Walking the Walk for Your Diabetic Patients

April 5, 2016

Do patients expect more from doctors who counsel lifestyle modification? What degree of importance do you place on setting a healthy example?

How important is it for patients to think we "walk the walk"? We spend a significant amount of time during patient visits discussing lifestyle modification – diet, exercise, weight loss, smoking cessation, moderate alcohol intake. How important is it to patients that we practice what we preach?

I once had a colleague, also an endocrinologist, who was significantly overweight. OK, let's face it, I don't know what his weight was, but I'm fairly certain he met the diagnostic criteria for morbid obesity. On several occasions, I've had his patients tell me, "how dare he tell me to lose weight when he's walking in with a doughnut!?" Now maybe he was of the extreme. Let's face it, by the time physicians are in practice, much like our patients, we've already established habits, some of which are bad.

Years of long hours, late nights, and stress lead to bad eating habits, lack of time for exercise, and for some, unhealthy means to relieve stress.

We can use this to help our patients. Yes, I know it's hard to quit smoking. I used to smoke. I tried several times before I actually did it, and here's how I finally did. Yes, I know it is much more fun to gain weight, and weight loss is hard. Very hard. Harder than quitting smoking. And it's a daily struggle. One I deal with every day. So I understand.

On the other extreme, I have had patients say accusingly (before I've given my weight loss struggle speech) "you don't know what it's like! You're all skinny!" Uh, first of all, thank you, but I'm not. I wish it were so, but, alas. Ok, maybe I'm not 70 pounds overweight, but I know I could be if I let it happen.

I am very self-conscious when I eat out. Oh, sure, I try to choose wisely for my own good, but I keep looking over my shoulder for patients when I do break down and order that side of fries. I like when my patients see me at the gym. It's proof that I believe what I tell them about exercise. I wear an activity tracker, too, and when patients see it, they point it out and this often it leads to a more in-depth conversation about exercise.

Maybe it's less crucial for other specialists. Does a patient care if their eye doctor is overweight or if their surgeon works out? Perhaps. But I would not be surprised if they expect more from endocrinologists, cardiologists, and other specialists who give them lifestyle advice.