Psychiatrists Are Setting an Unhealthy Example

One current public health focus puts the emphasis on prevention, rather than after-the-fact treatment. With mounting evidence in support of long-suspected mind-body connections, psychiatrists must consider physical activity as both prevention and treatment.

The definition of healthy behaviors is a moving target and, to a degree, subjective, culture-bound, and value-based. Nevertheless, few would argue the benefits of physical activity.

“Do as I say, not as I do” is both a cop-out and an ineffective teaching/motivational strategy. The finger-wagging obese physician rarely inspires healthy eating habits. It is much more effective to learn by observing the recommended behavior. One primary example of a healthy behavior I value and try to model for my patients is openness and curiosity about oneself and the world. Yet, I fail in the physical activity department.

While I exercise during non-work time, I spend my working hours entirely sedentary. As a therapist, I sit in a chair for many consecutive 50-minute sessions, moving little more than my mouth muscles and ear bones. Recent studies suggest physical activity outside of this time does not make up for those sedentary hours.

Though my patients occasionally lie on a couch, we tend to “sit down and talk” during important discussions, because there is something about this posture that lends itself well to the activity of talking and active listening. If we considered alternatives, they might include taking the therapy session out of the office or doing some physical activity throughout it. However, issues of privacy/confidentiality, time constraints, and greater potential for boundary violations limit the concept of leaving the office.

Within the office, I suppose we could consider recent trends, such as standing or treadmill desks, or those gadgets you peddle while seated. Perhaps sitting on balance balls and working our core muscles? People think psychiatrists are wacky enough already.

Psychiatry is more than just a job; it is a profession that offers the privilege of engaging in unique and rewarding relationships. That said, I am being hired to do a job, and there is a responsibility to provide that service in a way that is in the patient’s best interest, rather than self-serving.

This is not about physician dissatisfaction or burnout. Instead, I present this as a conflict between the principles of beneficence and nonmaleficence. If anyone has any good ideas, I am open to them.

Steven P. Levine, MD, is a board-certified psychiatrist and therapist. He received his psychiatry training at New York Presbyterian Hospital and Memorial Sloan Kettering Cancer Center and currently practices in Princeton, NJ.