Tuesday, February 12, 2008

Fat-hating doctors

Someone asked me to write about this topic, and they linked this article about the doctor survey where a bunch of them admitted to severe prejudice against fat patients. At that friend's request, I am going to give my opinion about this topic.

"...I had one doctor who blamed me and told me I got PCOS from being fat."

The blog First Do No Harm contains story after story of people, mostly women, who have been treated so badly by doctors because of their fat that, in many cases, it took years for them to get a real diagnosis and treatment.

A recent survey of doctors showed that they had very negative attitudes and feelings toward their fat patients:
When researchers asked more than 400 physicians to name patient characteristics that provoked feelings of discomfort, reluctance, or dislike, one-third of the subjects mentioned obesity, making it the fourth most-common condition named after drug addiction, alcoholism, and mental illness. The subjects also linked obesity to negative qualities such as poor hygiene, hostility, dishonesty, and noncompliance with prescribed treatment. Another survey of family physicians found that two-thirds said their obese patients lacked self-control and nearly 40 percent characterized their obese patients as lazy. Nurses expressed similar attitudes—nearly half reported that they were uncomfortable caring for obese patients and 31 percent told surveyors they would prefer not to care for obese patients at all.

Puhl and Brownell found documented evidence that health professionals' deeply held negative stereotypes adversely affected their clinical judgment, diagnosis, and the quality of care delivered to obese patients. A survey of more than 1,200 physicians revealed that most were ambivalent about caring for overweight and obese patients, and did not intervene and treat them with the same determination they displayed toward normal-weight patients.

I'm not making this stuff up. These are the things that medical professionals actually admitted to thinking and feeling about fat patients. And I have this to say:


I read the doctor blogs. I see doctors complaining that their patients get information off the internet and come in with a request to be tested for this or that. You know what, guys? Look at the above quoted paragraphs and tell me that we don't need to advocate long and hard to receive proper care when the only diagnosis many doctors can come up with is "fat", and the only treatment is "eat less and exercise", when someone is suffering from excruciating bursitis, appendicitis, or Cushing's disease.

It is malpractice to refuse to treat a person's medical condition(s) because you don't like how fat they are. It is arrogant to think that they aren't capable of seeing through your bullshit eventually, and figuring out that you caused them harm by withholding treatment. It's doubly arrogant to assume that, because you have a medical degree, that you know more about everything than a "common person". The less informed will not realize just how badly you're harming them, while the well-informed are not going to stand for this. If you are a doctor, and you dismiss fat patients as not worth your time, then you do not deserve the title. It's childish and cruel, and you fucking know it.

Also, this whole thing about doctors being gods who know all? Look, I worked in aquarium stores for over 10 years. Aquariums, being a luxury item, are a frequent purchase for doctors, and, that being the case, I had a number of them as regular customers. I have to say, for people whose job is knowing the functions of the human body, most of these guys had such a limited grasp of the very basic biology required to keep an aquarium that it really scared me to think that they were actually charged with the task of keeping humans alive and healthy. If I can explain how to keep fish to a high school dropout, and have that person be very successful at it, then it's damned frightening for someone with a medical degree to tell me repeatedly that they don't "get it" when I explain for the 10th time why their methods are killing their fish.

I do understand that many of today's physicians are overbooked, undereducated, and not well-compensated. I'm sorry for that, and I hope that something happens to change that situation. My last doctor wasn't too bad, really, but because he had all of three minutes to listen, talk, diagnose, and write prescriptions, things got overlooked--one of which ended in surgery that may have been prevented with earlier intervention. He was nice, and he was actually pretty realistic about my being fat. I happened to meet someone else, though, who charmed me into his practice by being a fantastic aquarium store customer, and chatting with me about how he treats fibromyalgia patients (he also happens to be partnered in his practice with THE fibro doc in this area, so he has a great resource if he needs to find anything out).

I'm very lucky; my doctor is down-to-earth, caring, and actually gives a damn about his patients, no matter what they look like. He is also an expert aquarist--and, when I gave him cat advice, we were able to talk about pheromones and their different functions, and he was able to talk about it intelligently*. I suppose he has a bit of an edge, though; he was a high school biology teacher for a while before he decided to become a physician and go to medical school. He really knows his stuff with treating fibromyalgia, thyroid disease, depression, and anxiety. He was the first one willing to do the full thyroid panel instead of just telling me that my TSH was "fine"--and, when I told him the TSH numbers I'd had with a previous physician, they apparently weren't fine.

This has rambled a bit, and I'm sorry for that, but my experiences have been difficult. Prior to both of the above mentioned doctors, I had some pretty stupid experiences, including one doctor who told me that my asthma was just anxiety, and that I needed to "learn to relax". Well, asthma is something that can be empirically measured on equipment. Did he do that? No. Have I had it done since then? Yes, and I don't think I need to tell you that the results were that I have moderate asthma. Anxiety is not something that can be measured, but it's also not controlled by "learning to relax". I apparently wasn't worth that guy's time, though, so I was dismissed and ignored. That's unacceptable. It's irresponsible. And it has to change.

* About doc and the cat advice: He was having trouble with his cat engaging in inappropriate urination. Since the cat tested negative for UTI or crystals, he thought it might be some anxiety due to family stresses in the house. The vet recommended Feliway, and Dr. D asked me why a pheromone would change inappropriate urination. I explained that it was a synthetic version of their cheek pheromones, which are calming to them. They're different from the pheromones used for marking territory or attracting mates. He was thrilled to have this explained, and I was thrilled that he was curious about the subject. He's pretty busy most of the time, and is really more into fish, so he isn't familiar with every cat product on the market. I've used Feliway in the past for a nervous kitty (she lives with my ex), and I use it in the foster room to help the scared kittens settle in.


liz said...

This is a great post. Thank you.

Mercurior said...

whats the difference between god and a doctor/surgeon? god doesnt think he is a doctor/surgeon.

in the most recent form of hippocratic oath, certain things have been removed, doctors have been taught that fat is profitable. Thats the doctors of today, more patients = more money, the doctors dont actually care about people, (there are always exceptions to every group).

luckily i am very healthy apart from constant bad throats. (i am just waiting for them to say its obesity).

mumboj said...

I think I finally understand what's with some doctors, they find fat bodies harder and more frightening to care for. They fear that on top of everything else, they will be overwhelmed by us, they feel powerless, this has made them very angry at us. The way many of them cope with these fears is to cling to the idea that fatness can be prevented, I now see that the thought that it isn't is intolerable to many of them, therefore they cannot bring themselves to accept it. It's a bit like people that work in a shop and say, this job would be great if it wasn't for the customers! It's a shame that they couldn't have been upfront and honest about their true feelings.

Anonymous said...

I never really was able to figure this out. Why be a doctor, if you're going to b**h and whine about your patients? Clearly you don't care about helping people with their health, if you're able to quibble over non-issues.

I watch Mystery Diagnoses. While I agree that alot of problems do come from doctors presuming that fat = unhealthy. There are stories of people who have spent years trying to figure out what a disease was, and went to countless specialists and doctors who did nothing.

What really is shocking is what some of those doctors told the parents. That they were overreacting, and should basically calm down and get over it. Alot of the doctors seemed to feel they were in a position to talk down to their patients, like one dealing with a small cranky child. Apperantly nobody got the memo, that we don't live in a time where people belive doctors are Gods.

It's amazing how doctors behave in general. It seems a good lot of them care so much more about their self-importance than being a doctor.

Also, I could go on and on about how it seems doctors have no concept what-so-ever about psychology. Hey, if psychologists & psychatrists have to take a year of medical courses. The doctors should take a year in psychology, at least. I have had so much trouble with doctors who think that my having an Anxiety disorder means they should treat me like I'm a child who is acting up for attention.

Like, yeah I really enjoy having people treat me like a 2 year old, because of something I cannot control. It's gotten to the point where I can't visit a new doctor without taking some Diazepam. That's the extent of the lack of trust I have regarding the issue.

I have a Korean doctor, who never bothered me about weight. I wonder if perhaps it was cause he wasn't taught medicine in a American college. Where medicine 101 is, Fat = Unhealthy, Diet is the Answer.

Kira said...

Violet, I certainly can't speak for every doctor. However, in my experience I find that many (certainly nowhere near all, but too many all the same) doctors go into the field for the money and the status, rather than out of a desire to help people. I'm a grad student in Biology at a university with a medical school, and I've seen this among both the pre-med undergrads in the classes I've TA'ed and amongst the med students. Further, several of the pre-meds I taught were able to get the good grades they needed by charming teachers, taking the known "easy" classes, and cramming for tests, but yet they had a remarkably limited understanding of basic biology - or, more importantly in my book, an interest in learning. For those few doctors whom are in it solely for themselves (for the status and money), why bother developing curiosity and good people skills?

M. said...

I'm pretty lucky with my GP. We had the weight discussion once, and then never again.

My Ob/gyn is a little more problematic, but I feel a sense of loyalty to her because she sterilized me without making me leap through any idiotic hoops, like when a friend got fixed and had to have a psych eval first.

I fully support calling practitioners on their bullshit when appropriate. I remember calling my allergist an asshole and storming out of his office after he told me I would have to get rid of my cats, or he wouldn't keept treating me. I then marched into the waiting room and told everyone waiting to see him that he was an asshole, and that they should find another allergist.