Doctors, Practice What You Preach

"Do as I say, not as I do" just doesn't work in medicine.

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The old adage, "Do as I say, not as I do," has never worked terribly well for parents, politicians or physicians. Not surprisingly, patients treated by doctors, nurses and other healthcare providers who are overweight and stressed out--even smoking--may say to themselves that a healthy lifestyle is just too hard--"If they can't do it, how can I?"

To combat this problem, two Johns Hopkins medical students recently launched a grassroots campaign to urge fellow medical and nursing students, as well as practicing clinicians, to practice what they should be preaching.  They want healthcare professionals to sign The Patient Promise, a personal--and public--commitment "to lead by example and practice healthy lifestyle behaviors comparable to those I would ask of my patient."

"Lots of healthcare professionals, including us, become too stressed and inactive and busy to keep up our end of the bargain. Eventually we would not be good role models for our patients," said 23-year-old Shiv Gaglani, who is completing his first year of med school. "If we can't make changes in our own lives, how can we expect patients to do the same? So much of health care spending and disease burden in society is due to things that could largely be prevented by stopping smoking, losing weight, exercising 30 minutes a day, and reducing stress," he added.

The idea for the Patient Promise project came mid-year, when Gaglani and another Hopkins first-year student, David Gatz, were taking a course on obesity, starting to work with patients in clinics, and studying with faculty who had done research connecting clinician health with patient health. "We want to make patients healthier by making clinicians healthier," says Gatz.

There's ample evidence that the way doctors look, feel and behave may affect the way they treat and advise their patients.  Studies have shown that many doctors and nurses fail to promote healthy behaviors in their patients, particularly if they are themselves poor health role models with unhealthy eating and exercise patterns, as well as stressful lives. The converse is also true: research suggests that if clinicians are healthier, they are more likely to talk with their patients about lifestyle choices and patients in turn may feel more comfortable getting and following their advice.

A recent Hopkins study found, for example, that normal weight doctors are more likely to counsel their patients about obesity, body mass index (BMI, a measure of obesity), and weight loss than those who are themselves overweight. Gatz and Gaglani were "shocked" to learn that, despite their knowledge of the dangers of chronic disease killers from unhealthy lifestyles, roughly 6 in 10 doctors and nurses today are overweight or obese, a level approaching that in the general population.

Since the launch at Hopkins last week (see the video), more than 300 students and clinicians have signed the pledge. The Hopkins organizers hope to get thousands of clinicians to  commit to living healthier lifestyles themselves, to partner with patients in encouraging healthier behavior, and to avoid stigmatizing those who are overweight or obese. Their website lists the signatories, so it is easy to check and see who is on board. And participants can sign up for email reminders about their health goals.

"It makes you accountable to your peers and patients," said Gaglani, who admitted that he had been overweight earlier in his life and had gained the proverbial 10 pounds in the first few months of med school. So, amidst the busy pace of his Hopkins' med school life (I interviewed him by cell phone while he was on a public bus), he's found time to start running and yoga groups with fellow students. At Hopkins, they have offered incentives such as free or discounted gym memberships.

Presented by

Cristine Russell is a senior fellow at Harvard Kennedy School of Government and the president of the Council for the Advancement of Science Writing.

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