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本篇文章截止时间为：2017年4月3日前译回

“Can I have cheese on my ham sandwich?” My patient asked me this question several times during the first few weeks of my employment at a state hospital. Although dieticians provided recommendations, I was ultimately responsible for entering dietary orders. Like most patients on the ward, my patient was prescribed psychotropic drugs that resulted in metabolic complications. As a result, she required dietary restrictions. Despite several explanations about these restrictions, she continued to request cheese on her ham sandwiches. After I had denied her request on numerous occasions, she finally said to me and asked: “Why can’t I have cheese? I am stuck in a hospital. I know I’m too sick to go home. I have nothing to look forward to except what I can eat.”

For many patients in an institutional setting, days are regimented from the time of “lights on” to “lights off.” They are told what activities to attend, when meals and snacks are served, and what they can eat. These patients have little control over many aspects of their lives, but they can choose what they put into their mouths. Food is such a basic human need that we often forget its psychological significance. In an environment where most control is taken away, patients can exert an influence on food. Hence many patients insist on certain meals, purchase “unhealthy” items from the canteen, and engage in an “underground” snack distribution system. Food serves as a mechanism to exert control in an environment where patients feel they have no influence.

Within reason, negotiating meals and snacks could provide patients with a sense of control and could increase treatment compliance. I added cheese to the patient’s order for a ham sandwich.

Kaustubh G Joshi, associate professor of clinical psychiatry

Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC 29203, USA

[email protected]

Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.