When Doctors Ignore Their Own Advice

I live near a health clinic, and on more than one occasion, have walked by men and women in scrubs smoking cigarettes. No human being is immune to nicotine’s addictiveness, but since health care professionals are supposed to advise patients against such behaviors, it’s extremely hard to justify the habit.

Earlier this month, a report published in The BMJ showed that one in 10 doctors admit to using tanning beds. The survey sample was small at only 163 U.K. doctors, but considering skin cancer is the most common cancer in the U.S., the fact that any physician would choose to partake in an activity that puts them at a direct risk for cancer is pretty mindboggling.

But indoor tanning isn’t the only doctor vice. Smoking, poor eating habits, being sedentary, and heavy drinking–while still not the norm–are behaviors not completely eradicated from the medical community.

An unforgiving culture

“It’s unrealistic to expect that knowledge should prompt physicians to avoid unhealthy behaviors,” says Anthony Montgomery, an associate professor of work and organizational psychology at the University of Macedonia in Greece. “Just like everybody else, they have a low risk perception with regard to their health.”

Montgomery says a big part of the problem is how physicians cope when they encounter health problems. In a 2011 study, Montgomery and his colleagues conducted an analysis published in Occupational Medicine that looked at 27 studies on doctors self-medicating. They wanted to examine the implications of a persisting culture within medicine where doctors do not expect themselves or their colleagues to be sick.

“We found that there was considerable evidence that physicians and medical students engage in high levels of inappropriate self treatment for reasons that include avoiding the patient role and occupational norms–keeping things inside the profession,” he says.

The study concluded that these behaviors could be occupational hazards for doctors, and that these problems are not benign for patients. Congruent research finds that doctors with bad health habits are less likely to counsel their patients on the same issues.

“Fifty years ago smoking was very common among physicians and nurses, though fortunately we’ve reduced that significantly,” says Shiv Gaglani, co-founder of a pledge for medical students called The Patient Promise. “Now however, physicians and nurses have the same level of obesity as the general population. Our caregivers are human too and can succumb to same behaviors that everyone else can.”

Montgomery, who typically studies doctor burnout, is working on a report that collected data from health care professionals in Croatia, Portugal, Macedonia, Greece, Turkey, Romania and Bulgaria and found that the effects of burnout were significant predictors of fast food consumption, infrequent exercise, drinking alcohol and using painkillers.

“Certainly most physicians I’ve met understand the paradox between what they preach and what they practice,” says Gaglani. “Seeking help is often complicated by the fact that you don’t want word to spread about your issues because it would spread within the community you practice. In some cases it could even mean the end of your career.”

Solutions

Gaglani created The Patient Promise in 2008 with his roommate at Johns Hopkins Medical School after they attended a course on obesity and motivational interviewing of patients.

“We realized that many of the harmful lifestyle behaviors we were learning to counsel against as future physicians were actually becoming part of our daily lives,” says Gaglani.

The pressure and stress of medical school was causing Gaglani and his peers to eat less nutritious food, exercise fewer times each week, and get significantly less sleep. “We asked the simple question: How can we counsel patients on important lifestyle behaviors if we couldn’t practice them ourselves?” says Gaglani.

And so the Patient Promise was created, and still serves as a pledge for health care workers to live the lifestyles they are recommending for their patients. The movement calling for doctors to be healthy has spread to many health care facilities.

Some hospitals have even incentivized healthy behaviors, like the Cleveland Clinic, which took staff health to task in 2014 and asked all of its employees to wear an activity tracker called Pebble. Target goals were set across the board, and participating in the program allows employees to get lower health insurance premium rates. So far out of the 26,790 employees and spouses participating, 18,302 have already met their target goal for the year: 100,000 steps a month or 600 activity minutes a month for six months.

The Patient Promise is available for all health care workers to sign as a pledge to patients and themselves. “We believe in the power of partnership and shared accountability between clinicians and their patients to lead healthier lives,” says Gaglani.