Do as I say, not as I do? Discussing lifestyle change in the doctor’s office


By: Jason Lippman, MD,

With the overwhelming health burden caused by the Western diet and way of living, lifestyle counseling has become one of the most important roles of a primary care provider. Each doctor likely has his or her own approach to the topic. One approach might be to stand strongly behind the facts and best evidence without discussing the doctor’s personal experiences on the matter – similar to the old motto “Do as I say, not as I do.” The argument for this might be that any fallibility on the part of the provider undermines his expert opinion. However, a contrasting view – and my preferred approach – is that the more human we show ourselves to be, the more we can connect with our patients and help them heal. I greatly believe in the powerful benefits that lifestyle change can have for my patients; yet, I will be the first to admit that the full list of facets to a healthy lifestyle are so numerous that no one will ever piece them all together.

It is important to point out that we doctors are just as bad – if not worse – than the average person in many parts of healthy living. For example, sleep hygiene guidelines are one set of important lifestyle routines that allow for increased levels of restful and restorative sleep[1]; however, no resident doctor will claim that he or she comes close to meeting these expectations due to documentation time, overnight call schedules, early mornings, etc. Furthermore, our consistency with diet and exercise are easily strained by the same work requirements throughout our careers. This is not meant as a complaint or pity plea; my point is that very few, if any, of us are providing these lifestyle recommendations with a flawless background in the topics being discussed. This can be a good thing for doctors if we are able to acknowledge our personal struggles as providers and use them to bring empathy into our conversations with patients.

When I am talking to a patient about sleep hygiene and its arch-rival: the smartphone, or heartburn and its adversary: the spicy Indian curry, one of my first steps is to admit that I am also a sucker for the same ill-advised indulgences we have been discussing. Breaking the fourth wall of lifestyle counseling acknowledges that changing habits is not easy for anyone. It is crucial to be serious about helping patients correct the lifestyle pitfalls that have made the Western diet synonymous with obesity, diabetes, and heart disease; however, patients should not be singled out by a provider saying, “Well, now you have Diabetes. You need to get your act together.” Instead, our goal should be to help the patient find a personal motivation and confidence in the ability to change. When a provider acknowledges that we all struggle, a safe environment is created to allow the patient to explore the possibility of change together.

“Do as I say, not as I do is” is a terrible concept. What we should be facilitating is an eyes-open discussion of lifestyle change. Knowing for a fact that regular exercise and a normative weight are cornerstones of healthy living has not meant that all doctors have success reaching ideal weights. Whether or not some of the fault lies in sacrifices we make our work is unimportant. Occasional personal struggles with healthy living allow us to empathize during discussions of these topics. Open discussion can build trust with our patients and break some potential for misconceptions. Otherwise, patients can easily find ways to question this kind of advice, as a fit doctor may seem distant from lifestyle concerns and an overweight provider may appear hypocritical in their recommendations.

My plea to our patients is this: please know that we are in your shoes. Lifestyle changes are very important because so many of the modern medical conditions stem from weight, diet, and social habits; however, the recommendations for perfecting the different aspects of healthy living are too many to juggle in two hands. As I regularly discuss with my patients, the first step to making changes should be to look at that long list of ways to improve diet, reduce stress, or combat poor sleep health and pick out one or two changes that will be easily made. Once these are part of our routines we can look to add more. Those long lists are not metrics to compare yourself to, but instead a list of potential improvements that can be added to your current routine. As providers, we are rooting for you – not judging you – and we know from our own experiences how hard it is to stay positive and avoid self-judgment. Let’s open up the conversation and grow together as imperfect doctors and patients.

[1] More information on sleep hygiene can be obtained through the American Academy of Sleep Medicine at


Jason Lippman, MD, is a second-year resident practicing at the Madsen Health Center Clinic. His primary medical interests include primary care, sports medicine, and population wellness.

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