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Should Doctors Be (Role) Models of Health?

Posted by Dr. Suzanne Koven  September 28, 2011 09:07 AM

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True story: when I was a kid, my pediatrician often had a cigar clenched in the corner of his mouth. The aroma of his stogie competed with that of the Pall Malls his receptionist chain smoked. Yes. In front of the patients. Including kids with asthma.
Times have changed. Last week, Baylor Health Care System in Texas was the latest of many medical organizations to announce that they will no longer hire smokers. What makes Baylor's announcement notable, in addition to the fact that they are one of the larger employers of health workers in the country, is that they will be subjecting prospective hires to urine nicotine screens. The Massachusetts Hospital Association, in contrast, relies on the honor system to deter smokers from applying for employment.
What are these tough new rules about? And how might they affect your health care providers?

Anti-smoking policies such as Baylor's are motivated by considerations that might move any employer: smokers lose more time from work due to illness than nonsmokers and are more costly to insure.

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But there is another agenda here, one a little more complicated than dollars and cents. Medical organizations that have banned smoking for employees often explicitly express the wish for health care workers to model healthy behavior for patients.
But does that work? And is it right?
As to the first question, one study of doctors at the University of Michigan showed that physicians who exercise and maintain a healthy weight are more likely to counsel patients about these behaviors. The training doctors receive in nutrition and exercise is poor compared with other aspects of our medical education and so doctors who have learned about these issues for personal reasons are better equipped than most to offer counseling about them.
As to the second question, it's hard not to be sympathetic with a hospital that doesn't want to hire smokers. Even if they don't smoke in front of patients-and there are very few opportunities to do so on hospital grounds anyway-patients may be aware of the odor of smoke on a health care provider's clothing or hair. This could undermine the patient's comfort and confidence, certainly.
But how do we decide which other health hazards to ban? Those stacks of pizzas that arrive in the hospital conference room at lunchtime? Sugary sodas and desserts in the hospital cafeteria? Should we fire nurses who don't wear bike helmets? Doctors who text and drive?
It's a tricky line to walk between health workers' responsibility to model healthy behavior and our personal right to be as unhealthy as anyone else.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

Suzanne Koven, M.D. practices internal medicine at Massachusetts General Hospital in Boston. She writes a monthly column for the Globe's G Health section and her essays have appeared in the More »


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