"Many doctors believe in a false premise that the patient is king. It's what I sometimes refer to as the restaurant model of medicine. Well medicine isn't a restaurant, and the patient is not a patron, and the doctor is not a waiter. ... part of the difference in medicine is that we're supposed to have professional norms, professional values, and professional commitments. If you keep telling people that ... autonomy of the patient is what must be served to make them happy customers, then you have a collapse of professionalism in the face of consumer demand." 
- Art Caplan, Professor and Head of the Division of Medical Ethics at NYU
The most dramatic shift in western medicine in the past twenty years is the deregulation of prescription drug advertising. It’s nearly impossible to watch television without seeing an ad for a drug promising to cure what ails you. An unintended consequence has been a shift in medicine toward a ‘restaurant’ model of service…i.e. ‘have it your way.’
Why should you have it your way by asking and/or demanding your doctor give you the prescription you want? Instead of self-prescribing, you should listen to your doctor about which course of action is going to make you healthiest. Granted, western medicine is certainly not an infallible answer to optimal health. But the point remains: it isn’t a doctor’s job to give you what you want, it is a doctor’s ethical responsibility to give you what you need.
Fitness faces a similar dilemma. The fitness industry is in the midst of unprecedented financial success, but that success is not correlated with the health and wellness of our populace. In fact, you could contend that as the fitness industry has grown, so have the problems of obesity, diabetes, and sedentary lifestyles. If exercising is an antidote to the dilemmas of obesity and metabolic syndrome, then why aren’t we seeing better results as more people are joining gyms and starting exercise programs?
The problem is gyms that are run like a restaurant rather than a doctor’s office. A restaurant gives the customer what they want. A doctor’s office gives the customer what they need. I certainly do not like going to see my dentist, but I sure am glad my dentist has the best interest of the health of my teeth and gums in mind.
In fitness, giving customers what they want has created an industry hijacked by half-truths and outright lies. Customers clamor for ‘magic’ programs, diets, and supplements that promise quick and easy results, and so those are what the industry provides. Because the customer is not the professional, they are also easy targets for misleading and oversimplified formulas for success (e.g., the calories in calories out formula for losing weight).
Furthermore, the customer-first mantra leads to the falsity of defining fitness by how you look instead the state of your wellness. While ultimately the customer has the right to look any way they like, the reality is that at its core, fitness is defined by functionality and health, not looks. We as fitness professionals have a obligation to promote hard truths and real fitness, not fads and snake oil gimmickry.
Customers in fitness must be treated fairly, ethically, and responsibly instead of being fed convenient, profit-motivated untruths. This means giving the customers results (what they need) rather than what they often want (the path of least resistance). Here’s what every fitness customer deserves and needs:
  • To be treated with respect
  • To be treated with empathy and compassion
  • To be held accountable to themselves
  • To be in a safe environment.
A proficient doctor or nurse ultimately cares only about the health of their patients, and similarly, a leading fitness professional cares firstly and immensely about the fitness and wellness of their patrons. It’s a doctor’s job to prescribe and a fitness coach’s job to coach. Results matter. Preferences don’t.
Fitness is about making uncomfortable changes that customers don’t always enjoy or prefer. It’s likely more profitable to tell customers what they want versus giving them what they need, but as Art Caplan’s quote points out, it’s also a question of ethics in terms of professional norms. We need to demand such professional norms from the fitness industry. While the customer is king, results happen by giving the customer what they need, not what they want.
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