Health Hypocrisy
You don't have to break the law to fail a
pre-employment drug test. In fact, you could lose your job just by using
countless products hanging on the wall of your local gas station. That's
because at my hospital, when an
employee's urine drops into that little plastic
device during a pre-employment drug screen, it is checked for something more
than cocaine, opiates and marijuana. It is tested for nicotine.
The consequences of the nicotine check are serious. My
employer has decided to not just ban smoking
but smokers. It is part of a push to
put the health back in healthcare workers. Tobacco users are given an
opportunity to quit with the help of employer-provided resources. If their
urine continues to test positive for nicotine metabolites, they must find
employment elsewhere.
This campaign goes beyond tobacco use. The hospital
system made headlines with its efforts to promote a healthy lifestyle for
employees. The CEO expelled fast food chains from the campus food court; for
those that remained, he purged the trans fat. Sugar-laden drinks and snacks
were stripped from vending machines and replaced with healthier alternatives.
The cafeterias overhauled their menus and even the snacks at employee
orientation got a nutritious tweak.
The hospital also focuses on employee fitness. They
provide memberships to Curves gyms and several hospital-owned gyms. Employees
can form work-out teams and record their progress online. Those who take
advantage of these exercise perks make their waistline smaller and their
wallets bigger: participants in any fitness program get slimmer health
insurance premiums.
These actions generated media attention and a
heaping serving of controversy. Supporters appreciate the convenience of
healthier options; detractors despair over the loss of choices. However, a
larger question is lost in the 
personal freedom debate: Does a healthy patient
require a healthy provider?
The ability to lead by example certainly has value.
As healthcare providers, we depend on our patients' trust in nearly every
aspect of our jobs. The appearance of hypocrisy on our part damages the
patient-provider relationship. How can a clinician who reeks of cigarettes
counsel a COPD sufferer to quit smoking? How can an obese primary care provider
counsel his diabetic patient to lose weight?
A clinician's appearance, habits or lifestyle does
not affect his clinical knowledge or technical skill. But patients open up the
private details of their lives to medicine's critique. Most assume their
medical providers hold themselves to the same standards as the advice they
give. Granted, it is unlikely a patient will see their clinician lighting up a
cigarette outside of a local bar. However, it is difficult for us to battle
internal hypocrisy and still achieve the sincerity required to change a
patient's life.
Personally, I don't mind the hospital's bold
lifestyle moves. Medical providers are already held to a higher standard than
other professions in countless ways. Perhaps personal health should be one of
them. In the meantime, if I want to eat a cookie, I will bring it from home.