Neil Skolnik, a primary-care doctor in Jenkintown, was aware of his hypocrisy, but that wasn’t enough to make him change his behavior until the day he found himself out of breath and sweating during a trek through Philadelphia International Airport.
There he was in his late 40s and on his way to Chicago to teach hundreds of other doctors about diabetes. He was overweight and out of shape, two of the biggest risk factors for the dangerous metabolic disease he knew so much about. Yet he didn’t even know what his own cholesterol levels were. He looked in the mirror, and he didn’t like what he saw. It was time to implement the advice he’d been giving his sedentary, overweight patients for years.
A funny thing happened after he started exercising and eating better. Sure, he lost weight — about 35 pounds — and felt better. But the surprise was that patients who had been ignoring him for years started listening. He recently wrote about his experience for the journal Circulation.
One of those changed was Tom Nadolski, a Flourtown man whose busy, stressful life was making it hard for him to exercise and eat right. His triglycerides, a measure of fat in the blood, soared above 400. Normal is less than 150. After a serious talk with Skolnik, he started eating better and joined a gym. He lost more than 20 pounds and ran a half-marathon for his 50th birthday three years ago. “By seeing him, I looked at it and thought it wasn’t just lip service,” Nadolski said. “This is something that he believes in, and it’s working.”
Nadolski, who concedes he’s put a few pounds back on and has eased up on the exercise, has managed to keep his triglycerides in the normal zone. He’s been able to avoid taking medicines, which was his goal. He was the inspiration for the “patient” in Skolnik’s essay.
The doctor, who hasn’t analyzed data from his practice, said many of his patients have made “really, really important changes in diet and exercise.”
He thinks the key factor was not how he looked but what he believed. “There may be a connection between the way we treat ourselves and the way we treat our patients,” he wrote in the essay. “Our deepest beliefs, manifest in our daily actions, are conveyed in every conversation with patients.”
Before his own epiphany, Skolnik, who is associate director of the family medicine residency program at Abington-Jefferson Health, often told patients about the benefits of diet and exercise, but he was not optimistic that many of them would do anything. “I always talked with an assumption, based on what I thought were my observations, that for the most part, people were not very successful,” he said.
After he tried changing his own behavior, Skolnik, now 59, understood what his patients were up against. He bought an elliptical machine the day he got back from Chicago. He thought he’d start with an easy 30 minutes. “I lasted seven minutes,” he said, “and that was an eye opener.” He thought about staying healthy for his kids and decided to make scheduling exercise a priority. He figured he could suffer a little on the elliptical or suffer later in doctors’ offices. He has made exercise a habit by piling his exercise clothes beside his bed, where they are the first thing he sees each morning.
When he talked with Nadolski after the airport episode, Skolnik told his patient that he really needed to make some changes. He could choose to exercise now or face the likelihood of taking medicines and dealing with serious health problems later. He talked about exercising with his kids, which resonated with Nadolski, whose children are now in their teens. If the kids saw him working out, Nadolski thought, “they realize you’re in the game here.”
Skolnik saw him every six weeks for the next six months, then two to four times a year.
He said the real transformation is in how he talks — and listens — to patients now. He believes they can change if they’re part of the discussion. He lets them choose whether they’d rather prevent problems or deal with them later. He talks to them about which exercise they might enjoy — because they are not going to keep doing something they hate. Maybe they will never love the exercise, but they can pair it with music or movies that make the time pass a little faster.
“When you present intelligent people with information, they make intelligent choices, and then you have to support those people,” he said.
He tells the young doctors he works with that introspection about how you’ve dealt with challenges is key to successful communication with patients.
Helping people change has “been one of the most gratifying things I’ve ever done,” Skolnik said. He estimates he spends 20 percent of his time now talking with patients about healthy behavior. Most of the appointments are 15 minutes long, and he’s had no trouble getting insurance payment for his efforts. He always ends the visit by giving patients one more choice: “When would you like to come back?”