Do As I Say, Not As I Do

You've got to start exercising and lose weight.

This is good advice for about two thirds of American adults.  A doctor could dispense this recommendation to every person who walks through the clinic door and hit the nail on the head about 70% of the time.  We Americans are not known for our slender, fit physiques and assiduous exercise habits.

What about doctors?  Well, it turns out that doctors are, in fact, healthier than people on the other end of the stethoscope, but only barely.  Fifty-three percent of physicians in the U.S. are heavy enough to be classified as overweight—a number only slightly lower than the general population (64%).

We do much better when it comes to other markers of health.  The rate of smoking among medical professionals has plummeted over the years, from 20% in 1970 to less than 5% at the turn of the century.  Prior to 1970, pretty much everybody was hooked on tobacco, even lung cancer specialists; so statistics prior to that year don’t matter much, unless you’re a writer for the TV show Mad Men.

We had a couple of smokers in my medical school class.  I was surprised to learn this, believing that all young pre-med students were sufficiently educated to recognize the dangers of tobacco.  Not so with these two who struggled to kick their habit before they started staffing the hospital wards during third year.  One of them actually had his grade docked because he skipped out once too often to catch a cigarette break during rounds.

Foreign doctors tend to be thinner than Americans but have more trouble with tobacco.  If you were to attend one of our big international meetings (such as the yearly American Heart Association conference) you would find scores of well-dressed men and women standing outside the convention center puffing away and chatting in strange languages on their cell phones.  Worldwide, about a quarter of doctors—including cardiologists—smoke, and in the Middle East and the former Soviet satellites the number rises to 40%.  One of my old Air Force friends—a fellow heart doctor who for a short time was deployed to Turkey—told me of assisting a local doctor with an angioplasty who was puffing away on a cigarette even as he deployed the coronary stent.

I have to believe that it must be a little tough for a doctor who reeks of Virginia Slims to impress on his patients the importance of healthy living.  We know based on recent research that overweight doctors tend to gloss over the issue of obesity more than their thinner colleagues.  Specialists at Johns Hopkins recently published a study showing that non-obese doctors are twice as likely to open a discussion about the need for weight loss as caregivers who are, themselves, in need of a tighter diet.  According to a summary of the research, the differences are stark:

The study found that normal weight physicians were more likely to talk about weight loss with their obese patients (30 percent vs. 18 percent of overweight docs), had more faith that patients would trust their advice (80 percent vs. 69 percent of overweight docs), and had more confidence in their ability to provide diet and exercise advice (53 percent vs. 37 percent of overweight docs).

But the biggest disparity of all was in the way physicians actually assessed patients. Normal weight doctors had a 93 percent probability of recording an obesity diagnosis in overweight patients, compared with only 7 percent of overweight doctors. In short, if a patient's body weight met or exceeded the doctor's own body weight, the patient was more likely to be judged obese. Normal weight physicians were more likely to provide recommended obesity care to patients, according to the study.

You can certainly understand a doctor being reluctant to preach diet and exercise when he does neither (and is wearing the pounds to prove it), but I think this is a little unfair.  When we dispense advice to patients we’re providing the summary of what we’ve learned through years of college, medical school, residency and clinical practice—but as doctors we’re under no obligation to provide testimonials from personal experience.  I can tell you with scientific certainty that your health will be better if you don’t get overweight even if I don’t follow my own advice.  Similarly, a doctor who smokes is not required to kick his habit before he tells you to kick yours.  The data speak for themselves no matter what your doctor looks like.

Sure, you say, but isn’t it hypocritical for my doctor to preach healthy living when she doesn’t adhere to her own advice?  You bet it is, but that’s not the point.  Just keep in mind that a visit with your doctor is a business transaction: you are paying her to tell you how to live happiest, healthiest and longest.  You’re not paying her to be your role model.

Still, whether we like it or not, we are role models—even if that’s not part of our job description.  A patient who receives a recommendation for weight loss from an obese doctor might just take that advice with a wink and a nod rather than as a mandate for better health.  As noted above, many overweight doctors already recognize this fact—if not overtly, then at least subconsciously—and blow over the subject entirely.

Doctors are human just like anyone else and, as such, are beset by the same temptations as anyone else.  We’d rather spend an afternoon on the couch with a meat-lover’s pizza than sweating away on an elliptical at the gym.  We’re not immune to the siren song of juicy barbecued ribs and a deep-fried mountain of onion rings, and we’re no more apt to snack on carrots or celery than the rest of you.

Nonetheless, despite the fact that it’s written nowhere in the oath of Hippocrates, we doctors do indeed have an unspoken mandate to embody our advice about healthy living just as much as members of the clergy have an obligation to live moral lives; as much as off-duty police officers are expected to drive within the speed limit; and as much as the men and women who write our country’s laws are duty-bound to remain uncorrupted by crime . . .  Wait—scratch that last one.  We’re talking about Congress, after all.

Fellow physicians (and nurses, for that matter), I challenge you to lead the lives you preach to your patients.  The moment patients enter the machinery of our medical system they start looking around—consciously or not—at the people who are preaching at them.  They decide whether to take our advice at least in part by how much we believe in it ourselves.

And, unfortunately, our patients can easily determine how much we believe our own advice by simply glancing at our pant size.