There was a very controversial presentation made at a recent meeting of heart doctors in Canada. Iâ€™ve been stewing about what to say about it for a week.
The title speaks to its inflammation:
Fat, unfit, unmotivated: Cardiologist, heal thyself
The presenter that made the stir, pediatric cardiologist, and IronPerson, Dr Brian McCrindle (Toronto) argued that overweight, unfit doctors are doing their patients a disservice. His bottom line: cardiologists are acting like the rest of Western society. They are not living a healthy lifestyle.
He made three major points. (in-depth coverage can be viewed here, on TheHeart.org)
- Studies show that doctors who eat well and exercise regularly more often recommend the same for their patients.
- Doctors haveâ€”like most peopleâ€”readjusted what they consider â€œnormalâ€™ weight. In one particularly striking survey, 40% of doctors were overweight, yet more than half classified themselves as normal weight. (Ed note: â€œuh-oh.â€)
- Finally, Dr McCrindle called out hospitals for their mixed messaging. He cited one study in which almost 90% of US hospitals had fast-food outlets on site. His presentation included pictures of familiar sites in hospitals: rows of vending machines and racks of candy bars at the cashier. To his presentation, I could add this recent impulse photo from a patientâ€™s room on the heart unitâ€¦
So what does a bike-racing cardiologist who lives in one of our nationâ€™s unhealthiest states say about all this?
Itâ€™s a tough call folks. I’ll offer three thoughts:
The state of the messenger argument:
I believe most doctors under-emphasize the healing powers of lifestyle changes, particularly daily exercise. The sedentary overweight patient with high blood pressure gets a pill rather than counsel to exercise. Every doctor knows exercise keeps that patient off medicine, lowers their risk of death and improves a list of quality life outcomes: better memory, better mood and better sex, just to name three of many.
What’s so hard about counseling patients about exercise? A lot. Not the least of which is the problem of how advocating for exercise often leads into life-coaching. Iâ€™m an AF ablationist, not a guru. Patients should expect me to tell them that exercise could treat their problem, but they should not expect me to explain how to schedule exercise into their day.
Most understand that the lifestyle choices of a doctor isn’t the reason why pills get used when exercise would suffice. Patients get pills because itâ€™s faster, easier and thereâ€™s a perceived risk of not prescribing pills. You can e-prescribe a pill, but not exercise and restraint at the dinner table.
And…it’s pure fantasy to believe that patients take me seriously when I tell them that I too, struggle with nutrition. They see me as skinny, but when I line up in a start grid of an elite bike race, I am chunky.
On the hospital junk food paradox:
I respectfully disagree with Dr McCrindle. Rows of vending machines in hospitals simply mirror our society. No one forces people to eat this stuff. No…let me rephrase that: no one forces people to gorge themselves on this stuff.
Our crisis of sedentary-ism and obesity is not the fault of fast-food restaurants and soft drink makers. The problem isnâ€™t the slice of pizza; itâ€™s eating the whole pizza. (Disclosure: My bike team is sponsored by a pizza company.)
Self-righteousness and karma:
The thing that conflicts me most about this intentionally provocative paper stems from the bad karma of criticizing others for the life they choose. And bike racers believe in karma. So do most ablationists. The ridge between success and failure, health and disease, happy and depressed is a narrow one indeed.
Think glass houses. I dare not pick up that stone and throw it, for if I did, my house would surely be drafty.
Having opinions, advocating for what is right, taking a stand and most of all, being human are all admirable traits for doctors. Self-righteousness, on the other hand; that, my friends, is the slipperiest of slopes.
Iâ€™ll pass on riding that descent.
5 replies on “CW: Does a doctor’s weight and fitness matter?”
A new primary care managers office opened up nearby… much more convenient for me. However, there was a nice big new sign out front with a above the waist photo of the doctor. Fat and very disheveled looking… No way I thought as he obviously does not value his own health, why would he value mine….
I agree with Dennis’ opinion. The messenger can affect the acceptance or perceived validity of the message.
I am an active, 64 year-old man. I cycle frequently, but race very infrequently. I have infrequent episodes of an irregular heart beat, usually lasting a few hours, but never over 100 beats per second and never lasting for more than 8 hours.
A few months ago, I was advised to begin taking warfarin by an overweight, unhealthy-looking cardiologist before first wearing a 24-hour halter monitor and obtaining those results. Prescribing that medication seemed like the doctor’s quick and easy solution to my problem, without even knowing the nature and extent of my AF.
I took that advice with a huge grain of salt. Separate and apart from what I thought was a snap, easy solution, it was impossible for me to ignore the doctor’s own lifestyle choices and health habits in advising me to take warfarin, with all of its testing and limitations. The doctor was obviously a person who did very little, if any exercise.
In spite the proven benefits of warfarin, I decided that I did not want the limitations and lifestyle changes that taking warfarin would require and that I am willing to make other personal lifestyle changes to try to reduce the possibility of a stroke.
Later, I was told by another cardiologist (an athletic and fit electrophysiologist, btw) that given my relatively light and infrequent episodes of AF, my athletic lifestyle and other personal factors, that I do not need to take warfarin now.
@thomas: what lifestyle changes were you advised to make re coumadin? I am just curious; when I was on it I was told only to get my INR checked regularly. The doc also suggested avoiding contact sports; a non-issue since I’m over 50 and gave that stuff up many years ago.
Interesting post, John. When I see patients in the grocery store they always check out what’s in the cart. When I eat lunch with our RDs I always take special note of how they eat.
Of course our ‘weaknesses’ showcase our vulnerabilities and that may allow us to connect.
MDs should be fit, but it’s not PC to criticize or mock the weight-challenged as Dr. Kelly, the comedian-orthopedist from Philadelphia, learned this week.
Hospitals (and schools) have crap in vending machines because they make money. I’ve blogged about this.
If Thomas falls off his bike with an INR of 2.5 and hits his head, he might die.