Physicians are Influencers

The comedy channels on my car satellite radio are handy for combating fatigue the last hour of my commute between Brooklin and Caribou. After dark on New Year’s Day I caught a comedian ranting about being told he was overweight by a doctor with the same predicament, and how the two sort of bonded and quickly dropped the subject after that. And I still remember the diabetes expert at Uppsala who couldn’t button his lab coat!

Like it or not, we doctors are under a certain amount of scrutiny. People check out our grocery carts, our cars, lawns, clothes and body sizes (mostly organic, 2010 German SUV with 256,000 miles, coastal scrappy and professionally maintained lush but with dandelions up North, always a tie, 165 lbs).

A certain amount of self disclosure and deprecation can be a good thing, but too much can get in the way of a therapeutic relationship.

I use myself as an example in some very calculated ways, some of which I have mentioned before in older blog posts:

I tell people “I was a strict lacto-ovo-vegetarian for fifteen years, but I gained too much weight.” After their jaws settle in their lowered positions, I go on and explain: “I lived on pasta, oatmeal and sandwiches – all carbohydrates.”

I also tell the story about how I at age 50, in a dance studio with wall to ceiling mirrors, figured out (when my wife said “Your belt is crooked”) why standing straight always gave me a backache: I have one leg that’s more than an inch shorter than the other. Now I just put my weight on my long leg and stand on tiptoes on my short leg and have zero pain and a better posture. (Know your body…)

Self disclosure is risky when it touches on subjects that could undermine our patients’ confidece in our ability to help them, because they ultimately care more about whether we can help them than what we’re like as people. That includes sharing our frustration with “the system”.

But when it comes to how fit we are, what’s in our grocery carts and whether we ever use a push mower, go for hikes, jogs or simply walk to the post office, we need to consider the public health messages we broadcast to our communities.

Here is where I wonder if younger physicians might believe these kinds of considerations belong to a bygone era. If so, I think they haven’t kept up with the Internet phenomenon of “influencers”. I stumbled onto it when I was looking for audiobooks on how to promote your ideas. I naively thought that’s what “influencers” did. After just a few minutes of listening I realized that “influencers” are people like most of us, who choose to publicize their lives, their tastes and their pursuits and become promoters of products.

Health care professionals are by default influencers, because people are naturally curious about our habits. After all, when I first came to this country, dentists recommended a certain sugar free gum and doctors had been known to prefer a certain brand of cigarettes.

Just like we have abdicated some of our power and leverage in dealing with health care organizations, I think we often underestimate the influence we can have on our patients lifestyle choices.

In fact, the woman I described in my previous post said, when I entered the exam room, “you look great, what are you doing?” I quickly ran through my daily diet (extremely low carb), my age (65), work hours (60, loving every minute), farm chores and so on.

We are being watched, and we have a chance to influence others with our own healthy examples.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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