You're right in a limited way, but the way it was put to me, doctors don't see it as possible to effectively pitch both approaches in the same session with a pa

You're right in a limited way, but the way it was put to me, doctors don't see it as possible to effectively pitch both approaches in the same session with a patient. You probably won't see them a second time, so you have to lead with the pills and concentrate on the pills. It's your one shot to get them on a medication that will extend and improve their life if there is one for their condition, like metformin or a statin, so even though you mention dietary changes, you're not making a realistic effort at convincing them to try it, because that would involve a lot more time and discussion and coaching about what a healthy diet is. You focus on the medication because getting them to take medication daily is a realistic goal that will succeed with a decent percentage of patients. Also, if you stress the dietary approach too much, a lot of patients will eventually ask, "If I make the dietary changes, is it possible I can avoid taking medication?" and you have to say "yes" and now the odds are you'll never see them again and they won't get either. So you mention the dietary changes, just so they know it's effective if they're inclined to go that route, but you focus on getting them to take medication. It's definitely a sad compromise aimed at the average patient, and doctors hate it.