Smoking.

[Guest UWOMED2005]

I agree that Doctors should smoke, should only drink socially a couple of times per month, be a perfect BMI, should eat healthy, exercise regularly, sleep 8-10 hours per day*, not let work stress them out, and have a perfect genetic makeup**. . .

 

FOR THEIR OWN HEALTH.

 

But not as a role model. It's better for doctors to be healthy themselves, but not 100% necessary. I've worked with fantastic doctors who are overweight, or are too busy in clinic to exercise. It doesn't make them bad doctors.

 

And MOST docs I've worked with don't get enough sleep on a regular basis!!

 

If a role model was what you needed in a health service provider, then you wouldn't go to a doctor. . . we'd go to members of the National Cross Country skiing team or some other cardiovascular intense sport.

 

But I will agree med students and doctors should STRIVE to be as healthy as possible. As should the general Canadian Public.

 

One last point - I have to point out that a doctor who has struggled with Health vices is probably going to be more useful than one who is naturally inclined to be healthy. A doc who is genetically thin despite scarfing down pizza and beer every night might have problems relating to someone who struggles to keep themselves at a healthy weight.

 

Likewise, I have to admit I was shocked at how overly simplistic some of my classmates saw quitting smoking, having never smoked themselves. It's not an easy thing to do, and telling a patient "to just quit" and handing over a quitting smoking pamphlet probably isn't going to help them quit at all!

 

*yeah right - that one is in particular unrealistic

 

** this last point brings up an interesting "slippery slope" argument in terms of lifestyle choices and uncontrollable health factors such as genetics. . . if doctors are supposed to be role models of health, are you saying those who have health problems not due to lifestyle choices are also poor role models?

[Guest studentz]

I think that the concept of doctors as "role models for health" is frankly paternalistic and rather insulting to patients.

 

A great deal of research into smoking cessation and relapse prevention has shown that people (patients) are much more likely to at least initiate cessation behaviour when their physician tells them to, especially when the request is made in conjunction with a referral to some type of program. This is especially true in CHD patients. You, as a doctor, completely lose this advantage (I would think) if your patients know that you're a smoker.

[Guest peachy]

You, as a doctor, completely lose this advantage (I would think) if your patients know that you're a smoker.

Why? Why would a doctor saying "I know full well how hard this is, and there are no guarantees, but from my experience this is your best shot, let's give it a try" be ineffective?

 

Personally, I think that there are lots of physicians (both smokers and non-smokers) who will be more effective at this, and lots who will be less effective. But it depends on empathy, and your ability to relate to your patient far more than on whether you yourself smoke. And someone who has dealt with the problem themselves has had far more opportunity to develop that empathy, I think.

[Guest wattyjl]

UWOMED's points are well taken, and i recognize that my position on this is somewhat idealistic. i am certainly not a model picture of health, though i am trying (we'll see if i can keep the pounds off come clerkship/residency).

 

i will not give up my position that i *think* doctors should try to behave as role models, or, would be more effective if they recognized that to some extent, they are role models.

 

it seems simple to me. you have no extended knowledge of health or finances. would you be more apt to listen to your doctor if they told you to invest in stock X, or your broker? would you be more likely to listen to your broker if they told you to quit smoking and eat better, or your doctor? now, if your broker goes broke, do you still trust them? if your doctor engages in the same destructive activities they are warning you against, do you take their advice to heart?

 

i fully recognize that a competent doctor a healthy person does not necessarily make, and that physically unhealthy (if you can separate that out) docs are just as competent as marathon-running docs. however, a lot of things in life come down to superficial perception. and is it that unreasonable to conceive of a patient saying to themselves: "if they don't do it, it can't be that big of a deal".

 

Why? Why would a doctor saying "I know full well how hard this is, and there are no guarantees, but from my experience this is your best shot, let's give it a try" be ineffective?

 

Personally, I think that there are lots of physicians (both smokers and non-smokers) who will be more effective at this, and lots who will be less effective. But it depends on empathy, and your ability to relate to your patient far more than on whether you yourself smoke. And someone who has dealt with the problem themselves has had far more opportunity to develop that empathy, I think.

 

i completely agree with this - of course anyone who has gone through the experience or a similar experience should be better able to relate, whether it be addiciton to smoking, alcohol, over-eating, etc.

 

but wouldn't it be better to be able to say: "i too struggled with X; i worked hard, and continue to work hard, to overcome it, and i know i'm better off for it. i'd like to help you try and do the same."

 

anyway, as was said, we live in the real world with real people, idealism has no place here :b

[Guest nby]

I think that what wattyjl and I are trying to say but have been unable to put clear enough is something like this:

 

we all agree with your above arguments, with never having smoked doc A's "just quit, here's the pamphlet" approach is much less effective than chain smoking doc B's "i understand and have been there" approach.

 

I think wattyjil and I are looking at it a little differently though. I know I am more saying that a doc would be better equiped to council someone on something if they are themselves responsible with it. That makes the comparison of chain smoking doc B's approach with the 6 month later having quit doc B's approach or with the hypothetical never have chain smoked doc B's approach. (so persuasive and personal skills are consistent)

 

Basically, lifestyle will not make nearly the effect that personal skills and persuasive skills will, but an improvement in a doc's role model qualities will have make an improvement in his/her effectiveness.

 

I don't think I need argue that docs should be intrinsically driven to be the best at their career they can become (while leading a balanced lifestyle of course).

[Guest UWOMED2005]

i will not give up my position that i *think* doctors should try to behave as role models

 

Definitely. Couldn't agree with you more if you word it like that. And it's better if they ARE behaving like role models.

 

But I don't think it's all that much better when doctors find it extremely easy to be role models. . . ie they are naturally thin, have never ever put a cigarette to their lips and find such habits absolutely disgusting. If they can't relate and take a holier than thou approach, that ain't good either!

[Guest Hal9000]

Wow.

 

Had no idea that my simple question would initiate a debate like this.

 

Nevertheless, I hope that I get an question like this in my interview. In an nutshell, it seems that the physician as a role model vs. the physician as a person/human being is at issue here.

 

Keep going....