t alive today,” he said. “Once a patient undergoes an amputation, their five year survival is about 30 or 40 percent, and this was seven years ago.”
“Perhaps the most important thing to take away from this,” he added, “is that time is of the essence. We have to figure this disease out.”
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