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
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.
Med school itself can be a risk factor for poor health habits, given the long hours and stressful schedule, with little time for healthy meals. A 2006 study found that by the end of med school, student were less interested in nutrition counseling of their patients than they were when they started. However, those with healthier eating habits and personal physicians who encouraged prevention were more interested in nutrition counseling than their peers. Another study found that students at medical schools that encouraged healthy habits among their student body were more likely to counsel their patients about prevention.