W
ould you ask your pa-
tient to do something
that you would not do?
Tough question. For
many physicians, doling
out medical advice and counsel is a major
aspect of our daily care. One of the most fre-
quent topics, certainly in my field of primary
care internal medicine, on which I opine is exercise: the physical
benefits, the mental benefits, and the freedom and joy it provides.
I discovered a long time ago those elements of exercise and fitness
in my life. At some point later, as I worked through training and
my first years in practice, my patients showed me that my effec-
tiveness as a physician counselor is augmented by practicing what
I preach.
As I counsel patients, I often receive a question as a response
to my advice, a feeler to see if I follow my own recommendations.
Patient queries about my personal life and habits are certainly not
uncommon and, truthfully, are not unwelcome. “Have you had
your hepatitis A vaccine, doc?” “Would you take a biologic drug
if you had my diagnosis?” “Would you take malaria prophylaxis if
you were going on safari?” “Would you get a PSA test?” “Don’t you
ever go out for a burger and fries?” “What is your exercise routine,
doctor?”
These and many other questions are great reminders to keep
my own health habits in check, reminders of the many decisions I
may be lucky enough not to have to make, and sobering remind-
ers of when I fall off the wagon I’m supposed to be leading. My
favorite query, though, is about my exercise habits. I am more than
happy to wax poetic about the benefits of exercise both for my
mental and physical health. When patients ask me my workout
routine, I tell them about it because I am proud of my efforts, and
I am proud to demonstrate that I am fighting for good health too.
I want patients to understand that, indeed on this account, I am
doing what I am asking them to do. I simply enjoy exercise and the
sense of satisfaction it gives me. I hope that some of my joy rubs
off on patients and motivates them to get moving on their own
exercise and fitness routine.
The job of counseling patients on how to remain healthy and
prevent big problems before they come along requires wear-
ing many hats. The job is part motivational speaker, though less
Chris-Farley-van-down-by-the-river and more Stuart-Smalley-
I’m-good-enough-I’m-smart-enough-and-Goshdarnit-people-
like-me. The job is part de facto divorce lawyer, separating people
from their ‘bad’ habits, and part primping matchmaker, joining
people with attractive and desirable ideas to enjoy the task of stay-
ing healthy. The job is part nerdy statistician, doling out data that
FEATURE
proves healthy habits bring positive long term outcomes, and part
cool-kid-in-the-class making living all that data look so enjoyable.
The job is part skilled listener, knowing when I have said enough,
and part skilled talker, knowing when to encourage and nudge a
patient forward in their quest for good health. Convincing and
motivating others, and oneself, to consistently exercise as a means
to good health requires all the job skills noted above. Every patient
brings unique challenges to the table when attempting to achieve
‘therapeutic lifestyle changes’, and exercise can be one of the most
challenging aspects of TLC.
I encourage exercise and fitness achievement for myself and for
my patients, regardless of the challenge. Since I began exercising
in earnest late in college, exercise has become a big part of my life,
growing more so by the year. These days, three kids in, achieve-
ment with exercise means consistently showing up and winning
small battles in the gym, not necessarily attempting to win The
CrossFit Games. However, the rewards are worth the challenges,
many times over. Exercise makes me feel better and makes me
more energetic. Exercise calms the anxieties that sometimes come
with caring for other people’s health. Exercise gives me an excuse
to make killer workout music mixes that make me smile. Exercise
helps fulfill what need I have for vanity, a point which I will admit
I have a need (I am not denying my goal of a six pack before I hit
40). Exercise gives me a place to set and meet personal challenges,
such as when I ran my first mini-marathon five months after my
twin daughters were born. My wife may recall it differently, but
those training runs in my first Spring as a parent were epic and
proved for me that I could be a stronger and more dedicated dad
than I thought possible. Exercise is a true architectural corner-
stone for the structure that is my life. I suspect I would crumble
without it.
One of the greatest joys of practicing medicine, for me, is when
I achieve success with a patient, particularly with fitness. However,
it’s not all about me. I get immense joy from patients’ success, from
their pride in meeting their own goals. I can see that patients feel
better about themselves, and truthfully just feel better, when they
achieve fitness goals. Without fail, patients beam from ear to ear
when I note their hard-earned weight loss, and sometimes even
double fist pump simply because, as they will say, “You noticed.” I
know that smile, and fist pump, because it is the same one I have
each time I reach a milestone with fitness, cross a finish line, buy
new pants one size smaller, or run the literal extra mile. Because
I exercise, I am better equipped to care for my patients because I
am caring for myself. And, I can look my patients in the eye and
say with complete honesty, “I am not asking you to do something
I wouldn’t do.”
Dr. Kolter is a practicing internist with Baptist Health.
MAY 2019
27