When I worked as a Junior Doctor in an East-End hospital, the Mess had a make-shift roof-top garden. It was grim. A grey 5 x 5m space where air vents would spill out amongst the pebbles, and smoke would blend in with the London sky. Conveniently this mostly served as a smoking area. Doctors who had finished night shifts would come in, step out and spark up. This oasis however was in view of the hospital entrance. It was deemed by the hierachy that this was not the image of medical professionals the hospital wanted to portray. As such the door was padlocked. No sign asking for us not to smoke, padlocked. It seemed we simply couldn't be trusted.
As a non-smoker I was indifferent to this. It's difficult to argue with the negativity this undoubtedly drew upon/toward us. But what I was more interested by was where do we draw the line? What about fat doctors?
I raise this as a semi-serious point. Smoking is so stigmatised that the hospital feels comfortable enough to ban it outright. And I am onside with that one. I for one would not want a 'do as I say not as I do' doctor, reeking of cigerettes with stained fingers and yellow teeth telling me I should stop smoking. The trouble is this can easily spill over into other health promotion instructions. Would I want a fat doctor telling me to lose weight? And how can they expect patients to follow what is often incorrectly framed as easy lifestyle choices when they aren't doing so themselves?
This point is only a side. The main course obviously takes place in the canteen.
The majority of the worldwide disease burden is made up of what are collectively called 'non-communicable diseases'. These are diseases you can't catch, and are predominantly made up of heart disease, diabetes, cancer and lung disease. The main drivers for these are diet and lifestyle/circumstance. Important - lifestyle implies choice. But we know poorer people tend to have poorer health. This is multi-factorial and includes education, local environment, peer-group behaviour and personal finance. Hence circumstance is used as many people cannot simply choose to shop at Waitrose and join a spa.
With diet playing such a vital role, it seemed crazy to me that the hospital canteen would reglarly plate up high-sugar low-fibre processed meals to our patients. One of the main drivers for patients being in hospital - a poor diet - was being fed to them 3 times a day as we were trying to combat the toll that this has taken on their bodies. The irony was clearly wasted on the chief executive. And how did we decide to address poor behaviour within the hospital? Padlock the mess door.
If we are serious about setting examples for disease prevention, and we need to be because trends for conditions such as Type-2 diabetes and childhood obesity are all heading in the wrong direction, then we need to set a better example but at an institutional level. These decisions are harder to make than bolting a door. We wouldn't dream of having a bar next to the liver unit, why is hospital food any different? Why is it ok for one of the leading tertiary centres in the UK to have a McDonalds on site? Some may say they paid good money for the premises, but what about the incalculable costs of endorsing fast food and normalising their presence within healthcare? Can we really expect patients to 'eat-better' when this is the example we are setting them?
So I am all for healthcare professionals leading by example, by all means ban smoking. But let's not perform gastric bypass operations in one room and serve up burgers in the next.