Thomas P. “Tip” O’Neill, who served in the United States House of Representatives from 1953 to 1987, and was Speaker of the House from 1977 to 1987, was famous for having said that “All politics is local.” I believe he was saying that you come to understand issues more comprehensively when they touch you directly and personally. 

For example, I could study asthma for many years and, someday, come to feel proficient at diagnosing and caring for asthmatic patients. But it’s completely different if I, myself, also carry a diagnosis of asthma; or if my young son develops it and suddenly needs his family to accommodate nebulizer treatments twice a day, effective immediately; or if you grew up with a sibling whose childhood years included several trips to the emergency room and several missed days of school each and every winter. That’s a completely different kind of understanding.

This post is a call to physicians, clinicians, my blog readers, and you, the patients for whom we care.

I am paraphrasing Tip O’Neill here by saying that all health is personal. I can learn a lot about diabetes and blood sugar control. I can control hypertension with the best. I know how to identify risk factors for coronary artery disease, and to calculate Framingham risk scores. I have started patients on statins for cholesterol lowering, and I have switched them to different ones when necessary. I can do all these things. 

I have seen my colleagues encourage patients, perhaps half-heartedly, skeptically even, to “lose weight and get some exercise.” But I can do all of this much better if I learn first how to do it on my own behalf, for myself.

Learning to provide patients with constructive care, and guiding them to make their own lifestyle-based decisions starts with learning to care for oneself; smokers will, of course, be skeptical of accepting advice from a doctor who smells like tobacco. Doctors who figure out how to enjoy more fruits and vegetables, nourishing fats, legumes, and whole grains will understand better how to inspire first steps in their patients. Call it “walking the walk,” or “be the change.” The single most significant factor affecting doctors’ inability to make headway with the obesity epidemic is the fact that we are, first and foremost, members of the same communities as our patients, and, as such, subject to the same unhealthy community structures, pressures, and food supply. This means communities that are built on an automotive instead of human scale, which reduces opportunities to move; work-related expectations that provide a profound lack of time for rest and recharging; and ceaseless messaging and availability of ultraprocessed edibles. We are all blind together.

Nevertheless, those with the greatest awareness of a problem are the ones who are responsible. How can I show a patient what a few steps in the right direction look like when I look as if I don’t take any myself?