Jonathan Bonnet, MD
Duke Family Medicine, PGY-3
I was fortunate enough to attend the National Physical Activity Plan Congress last week in Washington, DC and was inspired by many of the leaders working in the field of physical fitness and activity.
One program, in particular, really caught my attention. Walk with a Doc (WWaD) has a simple idea: encourage physical activity in the community by walking alongside physicians. I think it’s safe to say that the last time each of us had a visit with our doctor, he/she discussed our health behaviors and/or lifestyle, which more than likely included a question or two about how active we have been. Physicians also typically encourage their patients to get active, eat healthier, cut back on alcohol intake and to stop smoking. What impressed me the most is the extra step WWaD takes to engage with their patients and local communities. They encourage their patients to walk alongside them. By being outside and actually leading by example, I strongly believe that physicians not only connect with their patients on a higher level by building rapport, but it also makes the visit less formal and transactional. If I were a patient and walked alongside my doctor and we chatted about things other than health and medicine, I would feel that much more comfortable and more willing to share any issues that I was having. By re-shifting the context in which providers interact with their patients, using this less formal, social setting can have profound results.
I had the pleasure of meeting and interviewing Dr. Jonathan Bonnet for this blog post and I feel privileged to share his story with you all.
Me: Tell us about the path you’ve gone through – college/medicine/residency – and what captured your interest with Walk with a Doc.
Jonathan Bonnet: Sports had always been a large part of my life growing up. It wasn’t until undergrad at Ohio State University (OSU), when I fell in love with exercise and physical activity. I ended up majoring in exercise physiology, working in the exercise labs at OSU, and ultimately becoming a personal trainer and interning at Anytime Fitness. The ability to change lives with physical activity inspired me to do more for health and pursue a career in medicine. As fate would have it, in my first year of medical school at OSU I discovered the national nonprofit organization, Walk With a Doc (WWaD). Ironically their national headquarters was located in Columbus, OH. Although the name had initially caught my attention, the people and program inspired me to get more involved and stay involved indefinitely. I was struck most by the simplicity of the program, as well as the open invitation to the entire community. The premise was simple: bring doctors and healthcare professionals together and practice what medicine preaches. I loved the idea of literally ‘walking the walk’ with patients and the community. The walks are a fun, social event, with the added benefit of everyone getting their daily exercise, too. After getting involved with the local walks as a medical student, I initiated an Ohio State Walk With a Future Doc program with my peers. My passion for the program as well as my interest in promoting physical activity has continued through residency. With the support of the Duke Community and Family Medicine department, we launched the Duke Family Medicine (WWaD). Although the walk targets the patients with obesity, it is open to everyone, including the Durham community at large.
Me: What inspires you on a daily basis, especially when things get hard?
JB: I am continuously inspired by the patients I see, my community, the WWaD leadership, and above all else my family and friends. When I see the people around me, with life situations much more challenging than mine, rise up and make the best of their circumstances, I feel truly inspired to help others do the same. I have been incredibly blessed in my life and have a passion to help spread and promote health and happiness to everyone around me. Seeing family, friends, and loved ones suffer the consequences of largely preventable chronic diseases is devastating. Research has already shown that lifestyle behaviors – being physically active, eating a healthy diet, not smoking, and maintaining a healthy weight – can prevent 80% of the chronic diseases we face. This failure to translate what we know into what we do drives me to help make a difference. I firmly believe we can make a difference. It won’t be easy, but it will absolutely be worth it. Dennis Waitly said “there are two primary choices in life: to accept conditions as they exist or accept the responsibility for changing them.” I have chosen the latter.
Me: What do you think it will take for our society to view health more seriously? As in, why is health lower in priority to careers and education and relationships?
JB: In general, health is something that everyone, who has it, takes for granted. It is not until we lose our health, that we realize how precious and valuable it is. I think it is also important to realize that health encompasses more than merely being “not sick” or working out everyday. Health encompasses the physical, mental, social, emotional, and spiritual aspects of life. Health is much more difficult to measure than education, career accomplishments, or relationships. One of my favorite quotes is that not everything that can be measured, counts, and not everything that counts, can be measured. Health is a somewhat ambiguous part of life that is difficult to assign value, and it is not something that generally changes overnight. The gradual loss of health, or what I would prefer to say, lack of vitality, makes it difficult to have a sense of urgency and need to prioritize health when it comes to day-to-day decisions. Eating unhealthy food or not being physically active any single day has minimal effect on long term health. It is the cumulative effect of the day-to-day decisions that promote or impair “health.” Humans are much better at understanding and appreciating short term consequences and that is why health tends to fall lower on the list of priorities for many people.
Changing this societal view on health is tough. Culture and social norms dictate much of this. People who sacrifice sleep for their jobs are idolized. We tend to measure success by material goods, achievements, awards, and honors, rather than the parts of life that matter most: family, friends, health, etc. It is not something that will change overnight, but it has to start somewhere with someone. That someone is you, me, and people like David Sabgir, who started WWaD. It doesn’t have to be profound. Simply deciding to embrace the challenge of being the healthiest version of you possible, is an incredible start. If there is demand, government, businesses, and societies will change. It will take an honest conversation with ourselves about what truly is important in life, followed closely by an enthusiasm, passion, and dedication to practicing those values everyday.
Me: What are some things/concepts/ideas/insights you’ve noticed that have helped/hindered health-related outreach and education in communities? Specifically from a provider perspective.
JB: As a provider, one of the most challenging aspects of care is to really understand the situation and environment a patient is coming from. It is difficult to do more than graze the surface of what a patient’s living situation and day-to-day life actually looks like in a 15-minute visit. Although it is easy to be idealistic and think everyone can adopt healthy lifestyles, the truth is that the choices we make are subsequent to the choices we have. Frankly, I have patients who do not have healthy options. It is choosing between two bad choices, and that makes it tough. Oftentimes, it takes multiple office visits and getting to know patients very well before they feel comfortable discussing many of the underpinnings that contribute to their health, or lack of it. Patients are prideful and often times want to “please” their doctor by saying they take their medicine as prescribed and eat healthy, when in reality, the situation may be entirely different. We know that social determinants of health play a far bigger role than the one-on-one medical care a physician provides, but these are “messy” issues, that do not have quick fixes. Aside from solving world poverty, I think the single best thing we can actually do in health care is to take the time to not talk, but actually listen to our patients and their stories. It is not until we understand our patients values and what drives them, that we are able to facilitate them in making the best decisions for their health.
Me: What are the current needs in your city as they relate to social determinants of health (ie SES, poverty, access to care, transportation, safety, etc.)? Social determinants of health are any factors that directly or indirectly affect health. For example, being homeless could cause stress and malnutrition which could drastically affect one’s health.
JB: As with any community, the social determinants of health play a much larger role in the well being of its members than anything that can be done by a doctor in a single office visit. Access to healthy nutritious food and water, medical care, areas to be physically active, education, shelter, and resources are all critical pieces of health. The Durham community is no different. There are individuals suffering from any and all of the aforementioned components. Obesity is arguably the most pressing health issue this country has ever faced, and social determinants contribute significantly to this. Although it is multifaceted, it has been exciting to be part of a residency program that understands these issues. At Duke, we started a Walk With a Doc to facilitate physical activity among our patients, staff, and community. Additionally, we brought the Veggie Van program to the Duke Family Medicine Clinic every Thursday afternoon. The Veggie Van offers subsidized fruits and vegetables to the community in an effort to make healthy food affordable and accessible to everyone. We are also collaborating with the Durham Public Health Department to identify and offer other services that are beneficial to the community. None of these interventions alone will solve the problem, but it is our hope that the collective effort will yield meaningful changes in the health of our community.