There is an old phrase that exhorts us to "Lead by example." Stated differently, some say that more is "Caught than taught." The reality of this principle comes into sharp focus when you become a parent and try to raise children. Somehow, they are not satisfied with the phrase, "Do as I say and not as I do." Rather, our actions have powerful effects on their behavior.
As I look at my own kids, I see many ways in which they are a small expression of me - for better or for worse. My oldest, in imitation of me, asks whether he should be taking protein supplementation. At one point one of my kids has expressed a desire to be an ED doc (mind you, my kids' ages are all in the single digits). And unfortunately, I see the not so exemplary way that I handle frustration and stress manifested in my kids as well. The power of example is an important force in molding and shaping behavior.
I believe that this is also true in medicine. Healthcare professionals have long been revered in society. If you look at surveys of the most respected jobs, doctors traditionally score very high. With this, comes a profound ability to speak into the lives of patients. In ways that are not transferrable in other contexts, we have the ability to sit with patients, analyze their behavior and then make recommendations about how to improve the landscape of their health.
Unfortunately, we have also taken this sacred relationship for granted and at times have taken advantage of it. This happened most clearly during the COVID-19 pandemic. There were those in medicine who touted the line, "Follow the science..." as a way of coercing behavior and shaming patients into following a certain list of recommendations. The net result was a triumph of paternalistic medicine over individual agency.
But as we come back to the realm of more proven science, there are many areas where we as physicians have the backing of data and experience giving us the ability to give authoritative recommendations. Even recommendations that our patients may not be immediately open to hearing. An obvious example is smoking. It is extremely clear that cigarette smoking causes profound damage and has detrimental health consequences. We as physicians are right to tell patients the truth about their decisions and warn of the consequences to come.
For me personally, when I was younger, my doctor told me that I should start exercising. At the time, I hated working out and I had no desire to follow his recommendations. And even though my agency won in this particular circumstance it did not diminish the rightness of his recommendations and assertion that strength and endurance are extremely important aspects of our overall health.
So, the question comes, if there are areas where we would argue for the rightness of benevolent paternalism, even when it comes into conflict with individual agency, from where do we derive the authority to make such claims? Certainly, there needs to be a healthy dose of quality data. But more importantly, the authority comes from our example. If we ever expect our patients to make healthy choices and to view a healthy lifestyle as desirable, we need to demonstrate by our example what that looks like.
Unfortunately, as I look around the physician landscape, I see too many physicians that are just as unhealthy as the patients we serve. We are over-worked, under rested, overweight and are just as unhealthy as the patients we see. So, what should we do?
Fitness:
I believe that the foundation to health begins with fitness. Setting aside the neuro-cognitive benefits, getting active and daily making yourself a little more fit than yesterday will pay huge dividends in all areas of your life. Dr. Peter Attia in his book Outlive discusses how fitness is important for health and longevity. Dr. Gabrielle Lyon in her book Forever Strong discusses how building muscle is important for mitigating against metabolic syndrome. There is a large amount of literature that discusses the impact that sarcopenia has on morbidity and all-cause mortality. As physicians if we want to truly promote health and longevity in our patients, it is important that we lead by example here. You don't have to become a marathon runner or powerlifter. But shooting for 150 minutes per week of some form of resistance training and/or Zone 2 cardio is a great start.
Nutrition:
You can't out work our out exercise a bad diet either in quantity or in quality. Unfortunately, everything in modern society (from time pressures to processed foods) fights against healthy nutrition and makes it very difficult to maintain a healthy diet. As a mental exercise, take a picture of your next dinner plate and then google each item on your plate. The results will surprise you. You will find that you are consuming more calories than you estimate, and your plate is filled with more carbs than you realize. As physicians, we need to have a healthy understanding of our caloric needs, recommended daily amounts of macronutrients, and try to formulate a diet that fits within these parameters. For more information, I again recommend Dr. Lyon's book.
Sleep:
Sleep is the perhaps one of the most neglected areas of health, yet one of the most important drivers of our overall wellbeing. Proper sleep has been shown to be a vitally important factor that supports our mood, energy, attention, memory, metabolic health, immune health, and much more. Dr. Matthew Walker in his book Why We Sleep demonstrates in great detail the importance of vital time in our day. And bit that is most alarming is that chronic sleep deprivation is associated with long-term cognitive decline (i.e. dementia). But as driven physicians and professionals what is the first thing that we compromise? Our sleep! Healthy sleep begins with targeting a sleep window of 6-8 hours per night in an optimized sleep setting (that means no late-night doom scrolling).
Work/Life Balance:
The saying goes, "All work and no play makes Jack a dull boy." Work/life balance is probably the most elusive element on this list. But it is vitally important. My wife and I like to quote the line, "Medicine is a jealous mistress." Without intentional restraint, medicine will take more of you than it gives. And in the process marriages suffer, families suffer, and ultimately you suffer. While work is important. And working hard is right and good, you do have to create boundaries to allow space for other priorities in your life. In the end, our lives should be defined more by the quality of our relationships than the quantity of our work.
Mahatma Ghandi famously challenged us to “Be the change you wish to see in the world.” This certainly is an exhortation to take the initiative to enact changes. But it also is a reminder that without being an example, our words are just that – words, with little or no power to compel other people to join us. Taking good care of our patients begins with taking good care of ourselves. It not only gives us a better physical ability to do our job, but also gives us the authority to speak into the lives of those we are trying to serve.
Comments