Sunday, June 06, 2010

Leading By Example or Intimidation?

Two cardiologists, two very different approaches.

One is this:
He’s an early riser, to say the least — up between 4 a.m. and 4:30 a.m. every day.

First thing on his morning agenda is a cup of green tea. Settling into his home office, he quietly checks his e-mails and reads for about 30 minutes. This is his quiet time, when he prepares himself for the day.

From 5 a.m. to 5:30 a.m. he writes grant proposals, clinical research papers and the like. “It’s amazing how much you can accomplish in the early morning,” he said.

At 5:30 a.m., he’s on his way to the medical branch Field House, which is five minutes from his East End condo. There, he swims laps for 30 to 40 minutes (on an empty stomach) and then showers to head back home.

While he used to enjoy a quick jog in the mornings, a knee injury keeps him away from high-impact exercise.

At 6:30 a.m., it’s finally time for a heart-healthy breakfast at home with his wife, Tamami.

The meal is always the same: salad. But it’s not the salad you’re typically served before a meal.

It’s a special salad he spent years perfecting and includes lettuce, seafood, wasabi, eight kinds of vegetables, ginger, olive and sunflower oils, vinegar, whole jalapeños and mozzarella cheese.

“Every morning, I know I’m getting at least one excellent and nutritious meal in for the day,” Fujise said.

“I never know how the rest of the day will go, but I can feel good about my morning knowing I had the perfect breakfast.”

From 7 a.m. to 7:45 a.m., Fujise responds to more e-mails at home and tends to his department’s administrative work. By 8 a.m., he’s in his office on the medical branch campus.

As the head of cardiology, Fujise frequently is called into business lunches and dinners, which can make it difficult for him to maintain his heart-healthy lifestyle.

His compromise is to order appetizers instead of entrees, a house salad with vinaigrette or grilled fish.

If he’s fortunate enough to not have a lunch meeting, Fujise enjoys a lunch he brings from home.

His preference is one piece of dark chocolate (76 percent cocoa), one box of raisins, a handful of mixed nuts, some tofu and green tea.

While not advisable for everyone, Fujise and Tamami engage in “calorie restriction,” whereby they restrict their caloric intake by 20 percent to 30 percent.

Comfortable at 156 pounds and 5 feet 10 inches tall, Fujise aims to eat no more than 2,000 calories each day. He gains weight fast, he said, and must monitor the scale daily to keep himself in check.

“My wife does an outstanding job of handling my meals and pushing me to exercise,” he said. “Like everyone else, some days I’m weary, but she pushes me to the door and encourages me every morning.”

Fujise does not eat sugar because of metabolic syndrome concerns, although he will have Splenda on occasion, nor does he partake in office doughnuts or cakes or any fried foods.

If he hosts a lunch meeting, he makes sure there are healthy food options.

“I don’t want my young medical students getting accustomed to fried foods. My goal is to promote heart health,” he said.

Coffee also is absent from his heart-healthy list, although he understands why many people must have their jolt in the mornings.

He used to be a coffee drinker himself, but he found the caffeine in coffee to be equivalent to that in green tea but without the jitters that often come with coffee. Plus, green tea has been proven to help fight cancer, he said.
... and the other is this:
He was the most respected man in our training program. The oldest cardiologist at our institution, gruff, never afraid to shy away from a four-letter word to make his point, and with the uncanny ability to diagnose critical aortic stenosis (pulsus tardus et parvus) or insufficiency (bisferiens pulse) by placing his hands on his patient’s pulse. No echocardiogram was necessary. His incredible knack for inductive reasoning of associated diagnoses was unparalleled. His breadth of clinical experience and expertise unequalled. I had always held him in my highest esteem – a real model to follow.

So after returning to that institution of higher learning after fellowship training and getting settled in my new routine as a young staff physician, I headed to lunch with an entourage of medical students and residents. It was then that I saw him, my medical idol, in line with a burger and fries, and a tall Coke.

“Hello, Dr. B., how have you been?”

“Hell, just fine, Wes.” It was then I noticed his tray.

Smiling, I quipped, “Dr. B., aren’t those things bad for you?”

“Well, shit, Wes,” he smiled with a twinkle in his eye, “... I look at this way. I have a 50-50 chance of dying of cancer or heart disease... and I’d much rather die of something I understand!”
Here's the question:

Which cardiologist would you chose to be your doctor?



PGYx said...

How can I get the recipe for his salad? It sounds amazing and like just the ticket to start my days as an intern!

Named Just Bob said...

Laughed so hard, I nearly...well you know. I love the guys that take their professions but not themselves seriously.

Anonymous said...

A man who is honest with himself means far more to me than one who leads a seemingly joyless ascetic-esque life. Just saying.

Steve Parker, M.D. said...

Which would I choose?

As a patient, I would probably do well with either one. Coin toss, or get more information.

Our culture makes fun of obsessive-compulsive traits, as in Doc #1.

But that attention to detail can be life-saving in a physician.

I consulted on a hospitalized patient last week who had a grade 3-4/6 systolic murmur, but the Attending cardiologist didnt' even mention it in his H&P, nor the documented history of aortic valve disease.

I'm hoping that oversight was a fluke.


Anonymous said...

That's a good question! Assuming both have equal competence at their job, I'd decide based on their attitude toward patients. If Doc #1 uses himself as a role model and example, that's great. But if he uses himself as a paragon, and scolds patients with his "perfection", I'd steer clear. He might well understand that there are many barriers to keeping up a lifestyle like his: not all of us have the wherewithall to do things exactly as he does. But if he encourages compliance without being preachy (or, heaven forbid, without screaming or shaming), then yeah, I'd like to have him on my team to provide a living example of how to do stuff. I can use all the positive role models I can get.

If Doc #2 flaunts his lifestyle choices in a "do as I say, not as I do, you'r a bad patient but don't mention my behaviors" way, I don't want his hypocracy. I went to a doc for years who smoked cigarettes during physical exams (and dropped ash on me a couple of times) all the while preaching on the evils of smoking, and not acknowleging his hypocracy. But if Doc #2 again, uses himself as a living example and joins in with me a the patient in a way of "hey, we all struggle with this, here is the info you need to make informed choices, and I will accede to the fact that it's your choice (once I've given you the info" then he'd be ok for me too.

Attitude counts as much as the behavior, in my book.

SharonRN said...

A dear friend and neurosurgeon, the late Dr. Katherine Hammock, lived as Dr.1. She kept a bag of spinach in her car as her snack. She was killed in a head on with a truck after her typical 16+ hour work day. She crossed over the line driving too fast. Life is all about choices. She had such energy, was vital until the end, and saved many lives. Dr. 2's life may be shorter and less energetic, but he also saves many lives. For me, it is the person who listens to me and who remains at the top of their game.

Elaine Schattner, M.D. said...

Interesting, and of course most would choose the heart-wise physician example-setter.

But I think most of us are perceptive enough to know that sometimes people who look good aren't so perfect as they seem. I'm not saying this is necessarily the case about the healthy breakfast-eating, early-morning swimmer (practices I can definitely relate to), but that sometimes people have good qualities that aren't evident at their waistlines, and have bad ones hidden in the closet.

My point is not to make assumptions about who's the better person or doctor.

Lisa said...

Well, I actually told my cardiologist that dying of Torsades du Pointes beat the hell out of Breast Cancer. I guess my answer is obvious.

Jodi said...

Tale of two extremes? All things in moderation. Doctor number one has impossible standards for me to live up to, so if he is preaching to me to try and follow his lead, lest I be unhealthy, then no thanks. Guilt and shame are damaging to the health as well, and they are two reasons I would feel less compelled to show up in his office for my necessary appointments.

I am not averse to doctors saying one thing, but doing another with their own lives. As a parent, that is a no-no, but doctors should not be looked upon as parental type figures, but as educators and assistants. I just want them to educate me about the facts, whether or not THEY follow them is none of my business. I am more interested in a doctor helping me with MY health, not their own. All I ask is that they provide me with the education, NOT the example. If they want to die prematurely of lung cancer from smoking - that's their choice, as long as they made that choice knowingly. I expect the same from myself - educated choices. My doctors' personal life choices are largely irrelevant to my life, as well as my health.


Jodi said...

Yet another thing came to my mind:

Doesn't this kind of highlight the problem we have with patient expectations for our physicians to be perfect, or at least a little less than human than the rest of us?

So in any population there is a small percentage of people with the intellectual abilities to be a doctor, and then within that group there is a small percentage of people willing to be dedicated to what it takes and make the sacrifices required to be a doctor, and then within that population there is also a small percentage who can handle the blood and guts, and NOW we include that these people have to also be willing to diligently walk the walk of a healthy lifestyle?

For me, I care what my doctor knows professionally, not what he does personally.