Doctor Patient

I did a little “self care” earlier this week.  I did it by not caring for myself.

I went to the doctor.

I was sitting in the waiting area for my appointment and saw the mother of one of my patients.  ”Why are you here?” she asked.

“I have a doctor’s appointment.”

She got a curious look on her face, asking, “Don’t you doctors just take care of yourselves?  I thought that was what doctors did.”

We do take care of ourselves, in fact we do it far more often than we should.  Being your own doctor allows for a lot of denial.  When you spend your day advocating healthy lifestyles after you had trouble finding pants would fit in the morning, denial is necessary.  Do as I say, not as I do.

I realize that this is hypocrisy; that is why I was at the doctor on Monday.  My patients have noticed my expanding waistline, commenting on it more than I would wish.  Certainly my pants get in the way of denial as well, not forgiving the fact that I have been under a whole lot of stress.  Pants don’t accept excuses.

So I found myself in the unfamiliar experience of being the patient.  Instead of closing my mind and emotions to my own body, I had to frankly assess what I was doing to it.  Standing on the scale was as frank of an assessment as I would ever want.

“So why are you here today?” asked my doctor, a man 5-10 years my junior.

“For a physical.  I just need to start taking better care of myself.  I’m getting fat.” I said, feeling a bit ashamed at being “outed” to a colleague (as if he didn’t notice my pants).

“Yes, you are up 10 pounds from last visit,” he said without judgement.  ”I think you know what comes next.”

“Yes I do; I have given the same talk numerous times each day.  I need to be eating better.”

“What about exercise?”

I smiled.  ”To be honest, I don’t really like exercise all that much.  I won’t say that I don’t have time for it, because I know I do.”

He seemed to appreciate my honesty, and we launched into a discussion of how to find an exercise routine that would be easier for me to do.  Going to the gym takes too much preparation, and it requires that other people (some of whom are my patients) see me in my non-exercised body.  I suppose this may be a good thing in some ways, as they would see me as practicing what I preach, but that doesn’t salve the ego enough.  Going to the gym gives me too many excuses to put it off for a day.

Then we talked about exercising at home.  I have some weights around the house, but they presently serve only as things to kick accidentally and test my resolve to avoid cursing.  I’ve gotten exercise equipment in the past, and it has done really well at holding laundry.  I am afraid to invest too much money in something that will serve as a guilt-trip.

Still, I know I have to take the plunge.  Reasons are reasons, but eventually they become excuses.  My pants don’t listen to excuses.

In some ways it is harder to be a patient as a doctor.  Despite the fact that I know what symptoms to look for, know what food to eat, and what the latest information is on exercise, it is hard to listen to my own voice.  When sitting in the exam room, doctors are trained to shut off part of their emotions.  This is necessary because we have to face a whole lot of pain, doling out some of that pain ourselves.  I have to be brutally honest with people who I want to like me.  I have to order painful procedures and even perform them at times.  When looking for pain, I have to inflict some of it (as in “does this hurt?” while grabbing, poking, or pushing on a spot of declared pain).

Beyond that, my job necessitates that I watch people get sick, suffer pain, and die.  I am holding back an irresistible force.  Everyone eventually gets sick and dies, and I have been tapped with the task of helping them through it, and often shepherding them through to the end of their lives.  I have to do so with compassion and kindness, but I also have to emotionally survive, because there are thousands of people depending on me to do this job.

So when I am tasked to become the patient, I have to put down defenses that have been constructed over decades.  It’s not easy, but I have to do this.

I can’t make excuses.

My pants won’t accept any.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player.  He is a primary care physician.

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13 replies »

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  2. Rob, like so many of your posts, I enjoyed this one as well. I applaud your effort to get in better shape and to try to walk your talk that you have with patients. I think that is important for us to try to do as doctors, both as an example to our patients, but, more importantly, for ourselves.
    I strongly encourage you (and anyone reading this) to check out Switch: How to Change Things When Change is Hard, by the Heath brothers. It presents a fantastic way to think about how to make changes in our lives.
    Good luck!

  3. Thanks for a very persuasive post. Nothing is more effective than well informed advice delivered with good-natured humility and self-depricating humor!
    I’m going to schedule my check-up!

  4. While I recognize your suggestion that it is harder for you to ‘fess up to your doctor and face the other side… you should try it in your patient’s shoes one day.
    Many doctors are equally respectful of all patients. My family practice physician is marvelous.
    However, I have seen many times that doctors can be insulting, patronizing, and downright rude to people that aren’t in the fraternity. Certainly from your description, your doctor recognized your ability to make good health choices and respected helping you find a way to do so. All patients deserve the same.

  5. Knowledge does not equal behavior change. It is a necessary component a lot of the time, but it will not automatically lead to it. We, like our patients, are quite human.
    Yes, my doctor uses the same EMR as I have (although not quite as well as I do!). I am always taking notes when at this kind of visit as to what is good and what is bad. They run their office quite well, so overall I was happy. Better than us? Not sure. Probably about the same.

  6. Does you doctor use an EMR-?
    How do you compare the experience from that standpoint to your own office?

  7. I enjoy your post so much… I like how the other patient asked you about you consulting a doctor considering you are a doctor. I have asked my friend the same question too, she is a general doctor and he honestly admits that even a doctor needs another doctor’s opinion when it comes to health. I think it is human nature to deny what you are feeling especially when it comes to health.

  8. OK, here’s my two cents. Which is less fun, exercise or diabetes? Having spoken with diabetic clients, I think I’ll continue to walk up and down hills listening to my favorite podcasts. If you don’t have time, then just eat the same stuff, but only 2/3rds of it.

  9. It won’t be that terrible!
    Ramp that second breakfast down to an apple instead of a bagel/donut, pass on the chips/fries at lunch, harass your wife to not buy salty/sweet snacks to keep around the house – before you know it those pounds will be gone.

  10. Rob,
    I loved your post because I can relate to it so well.
    While I never had a weight problem, my cardiologist was after me for years to do some sort of exercise beyond walking, which I enjoy, that would get my heart rate up. For me, though, anything to do with sports or exercise, aside from walking, always came hard. It was work and effort but no fun and I didn’t like it or want to do it.
    About three years ago, a female colleague convinced me to give Pilates a try and arranged for me to do it twice a week one on one with a personal trainer and nobody else around but the two of us. Everything was customized for my capability and limitations. I’m still at it almost three years later.
    After my CABG in 1999, I bought an expensive exercise bike but only used it for a short time because I didn’t like to wear the heart monitor. I was subsequently told that as long as I can carry on a conversation without breathing hard, I should be OK without the monitor. I started using the bike again shortly after I started Pilates and I do it while watching TV which makes it palatable. I’ve realized tangible benefits as a result in terms of both stress test exercise tolerance and a considerable increase in HDL.
    So, for many of us, even though we hear your advice regarding exercise and diet and know you’re right, actually following through and executing is often easier said than done unfortunately.