Physicians Ought to Practice Leading by Example

It’s easy to talk the talk -- walking the walk is the challenge. But physicians need to walk that walk in order to boost their credibility when it comes to counseling patients.

Put yourself in your patients’ shoes: Are you going to put much stock in a smoking-cessation message delivered by a doctor who reeks of cigarette smoke? Or be lectured to on the importance of healthy eating and exercise by a physician who is 50 pounds or more overweight? Nick Nicholson, MD, a leading bariatric surgeon and founder of the Nicholson Clinic in Plano, Texas, explains why it is extremely important for physicians to lead by example.

“I would be hard pressed to go to a hair transplant specialist who is bald,” Nicholson explains. “In my case, people expect to see fit bariatric surgeons.”

Taking the Walk

Nicholson says it’s difficult to determine whether more doctors are walking the walk today than in the past. One indicator might be the Physicians’ Health Study, which has followed the health practices of more than 20,000 male doctors since 1982. According to the study, as of 2007, 35 percent of the doctors in the study were maintaining a healthy weight, while 40 percent were overweight and 23 percent were obese. A key factor in everyone’s life, including physicians, is stress. How you handle stress is important when it comes to setting that healthy example.

“There are many ways to deal with stress,” explains Nicholson, who chooses healthy options when eating instead of grabbing the nearest convenience food, and counsels patients to do the same. “Of course not all methods are healthy. Some are coping mechanisms. Doctors should find a method that works for them and is healthy at the same time.”

Some positive methods for handling stress that Nicholson recommends include meditation, exercise, painting, volunteering, walking or cleaning the house. Negative methods include working more, smoking and drinking. These latter methods may relieve stress, but are not necessarily conducive to good health.

Nicholson has developed a regimen he calls “little steps can add up,” such as taking the stairs at work or parking his car at the far end of a parking lot. He says that adhering to the regimen can make a big difference.

“I got into the ‘little steps’ thing when one day I had been on a stationary bike ride for 45 minutes at the maximum settings and realized I had almost burned off the number of calories I had eaten for my light lunch,” he explains. “By adding 10 calories per day, the amount in one lifesaver candy, it equals one pound of weight gain per year. Imagine it over 20 years. Now add in a 100-calorie snack pack per day. That equals 20 pounds per year. Imagine that over 10 years.”

The key, says Nicholson, to the “little steps” approach is that you have to do it all the time or it won’t work. “It has to be a lifestyle change, not a fad.”

Engaging Patients

Nicholson says that broaching the topic of a healthier lifestyle with patients is never easy, but it’s even more difficult for a physician who is not leading by example. In that latter case, he suggests doctors utilize the services of a colleague where patients can more readily “buy into” the message being delivered. But even for doctors who are walking the walk, there is no delicate way to deliver the message of a healthier lifestyle.

“It’s important to be tactful when discussing it,” says Nicholson, noting that physicians to have an advantage over others when broaching the topic. “It seems to be easier in a clinical setting, because patients come to see a doctor of their own volition. They want to get healthier, or stay healthy. It makes it much easier to have the conversation as a physician.”

Advocating the “little steps” approach can also help. “There’s no need to avoid lifesavers for the rest of your life,” Nicholson says. “Just take the stairs down to the first floor. You don’t even need to take the stairs back up.”