Does anyone actually think that Brooke Shields or Lauren Bacall drinks milk when she's not on camera in the "Got milk?" advertisements?
So, why do we react differently when we find out that a doctor, in this case Dr. Robert Jarvik, wasn't actually the fit rower sculling across a lake in an ad for Lipitor - that it was a stunt double?
We hold doctors to a higher standard. We expect their health advice is based on their years of training and experience treating patients, and on the results of scientific research. Not only was the Lipitor ad that was pulled last week deceiving, but it seemed unprofessional for a doctor to deliver a testimonial based on his personal experience taking the cholesterol-lowering drug.
Yet the controversy over the Jarvik ads shouldn't overshadow the fact that sometimes patients want - and should get - advice derived from their doctor's personal experiences.
In medical school the ethos of not sharing one's personal life with patients is emphasized frequently. After all, patients come to see a doctor with a myriad of problems - physical, mental, and sometimes emotional. They are not paying to hear about their internist's hot flashes or their neurologist's father's increasing senility. And certainly, psychiatric patients are not helped by hearing of the obsessional tendencies or kinky dreams of the treating physician.
However, it turns out that outside of psychiatry, where the risk of such revelations can be dire, sometimes a physician's personal health journey can be helpful.
Facing a difficult decision about whether to take a medication or undergo a test, patients sometimes ask Dr. Marcelyn Molloy, an internist at Massachusetts General Hospital, what she would do. In addition, in trying to motivate a patient to lose weight and exercise, she sometimes tells how she integrates diet and exercise into her busy life. Having faced a painful end of life decision with her father, Molloy may share her family's decision journey to offer empathy to a family in crisis.
Dr. Allan Goldstein, a pediatric surgeon at Mass. General, reaches out to families occasionally with his family's stories. "I know that when I go to the doctor, I like when he talks to me like a fellow human being, with an understanding of what it's like to sit on the other side of the exam room. So, I try to do that for my patients and their parents." He may mention that his own children have had surgeries to let a parent know that he understands their fears and apprehension.
Dr. Ali Peccei, an obstetrician with the Vincent Obstetrical Service at Mass. General, does not hesitate to recommend the midwives at her hospital for low-risk pregnant mothers, based on her own excellent experience with the midwives there. A woman hesitating about receiving an epidural anesthetic for delivery may also be reassured by Peccei, based on her experience as a laboring mom, not as a physician.
When considering a medical procedure, patients often struggle to weigh their risk based on statistics. After all, knowing that one has a 1 in a 100 chance of a complication is not helpful if one is sure that she will be that 1 in a 100. Having one's own doctor say that she took the risk and had a good outcome can be enormously reassuring to a patient.
In my own practice, I may offer a personal health experience if a patient is really on the fence trying to weigh different options. For example, many parents struggle with the decision to give their 11-year-old daughter the three HPV or human papilloma virus vaccines, called Gardasil. Many are wary of vaccines, especially relatively new ones, and the benefits of such a vaccine for a child who has not yet entered puberty may seem dubious. In such a case, I might say, "I would give this vaccine to my own child." In a parent's mind, this can be putting your money where your mouth is.
Patient-physician boundaries are sacred and should not be crossed unless the patient clearly stands to benefit. But, there are times when reaching across that barrier as a fellow human struggling with the same difficult decisions regarding health care choices can be of enormous benefit and comfort to a patient.
Jarvik, who went to medical school but has never practiced medicine and cannot write prescriptions, violated that sacred trust by suggesting that viewers should trust his advice because he's "a doctor and a dad." It's obvious that he was making money for the ads - at least $1.35 million, according to published reports - but it's not obvious that his personal experience was the invention of an ad executive.
Most physicians are not hawking their personal medical choices in magazines. In the exam room, when patients face difficult decisions, reaching across the patient doctor boundary can be humanizing and helpful.
Dr. Victoria Rogers McEvoy is chief of pediatrics of the Massachusetts General West Medical Group and assistant professor at Harvard Medical School. She can be reached at mcevoyvicky@gmail.com.
