Do as I say, not what I do!

In the country town where I grew up there was a GP who got very drunk at the golf club on a regular basis. His antics were a source of community amusement, and he had a lot of patients with similar alcohol misuse problems – mostly because he never talked to them about their drinking habits.

I grew up in an in an ordinary lower middle-class family in a rural town where the doctors and other professionals were generally held in high esteem. They were a source of advice and wisdom, but also of entertainment and gossip. They were expected to set the standard of behaviour for the rest of us and when they erred it was big news.

This must have made it hard for the health professionals who chose to work in towns like ours. The rewards were great, but community expectations were very high. It would have been difficult just to be human.

Some things have changed.

Doctors are no longer held in the same regard by the community as they once were – until you need them yourself of course! The media slams perceived medical greed and incompetence at every opportunity. In the 1980’s, when this began, many young doctors like me had trouble dealing with this lack of respect, but it has become the way of the world. We all need to be resilient and not rely on the opinions of others to bolster our self-esteem. We also need to remember that to be respected we need to earn it rather than just acquire it by virtue of education, status and position.

There are also some things that haven’t changed.

People still look to the health professionals in their community for examples of good behaviour. They expect us to be reliable and ethical, to maintain a professional stance and not let our personal beliefs and issues interfere with their care. They also expect us to model healthy lifestyles.

If you are a health professional do you smoke, drink too much alcohol or eat an unhealthy diet? Are you too thin, overweight or obese? Do you avoid exercise? Do you work too hard and fail to take your holidays?  Do you spend too little time with your family? Do you solve problems in ways that undermine your own well-being?

These are not great ways to model healthy behaviour for the people you care for. How must it feel to be told to lose weight by a doctor who you know does little exercise, eats badly and is overweight herself? Or be told to take more time off by an obviously overwrought health professional who works long hours and never takes a holiday? Does the “do as I say not what I do” mantra work in this situation? Are you, as the person receiving this advice, going to take it seriously? And, as a health professional, are you less willing to talk about diet, exercise, or alcohol for example if these things are areas of vulnerability for you?

What do we need to do?

As health professionals we need to remember that we are also human beings and we are being observed by others as such. If we are observably not modelling healthy behaviour we probably need to talk to our patients about why this is so for our advice to carry any weight.  

We also need to make sure that our own bad habits don’t make us less likely to discuss the same issues when we see them in our patients. If that’s the case, we are doing them a serious disservice.