A Unique Approach to Introducing Partnership into the Clinician-Patient Relationship

Chronic Disease
The rapid increase in lifestyle-associated chronic disease, notably obesity and diabetes, poses a significant problem both at the individual and societal level. Even with present levels of awareness and education, healthcare professionals often succumb to the same lifestyle-associated conditions; for example, approximately one in four physicians is obese and one in three is overweight. Mounting evidence shows that this not only adversely affects the health and performance of the individual clinician; it also negatively affects the doctor-patient relationship due to serious issues such as lack of credibility and less likelihood of encouraging patients to address lifestyle behaviors.

The Patient Promise:

About The Patient Promise

Example is not the main thing in influencing others. It is the only thing.
- Albert Schweitzer, Physician and Nobel Peace Prize Laureate (1875-1965)

Hippocrates, Not Hypocrisy

Let thy food be thy medicine, and thy medicine be thy food. Walking is mans best medicine
- Hippocrates, Father of Western Medicine (460 B.C. 370 B.C.)

The Patient Promise is a unique commitment between healthcare professionals and patients that aims to instill a deep sense of partnership into their relationship and, in the process, change the culture of healthcare for the better. The promise encourages clinicians to improve their well-being, oppose weight discrimination, and as a result improve patient health. The text of The Patient Promise was written by members of the Johns Hopkins School of Medicine Class of 2015. Along with national experts in clinician well-being and patient interaction, dozens of Hopkins SOM & SON faculty, administrators, physicians, nurses, and patients provided feedback that profoundly shaped the final version of The Patient Promise, seen below.

Learn More & Sign The Patient Promise! Website: www.ThePatientPromise.org E-mail: info@ThePatientPromise.org Facebook: www.Facebook.com/ThePatientPromise
About the Symbol
The symbol of The Patient Promise aims to represent the major themes embedded within the oath. One motif that emerged was that many of the key words and foundational concepts of The Patient Promise begin with the letter P: Patient Promise Healthcare Professional: Practitioner, Provider, Physician Partnership Preventive Medicine Health Promotion Since P is also the most anthropomorphic of the letters, facing two Ps towards each other conceptually represents a conversation between the Patient and the Healthcare Professional. Symmetry is important because The Patient Promise emphasizes the need for the Patient and Healthcare Professional to view each other as equals in their pursuit of healthier lifestyles. Finally, the Ps are interlocked to symbolize the renewed sense of partnership moving forward.

Health professionals take the Hippocratic Oath to express their commitment to patient care. Similarly we should practice what Hippocrates recognized many years ago and avoid hypocrisy by making the commitment to lead by example and incorporate healthy lifestyle behaviors into our own lives.
Leading by Example Like many Americans, I used to eat too much and exercise too little. I couldnt resist a plate of fresh-baked goodies, and had lots of excuses about why there was never time to work out. But two years ago, I found both willpower and time upon learning that I was at risk for diabetesIn the first six months of my new routine, I lost 25 pounds, about 12% of my weight. Ive kept that off ever since. My percentage of body fat went from 24% to 14%...Ive never felt more fit.
-Dr. Francis Collins: Director, National Institutes of Health

Clinician Health
In 1974, there was a high prevalence of smoking among US healthcare professionals: 18.8% of Physicians 31.7% of Nurses

The Patient Promise

As a healthcare professional, I understand that: Our society is increasingly burdened by chronic diseases, many of which may be minimized or even prevented through healthy lifestyle behaviors. My role within this society is to restore, maintain, and enhance the health of my patient by offering guidance, hope, and advocacy. My actions and inactions reflect my priorities, influence my credibility, and affect the well-being of my patient. My position therefore calls me to lead by example and practice healthy lifestyle behaviors comparable to those I would ask of my patient. Thus for the sake of my health and that of my patient, I promise to work towards the following ideals: I will engage in regular physical activity. I will consume a balanced and nutritious diet. I will refrain from the use of harmful substances. I will diminish personal stressors and look after my mental well-being. I will encourage my patient to adopt these healthy lifestyle behaviors. I will work alongside my patient as a partner in this journey. I will identify and guard myself from potential prejudices against my patient based on unhealthy behaviors, recognizing the often complex origins of these habits. I will respect and seek to understand the beliefs and traditions of my patient that affect his or her health. I will do my part to promote healthy lifestyle behaviors within my community. Recognizing that enduring change of this nature requires time and continual reinforcement, I make this promise freely and upon my honor to myself and to my patient.

The Movement
The Patient Promise is a movement that will achieve its goal of improving patient health by improving clinician health through the following methods: Partnership - Rather than a coach-pupil relationship, The Patient Promise places the clinician and the patient on a shared journey towards healthier living. Accountability - Making a public declaration towards healthier living makes clinicians accountable to their patients, and vice versa. Education - The Patient Promise website includes practical information on how to make improvements to ones health, even within the confines of the busy lifestyle of a modern healthcare professional. Awareness Public expressions of The Patient Promise such as white coat lapel pins or waiting room wall hangings provide a natural way for clinicians and patients to discuss lifestyle-associated chronic disease. Advocacy Once The Patient Promise has spread widely among healthcare professionals, healthyminded clinicians will be able to work towards improvements that make healthy living easier.

As research began to confirm the significant health consequences of this lifestyle choice, its acceptance within the culture of medicine changed. This was reflected in a precipitous decline in smoking rates, such that today it is only seen in: 3% of Physicians 8% of Nurses

Research has shown that this trend has important consequences for patients as well. Physicians who do not smoke are more likely to encourage their patients to quit smoking than clinicians who do smoke. Though clinicians have largely overcome smoking, they now often succumb to the same lifestyle-associated chronic diseases that their patients do; for example, approximately one in four physicians is obese and one in three is overweight. Mounting evidence shows that this not only adversely affects the health and performance of the individual clinician; it also negatively affects the doctor-patient relationship due to serious issues such as lack of credibility and less likelihood of encouraging patients to address lifestyle behaviors. Recent evidence includes:

Acknowledgements
We are grateful for the tremendous support of our advisors at and beyond Johns Hopkins. In particular we would like to thank Dean Thomas Koenig, Dean Sarah Clever, Dr. Erica Frank, Dr. Eric Bass, The Office of Student Affairs, and the Osler Center for Clinical Excellence.