Don’t smoke. Don’t drink. Don’t eat fatty foods. Don’t eat sugar. Don’t eat so much. The doctor is frequently in the position of counseling, or in a different view ordering, the patient to abjure certain pleasures. Even when framed in positive terms—“exercise more,” “eat better”—the theme echoes that leisure is bad, discipline good.
Advising the patient regarding what we call lifestyle modifications, or what the ancients called regimen, is susceptible to a number of pitfalls. The first is the risk of sounding judgmental; this is the easiest to avoid. The second is tougher: how to advise a patient to lose weight without engaging the myriad of complex issues that determine how one eats. “Hey, you were here for your annual physical exam—am I supposed to get involved in what eating means to you? How could I ever do that in the time allotted?”
The third is most problematic of all: the physician can sound like, or become in fact, the exponent of a simplistic world of rectitude, an authoritative representative of the collective superego, a stern principal, a disapproving papa, a large and powerful should. Armed with the epistemologic force of science and the reassured complacency of social privilege, the doctor tells you what not to do.
Not for nothing was Apollo a god of medicine: his clarity, his upwardness, his singular and ideal calm set against the dark ecstatic Dionysus.
Charles Bardes is a physician who lives and works in New York City, where he teaches and practices general medicine at Weill Medical College of Cornell University as Professor of Clinical Medicine and Associate Dean. He is the author of Essential Skills in Clinical Medicine and articles related to medical education. (3/2006)