52 Becoming a Patient
Practicing What They Preach: Health Behaviors
‘‘I tell patients to do a lot of things that I don’t do myself,’’ Deborah
sighed. Despite aggressiveness in their own medical treatment once they
became seriously ill, many had previously found it hard to practice what
they preached concerning preventive health behaviors. Many failed to
engage in health prevention: not seeing a doctor for decades until be-
coming seriously ill, not extending their roles as doctors to their own care.
These physicians were ‘‘only human.’’ These discrepancies in behavior
illuminated the divides between treatment of present illness and pre-
vention of future ailments; treatment of self versus of others; and one’s
medical self versus one’s patient self. The pursuit of future health proved less
motivating than the elimination of present symptoms.
Many physicians were aware that they didn’t follow the recommen-
dations that they gave others, but they remained unable to alleviate this
discrepancy. Deborah said, ‘‘I give advice, and think: Why don’t you give
that advice to yourself ?’’
Repeatedly, gaps arose between doctors’ advice and practice concern-
ing, for example, diet. Many doctors consumed high fat diets, despite
having high cholesterol, and advising patients to do otherwise. Jessica, the
pediatrician with Hodgkin’s lymphoma, ate unwholesomely, and avoided
accessing medical treatment for fear that doctors would reprimand her.
She rationalized that she would die young anyway.
I have very bad eating habits. My diet is unhealthy and my
cholesterol is high. I preach about it all the time to my patients,
then go eat at Burger King. I don’t have a lot of willpower. I
say to myself, I’ll deal with it when I get something really life-
threatening—my first heart attack. After I turned forty, I put on
a lot of weight, as many people do—but a lot. My oncologist
always yells at me. I don’t exercise. I say, ‘‘I’ve had cancer, I’m
going to die early anyway’’—which is kind of crazy—or ‘‘I’m going
to die from some other cancer.’’ It makes me see doctors less.
I know I’m fooling myself.
Jessica recognized that she was rationalizing, but still found it hard to
change. She resisted because of countervailing reasons—enjoying life and
gaining pleasure now trumped logical concerns about future harms. It was
hard even for these doctors to imagine their feelings in the future, high-