Do as I Say, Not as I Do

Doctors are capable of making irrational and incorrect choices just like the rest of us. This provides us with a valuable lesson. Education, information and intelligence aren't always guarantors of responsible decision-making.
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We rely on medical professionals for advice, both in terms of acute medical conditions (the prescription of antibiotics to cure infection) and more general healthy-lifestyle choices (smoking is bad for you, don't eat McDonald's for breakfast, lunch and dinner). However, doctors don't always follow their own advice. We can all think of examples of doctors who drink, smoke, scarf down too many cheeseburgers, and some who do all three. Jesus tells us, "physician, heal thyself," and perhaps he is right. Do our physicians have some type of obligation to lead by example? Or are their words enough?

On the face of it, this might seem to be a relatively simple issue. All human beings are entitled to some measure of autonomous agency (how much, and under what circumstances, is obviously up for debate). People generally seem to agree that rational, fully-functioning adults should be allowed to make their own choices regarding perfectly legal behavior. We don't think a smoking lawyer or a morbidly obese postman have these obligations to live healthily. We might not endorse their behavior on a personal level, but as a society we realize that those choices are theirs to make.

All of this is a roundabout way of asking, so what is the big deal about doctors? If the lawyer can light up and the postman can enjoy a regular hot grease injection, why not our local GP? If anything, being a doctor involves at least as much stress and pressure as being a postman or a lawyer. Dealing with life and death on a daily basis (at least to some measureable degree) arguably puts undue pressure on a person and, because our vices may be nothing more than a simple pressure-release valve for accumulated stress, perhaps it makes sense to not question a doctor's unhealthy choices.

However, medical professionals are unique in another way. We rely on the truth of their advice. Indeed, they are licensed to dispense medical advice. We might trust our postman to deliver our letters, but if we have a question about a newly-detected lump, broken bone, or our weight, we would be better off seeking the counsel of one who is licensed to dispense medical advice. There is an implicit -- and hopefully correct -- assumption that goes along with the dispensation of this advice, namely that those giving it know what they are talking about. Now, while smoking, or drinking, or eating junk food are not automatically indicative of a lack of knowledge, they do foster a certain disconnect.

There is something particularly interesting about the form that such a disconnect takes. If we see a doctor with a lit cigarette we don't automatically assume that he or she isn't a capable professional. Rather, we assume that the doctor in question knows the risks of smoking -- probably better than most -- and yet still chooses to smoke. This is a dangerous -- albeit predictable -- conclusion to reach.

We know that medicine requires more graduate education than most professions. We know that it requires dedication, intelligence and the application of reason. It is because of this knowledge that our assumption is that the educated, intelligent, driven, and smoking professional in front of us is able to assess risk at least as well -- and probably much better -- than we can. This disconnect does not come from a lack of appreciation for the doctor, it comes from an over-appreciation. It's easy to imagine that such an endorsement is, if anything, stronger than those handed out so freely by movie stars, musicians, and the more predictable poster-children for ill-advised lifestyle choices.

Interestingly, there has been a move on the part of some institutions within the past several months to combat exactly this issue. The University of Pennsylvania Health System has adopted a policy that allows them to discriminate against smokers. While the ethical implications and actual feasibility of such a policy are certainly up for debate, it is perhaps encouraging to see some sort action being taken.

Ultimately, however, an argument of undue influence falls short. Why? Because it does not give ample credit to the power of choice. That is not to say that people cannot be unduly influenced, they certainly can (such an argument becomes even more plausible when one considers less independent rational actors, namely children and teenagers). However we -- as independent agents -- must have the ability to make their own choices. Just because your doctor smokes doesn't mean you must start, just in the same way that it doesn't disqualify him or her from giving you correct and helpful medical advice. Ultimately we need to recognize that doctors aren't superhuman. They are capable of making irrational and incorrect choices just like the rest of us. This provides us with a valuable lesson. Education, information and intelligence aren't always guarantors of responsible decision-making.

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