Mexico Medical Student |

I found this “video editorial” on Dr. RW’s blog about a “tight white coat syndrome,” where the author basically admonishes overweight physicians as being bad role models. I’ve admitted I was a fat medical student here before, but I try not to make an issue of it since, like I’d want of everyone around me, the ideal is to just take it in stride. There’s always a risk of someone like me (in this case) rebutting a piece like this, but I have to get this off my chest nonetheless. First of all, the author writes the following:

Sadly, those [doctors] who fail to embrace lifestyle recommendations in our personal and professional lives promote a public perception that lifestyle change is ineffective or unrealistic.

Once can take the completely opposite viewpoint that doctors who “fail” to keep a “normal” weight could perhaps be seen as more fallible, more human, more (and this is the key here) approachable when it comes to weight management issues, since they are obviously no stranger to them. It is the height of arrogance to continue with the charade of the doctors-are-superbeings-type persona of the moldy old school. You know the kind: self-assured, attractive, knowledgeable yet affable–all those things that you can read about a leading man/woman on any random TV medical drama. Whatever. The people I go to school with and the people that I’ve known to have finished medical school (and their classmates) are all a bit nuts at best, freaking committable at worst. Where do you think the excessive physician substance abuse rates come from? You’d be surprised how many of your well-toned, attractive, “just have it all”-type doctors go home to drown their stresses in a bottle/pipe/syringe/rx narcotic. Is perhaps burying a few of those stresses in a doughnut or a 2-inch high porterhouse such a crime? Of course it is, Fatty, because unlike the dinner of 6 scotches, 2 Vicodins, and 10 cigarettes Dr. Feelgood had on his balcony last night to rid himself of the day’s shite, Dr. Mixalot’s junk in the trunk is in plain view of everyone to see.

As for unrealistic, how do you think the inner-city mother on public assistance who, thanks to our food industry lobby, has ready access to starchy processed foods all approved by the state, to look at a doctor making $250,000/yr with a “healthy lifestyle” and say to herself, “Well hell, if he can do it, so can I!” Again, it is the height of arrogance to think that doctors are going to be so looked up to, so viewed as the ideal to which one should strive. Doctor’s are looked up to and respected for being the practitioners of health care, not for being the embodiments of health themselves.

Despite dramatically increasing obesity rates, we have failed to improve our dismal obesity counseling rates. The physicians who fail to recognize and treat obesity are often the ones who personally fail to heed lifestyle recommendations, and these doctors may sometimes lose credibility with their own patients.

I actually laughed out loud at the first part of this. The whole, “We’ve failed to improve our dismal obesity counseling rates” just smacks of sales/marketing jibberish (or healthcare administration, whichever you prefer), not thoughtful patient care. I don’t know about anybody else who has struggled all their life with their weight, but any physician who actually asks me, a “lifer,” if I’ve thought about losing weight or if I realize being so heavy carries health risks, or any other such mundane question will be met a smart-ass answer of “Why no doctor, do you think I’m overweight? Gee, I never thought of that before. I’ve heard about that thing called diets, but nobody really explained it to me in a way I could understand.”

Tight White Coat Syndrome sufferers probably have lower incidence of asking patients about their weight issues because being sensitive to the issue themselves, they probably have a better natural feel for whether the person is receptive, choosing not to potentially alienate a patient in their judgment, rather than be bull-headed about the issue, not because they are ashamed of themselves. Come on! That’s really insulting. I have seen many doctors in good physical condition not ask me details about what I’m doing to lose weight. In my case, the reason most physicians don’t bring it up w/me is that in just a few seconds in talking with me, it’s clear that I’m a well-educated, self-aware individual coming to them for a problem that (usually) is not even indirectly weight related at all. For them to bring it up would be a leap for the clinician, and there’s got to be a good reason for doing it because it’s a sensitive topic. That’s not necessarily perfect medicine, especially since you aren’t addressing a potential disease/problem, but the goal is to threat the patient is it not?

I know we can do much better. First, we must recognize that the human body needs at least an hour of exercise daily for optimum health, and every able-bodied physician should strive to achieve this…imagine the example we would set! As individuals we will feel better and stronger, and as a medical community we’ll serve as better role models for our patients. To succeed in healing others, we must also heal ourselves.

Man, I want some of that Kool-Aid he’s drinking. Every “able-bodied” physician implies that some physicians are not able-bodied: we need to cull the herd of these gimps and ensure that patients don’t perceive an older physician who succumbed to an orthopedic incident and now walks with a cane or some other physically obvious disability and think they are weak. It’s like the limping gazelle in the back of the pack as the lions come–it’s just nature allowing the fitter ones to move on.

All kidding aside, I’ve made some really sarcastic and acerbic remarks on this subject, half in fun and half seriously. I doubt anybody can show me an overweight physician that would claim that their condition isn’t at least a potential health risk. Physicians, like any members of any profession are human and are subject to the same baseline fallabilities, diseases, etc. as any other person. What makes physicians unique is the respect and authority we have (or at least should have) in treating people’s illnesses. Physicians need not be ideally thin or even close to it to accomplish this. A doctor firmly grasping a spouse’s uncertain hand to reassure her things will be OK or the advice/medicines given to treat an illness are all independent of BMI. All clinical things being equal, would you as a patient rather have a heavy-set physician that’s tuned in to your needs, plugged in to your case, perhaps even easy to talk to, or would you rather have a
physically fit, starched collar (to accentuate the bulging jugular veins), too-busy-to-really-talk-to-you asshole?

One could rightly see the fallacy in that comparison and say that the two need not be so mutually exclusive, but then we get back to the first problem of physicians needing to be perceived as “having it all:” smarts, looks, compassion, ethics, teamwork, etc. Perhaps the healing that needs to begin is that the elimination of elitism and insensitivity. I am actively trying to lose more weight for my health, not because of how it will look to my patients. It is and will be a lifelong struggle that I’m sure my patients, regardless of my specialty, will ask about. My belief is that when I honestly communicate it, they will feel a connection that could potentially enhance the doctor-patient relationship, rather than sow the seeds of mistrust, as Dr. Dansigner would have you believe.

But if a famine comes, I’ll be rolling in the dough having easily outlived Dr. Dansinger and taken his patients.

UPDATE: Dr.² Nick Genes (of “Grand Rounds” fame) has “weighed in” on this subject, too.