My Fiduciary Standard
“Fiduciary: A person who is required to act for the benefit of another person on all matters within the scope of their relationship; one who owes to another the duties of good faith, trust, confidence, and candor.”
Black’s Law Dictionary, 11th ed. (2019)
Somewhere along the way, we decided only doctors have to mean it.
Your physician is legally bound to put your interest above their income, their convenience, and their ego — and there are career-ending consequences for breaking that. It is called the fiduciary standard, and in medicine it is not a slogan. It is enforceable.
Almost no one else who shapes your life is held to anything close. The person selling you a car. The coach selling you a protocol. The advisor selling you a plan. Most of them owe you nothing beyond not committing outright fraud. They can recommend what pays them. They can promote what they are paid to promote. They can cite a single study of twelve people and call it settled science. And if what they sold you harms you, that is yours to carry — not theirs.
Where I Stand
I think that is backwards.
I think anyone who sells, advises, or counsels another human being should be required to act in that person's best interest — not their own — and should answer for the harm when they don't. Not just the maker of the lemon. The salesman who knew. The dealership that looked away.
I will also tell you the honest limit of that belief: I don't actually know it's how you should build a society. Bind everyone to this and maybe you get fewer jobs, less risk-taking, a slower world. It's an empirical question, and I don't have the answer, and I'm suspicious of anyone who says they do. So this isn't a policy proposal. It's just where I stand.
I hold myself to the standard because it is the right thing to do — not because a license requires it of me. And I know I can hold it, because I held it before anyone required anything of me. It is how I sold cars. I don't do that professionally anymore, and I don't know how reasonable it is to expect this of everyone. But I hold myself to it. That has not changed with the setting, and it will not change with you.
My Obligation to You
As a board-certified Family Medicine Physician and Fellow of the American Academy of Family Physicians, the fiduciary obligation is baked into the oath I took and the standards I answer to every day. But the version I bring to your performance isn't the license. It's the habit the license enforces:
Every recommendation, every protocol, every practice I put in front of you has passed one test — is this in your best interest? Not my bottom line. Not an affiliate deal. Not what worked for me personally and might work for you if you happen to share my genetics, my sleep, and my stress load. Your best interest. Specifically. Individually. Honestly.
In practice that looks like this. When the evidence is strong, I'll tell you and explain why. When it's promising but thin, I'll tell you that too — you deserve to know the difference between a meta-analysis of 50,000 patients and a pilot study of 14 college sophomores. When something is overhyped, I'll tell you exactly why, even when it's popular, profitable, and aggressively marketed. Especially then. And when I don't know, I'll say so. Pretending certainty where none exists is not medicine. It is sales.
What I will never do: recommend a product I wouldn't take myself. Cite a study I haven't read. Sell access to advice I wouldn't give my own family. Pretend certainty where the evidence is incomplete. Prioritize engagement over accuracy.
The Sophists
Ancient Greece had a name for people who sold the appearance of wisdom to anyone who could pay, indifferent to whether it was true: sophists. They were persuaders for hire. The truth of the thing was somebody else's problem.
The wellness and performance industry is full of their descendants — and they are the ones I have a problem with. Not the honest operators. Plenty of coaches do right by their clients every day and never once use the word "fiduciary"; they don't need the term to hold the standard, and I'm not talking about them. I'm talking about the industries that profit specifically because no one requires them to be right.
You've seen them. The supplements that do nothing but make your urine expensive. The elimination diets built on one bad study. The injectable protocols pushed on people who aren't even deficient. The fear-mongering against proven interventions by people who quietly don't follow their own advice — because they know the actual clinical consequences. None of it is illegal. Most of it isn't even dangerous. Almost none of it is what the evidence says you need. It persists because misery and fear are profitable, and because the bill for being wrong always lands on you.
That is the whole business model I'm standing against: profit on one end, consequence on yours.
THE UNCOMFORTABLE TRUTH
The wellness and performance coaching industry is largely unregulated. Anyone can call themselves a coach, a health advisor, or a wellness expert. Anyone can build a following, launch a course, and sell you a protocol with no accountability for what happens next.
Some of them are genuinely trying to help and doing real good. But the structure of the industry does not require them to. And when financial incentives exist alongside the absence of accountability, the outcomes are predictable.
You have seen it. The supplements that do nothing except make your urine expensive. The elimination diets based on a single poorly designed study. The injectable protocols recommended to people who are not even deficient. The fear mongering against proven, demonstrated health interventions by people who quietly do not follow those same recommendations themselves, because they know the actual clinical consequences.
None of it is illegal. Most of it is not dangerous. Almost none of it is what the evidence actually says you need.
WHAT THIS IS NOT
Two things get confused with SPMD constantly. It is important that we explicitly name and address them both directly.
The first is physician coaching aimed at physicians. Burnout recovery, leadership development for clinical executives, programs built by doctors for other doctors navigating the specific weight of practicing medicine. That work is real. It is needed. Burnout recovery is something we do address and work with at SPMD, but that is not the focus of SPMD.
The second is executive coaching without a license behind it. Talented people. Real frameworks. No diagnostic authority, because diagnosis was never part of their training. No fiduciary obligation, because nothing requires one.
SPMD sits in neither category.
This is a board-certified physician's fiduciary standard, the same one owed to any patient, applied to a population that was never going to walk into a hospital system for this kind of help. Executives. Military leaders. Operators. People carrying outcomes that matter, under real pressure, who do not happen to hold a medical license themselves. We take care of both issues, physician burnout and the lack of diagnostic rigor in coaching, but we do not solely focus on either one. The SPMD process diagnoses the underlying cause of what our clients are experiencing. We resolve that cause. We build new behaviors and habits to prevent a return to the impaired state. Then in Precision Coaching, we focus on improving performance in a sustainable manner, not simply maintaining a return to baseline.
What never changes is the standard of our coaching and training, regardless of who is sitting across from me. SPMD is for anyone who has to perform consistently in high pressure situations. That is in sharp contrast to the population most people assume when they hear "physician coach." SPMD can be for anyone. It is not for everyone.
The Difference
Here is what actually separates the standard from the slogan.
I face real professional consequences for getting it wrong. My license. My board certification. My standing with the American Academy of Family Physicians. My ability to practice medicine. All of it is on the line every time I make a recommendation — and none of that stops applying just because the setting shifted from a clinic to a coaching program. The obligation travels. The standard of evidence travels. The consequence for being wrong travels.
That is not a liability.
That is the entire foundation.
If that standard matters to you, start with the free Leak Assessment — or just email me at will@SustainablePerformanceMD.com. Every one gets read and answered personally.
SPMD assesses performance, not health. SPMD is not medical care. Where that line sits is spelled out on the disclaimer page.