Leopold, a retired symphony conductor, came into my office to go over lab results from his recent physical exam. Most of them looked pretty good, except for that pesky cholesterol. Dietary changes hadn't met with much success, so it was about time to start a medication. Then he asked if there was anything else that I had found, either during his exam or in his labs. I hesitated, as I knew I was about to broach a touchy subject.
"Well, I see that you have gained some weight since your last physical."
The truth of the matter was that I was sugar-coating it. He was beyond pleasantly plump. But it's easier to tell someone that he has "gained a little weight" than tell him he is obese and needs to lose 75 pounds. I have tried that approach before, and it doesn't fly. People see how much they need to lose to get back to their high school prom weight, figure it is too much, get discouraged and just plain give up before they even try.
The maestro reached out and tapped my belly with his bony finger, the only part of his body that was still skinny.
"Well look who's talking, Bud!" He emphasized each syllable with a firm, staccato tap, tap, tap. The way he waved that finger around, it was as if he were back on the podium with his baton.
He did have a point. I had gained 40 pounds since my own high school years, back when disco was still king and gas cost only $1 a gallon. However, I was still offended at his effrontery.
After all, this visit wasn't about me — it was about him. It didn't matter if I weighed 120 or 320 pounds. And I sure as shooting wasn't going to tell him what my cholesterol was either. It's very clear right there in the doctor's manual that my job is to provide my best recommendations for healthy living to my patients, not the other way around (and if it isn't, it ought to be). Heck, I don't tell Leopold how to get the most out of the string section during Bach's Chaconne.
Even after he left, I had trouble getting his words out of my head. I couldn't help feeling like a bit of a hypocrite. It's just like when parents tell their children to do as they say, not as they do. That doesn't go over well with kids, and apparently it doesn't work much better with patients.
Of course, doctors come in all shapes and sizes, just like everyone else. For that matter, a doctor could have health problems of his own — maybe even smoke like a chimney — and still be able to deliver excellent patient care.
Some patients are even drawn to these imperfect doctors. A patient once told me that she sought out physicians whose weight problems were worse than hers. That way, she would feel less uncomfortable baring it all during the exam. (It also may have been a veiled reference to the fact that I needed to slim down.)
We all do best when we have an example of how to do something right. That's why the folks in Alcoholics Anonymous highlight people who have successfully battled the demons of alcohol excess. A doctor who tells his patients to get some exercise but then comes up with excuses as to why he can't exercise himself (and, believe me, there are lots) is signaling that he doesn't truly believe in the importance of physical activity. On the flip side, if a doctor walks the talk, that carries more weight (since we're on the subject).
So, after the maestro's accusatory tapping on my kettle drum, I did some soul searching. I suspected that he was the only one of my patients bold enough to come out and say what many others had thought.
Maybe that's why I couldn't get any of them to lose weight. Perhaps they took one look at me and figured that if I didn't think my extra 40 pounds were a problem, then maintaining a healthy weight was no big deal. After all, I was the one with all the training in health and wellness. If a car mechanic never changed the oil in his own car, then others would naturally assume that they needn't be bothered with that necessary bit of preventive maintenance.
But what many patients don't quite understand is that doctors are just people too. Shedding excess pounds doesn't come any easier for us than for anyone else. Physicians don't get a special pass on the old "calories in, calories out" equation. It is downright difficult, especially if you are a foodie like me.
I have observed the same problem with smokers who try time and again to quit. In medical school, one of my supervising doctors was a chain-smoking lung specialist. You think he didn't know what each puff was doing to his lungs? Of course he did, but that didn't stop him from joining the other smokers outside the back entrance of the ICU at the veteran's hospital.
So, after my visit with Leopold, I decided to get serious about my own health.
I truly believe that a successful weight-loss program involves both eating right and exercising in order to make significant and lasting changes. I started bicycling to my office, which worked out well as my commute was only six miles. Four years later, I'm now one of those die-hards, riding five days a week, even in the rain, snow or dark of winter. It helps that I have a nice hot shower waiting for me at my clinic.
Eating well has been a little more difficult, but I'm not giving up. I focus on having a good balance of foods and try to limit the total calories. I've met with some success but still have a ways to go. As the engineers like to say, it's a work in progress. In the meantime, I share my struggles with my patients, both giving and receiving pointers on how to stay away from the Kettle Chips and other naughty foods.
I'm proud to say that I have managed to shed a few pounds and am well on my way. It'll take a while. After all, I didn't put it on overnight.
And here's the best news: Patients are starting to catch my enthusiasm. They proudly announce that they're mall walkers or are training for their first "Couch to 5K" race. Some ask me how my bike riding is coming. Fellow bicyclists share tips on routes or longer weekend rides.
A few have lost weight, and I rejoice with them on their success. The way I see it, we're all in this together.
Now, if I can just get Leopold to buy a bicycle …
Dudley is a Seattle physician.