Getting doctors to practice what they preach

It's ironic that the year we, both new medical students, moved across the street from the nation's best hospital and began learning how to manage the health of others is the same year we stopped taking care of our own. It was a year of ups and downs.

As our physical activity and healthy food intake went down, our body-fat percentages and stress levels went up. In turn, so did our risk for developing chronic diseases and conditions like obesity, hypertension, diabetes and even certain types of cancer.


Fortunately, many of us know how threatened our society is by these lifestyle-associated chronic diseases. Pick up the paper and you'll read headlines about New York Mayor Michael Bloomberg's battle against super-sized soft drinks. Turn on the TV and you'll see "The Weight of the Nation," an HBO documentary series chronicling the epidemic levels of obesity our country is facing. But not many know the extent to which these diseases burden the very people charged to combat them.

According to recent studies, an astonishing 63 percent of male physicians and 55 percent of female nurses suffer from "tight white coat syndrome" — a number shockingly close to the proportion of the general population that is overweight or obese (72 percent). Medical professionals have, presumably, both the resources and the knowledge to better care for themselves. If we aren't practicing the healthy behaviors we prescribe, how can we expect our patients to do any better?


According to a paper published in Obesity earlier this year, physicians with a normal Body Mass Index (BMI) more frequently counsel their patients to adopt healthy diets and exercise behaviors than physicians with elevated BMIs. Similar studies show that clinicians are more likely to counsel their patients on the behaviors that they personally practice. Pediatricians' health habits correlate with whether they discuss healthy lifestyles and deliver preventive care; nonsmoker physicians are more likely to encourage their patients to quit; and medical students who regularly engage in physical activity are more likely to counsel their patients to do the same.

These findings are the foundation for The Patient Promise, a grass-roots initiative we've launched this month at the Johns Hopkins University School of Medicine and the American Medical Association annual meeting in Chicago. Our goal is simple: to improve the health of patients by improving the health of their health care providers. Clinicians who sign The Patient Promise make a public commitment to adopt health-enhancing behaviors such as physical activity, a balanced diet, harmful substance avoidance and stress management, just as they would — and should — ask of their patients. In the words of physician and Nobel Peace Prize laureate Albert Schweitzer, "Example is not the main thing in influencing others. It is the only thing." The Patient Promise also urges clinicians to counteract unhelpful and ineffective language and strategies regarding obesity, especially in the health care environment. Unhealthy behaviors and outcomes have more complex origins than stigmatizing explanations like apathy or laziness; such "diagnoses" only alienate patients in need of treatment or preventive care.

Nearly 400 current and future clinicians from 38 institutions across the country have committed to the patient promise, which recently was featured in The Atlantic. Our goal is for at least 1,000 students and health care providers to sign on to the promise by the end of the summer.

The Patient Promise symbol, two interlocking gold Ps on a navy shield, provides awareness and accountability when worn as a lapel pin on a clinician's white coat or badge. Intended to promote conversation in which patients can ask doctors, nurses and others about their efforts to adopt healthy lifestyles, we hope this will help patients to see them not as disciplinarians but as partners on a shared journey toward better health. The clinicians, having embarked on this journey as well, are better able to understand the challenges of implementing healthy behaviors in their patients' lives, and will be able to offer more credible and practical advice based on their own experiences. Together, patients and their care providers can thwart the advance of lifestyle-associated chronic disease in America.

More than 2,000 years ago, Hippocrates recognized the importance of healthy lifestyle behaviors when he wrote, "Let thy food be thy medicine" and "Walking is man's best medicine." These sage words are still relevant today. Thus, as future health care providers, we challenge ourselves, our peers and our clinician counterparts to lead by example. In doing so, we embrace Hippocrates — not hypocrisy.

Shiv Gaglani ( and David Gatz ( are medical students at the Johns Hopkins University School of Medicine. To learn more about The Patient Promise, visit