Never trust a skinny chef, or a sick doctor?

Lately I’ve been thinking a lot about the responsibility of doctors to act as leaders in their communities. Part of this inspired my last post – ‘Do you wish you were Dr Incognito?’. I’d like to follow on by reflecting on what kind of responsibility doctors have to act as role models for healthcare.

There are a bunch of jobs out there in the world where you really need to practice what you preach to have any real credibility. Like the old saying goes, who would trust a skinny chef? Surely the only possible explanation is that the food they prepare is either impossible to force down, or causes violent projectile vomiting when you eventually manage to do so. I was a The Cook and the Chef fan, and Maggie Beer‘s buttery excess would win hands down in my eyes over Simon Bryant‘s more restrained style – Every. Single. Time. (There’s something in the fact that I have somehow managed to turn such a congenial show into some kind of showdown, but I’ll save that for another day)

This logic extends easily. Think about a few others – how much vocational trust would you put in:-

  1. A morbidly obese personal trainer?
  2. A footy coach who doesn’t even know the rules?
  3. An English teacher who has difficulty with spelling?
  4. A dentist with awful teeth? (starting to get closer to home, aren’t we?)

It’s actually quite a fun thought experiment, matching professions with completely incongruous personal characteristics. (Prizes for the best suggestions mentioned on Twitter with the hashtag #notjustagp or in the comments below!)

But it’s not that simple. At the same time, there’s a grand tradition of people doing things poorly in their personal lives that they’re paid to do all day long. Think about the builder with the eternally unfinished renovation, the mechanic driving the total hunk of junk, the formula 1 driver getting their car impounded (or maybe that’s doing the job perfectly!).

So, where does this place me as a doctor? Do I need to be a picture of good health to have credibility in the eyes of my patients?

Bad-taste patient joke or not, more than once in my so far short career in general practice I’ve heard a variation of the phrase ‘Well, you can’t be a very good doctor if you got sick’. This always makes me shudder – do people SERIOUSLY think that if I’m ever unwell, I can’t be an effective health practitioner for somebody else? After all, being a GP I’m pretty much cannon fodder for nasty colds and violent gastro without even thinking about the more serious risks of infectious diseases like hepatitis C.

But colds aren’t my fault, they’re noble afflictions suffered in my Hippocratic pursuits. So, surely I can gain some kind of ‘Good GP’ exemption for being unlucky enough to contract these kinds of diseases. Perhaps they could even introduce a new Medicare item number for each infectious patient I’m exposed to – danger money, if you will.

So my credibility is safe provided that I don’t catch any ‘self-induced’ diseases.

Although, that year I got influenza after not being vaccinated, well, that was another sacrifice because I was just too busy at work to get the jab. And as I fret about an expanding waistline, I shouldn’t blame myself, but rather the profession that demands so much time, and leaves me so exhausted at the end of the day that I couldn’t possibly do my ‘at least 30 minutes at least 5 times a week’.

(At this point I’d thoroughly recommend following the Social Determinants of Health hashtag on Twitter – #SDoH. Would also highly recommend Melissa Sweet on Twitter, or at Croakey Blog)

So for doctors, as it is for our patients, our own personal health is a complex interplay of personal and societal factors as well as disease factors. Where does the right balance lie? If a doctor is obese, is their advice that a patient should lose weight taken any differently than if they were a normal weight? I’m not sure, but I clearly probably shouldn’t light up a cigarette whilst counselling a patient on smoking cessation. (For the record, I’m a non-smoker – because I wouldn’t want you to assume the alternative and lose professional credibility)

At the end of the day, whilst we can’t avoid being role models, I think the concept is faulty. We’re not there to role model for our patients, but to provide expert advice, guidance and treatment. Our true calling is to inform our patients and guide them to a decision based on their own beliefs and priorities. Or put differently, it matters not what montrosity of adiposity lies beneath our dashing sweater vests, but rather it is the clarity of our thought, and wisdom of our advice, that we should be modelling for our patients.

 

I’d be delighted to hear your thoughts on how doctor’s personal characteristics and foibles alter the nature of the relationship with their patients.

 

 

 

 

 

 

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15 responses to “Never trust a skinny chef, or a sick doctor?

  1. Too busy to get the flu jab is not a great excuse… I reckon I could jab you have have you out of my room in about 1 minute.

    That aside, the obese doctor has been in a few recent studies….

    A study published in the journal Obesity from the Johns Hopkins Bloomberg School of Public Health in Jan 2012 shows that obese doctors are less likely to talk to their patients about weight loss — 18% of obese doctors talked to their patients about weight whereas 32% of normal weight doctors covered the same topic. So doctors feel it too – doctors who are obese are well aware that they may come off as hypocritical if they are telling their patients to do something that they apparently have a difficult time with.

    And here…

    1. Puhl RM, et al. The effect of physicians’ body weight on patient attitudes: implications for physician selection, trust and adherence to medical advice. International Journal of Obesity advance online publication 19 March 2013; doi: 10.1038/ijo.2013.33

    Respondents reported more mistrust of physicians who are overweight or obese, were less inclined to follow their medical advice, and were more likely to change providers if the physician was perceived to be overweight or obese, compared to normal-weight physicians who elicited significantly more favorable reactions.

    This study suggests that providers perceived to be overweight or obese may be vulnerable to biased attitudes from patients, and that providers’ excess weight may negatively affect patients’ perceptions of their credibility, level of trust and inclination to follow medical advice.

    Food for thought? The buttery, creamy, chocolatey kind? 😉

  2. I love it when I have a mild URTI at work. Especially if I’m sicker than the person sitting in front of me, asking for a med certificate off work…

      • AH, this is the subject of GANFYD, previously covered by Prof Max Kamien and often source of misery in the doctors.net.uk fora

        Why should medicare subsidise a consult for a sick note for the employer? Why should the employee pay a private fee for the note, if the employer requests it?

        More simply, why cannot people self certify for simple illness

        THIS NEEDS A PODCAST

      • My favourite was always seeing a police officer for a medical certificate.
        They’re trusted to carry firearms and uphold our laws, but can’t be trusted when they need a couple of days away from work due to illness.
        I know that it’s important for someone to police the police, but I’m not sure that this is what the saying was going for!

  3. Or the Financial Planner who has overdue bills and takes out a massive loan they can’t support…! Great post Dave with lots of thoughtful points raised. Doesn’t surprise me to hear that overweight docs are less likely to discuss weight with their patients either – so the issues can go both ways. But true that our main role is to advise, support and educate, and lesser of our role is ‘role modelling’. Hard to avoid that though, especially when we are using social media!

  4. I type this with a patient derived URTI, so I understand your pain Dave. Luckily today was teaching and not in the clinic. Mel Clothier has blogged on a similar pang of guilt turning up for work when unwell: http://greengp.wordpress.com/2013/03/12/doctor-as-patient-sick-gps-and-the-self-treatment-dilemma/

    My GP at uni when I was studying medicine was well and truly obese. I can’t say that I trusted him any less because of his body habitus. True, all I was there for was the occasional immunisation and not lifestyle tips. But if he ever said that I needed to shed some kgs, it wouldn’t have rang true. Or ould he have neglected to mention it at all to avoid that awkwardness? I used to also wonder about my colleagues who were smokers. When it came to counseling for smoking cessation, how did they go about it? Either come across somewhat hypocritical, or not talk about it at all?

    While I agree that we are there mainly for expert advice and guidance, I believe there is scope to be good role models also. So even if a GP is overweight or has poor cholesterol/sugars, then they should be actively focussing on diet and exercise as well as having their own GP for any intervention that may be needed. Its what we ask of our patients, we should do or strive for the same! Admittedly, I have recently been feeling the same guilt asking patients to exercise more often when I only get 30-60 mins in a week!

    Great topic Davo, look forward to more comments….

  5. Hi folks
    I knew an orthopaedic surgeon who ran vegetarian cooking classes to promote healthy eating. Patients would come back from seeing him with more lifestyle advice than if they had gone to see the cardiologist or diabetologist! The surgeon always said it was a wasted opportunity to improve someones lifetstyle if he did not dispense such advice..and he was a clear role model in this regard!

    I also knew a general medical registrar during my residency who was overweight and a heavy smoker. He was a well respected colleague amongst the consultants but when it came to COPD patients he was not strong on the smoking cessation message!

    I used to smoke but gave up years ago. I find it helps me with my efforts in counselling patients. I understand the struggle some find it to quit smoking.

    Having children has made me a better doctor, to understand the issues of parenting and being a role model as well .

    But we are human. I think patients respect honesty and being human. They do not expect us to be perfect . If they see an overweight doctor who is happy with their body image and is confident yet admits to need for healthy lifestyle choices personally then that is someone they will respect for being honest.

    We like others will struggle with the fragility of life. We will suffer the same illnesses and injuries that befall,our patients..infertility, trauma, mental illness, drug addiction..

    and ultimately it is our conduct, our behaviour and attitude in the face of that struggle that makes us respected role models in society. How we treat each other when things do not got our way, when things are darkest.

    • Some great points, Minh. I must admit that often I see my job as an educator of patients – the ultimate decision is up to them. So regarding diet and exercise, I try to tailor my message more around the idea of ‘This is what will make you the healthiest and give you the best benefit in terms of years lived, and years lived being healthy’ and letting the patient decide whether or not achieving those things is a priority for them. If my patient is aware that having high cholesterol and being overweight will increase morbidity and mortality, but truly finds great joy in overindulging, and doesn’t wish to change, then I believe I need to respect that.
      However, this gets really tricky when some of the components of a patient’s social determinants of health might influence how they process this education – if my patient has had a troubled childhood, poor education, legal problems as an adult and struggled with nicotine addiction or their weight, then I need to also help provide the support that they need to assist in making changes that will lead to a happier, healthier life. My happy over-indulger may actually be over-eating because of complex mental health or self-esteem issues, and this also falls into the doctor’s purview as something to consider and assess.
      The idea of having personally experienced something making you better able to care for patients with that problem is an interesting one, and I’m not sure I’ve fully formed an opinion on it. Of course, I have the training to provide assessment and investigation of a cervical lesion, despite not having a cervix. I see sick children and provide advice to parents all the time without being a father myself. But the reality is that my wife (also a GP and a certified female member of the species) does a LOT more women’s health than me, and perhaps my parents of the sick child would have preferred to see a doctor who was also a father. No answers, just musings.

  6. our job as Doctors is to educate..that is in fact the Latin derivation of the word Doctor. But as GPs we have the unique opportunity to be advocates as well. To try to address those social determinants as you cite

  7. Pingback: I’m not a racist, but… | Not just a GP·

  8. No.Dont put pressure on yourself.A doctors not meant to try to hold an image of perfection.They are meant to take personal responsibility for their health though like everyone else.
    A doctor who smokes lecturing on giving up smoking will be seen as a hypocrite by patienta but with excess weight,that could be either due to personal laziness or due to health issues.

  9. Pingback: Trust me, I’m a (SNAP) doctor! | GreenGP·

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