This article was originally published in Australian Doctor.
In my short, undistinguished medical career, I can recall a single moment of shameful hypocrisy. I won’t pretend there aren’t more, but only this one hasn’t yet been wilfully erased from my consciousness.
During my RACGP exams, my medical knowledge and BMI were at dizzying heights. I adhered strictly to every tenet of the Exam Cram Program and the No-Carb-Left-Behind Diet.
As I would read, I would feed. In a strange causation-correlation fallacy, I almost felt myself getting smarter as I ate more cake.
These were the lies I told myself.
I wasn’t a size that anyone would publicly call ‘fat’, but I was, quite publicly, fat. I learned this when a colleague, fresh from six weeks of annual leave, walked into my consult room and said ‘you’re fat’. He shut the door on his way out as I wiped my tears with a Cadbury wrapper.
Within a few days of this incident, a male patient of my age presented for some minor issue. After sorting that out, discussion flowed to his general health and the conversation naturally segued into weight loss, and healthy eating.
This was relevant as he was overweight. Relevantly, however, he was notably less overweight than me.
While he was certainly correct about cutting down on sugary drinks, he thought eating veggie burgers from fast food joints would help him lose weight too. He also intended to start a 30-day home liver detox diet. As I began to explore his beliefs and make alternative (or rather more mainstream) recommendations, I felt him resist.
Now, this could have been for many reasons, and by guessing these reasons I’m sure I’m projecting my own insecurities. But I don’t think it’s a huge leap to venture that he was resisting due to the irony of getting health advice from someone visibly fatter, more stressed and more in need of sleep than him.
It might seem a tad unfair to assume patients make snap judgements about their doctor’s health — after all looks can be deceptive. But this is beside the point.
If patients do make such judgements about our lifestyles based on our presentation (and I believe they do), then this perception is relevant, considering we are the ones dishing out the advice.
Furthermore, when it comes to promoting a healthy lifestyle, our competition is growing increasingly fierce. There has never been another time in human history when the air was more saturated with health advice.
The wellness industry is at its largest, and the methods of targeting consumers ever more inventive. A lot of the advice is good: exercise more, eat more vegetables, stress less. But then it offers glowing skin if you agree to swallow acai berries and vitality if you drink the new ‘god-knows-what-seed’ smoothie.
In the face of this aesthetically competitive branding, is it really surprising that patients would question health advice coming from a seemingly unhealthy doctor?
I no longer have to imagine this scenario. The day I attended to that young man, this unhealthy GP lost out to the promises of the liver detox program. Its marketing strategy beat my marketing, which that day was my waistline.
Maybe, we should see this as an opportunity to get better at marketing ourselves and our advice. A colleague I know puts her bike helmet on display, hoping it will start a conversation about exercise. My previous GP supervisor has a photo of himself at the top of Kilimanjaro, holding his walking stick high (the subtext being he climbed, rather than took a helicopter, to the top).
But in this day and age is that enough? I’ve had patients casually throw Spartan, Amaranth and buttered coffee into conversation. They think I know what these things are. And why wouldn’t they: I’m the one claiming to be a health expert.
Do GPs have to literally ooze health and wellness all of the time? The truth is that because we’re human too, there will always be understandable lapses in our own health.
For example, much of my noticeable weight yoyoing is due to month-long courses of prednisolone that I occasionally, and unavoidably, have to go on.
In those moments I have to consciously give myself permission to continue dispensing good advice, even if it feels hypocritical. The same is true for the doctor who smokes; he is still correct in discouraging his patients from doing so.
However, there is a silver lining in all this. In moments of poor heath, there is one edge the unhealthy doctor might have over the healthy one: a deeper empathy for the patient’s position.
There is nothing quite like having the understanding and companionship of someone who is walking the same path as you. Mutually recognising this might just blunt any cynicism and help both physician and patient.