GPs may constantly tell patients the benefits of diet and exercise, says Pulse’s GP registrar blogger Dr Syed Arfeen – but they don’t all practice what they preach
I don’t suppose I will make many friends with this. But just as sometimes in medicine – both clinical practice and research – we have to be straight and say what we think even if it is disliked or not to our listener’s ears’ approval, I will do so anyway. So, with that disclaimer out of the way, I will say just how disappointed I was when attending a recent study day for GPs in paediatrics to see so many of them being overweight.
The existence of it in the current milieu of general practice, when we’ve moved beyond simply tackling life-threatening conditions such as infections to a health promotion role, while acutely aware of the obesity epidemic in the UK, is eyebrow-raising.
GPs are the frontline medics (alongside A&E, although their role usually involves little health promotion) and the first ones to consider primary prevention for any condition (alongside public health doctors, though they unfortunately don’t consult patients individually). And no condition at this present moment requires as much primary prevention as obesity.
Professor Harold Ellis, the Emeritus Professor of Surgery at the University of London who began practice in 1947, often recalls that they never used to have obese patients but that when they began to see them they would think to themselves ‘What is this?’ We certainly do not give it a second thought anymore, and Pulse readers will be well aware that the rising incidence of obesity is mirrored by the rising incidence of diabetes and cancers.
All of us consulting will have every week many times over given the health promotion talk. Yes, you know the mantra of ‘diet and exercise, 30 minutes five times weekly and cut down the fats and salts’ – and often with a statin on top. So how then can we face patients in a state of corpulence? It’s the old ‘do as I say, not as I do’ maxim of medicine shining through again.
Indeed, I’m surprised that amongst all the negative press about doctors, this issue has not made its way onto a letters page from a dissatisfied if observant patient. Perhaps patients are still so overwhelmed by the consultation itself or the advice, or are so fond of their GP, that they see in them no faults. But to a more discerning eye it would be a difficult position to hold.
Leaving aside the surprise that overweight GPs do exist, the question to ask then is why?
Is it too much sitting behind a desk pushing across prescriptions, as a surgical colleague likes to jest with me about? I can’t see this being the case, as GPs are much more dynamic these days – clinic here, meeting there, with a home visit thrown in-between.
Or is it the long hours that preclude exercise? Given the current working hours arrangement and that more GPs than ever are part-time, this explanation also seems unlikely.
Ultimately, we can’t explain this away in any terms other than, as an exam book says, a ‘mismatch between food intake and physical activity.’ I accept there are caveats, for example post-partum mums, but generally by far the most likely explanation is that GPs are as much at the mercy of the vagaries of modern living as their patients.
However, the difference is that the overweight GP cannot claim ignorance of the issue, and should surely aspire to live the very healthy lifestyle they are advising their patients to live on a daily basis. Of course it will be hard to balance with a job and a family – but only as hard as it is for the many overweight patients out there.
But if health is a biggest blessing a person can have, then the prize is certainly one worth vying for. As a GP registrar it is disappointing to see GPs, who are my future colleagues, but for the moment my seniors, my teachers and my role models, seemingly take their eyes of the prize.
Dr Syed Arfeen is a GP registrar at the Emperor’s Gate Surgery in Kensington, London.
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