Facing the fats

Leading from the front; is it necessary for physicians to practise what they preach?
Facing the fats
By Joanne Bladd
Mon 03 Mar 2008 04:00 AM

Leading from the front; is it necessary for physicians to practise what they preach?

In a recent talk, I heard Dr 'Toby' Cosgrove, CEO of the Cleveland Clinic, explain why he won't hire doctors that smoke. Physicians, he said, should practise what they preach and those he hired were expected to.

This philosophy has got me thinking. It's a fact that, rightly or wrongly, sitting on the business side of the doctor's desk brings with it a degree of public accountability.

For example, whenever doctors are exposed in any form of shady dealings; be it minor malpractice suits or terrorism charges, you can be sure to find someone poring over the paper, whispering in scandalised tones; 'And he's a doctor.'

But just how far should this public responsibility be expected to stretch?

I ask because, on my frequent tours of local hospitals, I've noticed a trend. To put it frankly, many physicians seem to need a larger size of white coat these days.

It would appear a burgeoning number of doctors are letting the side slip on the battle of the bulge.

It is to be expected - the medical profession didn't get a pass card on the obesity epidemic, after all - but the question is, It is acceptable in the healthcare industry?

I realise this column teeters dangerously close to being fattist but - political correctness aside - if physicians are just paying lip service to the tenets of healthy eating, can they reasonably expect patients to follow their advice? It's a topical question.

Few people would studiously take advice from a financial adviser who had filed for bankruptcy, so do doctors have an edge in the 'do what I say, not what I do' stakes?

The (albeit limited) evidence suggests no. One study reported that patients were less receptive to weight-loss counselling, when plumper physicians dished out the advice.

(I'm guessing the cognitive process goes something like this; 'I'm being told to lower my weight, but my physician hasn't. In that case, it can't be as serious as he or she is telling me because if it were, surely they'd be the first on the bandwagon.')

The crux of the matter is that talk is cheap and action requires, well, action. Physicians are in a demanding profession. They start early, and finish late.

The odds are stacked against their ability to stick to a healthy lifestyle. But when habits are visible, I do believe doctors have some obligation to practise what they preach.

Many doctors are going to disagree with me. (Vocally, I'm sure.) But if we're backing a push to preventive care, I don't believe it can be credibly enforced when front-line physicians are losing the fight themselves.

Please; don't just talk a good game; walk the walk. (And preferably for 30 minutes a day, briskly enough to raise your pulse rate.)

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