Angry Doctor

Friday, November 11, 2005

Do as I say, not as I do

A comment on one of the posts asked if doctors should lead by example when it comes to the matter of maintaining a healthy lifestyle.

I am not actually a big fan of the 'lead by example' or 'practise what you preach' school. It’s not that I don’t think you should not lead by example or not practise what you preach, but I don’t think someone should be deterred from a right course of action simply because the person advocating it is not living it himself.

If a smoker advised you not to start smoking, would you ignore him and start smoking just because he is not practising what he preaches? Conversely, if a smoker asked you to start smoking, would you do so just because he is leading by example?

I believe that any advice should be judged on its own merit, and not by the person giving it.

As for the matter of giving healthy lifestyle advice, I think some 'healthy' doctors do inspire and some 'unhealthy' doctors nonetheless do manage to convince patients to adopt healthy habits. However, I suspect most of the time the more likely scenarios are:


Scenario One

Fat Doctor: Mr Tan, you need to reduce your weight. You must watch your diet and exercise more often, OK?

Patient says: OK, doctor. I try my best.

Patient thinks: What the heck? You yourself so fat ask me to lose weight… you lose some weight first then we talk lah! Hmm... now which burger joint should I go to for lunch?


Scenario Two

Fit Doctor: Mr Tan, you need to reduce your weight. You must watch your diet and exercise more often, OK?

Patient says: Easy for you to say, doctor! You work in an air-con room all day and make so much money, sure free to go California Gym to work out and buy expensive organic food lah. We all have to work long hours to make ends meet, eat cheaply at hawker center where the food is all unhealthy, and at the end of the day we are too tired to exercise!

Patient thinks: Hmm... now which cha kuay tiao stall should I go to for lunch?


In both cases, the thought pattern is immature and not helpful. The doctor's state of health has nothing to do with whether the patient ought to keep a healthy lifestyle, and to use that as an excuse to not keep yourself healthy is stupid.

I think until the system is willing to hold patients accountable for their own diseases, things will not get better. But given the fact that healthy lifestyle is not 100% disease-proof, and the impracticality of monitoring everyone's lifestyle habits, I can't see that happening in the short term.

13 Comments:

  • Personally I think doctors should practice what they preach.

    While I would agree with your post that both scenarios show some immaturity in the thoughts of the patient, one wonders what teh thought process of the fat doctor is.

    For example, if I were a fat doctor telling my patient to lose weight. What would be my thought process? "oh here I am telling this patient to lose weight while I know how difficult and near impossible it is and thus don't relaly expect that he will succeed. I might as well just give up and not ask my patients to lose weight".

    Trust me, more often than not, that is what fat doctors in Singapore would say. "Don't even try lah, you're wasting your time. Just prescribe some drugs and be done with it"

    I know because I used to be overweight and had a lot of difficulty losing weight but at the same time knew that drugs like Reductil and Xenical wouldn't work alone and hence would never take it myself but would prescribe them to patients.

    Absolute hypocrisy on my part and I admit it. But since losing weight and getting back into shape, I now advise my patients knowing it is possible and teach them how to. (Of course not every patient succeeds.) Losing weight is difficult but not impossible. And exercising alone without reducing calorie intake is the most stupid way to lose weight. To burn about 200 calories, you need to run on the threadmill vigorously for 30 minutes! One can of coke is about 150 calories! I have seen a lot of fat guys running really slowly at the gym for 10 minutes and then gulp down a can of coke after that. Guess what they gain weight in that transaction!

    Anyway now that I am no longer fat, if I advised a patient to lose weight and they chose to think immaturely, it at least has nothing to do with me.

    We should practice what we preach. Why shouldn't we?

    By Anonymous Dr Oz bloke, At November 11, 2005 5:27 pm  

  • Fat endocrinologists, balding dermatologists, ugly plastic surgeons. How dare they! :)

    I'm not saying we shouldn't practise what we preach, I'm saying the patient shouldn't not heed our advice simply because we don't practise what we preach.

    I think we've been conditioned over the years to expect people to practise what they preach and scorn them when they do not, Fine, but scorn the person, not the advice!

    Fat doctors are indeed... well, let's say I don't understand them either. Until SMC decides that we need to pass IPPT or meet a BMI standard before recertification...

    By Blogger angry doc, At November 11, 2005 5:44 pm  

  • I guess what I'm trying to say is that fat doctors are less likely to initiate and talk to their patients about losing weight.

    Doctors who smoke would be less likely to initiate talk about quitting smoking when seeing patients who smoke.

    Advice needs to come from the heart sometimes. Patients are people with feelings. The non-verbal cues are sometimes more important. I doubt a smoking doctor can look his patient in the eye and say "You must stop smoking or you'll be killing your family with your passive smoke" or something like that.

    By Anonymous Dr Oz bloke, At November 11, 2005 6:15 pm  

  • Dr Oz Bloke

    Love your comments, keep them coming in.

    You are fantastic.

    By Anonymous Anonymous, At November 11, 2005 6:21 pm  

  • LOL! This post is actually quite funny.

    By Anonymous wife.of.an.un-doctor, At November 12, 2005 12:52 am  

  • I gotta second dr oz bloke here.

    The rationalisations that patients use are a different issue.

    Leading by example is not required of a doctor, but it adds weight to advice regarding obesity (he he sorry 'bout that).

    One can perhaps seem a bit hypocritical otherwise ?

    I have a similar story...lost 25kg after getting very overweight whilst working ridiculous hours and subsisting on takeaway. Took me 4-5 months of bloody hard work.

    In these types of patients I think you're best off waiting for a glimmer of progress and pouncing on it with all the positive reinforcement you can muster :)

    By Anonymous Epicurus, At November 12, 2005 7:57 pm  

  • well, an article i read several years ago in scientific america says patients tend NOT to trust fat doctors =)

    By Anonymous Anonymous, At November 12, 2005 11:34 pm  

  • Their loss.

    Some of the best doctors I know are fat.

    By Blogger angry doc, At November 13, 2005 10:42 am  

  • Little wonder why Singapore has one of the highest obesity rates in the world isn't it?

    Many of the best doctors are fat. It probably proves my theory right.

    I have never seen a fat doctor who is famous for helping people lose weight.

    By Anonymous Dr Oz bloke, At November 13, 2005 11:24 am  

  • I don't actually know any doctor who is famous for helping people lose weight, although I do know of a doctor who runs an obesity clinic who is... not slim.

    By Blogger angry doc, At November 13, 2005 11:59 am  

  • totally agree with angry doc. You don't need to be slim to dispense sound advice to slim down. If the patient wants the doc to take some of their own advice
    , the patient missed the point already. There are also many advice given that are not directly observable by patients. eg don't smoke and don't drink. Unless they are your personal friend they wouldn't know if you smoke or drink. But I guess not all patients are matured enough to take the advice for what it is.

    By Anonymous Anonymous, At November 13, 2005 1:38 pm  

  • Well then the question is whether the doctor who himself doesn't subscribe to the advice he dishes out can be considered "mature" too?

    By Anonymous Dr Oz Bloke, At November 13, 2005 5:36 pm  

  • I would say the doctor would then be immature 'as a patient'.

    As for how that impacts on his role 'as a doctor', I think the general opinion seems to be that it does.

    Where we differ is whether it 'should' his patients, and what's to be done.

    But given the statistics as they stand... well, let me write another post then...

    By Blogger angry doc, At November 13, 2005 6:56 pm  

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