Friday, July 22, 2011

Do As I Say, Not As I Do

I’ve heard patients say, “How could she smoke and she’s a doctor?” Alarmed and bewildered by the fact that an agent of health could partake in one of the most harmful acts of bodily destruction. In medical school, a sizable number of my classmates smoked and I always found it so counter-intuitive, mind-boggling that they would be learning about smoker’s lung in pathology and on class breaks would huddled outside the lecture hall sucking on their cancer sticks. These same colleagues would then be encouraged to exhort smoking cessation in our clinical skills session while we all sit, simulated patient included, in a room rife with the heaviness of second hand smoke. One would assume that there should be a direct correlation between knowledge on a topic and healthy decision-making but we know all too well that that is not the case. As Thomas Goetz states, fear of illness is not sustainable motivator for positive change in health behavior and that is true even if you’re a physician. It has certainly been true of me.
For the first time in my life, I am approaching overweight. I have a BMI of 24.5.  I feel awful, guilty and of course, hypocritical when I encourage patients to eat healthy and exercise, knowing that after work, I’m headed straight to Micky D’s for a snack wrap and fries on the way home, to then sit on the computer for hours instead of going running or doing my P90X work out that I planned.
I had been a vegetarian for 7 years, an exemplar for great health, a dancer, hiker, frequenting pilates and yoga classes - ever mindful of what I put in my body, knowing that eating healthy now would save me the medical bills later in life. Now, I pick at my mother-in-law’s stewed pork, munch on way too many cookies, and would eat all the mac and cheese in the world if I could. I barely eat portion one of the five portions of fruit and veggies we should all consume each day and please don’t ask me when was the last time I went to the gym. One would assume that as I watch the  dial on the scale climb, see buttons  of my favorite dresses pop out and feel my jeans rip at the thigh each time I wiggle into them that I would spring into action but this was more easily envisioned than practiced. The guilt increased as I increased in size, the will the make change was there but for some reason it could not be translated into action. While studying for my public health degree we learned of the stages of change for behavioral health.  I see myself lingering somewhere between contemplation and preparation, never quite making it to action. How then could I encourage my patients to action?
I remember when surgeon-general Regina Benjamin was nominated for the position and her weight was an issue. If she was to lead the country in overcoming obesity, shouldn’t she be setting the example? Conversely, a recent American Medical News article highlighted that doctors who share the same illnesses as their patients are usually better able to connect with patients as a result -- a doctor with multiple sclerosis has a leg up on other neurologists because he has felt the numbness in the legs that the patient is reporting. Instead of feeling guilty, could I not see my own struggle as a way of finally getting into the psyche of my overweight patients with diabetes and hypertension? Like them, I was too busy to prepare my own food and found fast food to be the more convenient, I had limited funds and again fast food, being a cheap option, was the easy option. With 3 fast food chains all within five blocks of my house it was just easier to walk there than to make the 1 mile trek to the nearest green grocer. So I began to tell my patients of my own struggle.
We would joke about eating burgers and fries but then I would let them know of the salad and fruit options  available at those same restaurants. I would tell them how I turned my one mile trek to the green grocer into my daily exercise. How I cut up all my veggies and froze them to save time in preparation for later. For my patients with iPhone’s I would rave about the Lose It! app which has helped me keep track of my progress. The more I shared my experiences and lessons learned with my patients, the more receptive and appreciative they seemed. I seemed human to them, not just another paternalistic know-it-all admonishing them and requesting unrealistic change. I learned that as doctors, while it is imperative that we practice what we preach, we at times, do fail. These failures can be an opportunity to reach out to patients, to identify with their own struggles and work together with them to improve health. I am now dancing twice a week and try to make it to the gym as often as I can. I always carry fruit  in my bag and bypass all fast-food restaurants on the way home.

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