Good for business: “Ms. Bennett has had the nerve to apply for a job seven miles from home, to avoid what can be a four- hour commute to work in Washington should there be rain or rubbernecking. She wants to be close if her kids get sick, or even to have lunch with them sometimes. She gamely shared her story with me about how she wants a new job–and not in a crazy place where she is expected to work late every night. She wants to ‘see the sun go down from home.’ She is willing to take a demotion and therefore a cut in pay. She thinks it will reduce her blood pressure and headaches.

And I’m thinking, ‘I’ll never see her again in the office, and then how will I pay my mortgage, my car loan, my cleaning lady, my kids’ college tuition, etc., etc.?’

Why does she think she should be different from all the other patients who get up at 4 a.m. and come home at 6 p.m. in a condition best-likened to a wet rag? No energy to cook, just give the kids pizza for supper and throw them into bed. Clean up, do the laundry, fall into bed for an all-too-short night of restless sleep, then stumble out the next day to do it all again–flogged along by caffeine.

These are the people who seem to make up a large part of my practice–and who look at me as if I’m crazy when I tell them they need to make time to exercise, or to brown bag it for lunch instead of nipping over to Arby’s for a roast beef sandwich and curly fries.

These are the kind of people who are my bread and butter–excuse me, bread and ‘I can’t believe it’s not butter.’ I don’t want them to exercise or eat healthy. When it comes to the bottom line, where’s the incentive for a doctor to get his patients better at all?”

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