Do As I Say, Not As I Do
From the October 4, 2006 issue of ”The Australian” is an interesting article regarding Australian doctors and the issue of whether the doctor should follow health practices that they preach to their patients. Should an overweight doctor counsel overweight patients about their weight? The article also presents statistics from the Royal Australian College of General Practitioners that suggest that doctors have their own problems which need attention.
- 57 per cent of general practitioners did not have their own GP, with 12 per cent nominating themselves
- 55 per cent undertook only low levels of exercise (compared with 38 per cent of the general population)
- 64 per cent had a post-vaccination test for hepatitis B, although almost half had a needle-stick injury in the past year
- 90 per cent had self-prescribed antibiotics, 30 per cent sleeping pills, 6 per cent opiate painkillers and 3 per cent antidepressants
- 26 per cent suffered from a medical condition warranting a medical consultation but felt inhibited about consulting a doctor
- Up to 25 per cent would treat themselves or not seek treatment for conditions such as alcohol and drug abuse or excessive tiredness, and 45 per cent for insomnia or sexual difficulty
- 19 per cent of doctors reported marital disturbance
- 18 per cent emotional disorders
- 3 per cent alcohol problems and 1 percent drug abuse.
A sad state of affairs for Australian GP’s; I doubt it is much better for United States physicians. One argument about whether the physician should counsel a patient with the same health issue as the patient is that the physician may have true empathy with the plight of his or her patient and this could be beneficial for the relationship.
Would you rather have an obese doctor talk to you about your need to loose weight or would you feel more comfortable if the advice came from a slim, trim physician? How about cautions against smoking by a physician who smokes? ..Maurice.
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posted by Maurice Bernstein, M.D. @ 11:11:00 PM
7 comments
7 Comments:
Although hypocrisy doesn't make the message or advice less worthwhile, it certainly does seem to tarnish the delivery a bit.
I really wouldn't want to hear about smoking issues from physicians who smell like cigarettes ... although I consider that to be more of a fault on my part than theirs - since in a physician/patient relationship, the message is most often more relevant than the individual messenger ...
There are some things I would prefer a "wounded healer" for though ... I would feel better understood if a physician whom I was seeing for something like depression had actually experienced it for himself.
An interesting perspective ... I once read about a physician who went through renal failure as a young man, and subsequently went through medical school and specialized in nephrology. He explained that he felt as if he understood his patients quite well, although he was always careful to never approach them from a patient's perspective. I believe that would inspire a lot of confidence in me.
Moof, I would be interested to know what you think about a patient confronting the doctor about what appears to the patient as the doctor's poor health habits, such as overweight or smoking as examples. Would a physician's disclosure of how he/she looks at their own lifestyle improve the doctor-patient relationship? Take this scenario for example: the patient says to the doctor "I smell that you have been smoking, what are you doing about it?" What do you think the doctor's response should be, which one of the following responses? "You are mistaken", "I do smoke but just occasionally". "I have a cigarette habit and like many habits people have, this one is hard for me to break ", "It's my wife, she makes me nervous and makes me want to smoke to relieve tension" or finally "You told me that you quit smoking 5 years ago and never resumed. Tell me, what was the secret to your success." Or..what else? ..Maurice.
Emotional health is an important quality on the list of possible problems a doctor may have. Doctors suffer from mental illnesses at the same rate as the rest of the population. Until a patient has dealt with a doctor who is mentally ill I don’t think one can grasp what they are capable of, how well they understand how to get away with inflicting harm, or how willing the medical system is to ignore behaviour that should sound alarm bells.
It is interesting that so many practitioners do not have a doctor. I believe I read 33% of female gynecologists do not go for pap tests. The 90% self-prescribing antibiotics isn’t shocking or dangerous in my opinion. There are areas that should be handed over to nurses such as prescribing antibiotics for various problems.
The pathologist, Francis Camps (1905-1972), who performed 88 000 post-mortems refused to consult a doctor and had a “genuine, if not irrational, fear” of doctors. This fear killed him when he assumed he had cancer but in fact had a stomach ulcer that could have been treated with surgery. However, it makes one wonder what he saw in those 88 000 post-mortems that made him so afraid of being treated by a doctor. What, in general, do doctors see that would make them ignore the advice they give patients about regular check-ups?
If I had a weight problem I’d rather deal with a chubby doctor than one who had never had a weight problem.
Truth in advertising: although I work around a lot of MDs who I admire and respect, I avoid putting my health in the hands of MDs unless I have what I judge to be a "serious" health concern that will not reslove on its own -- and then I usually negotiate to receive older, established, better understood interventions.
Why do I do this? First (knock on wood) because I haven't (yet) had to deal with things like cancer, organ failure, diabetes, and other really nasty diseases. But also because I've noticed how American style medicine trains howitzers on fleas. And I've noticed that MDs seem to have little knowledge or respect for vis medica naturae -- the ability of the organism to repair itself. In other words, I've noticed how dangerous many medical interventions are, and often decide to take my chances with disease rather than submit to the cure.
Bob Koepp has pointed out an important aspect of the risks involved in accepting the advice of physicians without any personal and special consideration. First of all, physicians are often under pressure by the patient “to do something”. It is very difficult for a physician to recommend “watchful waiting” when the physician considers the common desires of the patient for action and the physician’s concerns about risks of missing something or non-treatment in terms of malpractice suits.
Further supporting Bob’s concerns is the article by Adrian Fugh-Berman in ”Bioethics Forum” of the Hastings Center. “If a diagnostic procedure increases cancer risk, should patients be informed of that risk? Apparently not, at least for one procedure performed more than 150,000 times a day in the United States.1 CT scans use multiple x-rays to create three-dimensional images that are diagnostically useful but expose people to far more radiation than conventional x-rays. In fact, one CT scan exposes a patient to the lower range of radiation received by some Nagasaki bombing survivors. Up to one in a thousand patients will develop cancer from this exposure.2 Sixty million CT scans a year will thus cause cancer in thousands of people. Yet most consent forms are silent about this.”
While taking a nihilistic approach to physician’s advice may be unwise and even dangerous to one’s health in certain situations, patients should be fully encouraged to ask physicians questions of concern and consider that alternatives in diagnosis and treatments are often available. ..Maurice.
Dr. Bernstein, please forgive me for not checking in sooner. There's been a lot going on.
Regarding your question ...
I believe I would rather hear the physician answer "I have a cigarette habit and like many habits people have, this one is hard for me break."
However, I don't believe I would ever ask a physician something in a way that forces him to give me a direct, personal answer ... as I said in my comment, the message is often more relevant than the individual messenger.
However, if a physician who smelled like cigarettes was lecturing me about the evils of smoking, I might simply ask if he's comfortable giving advice that he's apparently not following ...
Although I would realize that the advice was good - in spite of the duplicity of the messenger - if I were to quit, it would be because I decided to of myself, rather than because the physician lectured me.
Going a step further, if the physician volunteered personal information, I would likely be able to be more open myself.
For example, a physician who is overweight, mentions his own battle with the problem, and uses that to lead into a discussion about a weight problem I might have, would predispose me to taking him more seriously ... and trusting him more fully.
Moof provided me with this link to a very interesting article on the same topic of this posting. It seems that a physician carrying the same burden as the patient may truely be able to communicate better to the patient. ..Maurice.
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