‘You’re Fat And Won’t Get Laid!’ - Acceptible Medical Commentary?
| August 25th, 2005Okay, not verbatim that, but just about. Here’s what I’m referring to:
A situation regarding the gratuitous ‘obesity’ commentary made by a doctor in New Hampshire has been causing quite a stir in both the media and in the blogosphere this week. I’ve been following the debate and commentary made about the situation and have been horrified at the sanctimonious bullshit people are spewing about the right of doctors to include inflammatory social commentary as part of their medical lecturing on the health risks of being overweight.
So here’s a bit of a rundown on what happened. Dr. Terry Bennett of Manchester, New Hampshire is being investigated for commentary he made to a patient that led to her filing a complaint against him with the New Hampshire Board of Medicine. According to MSNBC, Bennett is unapologetic and explains his actions as thus:
Dr. Terry Bennett, who practices in Rochester, said he has “an obesity lecture for women” that is a stark litany designed to get the attention of obese female patients.
He said he tells obese women they most likely will outlive an obese spouse and will have a difficult time establishing a new relationship because studies show most males are completely negative to obese women.
People have seemed to have a hard time grasping that not only is this charming doctor sizest, but he’s sexist to boot, and has a really poor concept of professional behavior.
A settlement was offered to Dr. Bennett by the New Hampshire Medical Board, but apparently Dr. Bennett feels that his actions were just fine and is in no need of changing his approach:
A settlement agreement was proposed that would have had Bennett attend a medical education course and acknowledge he made a mistake. He rejected the proposal.
“I’ve made many errors in my lifetime. Telling someone the truth is not one of them,” Bennett said.
The abrasive cacophony on web discussions is that being a doctor is a thankless job and the good doctor was being brave and kind for pointing out to the woman that she’s fat and that if her husband dies before her, she won’t be attractive to other men. I’m just boggling.
August 25th, 2005 at 5:31 am
Boy, that’s offensive, but good on him.
He’s seen a patient on five or six occasions, and told her that her “obesity will lead to high blood pressure, diabetes, heart disease, gastroesophageal reflux and stroke.” (FTA) He’s her doctor, he has a medical history of the woman, he probably has a good idea about whether this is preventable obesity, and he tells her that she needs “to get on a program, join a group of like-minded people,” (also FTA) and she does nothing? This was not radical advice. He was not recommending radical surgery, but that she simply take control of her life.
Good on him. Well played. She has a serious medical problem which will create severe complications in her life (so sayeth her doctor) and she won’t change her behavior. Maybe she needs something shocking said to her to wake her out of her rut.
K
This comment was written by Kevin Q.Report this comment to the moderators
August 25th, 2005 at 6:01 am
So, are people upset because Bennet thinks obesity is not healthy and told a patient so? Or is the part they are upset about where he said that “studies show most males are completely negative to obese women. “?
If it’s the first one, well, if a doctor has an obese patient and they think it will cause problems for the patient in the future or is causing problems, telling a patient to lose weight would be part of their job. I can see a scenario where a doctor never mentions weight or obesity because they don’t want to seem rude or offend a patient, the patient develops problems that are usually related with obesity, the patient sues the doctor because ‘the doctor never told me my weight was a problem, the doctor never told me I should lose weight. It is the doctor’s fault I am now sick.’
If it is the second, well, if the patient thought the doctor was rude, she should have said so and told him she was finding another doctor, and left. Preferably while telling everyone in the waiting room what a rude guy the doc was. Filing a complaint with the state Board of Medicine because your doctor wasn’t “nice” is just silly. Medical boards exist to investigate actual complaints about malpractice, negligence, practicing impaired or without a licence, etc… It is not there to make doctors be “nice”.
This comment was written by mousehounde.Report this comment to the moderators
August 25th, 2005 at 6:49 am
He said he tells obese women they most likely will outlive an obese spouse and will have a difficult time establishing a new relationship because studies show most males are completely negative to obese women.
So my question: is the problem that this advice is inaccurate, or is the problem that, true or not, this should be none of the doctor’s business?
This comment was written by Glaivester.Report this comment to the moderators
August 25th, 2005 at 6:54 am
Telling her all the health problems relating to obesity is fine. Telling her that she can’t get a man, not so acceptable.
What’s amazing to me about this story, though, is that all the articles seem to give the same basic info, and are all very defensive about the doctor. The articles are clearly not unbiased. I’m not sure if this is just the narrative that’s developed around the case, or because the medical board and the woman who filed the complaint aren’t talking to the press, so the only news they’re getting is from Dr. Bennett. It’s probably a combination of both.
But I wouldn’t like to be so quick to dismiss everything here without learning more about what was actually said and what the complaint was exactly about. The board says that it’s very unusual for them to intervene in cases where the doctor was rude, so there was probably some reason that they decided to do so.
Or maybe it wasn’t. Maybe it was exactly as was described, in which case I don’t think that asking the guy to acknowledge that he made a mistake and maybe crossed a line, and take a course should be too crazily radical of a compromise.
This comment was written by acallidryas.Report this comment to the moderators
August 25th, 2005 at 7:03 am
Kevin, you’re right that there are two elements in play.
First, there’s a doctor’s medical opinion that her weight is bad for her. Now, as Amp will no doubt point out, there are real questions about how bad overweight and obesity are, and there are good grounds for the claim that underweight is more associated with early mortality than overweight.
But this doctor isn’t assessing the population risk, just this patient, and he knows more than we do about her. That’s what you seem to be saying. Now, I think he may have an irrational or unsupported view of how bad being fat is. Or he may have a rational and supported view of her condition. Maybe he’s biased, or alarmist. Maybe he’s not. It’s very tough to tell from our remove.
The second element, though, is bringing the “you will die lonely” card to bear. The question is not, as mousehounde would have it, whether this is “rude.” The question is whether it is unprofessional. And that’s the basis of the complaint.
I expect my doctors to confine comment about my life to that which is relevant to my medical condition.
We can certainly all envision scenarios where a doctor’s comment is just completely unrelated to medical welfare. Suppose my wife had her annual GYN appointment, and her GYN said, “I think you should stop working.” So my wife might respond, “Why? Is my work affecting my health? Am I exhausted? Am I bringing pathogens home?” If the doctor said, “No, I just think that mothers ought to be home with their children,” we’d write a letter to the head of his department.
Of course, this is not exactly that. This is a doctor using something unrelated to her health to badger and browbeat her into doing something that, in his opinion, she ought to do for medical reasons.
So the analogy is more like this:
Doctor: “You should stop doing S/M. It’s bad for you. Your partner might hit your kidneys with a flogger and do damage. Or you could do nerve damage from bondage. I think it’s risky.”
Me: “Doctor, I appreciate your concern, and I know all those risks. I take measures to control them. Also, what I get out of it is worth a certain amount of risk.”
Doctor: “Well, if that doesn’t convince you, then let me try this: people think you’re a disgusting pervert, and if your wife dies, you’ll have a very hard time finding someone that will tolerate your perversion.”
Of course, I’d respond to this by writing to his department head. I wouldn’t complain that he was rude — I’ve heard worse. I’d complain that he was unprofessional. If he can’t convince me to do what he thinks is healthy by appealing to my health, then he’s done his job. He does not have an open commission to use any tactic he can think of to produce the outcome he believes is best — that’s not professionalism, it’s paternalism.
This comment was written by Thomas.Report this comment to the moderators
August 25th, 2005 at 7:13 am
Telling the woman that she is fat and it’s bad for her health is valid and is a doctor’s job. Telling her that she’ll probably have a hard time establishing a relationship with someone else if/when her husband dies is true enough, but very questionable.
As far as accusations of him being “sizeist” goes, that’s not justified. If he had said, “I think fat people are unattractive”, you might have a case. But it seems he said “Other people think fat people are unattractive”, which seems true enough to me. Why that may be is another issue, but in and of itself it’s a fact and one to take into consideration under certain circumstances. But again, why he felt that talking about this was sound medical practice is definitely open to question.
This comment was written by RonF.Report this comment to the moderators
August 25th, 2005 at 7:15 am
Do you know what is really disappointing? To find that even here, at a fairly ’subversive’ site, that replies indicate how readily people buy the standard line and trust the establishment. (The same thing happened when this topic was raised at a Mensa site. Obviously IQ and ‘radical’ political alliance are unreliable indicators of an individual’s ability to think outside the template.)
Dig a little, question a little and you’ll find a dark cloud of doubt settling over the validity of the obesity hysteria. Look at who is funding the research, its design and methodology, the affiliation of those sitting on healthand reasearch boards. The, oft suppressed, studies refuting the findings. The billions of dollars of vested interest at stake in the pharmaceutical, medical and weight loss industries and the injustices committed to protect that profit. Look at our human patterns of marginalisation and our need to project our fears onto a common enemy. Any of them would suffice as a starting point. You may just be surprised by the questionable credibility ““ scientific and otherwise ““ of what the good doctor ’sayeth’.
This comment was written by Penny.Report this comment to the moderators
August 25th, 2005 at 7:23 am
I’m sort of amused by the assumption that women generally want to “get a man”. Considering the available pool of American males, their high maintenance expectations of lifelong care and lack of capacity for intimacy I’m hard pressed to understand why anyone gets married at all and particularly after the children are raised.
This comment was written by colleen.The nation is full of bitter divorced men with issues and anger management problems. they vote republican and aren’t too bright. Why anyone would want to marry one is beyond me. Perhaps women gain weight because it’s the best way to discourage the insult of being seen as a possible caretaker/wife.
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August 25th, 2005 at 7:34 am
That ‘advice’ is insulting and unnessescary.
The woman may be overweight, but she does not need to be insulted and called unattractive because of one man’s subjective view of attraction.
I’m guessing he had no research to back up his wild claim that men don’t find fat women attractive - because if he did it would be bogus - surprise surprise, they do! There are even clubs.
Besides that, on what basis did he form his assumption that she would seek another partner *if* her current one died. What a loat of hypothetical hokey.
Another thing, if her weight was in anyway related to her self esteem, being told she was essentailly fat and ugly would certainly not improve things.
This comment was written by travelling punk.Report this comment to the moderators
August 25th, 2005 at 7:44 am
I am with Colleen. The term “merry widow” was coined for a reason. The doctor’s underlying assumption that a woman is nothing without a man who is sexually attracted to her is at the core of his unprofessional comments. I wouldn’t have complained to the board. I would have either called him on it right there and then or written to him later after I had a chance to collect my thoughts. What a jerk.
This comment was written by Barbara.Report this comment to the moderators
August 25th, 2005 at 7:47 am
Thomas, very good points, but I don’t think that your S/M analogy holds up here. S/M is a positive action - like choosing to ski, or ride a motorcycle, it is a positive decision that a person makes in their own life.
Obesity, however, is often brought about by the distinct lack of a positive decision. A person may wake up one day and say, “You know, I’d like to ride a motorcycle.” If my doctor didn’t continually warn me to wear a helmet and ride safely, he wouldn’t be doing his job, which is to help me look after my health.
Nobody wakes up and says, “You know, I’d like to be dangerously overweight.” They have made other decisions in their lives, and then failed to take the proper precautions - such as portion control, or getting adequate exercise. (The assumption, still, is that the obesity is patient-controlled, as the doctor in the article feels it is in this case.)
If I raced motorcycles for fun, and kept showing up at my doctor’s office with head trauma, he would be well within his rights (I feel) to do everything within his personal power to get me to protect myself and wear a helmet. There are states where a doctor can have a person’s drivers license taken away for reasonable cause. A little rudeness seems like a less-harsh choice.
K
This comment was written by Kevin Q.Report this comment to the moderators
August 25th, 2005 at 7:50 am
Of course, Colleen and Barbara have hit the nail on the head.
And there’s also this little-known secret: fat women often *do* actually get laid! By MEN!!! Shhhhhhhhhhhhhhhhhhhhhhh!!!!!!!!!!!!!
This comment was written by Crys T.Report this comment to the moderators
August 25th, 2005 at 8:27 am
My mother (widowed thirteen years ago at the age of forty when my father died of a heart attack) would be very surprised to learn that her new husband–who she has been with for nine years now–is not sexually attracted to her because she is overweight. Perhaps the doctor is just “doing his job” by telling his patient she’s fat. Doesn’t change the fact that he’s an asshole. And completely wrong about the getting laid part.
This comment was written by Blitzgal.Report this comment to the moderators
August 25th, 2005 at 8:34 am
I’m also sort of amused by the men posting here rationalizing their obvious distaste for the appearance of overweight women with concern for their health.
This comment was written by colleen.Report this comment to the moderators
August 25th, 2005 at 8:44 am
Kevin, first, this undermines your active/passive dichotomy. You’re agreeing that continued, conscious decisions to do dangerous stuff is grounds for doctor paternalism.
Second, I disagree in substance. If I climb mountains, and I get frostbite and mountain sickness, and I make a conscious decision to keep doing it, are you really okay with the doctor’s paternalistic decision to do whatever it takes to stop me? Should he call my employer and tell them I’m at imminent risk of death or serious bodily injury, and they need to condition my continued employment on reform of my unacceptable behavior?
Of course, you say, “[a] little rudeness seems like a less-harsh choice.” I’m not sure that treating this as a matter of degree is an acceptable way to analyze this. Generally, in matters of professional ethics, gray areas are slim and bright-line rules are common. This is a matter of principle. I don’t know what the rules of medical ethics are where this guy practices, but I’m taking a position on what they should be. I’m saying that he should not be permitted, as a matter of professional ethics, to use the social, non-medical consequences of a patient’s actions to pressure the patient into changing behavior when frank discussion of the medical consequences of those actions has failed to do so.
Rejecting this prohibition opens the door for doctors to use anything to get a patient to do what the doctor thinks is in the patient’s best medical interest. But we’re all rational adults here, with a right to make our own determination about our broader best interest, which is not simply our medical best interest. If a doctor doesn’t like his patient’s surfing, and the surfer says, “yeah, I know I could be injured, or maybe even eaten by a shark, but I love to surf,” should the doctor say, “nobody is going to hire a surfer, because everyone thinks they’re pot-smoking layabouts?” If a doctor’s warning about the dangers of body peircing fail to dissuade a nineteen-year old patient, should he threaten to tell his or her parents?
Or, let’s examine the Eugene Volokh controversy in light of this discussion: should a doctor whose honest medical opinion is that gay sex for men is relatively more dangerous than straight sex tell his bisexual male patients to stick to women unless they’re really unhappy? You’d say that’s medical advice as far as I can tell. But as soon as he explains the disease transmission rates, I say he’s done. The guys can accept or reject medical advice, and apply it to their own lives. If they say, “yeah, but I practice safer sex and I can live with the risks I do take,” I say that’s the end of the conversation. I say he ought not to be permitted to say, “yeah, but you know, bisexuals are without a home among either gay or straight people, and if you don’t settle down with a woman you can’t get married, and if you have sex with men, lots of women won’t want you, and …”
Kevin, are you really okay with a doctor stepping outside the medical professional role to use social pressure to enforce his or her medical advice?
This comment was written by Thomas.Report this comment to the moderators
August 25th, 2005 at 8:59 am
Have I got this straight: she wasn’t moved to make changes when he explained the health risks she was running, so he tried to sway her by warning her she might have difficulty finding a man?
What does this say about his perception of her priorities?
This comment was written by Nick Kiddle.Report this comment to the moderators
August 25th, 2005 at 9:06 am
A nit to pick:
Thomas said:
No, absolutely not. But he would be within his rights to tell you that if you continue to mountain climb without adequate protections, that your fingers will fall off, and you’ll be unable to work. What’s wrong with that advice? Absolutely nothing. It’s true, and it’s honest. I hope nothing I’ve said would suggest that the doctor is fine going outside of doctor-patient confidentiality. And if any previous comments give that you that idea, please amend them in your head.
As far as the comments themselves, yes, I think that they are sizeist and sexist. I think he was trying shock value. Sure it was rude. That rudeness has worked for at least one patient. Nothing says that doctors always have to be polite. If she wouldn’t take his advice about her weight control, he was within his right to stop seeing her as a patient. Instead, he tried a last-ditch effort which would either wake her up, or drive her away. Or maybe do both. It’s a pity we don’t know if it worked.
Thomas, to answer your last question, I am not fine with a doctor stepping beyond the bounds of doctor-patient confidentiality, but using the tools at his disposal with that patient is perfectly acceptable by me. If that means that he tries to apply peer pressure, that’s fine. And if the patient doesn’t like it, she’s free to leave, and to tell all her friends to leave, too.
K
This comment was written by Kevin Q.Report this comment to the moderators
August 25th, 2005 at 9:18 am
Kevin, I note that you think confidentiality still applies. I raised it not because I understood otherwise, but because I wanted to highlight the sensitivity of medical ethics. I no more think a doctor can step out of his or her confidentiality obligation in my “best interest” than out of his or her professionalism obligation.
You didn’t respond to the bisexuality hypo. Is it okay to tell the patient that fucking men will make him a pariah?
This comment was written by Thomas.Report this comment to the moderators
August 25th, 2005 at 9:21 am
Kevin said:
Kevin, I was just wondering how much you’re aware of how shock value, whilst having an effect on some patients, can have an opposite effect for other patients. Do you know what negative effects on health doctors can cause by behaving in that fashion?
Furthermore, do you have any idea how much the negative effect can be on health when doctors are rude/shocking/disrespectful to fat people about their weight? Or do you think it is worth it because you think any positive effects of such behaviour are to much more advantage than the disadvantage from any negative effects?
This comment was written by Sharon.Report this comment to the moderators
August 25th, 2005 at 9:25 am
Maybe she needs something shocking said to her to wake her out of her rut.
I don’t think that has the form of a valid medical judgment.
It’s the kind of thing one thinks when judging someone as a person, not as a patient.
I don’t think it’s necessarily inappropriate for a doctor to draw conclusions about the kinds of people their patients are, but there are a lot of doctors who screw it up really badly, and so doctors shouldn’t assume that they’re good at it on the basis of being doctors, or, in fact, that they’re being doctors when they do it.
Rebecca
This comment was written by Rebecca Borgstrom.Report this comment to the moderators
August 25th, 2005 at 9:30 am
Kevin, I’m deeply worried about your posts in this thread. You are demonstrating morbid stupidity and I think you should know that stupid people will have considerably less sex than people of normal or ideal intelligence. I’m very concerned that you will never have sex again if you continue to follow a lifestyle of overignorance. People aren’t attracted to people who are morbidly stupid. You need to take action to save your life.
This case is a classic example of why fat people don’t visit doctors. The idea that this doctor was acting in his patients best interests are just not true. Doctors don’t bother themselves to learn the real facts about the supposed risks of being fat. They just parrot the company line over and over and over. This doctor suggested she go to Jenny Craig or Weight Watchers. Both of which have been attacked by the FTC for lying to the public. Want to know what Weight Watchers *brags* about when saying how effective their program is? Average weight loss of just 6.4 pounds. And that’s in research WW bought and paid for. This case just illustrates what a complete joke it is to claim concern for a person’s health. All they do is keep blowing the horn of “treatments” which don’t work. The fact that the doctors don’t care that they promoting treatments with no chance of success hardly makes them saints of pure motives. It makes them irresponsible. In this case, he took the next step and was openly rude and mean-spirited. He also made clear the true “reason” for the weight loss culture. Its a cosmetic industry, not a health care one. Even if you wish to absolve him of irresponsibly advocating treatments that don’t work, he wasn’t expressing a concern about her health. He was complaining about her appearance.
This isn’t a solitary case. Doctors do this all the time and fat patients learn to avoid doctors. Those who don’t very frequently have significant health problems go undiagnosed because the doctors are too worried about whether they’ll get some. We know lack of regular health care or adequate health care is a major health risk, and its something every fat person faces. Just one of many contributing factors routinely ignored while pumping up the still not very significant health risks of being fat.
This comment was written by BStu.Report this comment to the moderators
August 25th, 2005 at 9:43 am
Why was this asshole of a doctor so concerned that the woman might face the horrors of widowhood sometime soon ? Did he just figure that her husband must be twice as fat as she, and thus subject to keeling over aaaany minute ?
Dickhead. >:
This comment was written by alsis39.Report this comment to the moderators
August 25th, 2005 at 9:45 am
Kim:
I have to respectfully disagree with you. Bennet stated the patient refused to allow herself to be weighed in his office, so he has no documentation of her weight. Unless you’re telling me that the woman was merely overweight and not obese, let alone morbidly obese, his telling her clearly that she is grossly overweight or obese and even mentioning that her husband (who he reports is also morbidly obese) and she should expect shortened lifespans and exacerbations of any underlying medical conditions is not inappropriate unless he called her a fat cow or something similar. I have battled my weight all my life, first as an underweight scrawny kid and then, when I developed Hashimoto’s in adolescence, having to diet and exercise just to maintain being anywhere from the upper range of my IBW to being a little chubby. This year I crashed and burned health-wise and have managed to put on 60 pounds in 6 months which, much to my chagrin, puts me in the morbidly obese category. I have always been extremely conscious of the weightism in this country (even at a very normal, extremely fit and healthy weight women are viewed as fat here) and how it’s affected me personally. As a clinical researcher who used to work directly with patients (heck, even my own mother flipping when the word obese was used to describe her because she’d accept being fat but not that she is obese - and she has been morbidly obese since I was in HS), I know how they tend to ignore or argue with even the most politely put diagnoses of obesity. If the patient did not like/appreciate Bennet’s “bedside manner” (and he does come across a bit coarse IMO), she could and should have just changed doctors. If she felt a complaint to the state medical board was in order - so be it, if there are an abundance of complaints about this behavior from this doctor, they have an obligation to approach him to discuss his manner at that time. This is not, however, a case in which action was warranted unless the diagnosis was inaccurate, he used inappropriate terminology instead of medical terminology or there are a lot of similar complaints; additionally, it is not a case for the state AGs office as it has become.
This comment was written by ol cranky.Report this comment to the moderators
August 25th, 2005 at 9:47 am
Thomas, to work the article toward your bisexuality hypo, I think that the doctor’s advice was closer to: “yeah, but you know, bisexuals are without a home among either gay or straight people, and if you don’t settle down with a woman you can’t get married, and if you have sex with men, lots of women won’t want you, and …so you should join a support group for others in your same situation, so you can understand all of the facts and have someone to talk to.“
(And my assumption here is that the doctor recommends a valid support group for lonely bisexuals, not some sort of crazy reeducation program.)
He wasn’t trying to convince her to get radical surgery, or upend her life, but to take control of her actions. Moreover, your hypothetical suggests that the giving of a medical opinion and the giving of the unwanted social advice all happened in one visit. In the case we have here, he saw her 5 or 6 times, hopefully over several years. (If it was in fewer than several years, then she’s already having health problems, and needs to take control of her life.) And after she wouldn’t listen to the advice for 4 or 5 times, he tried something radical. If the first few times a bisexual man goes to a doctor, that doctor keeps trying to talk him out of sleeping with men, the patient might want to consider getting another doctor, if that advice strikes him the wrong way. If the first time the doctor meets with a patient he tries to shock him into changing his behavior, well, something else is at work there.
Now, I’m not suggesting that all doctors should try to shock their patients, or that they should do it frequently. As pointed out by somebody else, not all people are good at making the kind of judgment necessary to properly determine the outcome. And different people will respond differently to this type of motivation. I, for one, don’t respond very well to peer pressure. It tends to piss me off. I have an aunt, though, who would sooner chop off her own arm than be without a man in her life. Sad, but all people are different.
This was an extraordinary measure taken by one doctor. I think it should be neither policy, nor punishable, but one extreme tool available to trained professionals.
K
This comment was written by Kevin Q.Report this comment to the moderators
August 25th, 2005 at 9:51 am
It’s true about fat people and doctors. I read a great article about an endocrinologist at the Mayo Clinic who was conducting a study about “non-intentional” movement (sometimes called fidgeting), a fascinating subject all on its own, but one of the things he said was how many of his patients told him that he was the first doctor they ever visited who respected their dignity — like, you know, shaking their hands, offering them something to drink, looking in their eye when speaking to them, and so on. Perhaps a lot of the disrespect is unconscious, certainly. And most doctors frankly don’t have a lot to offer an overweight person in terms of a remedy and aren’t interested in really counseling. I really don’t see the point of being insulting.
This comment was written by Barbara.Report this comment to the moderators
August 25th, 2005 at 9:55 am
talk about circular logic…”people have bad attitudes toward fat people; therefore, being a fat person is bad.” sort of like “society doesn’t provide any mobility or support structure for single / teenage mothers; therefore, being a single / teenage mother is bad.”
i left a doctor because of his constant harping on my weight. i asked him on many occasions, several different ways, to either not make these remarks any more or to make them in a different way; he acted like he never heard me. it’s one thing to make the statement you feel is important as a physician; it’s another to constantly pick on someone, person-to-person, because you plain don’t like aesthetically how they look. having been in this person’s position in that way, i don’t blame her for being offended.
This comment was written by beth.Report this comment to the moderators
August 25th, 2005 at 9:58 am
Kevin, that’s a long way around to denying the hypothetical. I postulated that the doctor wants him to not have sex with men. In my hypo, the doctor fails to persuade him to not have sex with men. Then, sure in his conclusion that what he’s trying t accomplish is in the young man’s best interest, the doctor changes tactics and uses non-medical, social stuff to brow-beat the guy into having sex only with women. You’re recharacterizing the hypothetical to say that the doctor wants him to feel supported. That’s not the hypo I presented.
If I were to recharacterize the facts of the post the way you recharacterized the hypo, it would look like this: Doctor tries to convince overweight patient to lose weight, citing medical concerns. She declines to lose weight. Concerned with the social condition her weight will cause, he asks her to join a fat-acceptance group to find men who are not averse to overweight female sex partners.
That’s quite a difference.
I’m not talking about whether shock as a tactic works. I’m not talking about how hard he tried. I’m talking about a very specific principle: whether a doctor, having tried and failed to convince a patient to do the healthy thing for health reasons, should be permitted to use social pressure to overcome the patient’s resistance.
This comment was written by Thomas.Report this comment to the moderators
August 25th, 2005 at 9:58 am
This doctor suggested she go to Jenny Craig or Weight Watchers.
Haven’t several Jenny Craig customers died while on that program? I’m glad that this MD had his patients health as his priority.
This comment was written by Jake Squid.Report this comment to the moderators
August 25th, 2005 at 10:02 am
I love the constant assumption by people like Kevin that body fat is a clear indicator that one is unable to “take control.” What does “control” mean in this context, anyway ? Sure, there are people who overeat, but not all of them are fat. (The reverse is also true: Some fat people don’t overreat, and it’s been pointed out here more than once that some fat people enjoy exercise, even knowing that it will never make them skinny.) Furthermore, it’s a strange sort of assumption to imagine that if a person enjoys a bowl of ice cream (not yoghurt) and a brief walk around the block (not pumping iron) there’s something inherently “out-of-control” about their own mental process. Isn’t that just a more sophisticated way of saying “fat” = “crazy ?” You know, because only a crazy person would choose ice cream over yoghurt when yoghurt could make her skinny. Please.
This comment was written by alsis39.Report this comment to the moderators
August 25th, 2005 at 10:15 am
BStu, I didn’t see your post before my last reply, or I would have included this in there. I have a friend (anecdotal evidence, I know) who lost 120 pounds on Weight Watchers. And make no mistake, she lost this weight only because she wanted to. There are many ways in which she could have chosen to lose that weight, including surgery. But she chose the way that gave her the most information about her life, and the tools necessary to control her life. She started eating in smaller portions, she started getting more exercise. She’s still “overweight,” but she’s no longer at such high risk for developing diabetes or having a heart attack.
You also make alot of noise in your post about doctors not knowing what’s right for their patients. (”Doctors don’t bother themselves to learn the real facts about the supposed risks of being fat..”) I fully believe that patients should be well informed and do research, and feel comfortable enough with their doctor that they can bring in a study and say, “You know, I read this, and it goes against what you’ve been telling me. Can you explain it?” And if your doctor ignores your questions, or doesn’t give a satisfactory answer, find another doctor. But when people just start saying “I know more than trained professionals because of what some guy said on the internet,” well, I lose a little bit of patience. It’s the same argument the Intelligent Design people are making: We know more than the trained professionals, because of something we read on a website.
It’s the internet, for crying out loud! I can find a website that says almost anything. And I’m not a doctor, so I can’t read medical websites and expect to understand what they’re saying. I might be able to follow the logic, but that doesn’t mean that they don’t start with an illogical assumption, which I might catch were I trained, but I’m not, so I wouldn’t.
What I’m trying to say is this: We have medical schools so that a few people can become experts in the field and help the rest of us out. If we don’t like the advice, we’re welcome to go to school and become experts ourselves, so that we can offer our own advice or do our own research. But until we do that, we should trust the experts, and consider doing what they suggest. But if we don’t like it, it is always our decision to not follow the advice, or to find another doctor.
K
This comment was written by Kevin Q.Report this comment to the moderators
August 25th, 2005 at 10:20 am
Alsis39, I am making the assumption about the controllability of her weight because that is the assumption the doctor was making. If he felt that her weight was caused by something out of her control, he wouldn’t have suggested “… you need to get on a program, join a group of like-minded people and peel off the weight that is going to kill you.” He would have suggested radical surgery.
K
This comment was written by Kevin Q.Report this comment to the moderators
August 25th, 2005 at 10:29 am
I’m making the assumption that the doctor’s assumption may well have been wrong. If you read some of the fat-friendly links here, you’ll probably notice the fallacy of the assumption that fat people are all gorging on Big Macs in front of the TV. (And that, by extension, there are no skinny people who do the same.) You can, of course, dismiss this by saying, “It’s just the internet,” if you wish.
I continue to puzzle that you don’t think the doctor’s threat that a fat woman can’t expect to find a sex partner to be a particularly extreme response. That seems plenty extreme to me. The suggestion of surgery would simply compound the extreme cruelty already inherent in the approach.
BTW, it’s not just whether your friend took off 120 lbs. that determines a supposed successful outcome with WW. Most fat folks will concur that weight loss plans can make you lose weight, but that’s only half the equation. The other half is whether the weight stays off forever– or comes back the minute the person is unyoked from the rigid controls of the plan.
This comment was written by alsis39.Report this comment to the moderators
August 25th, 2005 at 10:51 am
>>Thomas, to work the article toward your bisexuality hypo, I think that the doctor’s advice was closer to: “yeah, but you know, bisexuals are without a home among either gay or straight people, and if you don’t settle down with a woman you can’t get married, and if you have sex with men, lots of women won’t want you, and …so you should join a support group for others in your same situation, so you can understand all of the facts and have someone to talk to.”>>
Most support groups for bisexual people are designed to assist them in being bisexual. They facilitate bisexual relationships and help bisexual people solve related problems. “Support groups” for overweight people, on the other hand–like Jenny Craig and Weight Watchers, which have AlAnon-style meetings–are designed to discourage people from remaining overweight. They facilitate weight loss. The reference to a “program” makes it clear that the doctor was referring to groups like this, not to NAFTA. So, no, the analogous recommendation wouldn’t be to join a support group for bisexual men. The analogous recommendation would be to join Exodus.
And if a doctor suggested that to me, or suggested that not only that being bisexual might complicate my romantic life but also that being bisexual necessarily makes romance scarce, and that I should therefore consider not being bisexual, I would report him immediately.
This comment was written by piny.Report this comment to the moderators
August 25th, 2005 at 12:17 pm
And jesus, even without the dodgy psychological implications of this moron’s approach, it’s pretty common knowledge that the sort of weightloss techniques pushed by Jenny Craig et al. are unhealthy in and of themselves (eg, the food you have to buy for the Craig system is loaded with sodium, low on fibre, etc.), and so in no way promote the general idea of health.
This is about women being aesthetically pleasing to men, and has absolutely fuck-all to do with their physical well-being.
This comment was written by Crys T.Report this comment to the moderators
August 25th, 2005 at 12:57 pm
I have to disagree with this “doctor”. It is his job to fix her medical problems, not to sermonize about her lifestyle. This woman needs to remember that the “doctor” [and other professionals] works for her, and not the other way around. FIRE HIM!!!
This comment was written by Ted Mc.Report this comment to the moderators
August 25th, 2005 at 1:22 pm
How is not getting laid detrimental to her health? Even if it was true, which isn’t guaranteed.
This comment was written by Nella.Report this comment to the moderators
August 25th, 2005 at 2:06 pm
Crys, I was focused on my other point, though what you and others have said about women’s weight and sex is right. I’d love to see a study that examined women’s access to sexual partners and controlled for self- esteem.
I’ve had partners from about 100 lbs to probably about 300 … and I’m not even in that subset of people who prefer rubenesque partners. (I’m more like neutral on body type — it’s a small factor that I’ll overlook for chemistry and similar taste in sex.) As far as I can tell, overweight women who are confident and actively looking for sex don’t have that much trouble getting laid.
This comment was written by Thomas.Report this comment to the moderators
August 25th, 2005 at 2:20 pm
When I see a Dr. I want to be appraised of the medical issues and some options for treatment, or the effect of not treating them. I am responsible for my life and my choices on how to live it and deal with it are my responsibility. The Dr. as has been mentioned dumped a lot of his baggage on her, the assumption that she would need a man, or want a man. The assumed inability for her husband to affect change if he wanted or needed to. (the stress of telling someone they love is going to die, what is up with that?) The assumption that it would be her appearance that allowed her to have a relationship, and no one would want her. That she was not intelligent enough to realize what her life choices could bring. The big stick approach is always available, however people usually listen when they hear that someone is compassionate. I recently posted that I usually look for a female GP when I move, add this to the list of positives. Blessings.
This comment was written by Rock.Report this comment to the moderators
August 25th, 2005 at 3:24 pm
I’m surprised all those websites that claim excessive hairgrowth in women can be a sign of ovarian cysts are still up. I mean how dare they suggest that being a hairy woman might in any way be bad!
It’s sad that a real health issue has somehow gotten entangled with feminist body empowerment.
This comment was written by picomoo.Report this comment to the moderators
August 25th, 2005 at 3:51 pm
Yeah, because what could be more “unreal” than women being treated with respect ? There’s simply no way that either misogyny or fat-phobia could have crept into the hallowed halls of medicine to influence the views of creeps like this doctor. Doctors are above all that. Ho hum.
This comment was written by alsis39.Report this comment to the moderators
August 25th, 2005 at 4:02 pm
>>I’m surprised all those websites that claim excessive hairgrowth in women can be a sign of ovarian cysts are still up. I mean how dare they suggest that being a hairy woman might in any way be bad!
It’s sad that a real health issue has somehow gotten entangled with feminist body empowerment. >>
Would you have much sympathy for a doctor who told a woman that she should go on the pill to get rid of extra hair from a benign hormonal difference because she’d have better luck getting a man?
This comment was written by piny.Report this comment to the moderators
August 25th, 2005 at 4:03 pm
Picomoo, are you sincerely saying you can’t see the difference between discussing health issues related to appearance, and taking liberties professionally with regards to those health issues to discuss social issues related to appearance?
This comment was written by Kim (basement variety!).Report this comment to the moderators
August 25th, 2005 at 4:19 pm
KevinQ: Alsis39, I am making the assumption about the controllability of her weight because that is the assumption the doctor was making.
Actually, according to what’s being reported (usual caveats about accuracy of media) the doctor has a standard ” obesity lecture for women” that assumes (a) all his fat female patients are heterosexual and (b) all of them will be desperate to get a man.
My brother’s a doctor. I’d started a new job and was complaining of back pain. He told me - it was plainly, from his tone of voice, a “standard obesity lecture” that the reason I had back pain was because I was too fat and I had to lose weight.
I told him that if my doctor had told me that, I would have walked out of his surgery, or at least wanted to. Because it was absurd: I was overweight, but I’d had no sudden weight gain: I was pretty much the same weight I’d been for years. Therefore, if I suddenly had back pain, it wasn’t anything to do with being overweight: it was to do with some other environmental factor, and what he was suggesting was just stupid.
As it happened, I needed to reposition my computer monitor about four inches to the right. I did that, and the back pain went away. I didn’t lose weight.
This comment was written by Jesurgislac.Report this comment to the moderators
August 25th, 2005 at 4:29 pm
Kevin Q: If the good doctor had left his comments to what is medically known about links between obesity and disease, it’d have been one thing. Who the hell elected him to be this lady’s Dutch Uncle? It reminds me of rather nasty incident concerning a beer-swilling lout on a San Francisco bus many years ago; the driver informed him that he was allergic enough to alcohol even to become ill at the smell of it (a doubtful premise, if you ask me). When the driver stooped to telling Mr. Lager Lout about the evils of alcohol—during rush hour, mind you—I couldn’t contain myself and pointedly told him that if we wanted a lecture, we’d have gone to a temperance meeting. Everyone cheered.
This comment was written by DP_in_SF.Don’t get me wrong; I close my ears to the small tandem of fat activists who seem to think they’re owed a romantic life. But this woman came in for medical advice, not life coaching. The doctor should be disciplined severely.
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August 25th, 2005 at 4:32 pm
That reminds me very much of a problem my mum had with one moron doctor. Her complaint was anaemia, and the doctor’s snap diagnosis was heavy periods caused by her IUD. Which, say along with me, she’d been using for years with no noticable increase in periods and perfectly normal iron levels.
There are some doctors who seem to believe that what they conclude in two seconds of rapidly scanning a patient’s notes outweighs anything the patient can actually report.
This comment was written by Nick Kiddle.Report this comment to the moderators
August 25th, 2005 at 4:41 pm
I was overweight, but I’d had no sudden weight gain: I was pretty much the same weight I’d been for years. Therefore, if I suddenly had back pain, it wasn’t anything to do with being overweight: it was to do with some other environmental factor, and what he was suggesting was just stupid.
That’s a logical fallacy. I’ve been neglecting my roof for years, but it hasn’t leaked yet. If it suddenly starts to leak, it isn’t anything to do with my neglect: it must be an environmental factor. Right? No, obviously not; some negative effects take time to become problematic. I can start smoking today, and I’m unlikely to have lung cancer by tomorrow.
You alleviating your back pain by moving your computer monitor did indeed solve the problem. You changed the stresses being put on a damaged component, and reduced the level of stress to something that doesn’t cause pain - just as me wrapping a tarp over my roof will “solve” my leak. But my roof is still shot, and your back is still damaged from carrying too much weight.
(Assuming that your back is damaged, of course. I don’t know, and your brother probably doesn’t, either. But his hypothesis isn’t stupid; he’s advising you to fix the roof, rather than going to Wal-Mart every year for a new tarp.)
This comment was written by Robert.Report this comment to the moderators
August 25th, 2005 at 5:20 pm
That doesn’t change the fact that it’s irresponsible practice of medicine to blame all ailments on obesity or excess weight that could be related to excess weight. That in fact, to my way of thinking, is extremely irresponsible medicine.
Regardless, I still boggle at this doctors feeling that he is entitled to inject his personal social commentary into what should have been a strictly professional visit.
I don’t know about severe punishment, but I definitely feel it’s worthy of an enforced class on professional behavioral ethics and / or a fine for the ethical slip.
This comment was written by Kim (basement variety!).Report this comment to the moderators
August 25th, 2005 at 5:31 pm
Its only a logical “fallacy” Robert if you presume that being fat is an act of neglect and therefore must always likely be wrong. Your prejudiced thinking is a risk for precisely the reasons indicated. Her back problems were NOT a result of her size. Therefor focusing on weight loss as a remedy would have neglected her health. This is the thinking so many doctors employ which has the effect of denying fat people proper medical care.
Your logic only works if you accept an unsupported claim that fat is fundamentally unhealthy. Your logic only matters if you accept that there is a safe and effective treatment for being fat. Neither of which is true.
This comment was written by BStu.Report this comment to the moderators
August 25th, 2005 at 7:08 pm
I can imagine some situations in which the doctor’s behavior might have been appropriate. The woman could have been raised by wolves and still new to human society. Or maybe she’d recently moved here from from some forgotten island. Or perhaps she’d recently emerged from a coma she’d been in since early childhood. If any of those were true, then the doctor might reasonably have expected his “obesity lecture” to be helpful.
Otherwise, it’s hard to know what was going through his mind. Did he really believe his obese patients didn’t already know that society often measures attractiveness by body weight? Didn’t it occur to him that they hear that message from tv, magazines, movies, etc. on practically a daily basis? None of that had motivated them to lose weight, so what made him think that hearing it from him would make a difference?
This comment was written by Another Beth.Report this comment to the moderators
August 25th, 2005 at 7:49 pm
Piny,
A fair comparison would be a case of a non-benign hormonal imbalance. Of course I’d think it very weird that the ‘health risk’ part is not enough, and there’s a need for a ‘looks better’ argument.
Kim,
This comment was written by picomoo.There is such a thing as ‘quality of life.’ If the doctor told her ‘oh, you’re fat, ugly, and you’ll never get laid’ that’s one thing and I agree, that’s unprofessional. If he told her (as he claims he tells all his obese patients) that statistics for obese people show that they die earlier and have a harder time finding sex partners, that’s different. I mean he could have told her it’s because obese people have lower sex drives (for example http://abcnews.go.com/Health/Healthology/story?id=267395,) is that sizeist too?
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August 25th, 2005 at 9:05 pm
Picomo,
The situation with the fat and doctors is not really analogous to a webpage saying “excess” facial hair may be a sign of PCOS, because those webpages allow that the facial hair may have another cause (like genetics). A better comparison would be to having all women who have more-than-average facial hair get screen for ovarian cysts when they walk in complaining of neck pain and have no other symptoms of PCOS. Some doctors will tell even average-sized women they need to lose weight.
I had a doctor tell me since I wasn’t within the chart’s recommended weight (I was in the yellow range, not even the red , and I wore a 12 at the time) that I needed to lose weight. Not only that, but she told me I should do it by cutting back on bread. She did not ask me what I ate in a typical day or ask me about my exercise habits before she offered advice on how to lose weight. I went in for a routine physical, a TB test, and some supplemental immunizations so I could go to college, not for weight management counseling. Now, I can say my experience was not the worst reported: at least she didn’t tell me I should lose my chunky ass so I could find a man! I cannot imagine what she might have said to me if I had been much above average.
This comment was written by Denise.Report this comment to the moderators
August 26th, 2005 at 12:26 am
I need to preface my comments with my following opinion as a dialysis nurse: obesity IS linked to chronic pathological disease. High blood pressure, diabetes, heart disease, etc. Not that everyone who is fat is going to get these conditions, or that everyone who has any of these conditions is obese. (One can say that smoking is linked to lung cancer in a similar way.) There is a vast difference between obesity and fat. I, on the other hand, do not really understand why the BMI number for obesity keeps getting lower. However, the literature is strong. There was a recent study that negated this accepted finding, but that study was shown to be biased. I can only go by what the majority of research suggests.
I can certainly understand the patient’s frustration with the doctor’s comments. However, I can also understand the doctor’s POV. As her physician, she is paying him for his medical expertise and advice. This includes advice that some people may not want to hear.
Was what he said offensive? Surely. He should not have used those comments. On the other hand, I sometimes use scare tactics when my noncompliant patients do not listen to the usual “you should…, you shouldn’t…” lines. To the outside listener, it would seem fairly offensive when I tell patients they are basically putting themselves in the hospital or are shortening their lifespans due to their choices. But I also tell them that I consider healthcare a team sport, and I cannot effectively do my job (help keep them alive and well) unless they do their part. It is my responsibility to teach them how best they can stay healthy based on current medical literature, but I can only do so much as a healthcare provider. I cannot personally make sure that they take their medicines, avoid drinking a lot of water, or come to treatments.
I realize the advice I give is easier said than done. It is hard to avoid certain foods that previously were deemed healthy. But my patients are at risk for things such as heart attacks, pneumonia, osteoporosis, and death if they do not heed me. This overweight woman has the potential to be seen in my clinic (from diabetes or HTN) if she does not heed the doctor.
As I need to do my job, I need to do so with tact. The stable and secure client relationship is critical in this area. If I think the patient will respond with offense or contempt, the patient will not heed my advice. But if the patient realizes that I am relaying this particular educational tidbit because I care about him or her and am not being personally judgmental, it usually goes over better. I need to know the patient, and the patient needs to know me. The goals are compliance and health.
Without knowing more about the particulars of this case, I feel that the doctor did not establish a good rapport with the patient before this event. However, I do feel that he had the patient’s best interests at heart, and the patient probably felt overly defensive about her weight. He did apologise. If she didn’t like his advice, she could have accepted the apology and found another doctor.
This comment was written by natural.Report this comment to the moderators
August 26th, 2005 at 4:35 am
Yes she could have, natural, but that smacks of, “Let the fat person just shut up and take her medicine.” What he said was offensive - “surely” - and the complaint is valid.
The bad thing is that this type of thing happens all the time, everywhere. Doctors often use questionable tactics to “scare” fat people into not being fat. With this situation, a person finally called a doctor’s bluff - finally - which is a pretty courageous act. Just sitting back and taking it is really something that shouldn’t be condoned when a doctor is trying to “treat” one’s size instead of treating one’s health issues.
If a doctor takes a few minutes to read the latest studies from, well, anywhere, it’ll paint a really bad picture for fat people. But what’s worse is the unquestioning nature of not just the media, but some (many?) doctors as well. When there’s a study coming out saying, “Oh yeah, fat people have low sex drives,” I’d be thinking about it critically. 9 times out of 10, there is something about the study that makes its validity - at least, from a non-statistical angle - questionable. Like, say, the maker of a new sex-related drug sponsored it.
In Canada, recently, a study found that people surveyed thought fat people should pay more for insurance. 54%, in fact. But the study was funded by Aventis, the third-largest drug company on earth, on the eve of… yes… their new anti-fat weight-loss drug! Sometimes it’s simple to connect the dots, sometimes it isn’t, but doctors should try. And if they’re just surveying headlines, then they don’t have the whole story.
Fat people have been steamrolled for too long on this issue. Nearly everyone who is fat has a story about how a doctor did him or her wrong, and declared Imminent Death by Fat.
Ultimately, doctors are people too - not gods. It’s up to patients to take their input critically and thoughtfully, but when it becomes a personal barb, the line has been crossed.
This comment was written by Paul.Report this comment to the moderators
August 26th, 2005 at 5:38 am
Because he’s a doctor, and doctors’ words are the next best thing to Holy Writ.
OK, not all doctors think that way, but a disturbing number of them (well, more than zero would be a disturbing number) seem to.
This comment was written by Nick Kiddle.Report this comment to the moderators
August 26th, 2005 at 5:53 am
Sorry I stopped responding yesterday. I started getting WordPress errors when I loaded the site, and then, well, I just sort of lost momentum. Good arguments, though - some of you are really good at that. Though a few of you need to work on your non sequiturs and ad-hominems.
K
This comment was written by Kevin Q.Report this comment to the moderators
August 26th, 2005 at 6:10 am
Natural, you have your facts wrong. You say:
But this is wrong. The post notes:
So the medical board thought he should apologize. And what was his response? To refuse, saying he was right.
So that dispenses with your misconception that he was sorry for what he did.
I want to be clear here. I Do Not Give A Rat’s Ass if his advice that this patient shoudl lose weight is correct or incorrect. I don’t know her case or the research well enough to contest the doctor’s view.
And I don’t give a rat’s ass if he was “rude.” Keeping me in the waiting room without telling me why the doctor is running late or how many patients are ahead of me is rude. That’s not what we’re talking about.
We are talking about whether it ought to be a violation of this physician’s ethical obligations that, having failed to get a patient to do what is in her medical best interest, he steps outside his medical competence to express a view (uninformed) about the social circumstances of her life.
This is not about her right to walk out– which everyone recognizes. This is about what professionals can and cannot do. I’m a lawyer, and in my profession, we do not make statements outside our area of professional expertise to get our clients to do what we think they should do. If clients reject our advice, we live with our limitations. This doctor seems unwilling to accept the limitation that he is a professional serving a client, and not her paterfamilias.
This comment was written by Thomas.Report this comment to the moderators
August 26th, 2005 at 6:22 am
Same reason every fat negative person thinks it’ll make a difference when they belittle someone for being fat. They assume we haven’t heard that we should hate being fat. Indeed, for the vast majority of fat people, they are incorrectly assuming they don’t already hate being fat. These people think everything is so simple, so they treat fat people like idiots for allowing themselves to be fat. Its paternalism, plain and simple. They just assume fat people don’t know any better by virtue of us being fat.
Look at the subtext of natural’s post. Her attitude while quickly dismissing the argument that fat isn’t as bad as its made out to be treats the suggestion as absurd. It wouldn’t surprise me if she is one of the many people who see fat people as all desperately looking for excuses to stay fat. An idea so profoundly out of touch with reality as to make me wonder if those who believe it really have every met a fat person.
Its what natural omits that is important. She says fatness (I refuse to use the dehumanizing term “obesity”) is linked to a whole host of diseases. Her choice of words is significant here. “Linked” isn’t a medical or statistical term. That’s because the only technical term that could be used is one everyone knows to be weak. Fatness has been correlated to those diseases. It hasn’t been shown to cause them, so natural’s whole “not everyone who is fat will get them” is an unfounded way of insinuating that even some fat people will get those conditions because they are fat. We simply don’t know that. All we have are correlations. Now, is every disease correlated with fatness? Not at all. What many who point to correlations as if they prove their point fail to mention is that there are a host of diseases correlated with thinness. Indeed, one of the diseases natural claims fat people are at risk for, osteoporosis, has been shown to be a reduced risk to fat people. By extension, this means its an increased risk for thin people. Why is it deadly proof of the evils of fatness, but not worth consideration for thin people? Same reason the CDC is choosing to ignore that their own data says that “normal” size people aren’t as healthy as “overweight” people. Because they simply won’t consider the notion that thin isn’t perfectly healthy.
Concerning those correlations, it is important to control for other factors which could cause those conditions. This would be more helpful in identifying who is really at risk so achievable prevention can be attempted. But do researchers control for, say, weight cycling? The almost inevitable result of dieting which has itself been shown to cause many of these same problems? Nope. How about fitness level, since many studies have shown fat and fit is substantially healthy and other studies that show that fat people can make major improvements in their health and fitness without losing weight? No, not that either. Any factor which might suggest weight loss isn’t the best course of action isn’t considered. Any guesses why?
The fact that the diet industry funds a lot of this research can’t hurt. Probably more notable is that the vast majority of the researchers are “experts” in weight loss. Not exactly going to be interested in devaluing their expertise, so they case a wide net without regard for whether it paints an accurate picture of risks. After all, if they couldn’t justify the health benefits of weight loss, they quickly cease being doctors and become cosmetologist experts instead.
Indeed, as some skeptical researchers have discovered, if you don’t promote weight loss, you cannot be considered an “obesity” specialist. The entire profession is self-sustaining and should be looked at with a very healthy dose of skepticism. When natural quickly dismisses a statistical analysis as being “biased” without explaining why, it makes me laugh. The whole of “obesity” research is based on assuming weight loss is the answer. Is it any surprise that their research can be made out to support this? Even so, the research is frighteningly weak given how obvious it is assumed to be. The health risks are relatively slight and completely out of proportion with the measures taken against them.
But then comes the next question. Is weight loss effective at reducing these risks? That hasn’t been shown to be the case. Simply put, even if fat people were shown to be less healthy than thin people, that doesn’t mean a fat person who has lost weight is as healthy as thin person. Research hasn’t shown this to be true and a lot of studies indicate that its actually false.
But say that it is shown that weight loss is a benefit. Does that make it an achievable treatment? Maybe my health would be better if I was 6″ taller. Doesn’t mean its worthwhile for a doctor to berate me about not being taller. The fact is, weight loss has a record of extreme failure. Upwards of 95% is the figure accepted by government officials who are no friends of fat people. What’s more, 90% of failed diets have been shown to result in more weight being regained than was lost to begin with. This is why some have suggested that the leading cause for fatness is dieting. Children begin the cycle of yo-yo dieting at younger and younger ages. They are being started on path that will push their weight higher and which has been shown to be independently healthy. Not only is this a “treatment” that hasn’t been shown to work, its actually been shown to be genuinely detrimental to a person’s health.
Why is it the treatment to begin with, though? Have fat people been shown to eat more than thin people? That would seem to be the only assumption that could justify restricting food intake. Yet, it hasn’t been shown. The research suggests that while some fat people overeat, others undereat. Neither of which is at a proportion significantly different from thin people. Yet, all treatments of fatness assume that fat people aren’t eating healthy. Some might not be, but there is little reason to assume that it is causing their fatness.
The whole of the medical establishment’s case against fat people is built on one unsupported assumption after another. The fact that the folks writing the press releases and doing the research have a major vested interest in maintaining the status quo makes it no surprise that they look at this mountain of unfounded allegations and see conclusive proof that no one may argue against.
This comment was written by BStu.Report this comment to the moderators
August 26th, 2005 at 8:15 am
Denise,
I don’t know your medical history. If you are a healthy size 12, a pear and not an apple:), did not go up 4 sizes in a year, excercises, and all that good stuff, then yeah, I’m not sure where she was coming from. Did you ask why she thought you should lose weight?
The woman in question, however, was, allegedly, obese. And I would rather 100 overweight people get offended by their doctors telling them to lose weight than one overweight person actually die because he or she did not get information about the dangers of being obese and on how to deal with this condition.
This comment was written by picomoo.Report this comment to the moderators
August 26th, 2005 at 8:17 am
Thomas,
This comment was written by picomoo.In the original article it say he wrote the woman a letter of appology. Does she dispute this?
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August 26th, 2005 at 8:33 am
I heard the doctor interviewed on the radio yesterday. He said nothing about telling her fat widows don’t get mates but he did say that this woman was coming into his office all the time, asking to be seen by specialists and for tests to be done. If he said that about fat women not getting men, it was unprofessonial. But a doctor telling a patient that she should lose weight in blunt terms doesn’t sound outside the realm of his duties to me. We had to ask a doctor to be blunt with my father about his drinking. They often have to tell geriatric patients it’s dangerous to keep driving. It’s part of their job.
I accept that experts have an “anorexic mentality” when it comes to fat. They will call anyone overweight who doesn’t have a very low BMI (I’ve read that President Bush is overweight by some standards). But if you’re trying to sell me the idea that being 50 pounds or more overweight is not generally a bad thing for a person’s health, I’m not buying it. It’s not about not wanting to defy experts, its about not wanting to defy common sense.
This comment was written by Elena.Report this comment to the moderators
August 26th, 2005 at 9:47 am
>>Thomas,
In the original article it say he wrote the woman a letter of appology. Does she dispute this? >>
This was almost certainly _after_ she filed the complaint. He has also refused to acknowledge that he made a mistake, which makes one wonder what this apology consisted of:
>>A settlement agreement was proposed that would have had Bennett attend a medical education course and acknowledge he made a mistake. He rejected the proposal.
“I’ve made many errors in my lifetime. Telling someone the truth is not one of them,” Bennett said.>>
This comment was written by piny.Report this comment to the moderators
August 26th, 2005 at 10:00 am
Picomoo, I’m not sure what he alleges that he apologized for, because he refuses to acknowledge that he did anything wrong. If the apology was, “I’m sorry you feel that way,” or even “I’m sorry I was so blunt,” that’s no apology at all. What he needs to apologize for is what he did wrong: departing from his role as a professional, and instead making social commentary to browbeat a woman who failed or refused to heed his medical advice.
This is not about bluntness or rudeness. Rude is, “Hey! I keep telling you to lose weight or you’re going to keel over and fucking die! Are you trying to kill yourself, or are you in denial? Get your head out of your ass and take care of yourself.” That deserves an apology: “gee, I kind of lost my temper. I’m worried about you, and I’m not sure if you’re ignoring my advice or you just don’t want to make the changes you need to to be healthy. But I’m sorry I yelled at you.”
I’m not talking about that. I’m talking about using something outside the realm of the doctor’s professional competence to pressure the patient. That’s not rude, and it’s not okay no matter how kindly he phrases it. I’m saying it ought to be treated as a violation of his medical ethics.
This comment was written by Thomas.Report this comment to the moderators
August 26th, 2005 at 10:01 am
Thanks for showing us all why it is so difficult to achieve progress on fat issues, Elena. Your fingers-in-your-ears, “I’m not listening” approach is indeed precisely how most people see the issue. Doesn’t matter what anyone has to say. You’ve gladly allowed prejudice to be elevated to the status of “common sense”, so you feel that means you can shut down your brain and just belittle anyone who comes along. The marketing of the weight loss has been so effective that they’ve made aggressive foot-soldiers out of people who have no stake in the issue. Why? Well, its just “common sense,” of course. Everyone knows you’re supposed to hate fat people. What’s wrong with these stupid fatties not getting the message. Better tease them about how they’ll never have sex. That’ll learn ‘em.
This comment was written by BStu.Report this comment to the moderators
August 26th, 2005 at 10:26 am
Elana, it’s common sense that women can’t be policemen or firemen. That is, it was, within living memory.
It’s common sense that black people are not the equals of white people, according to first Justice Harlan (the guy who dissented from Plessy v. Fergusson and believed separate was inherently inequal). That was common sense a hundred years ago.
“common sense” seems, historically, to mean “unexamined widely held belief.” It doesn’t always hold up well.
This comment was written by Thomas.Report this comment to the moderators
August 26th, 2005 at 11:08 am
Kevin wrote (back in comment 30):
How can fat people possibly manage to be comfortable with discussing such issues with our doctors when they continually lecture us, belittle us, disrespect us, treat us as if we were ignorant, foolish and lacking in any kind of determination or wish for good health?
I can’t speak for any other fat person, but I consider myself lucky if I manage to get out of a doctor’s office without breaking down into incoherent floods of tears.
They are almost all like that. “find another doctor” is so easy to say, but so difficult in practice. Once I did find a doctor who would actually discuss what I came in to discuss (a little dermatitis) and treat what I’d come in for. I was extremely upset when this doctor moved away.
Firstly, bear in mind that some of us read actual research papers on the subject, don’t just assume that non-doctors get their information from the web. Secondly, doctors know more about medicine than we do, but we know way more about our own bodies than they do. And thirdly, given how keen doctors are to push treatment that most people find impossible in the long-term, it’s pretty clear that they don’t know much about improving the health of fat people.
Hint: it IS possible to help fat people to better health. Many research studies have shown a lot of ways to do this. A focus on weight loss is not one of those ways. Lecturing fat people is also not one of those ways.
This comment was written by Sharon.Report this comment to the moderators
August 26th, 2005 at 11:14 am
For the record, I do not hate fat people. I do not necessarily blame fat people for being fat. Reread my post. I did not say that obesity did not cause osteoporosis (noncompliant renal disease does).
My point to explain renal disease is to explain my position on this subject. I am sorry I was not more clear. It does not matter to me how my patients lost their kidney function (although uncontrolled diabetes, uncontrolled HTN, and persistent drug abuse are some common causes). It does matter to me that they are here, in the clinic in which I work. I try to ensure that they live long and healthy lives from this point on, considering the damage that has alrady been done. I am not judging them. It is the same for me for obese clients who come to me for my medical opinion (as a nurse).
Thomas, linkage means correlation. I thought I made myself clear that the literature has not proven causation. Most literature has not proven that smoking causes lung cancer. But they can be linked. Obese people do get HTN and diabetes and joint problems. So do people of normal weight, but I am talking risk factors. Obesity puts an additional strain on the body.
I am not trying to defend the doctor’s specific comments. I think that they were out of line. I am defending his ability to warn the patient of her additional risks by staying at a clearly unhealthy weight. She went to him with a problem, and it was his medical responsibility to try to get her to understand what she could do to help herself. He went about it in the wrong way. As I said, a similar piece of advice with more tact could prove more meaningful.
This comment was written by natural.Report this comment to the moderators
August 26th, 2005 at 11:57 am
Natural, the linkage vs. correlation issue was not my issue.
As to “tact,” however, I think you’re still not getting my point.
You say:
But he did not just “try to get her to understand what she could do to help herself.” Instead, when she ignored or rejected his medical advice, he stopped practicing medicine and began to do something else.
This is not about rudeness. This is about the kind of expertise he purported to have. It’s as if a lawyer were counseling a client about how to avoid liability exposure, and when the client ignored or rejected the advice, the lawyer took it upon himself to play the role of a priest, and say, “well, if you won’t do what I say for legal reasons, you should consider that if you don’t, you will burn in hell.”
This comment was written by Thomas.Report this comment to the moderators
August 26th, 2005 at 12:38 pm
Thomas,
The doctor claims he apologized when he learned she was offended, whenever that was.
As for his medical ethics, I’d say getting your patient to treat a potentially deadly condition trumps most other things.
I know there are any numbers of research papers out there on the quality of life of patients following mastectomies for example. Incuding how well these women can resume their social and romantic lives.
This comment was written by picomoo.Such research has been done for obesity as well, and shows what the doctor told this woman re: romantic relationships. So he is telling her information that is in fact within his realm of expertise, as it’s published in medical journals.
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August 26th, 2005 at 12:40 pm
My point was that using “linked” in place of “correlation” was a way of minimizing the notice people would make that its not causation. People know what correlated means. Linked has a more loose meaning and can be easily construed differently than correlated.
And all those correlations are meaningless if there are other factors that can be more directly linked to the conditions. Studies have shown that fat people’s heart disease and diabetes risks can be significantly reduced through small lifestyle changes that are unlikely to significantly impact weight. That tells us that lifestyle is something worth focusing on. Not weight. It also tells me that the medical establishment’s single-minded focus on weight could actually be the cause of these health problems. If a fat person engages in a healthy lifestyle, but finds that their weight isn’t significantly impact, they are at risk to presume their efforts are failing and either “give up” or attempt riskier measures more likely to produce weight cycling. Why wouldn’t they feel this way? If weight is what they are told they must change, of course they’d see these healthy steps as being worthless. The medical obsession with weight loss is hurting people’s health and that needs to be said.
This comment was written by BStu.Report this comment to the moderators
August 26th, 2005 at 2:35 pm
Thomas and BtSu, you’ve lost me. I’m not going to dignify the insinuation that I think it’s ok to hate fat people with a defense. Nor that I am not intelligent enough to know that prejudices and assumptions should be examined. Please.
That being overweight can be a manisfestation of an unhealthy lifestyle or can contrubute to health problems is a sensible point of view. I won’t assume you are intelligent enough to assume that this point of view doesn’t have to be demeaning to people, or excludes other ways people can be unhealthy or that being fat always makes you unhealthy, so I’ll say it: this point of view doesn’t have to be demeaning to people, or excludes other ways people can be unhealthy or that being fat always makes you unhealthy.
This comment was written by Elena.Report this comment to the moderators
August 26th, 2005 at 2:53 pm
I think it would be great if EVERYbody who has been advised to try lose weight started filing complaints, since the scientific literature very clearly shows that 1) attempts to lose weight put you at far greater health risk than maintaining a high weight, 2) those who focus on fitness and nutrition but NOT on losing weight increase their lifespan even if they never lose a single pound, and 3) attempts to lose weight often result in depression, yo-yoing, decreased self esteem, and lower levels of physical activity, while education on fat acceptance is related to higher levels of physical activity, lower cholesterol, lower blood pressure, higher self esteem, and lower depression levels. All of this information is plainly available to any person who will read the literature, and we have a good case for complaints against those in healthcare who would recommend an extremely dangerous “treatment” for a non-disease.
This comment was written by Virginia.Report this comment to the moderators
August 26th, 2005 at 2:55 pm
Elena, I usually skip the fat acceptance posts, because it’s not my issue. I only posted on this one because I really feel strongly about professional responsibility, and I’m annoyed when doctors seem to think that their profession has an open commission to tell everyone what to do.
But your “common sense” remark was such a clay pidgeon that I had to shoot it down. If you didn’t know that “I can’t back it up with facts, but it must be true because it’s just common sense” will always draw fire on Alas, then you just learned.
This comment was written by Thomas.Report this comment to the moderators
August 26th, 2005 at 4:08 pm
Being fat is different than being obese. Obesity is usually related to lifestyle while being fat is not necessarily so. One can be fat due to metabolic or psychological problems. One does not become obese merely by eating an extra ham sandwich at lunch and not exercising for an hour each day. Obesity is choosing to continue with that lifestyle and ignoring the fact that one is gaining more weight. Obesity is when one begins to suffer from joint pain, sleep apnea, and type II diabetes.
I have no problems with being fat. I have problems with obesity because it is the obese people who have health problems related to their condition. Obese patients have more complications to medical procedures. We should be helpful and sympathetic, but we should not ignore the fact that the obese patient who just has had surgery is at a higher risk for abdominal dehiscence because fat does not hold sutures as well. The patient is not served by this omission.
In the outside world, we should treat obese people the same as everyone else. However, when speaking about medical issues, I will call it as I see it.
This comment was written by natural.Obese patients have a genuine need for at least trying to lose weight safely. They will feel better, and they may spend less time in doctors’ offices and in the hospitals so they won’t have to listen to us in the first place.
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August 26th, 2005 at 5:02 pm
you know propaganda is a “funny” thing. it can turn people from loving, kind friendly open minded people to wild dogs ready to tear you apart without any conscious with closed minds.
instead of doctors using scare tactics just be honest but tactful, and if a pateint decides that they don’t believe in that or don’t want to apply it, that is fine, free will is involved, just because a doctor disagrees with people who ride motorcycles without helmets or likes pizza, it is not their place to enforce that on anyone through legislation or otherwise. free will is involved.
if everytime someone decides to put their lives at risk laws are passed or doctors use court orders or uses emotional blackmail to get you to stop because of the risks, then that would mean we can’t even leave our houses or drive cars as it is a known fact that 40,000+ accidents happen due to driving in cars and thousands die as a result or are severly injuried costing thousands in medical care costs.
also no doctor has a right to use harsh methods to try and bully people into compliance to what they think are in their best interest of their patients lives, it ultimatly lies in the patient to decide what to do, free will you know as long as they don’t hurt someone else in the process, then of course you have legal actions such as hitting someone with your car because you wanted to speed and drive reckless that sorta thing..
a doctor job is to help you understand your health, help you figure out what your parameters are and what to look out for, and give appropriate suggestions (note I said suggestions) on what to do. outside they have no right to try and force through whatever means he or she feels justified in getting you to comply,
mutual respect is what I am driving at. as for doctors being experts because they went to medical school a student is only as good as the teachers, so if the teachers are being duped being told half truths and tainted studies and research etc, naturally that makes what the doctors have learned there suspect on alot of issues.
I even read some of the same books they read and they obviously have forgotten alot of what they learned especially physiology, since that something I had a strong interest, especially exercise physiology since I wanted to understand how the body works in regard to running, since I like to jog, imagine that a obese person who can jog.I am not a gazelle, but when i was alot thinner I wasn’t one then either, just don’t have the genetics for that.
of course we won’t mention all the hidden agendas out there to keep people in the dark on most issues especially obesity (if it weren’t for that it would be something else) and appealing to emotions instead of logic and this is what we have, people hurting each other, doctors getting in trouble for parroting what the drug companies, dieting industry etc, have brainwashed them into believeing or perpetuating so as keep the money coming in. people dieting, getting fatter, being blamed when it is the dieting propaganda that is the problem, people hating people due to appearances.
you could take the obesity thing and substitute with jews, or blacks or short people or any other term and get the same results.
we all know that (substitute for fat)Jews, blacks or hispanics are all lazy sloths who can’t control their lusts in excesses and need to be curbed in any way possible even using intimidation threats or fear to get them to stop being so lustful. otherwise we are all going to suffer all the horrible consequences of morally degradgation all kinds of genetic deformities or skyrocketing costs of medical care.. these people are horrible. we can’t trust them, they are inferior species and need to be reduced as much as possible.
sound familiar? well we know these analogys are false but there was a time that was common knowledge or as some say commen sense.
this is propagandas ugly head. it is all around us, feeding us what the elites those in power what us to believe so they can control where we direct all our resources so they make more money or increase their control and protect their status, keeping the status quo as it were. so I say we need to question and see both sides of an issue before making any definitive decisions on whether it is acceptable or not.
RR.
.
This comment was written by roberta robinson.Report this comment to the moderators
August 26th, 2005 at 5:23 pm
“None of that had motivated them to lose weight, so what made him think that hearing it from him would make a difference?”
My father has those executive cardiology workups annually. He comes home every year saying, “He said I need to lose weight, but he didn’t put me on a diet.” To my father, if the doctor really took the issue of weight loss seriously, he would DO something, and schedule future appointments to monitor the progress.
The problem, of course, is that there isn’t any proven treatment to offer.
This comment was written by Shamhat.Report this comment to the moderators
August 26th, 2005 at 7:08 pm
natural -
For you from: http://www.techcentralstation.com/100704F.html
There is no “safe way” for anyone to lose weight. Losing weight is more harmful for you than staying at a high stable weight. And incase you haven’t heard even the very obese women have a higher life expectancy than “normal” weight men. So should we give all “normal” weight men sex changes and try and try to make them fat so they live longer?
This comment was written by cynth.Report this comment to the moderators
August 26th, 2005 at 7:28 pm
I think I could accept advice about my weight (losing or gaining) from my doctor, if the following were true:
1. They had taken the time to find out what I was eating and how, in detail;
2. They were fully aware of any pertinent medical conditions that might affect my weight;
3. They had specific suggestions for types of exercise that might benefit me (and I don’t mean an Xerox sheet about doing sit-ups);
4. They willingly acknowledged that proper weight levels are a) often disputed, b) difficult to pinpoint the causes of; c) require a long time to change;
5. They treated me like an intelligent human being who is, in fact, concerned about her health, and not a moron who just can’t stay away from the Twinkies.
But you know, this has never been my experience. I have, on the other hand, been harangued about my weight by a doctor who knew nothing of my medical history, during a visit about something completely unrelated to my weight in any way. So yes, I find this woman’s story completely believable.
It’s not just about fat and health; it’s about being respected, and not treated as a particularly stupid subset of patient because of your body mass. And if this case makes more doctors understand that, then it’s been worthwhile.
This comment was written by emjaybee.Report this comment to the moderators
August 26th, 2005 at 8:37 pm
BStu:
go visit Here is a link to the bias that I referred to earlier. I was unable to provide the link before.
BTW, I feel I would defend the doctor if this case were about an anorexic person. I am looking at this through a medical perspective in terms of health. Obesity in the medical community is a term that separates people according to health risks. It is not meant to be used pejoratively. Whatever the word connotes in the general public is not necessarily at issue.
In my job, have I told kidney patients that if they continue to miss dialysis treatments that they are killing themselves? Yes I have. Have I told them they will in essence stop their heart and have a heart attack if they don’t watch what they eat? You bet. I have done so because these people may be misplacing their want of control over their disease to consistently go against medical advice. Sometimes they have to be really scared before they change their behaviors. They have a condition that has increased risks.
These patients try to ignore their illness and go about their lives as if they don’t have this condition. If this is what they want, fine. It is their choice. However, these are the same patients that call and say that they can’t come in because they are sick (knowing that missing a treatment will only make things worse). They complain that they were in the hospital with pneumonia even though they ignored my repeated warnings to watch their fluid intake. Until they take themselves off dialysis (when I will lend my whole support and advocacy), I will help direct their behavior so that they can stay alive and healthy under my care.
I only mention my professional frustrations because I believe (although I may be projecting here) this patient was ignoring that she has a medical condition that routinely results in increased morbidity and mortality. If she wants to live as an obese woman, that is her wish. But again, if she comes in with medical complaints, she should get advice to try to lose weight along with the other tasks. What he said was clearly wrong, but he had a right to bring her condition to her attention. In fact, if the facts were different and she ended in the hospital, she could actually sue him for malpractice for not warning her.
Please try not to take medical advice personally. There may be asses in the profession who try to make you feel worthless and stupid. However, you are paying them for their services. If you don’t like their bed side manner, take your business to another doctor who will treat you with kindness and respect.
This comment was written by natural.Report this comment to the moderators
August 26th, 2005 at 8:57 pm
Cynth,
I am not doubting the genetic propensity for obesity. However, there is something other than genes going on when the rates of obesity have exploded within the industrial age. Alarmingly, the rates of type II diabetes in juveniles have followed this trend. When countries become more industrialized, their populations becomes heavier. One cannot explain this by simply stating that the industrial countries’ genomes have altered in this short of time.
Weight is not just a function of how one eats. It is also one of culture and lifestyle (including exercise habits). It is also one of metabolism and other health factors. It also has a strong genetic component, as your link suggests. One must try to combat all possible reasons for this condition in a patient in order to relieve this problem.
I do agree that doctors have very little nutritional training. This is related to medical schools’ lack of emphasis. Medical doctors do not have much dietary nor pharmaceutical training. If your doctor tells you to do something and does not give you a specific plan, ask him/her to refer you to someone who can. They should make an effort to provide you with good total care.
This comment was written by natural.Report this comment to the moderators
August 26th, 2005 at 9:25 pm
Here are some studies to show the complex subject of causation of obesity. Sorry I am unable to provide links.
Massive obesity in adolescents: dietary interventions and behaviours associated with weight regain at 2?y follow-up. By: Rolland-Cachera, M.F., et al. International Journal of Obesity, Apr2004, Vol. 28 Issue 4, p514, 6p-519.
Childhood Obesity: A Simple Equation with Complex Variables. By: Strock, Gregory A., et al. Journal of Long-Term Effects of Medical Implants, 2005, Vol. 15 Issue 1, p15, 18p.
How Obesity Causes Diabetes: Not a Tall Tale. By: Lazar, Mitchell A.. Science, 1/21/2005, Vol. 307 Issue 5708, p373.
Hyperexpression of N-acetylglucosaminyltransferase-III in liver tissues of transgenic mice causes fatty body and obesity through severe accumulation of Apo A-I and Apo B. By: Lee, Jungwoong, et al. Archives of Biochemistry & Biophysics, Jun2004, Vol. 426 Issue 1, p18.
Diet, nutrition and the prevention of excess weight gain and obesity. By: BA Swinburn, et al. Public Health Nutrition, Jan2004 Supplement 1001, Vol. 7 Issue s1001, p123.
This comment was written by natural.Report this comment to the moderators
August 26th, 2005 at 9:47 pm
Hi. I just read the first few posts, and frankly, I find it disturbing that so many people have accepted as self evident the utter, marketing-driven falsehood that “obesity is unhealthy.” Objective studies (those not paid for by the diet and drug industries, wink, wink), show quite the opposite and there’s quite a bit of credible literature about that.
It’s true: we don’t know this doctor’s patient, but according to information I’ve heard, it doesn’t seem he really does, either. He apparently didn’t even weigh her. I’ve also not heard what this lady actually went to see the doctor for. If it wasn’t about her weight, he shouldn’t have mentioned it. (And that’s what makes the suggestion that she somehow “asked for it” by going to the doctor; or that, because she’s fat, she “deserves” to be told the “truth” so offensive. Had she been thin, but ugly, or and been told: “You’ll outlive your husband, but no one elseis going to want you,” I doubt anyone would be confused as to whether this was unprofessional, unhelpful and uncalled for).
Too frequently, though, doctors do lecture obese patients about their weight, even though it has nothing to do with why they’re sitting in the office. For that reason, many fat people avoid doctors. And for THAT reason, real health problems theymight have are not diagnosed until it is too late.
This isn’t about whether men find fat women attractive. Some do; some don’t. It’s about whether people have the right to be treatedwith dignity and respect in the doctor’s office. It’s about whether doctors have the right to spew whatever bigoted, ill-reasoned medical mythology they want and hide it behind the falsehood that it’s all about “health.”
This comment was written by Frieda.Report this comment to the moderators
August 26th, 2005 at 11:57 pm
Natural: Do you care to address the “correlations” between the prevalence of high-fructose corn syrup in pretty much every processed food known to Americans and the sky-rocketing incidence of insulin resistance? That is much more directly linked to rated of diabetes than the number on the scale.
And I find your “fat” is okay while “obese” is not utterly ridiculous and insulting. “Dark people” are okay, but those “black” people are not. “Lesbians” are fine, but “dykes”, they’ve got issues. They’re never gonna get laid again. I’m only telling them that for their own good. Please.
You know what? I track my diet carefully, have for years. My macronutrients are usually in balance, calories regulated. I exercise five times a week. I run. My doctor says my bloodwork is “textbook”. My blood pressure is spot on normal. I weigh 310 pounds, I’m female, and I’m 31. I’m healthier than 75% of my “normal” weight friends.
And people like you can blow me.
This comment was written by cclough.Report this comment to the moderators
August 27th, 2005 at 7:15 am
Natural, that article on the “bias” is just about making excuses. They are all the stock excuses used to dismiss such evidence when it comes up. No great pains are taken to look for alternative explanations for findings of poor health in fat people. Why? Because that’s what they wanted and expected to find, so they don’t feel the need to probe further. Only when they get results they don’t like do they start look for reasons to ignore the results. Basically, what they are doing is saying that if you remove all of the sick thin people, the only sick people left are fat. That’s not good research and its an embarassment that it passes as such. Its about gaming the system to find the results that support “common sense”.
Another thing to note is the article’s end where it damns fat by association. Notice the “certain types of cancer”. What it fails to mention is that thinness has been associatated with other “certain types of cancer”. But one association is worth scare tactics, while the other surely can be explained away. Why, if you remove the bias by taking out all of the thin people who have cancer, you’ll find that thin people have no risk of cancer.
This comment was written by BStu.Report this comment to the moderators
August 27th, 2005 at 9:23 am
natrual -
from The Empire of Alarmists Strike Back
from
Doing It for the Children
From
The “childhood obesity epidemic”
what is the real problem and what can we do about it?
Jon Robinson, PhD, MS
from : Only the Plump Die Young?
This comment was written by cynth.Report this comment to the moderators
August 27th, 2005 at 9:32 am
Thomas:
You may be contemptuous of common sense and consider it some sort of passive acceptance of unchallenged ideas thrown out there by whomever. I see common sense as the sum of our knowledge based on experience and observation, and sometimes accepting the consensus of the experts, until it changes, if it changes.
With that in mind, no one is going to convince me that most people who find themselves 100 pounds overweight eat reasonable amounts of food and exercise everyday. My point of view hardly conforms to the “ideal weight” thinking, but it is indeed based on common sense and thought.
Now back to the topic at hand, the doctor was almost certainly a jerk, and probably unprofessional, but he may have also had a point about people who want to be tested and medicated and treated, but don’t want to face the fact that their own behavior needs to be changed in order for their health to improve. I have physicians in my family who despair of this attitude all the time; I’d bet most do.
This comment was written by Elena.Report this comment to the moderators
August 27th, 2005 at 11:48 am
Picomo,
Regarding my health history: at the time I was walking 2 miles a day and was a lacto-ovo vegetarian. I have an hourglass figure. The doctor pointed to the chart on the wall , saw my wieght was not in the “green” range and said, “You need to lose some weight” and proceeded to lecture me on how with advice that was already outdated. That was her only basis.
Since then, I have lost weight (unintentionally) as a side effect of cutting out cheese (lactose intolerance) and realigning my diet to include more whole grains and to largely exclude high fructose corn syrup. I still eat chocolate or other sweets daily. At a size 6, I still am not in the green range on that weight chart. If I walked in that office today, 30 pounds lighter than I was six years ago and thinner than 70% of the people I see around my town (a college town with about 40,000 undergraduates), I would still be “overweight.”
I have enough issues about my appearance (as thin as I am) after being constantly bombarded by images of size 0 and smaller models in the media, whose photos are airbrushed to remove protruding ribcages and other bones from the pictures (seriously, just look at Glen Feron’s Art of Retouching). I don’t need a doctor telling me, when I am an average or thinner size, that I need to lose weight because I don’t match the ideal of a chart on the office wall. No one should have their health concerns dismissed or be otherwise mistreated because they are larger than the “health” industry wants them to be.
This comment was written by Denise.Report this comment to the moderators
August 27th, 2005 at 2:08 pm
Elena, then the doctor should have said, as I sometimes say to my manifestly unreasonable children, “what do you think I can do for you? What do you want from me?” The doctor, presumably, has knowledge on his side, but he has no control over a patient’s willingness to conform to his recommendations. I happen to think that a recommendation to just “lose weight” is hopeless anyway, especially given the state of knowledge of the average doctor, which is nil compared to that of nutritionists, for instance, or a well-trained exercise physiologist. If the person had (for instance) a bum knee, this doctor would likely have referred her to a physical therapist, but in this case he thought it adequate to give her useless advice and no real assistance. It’s more than being a jerk — because even though he apparently sees her weight as a real medical issue, he didn’t even trying to approach it medically. Imagine telling a smoker who consults a doctor because he is out of breath that he needs to quit because smoking makes her smell bad and gives her premature wrinkles, so she’ll be much less attractive to men, and so on. Well, it’s true, but it’s not really apropos.
This comment was written by Barbara.Report this comment to the moderators
August 27th, 2005 at 3:45 pm
Denise,
This comment was written by picomoo.Your story sounds like it could be used to argue anti-fat bias in the medical establishment. And I do hope you take it up with your doctor.
However, there is a very serious epidemic out there of obesity (like size 22 or whatever that translates to for men.) And the battle to get doctors to see that someone can be more than the ideal weight for their height and still be perfectly healthy and not care who does or does not consider them to fit the anorexic beauty ideal is just not the same battle as that to get seriously obese people to realize that being 200 pounds overweight is a real health risk. I would hope both of these battles can be fought at the same time.
And, for all it’s worth, I hope you find yourself in a place where you’re healthy and happy with your appearance.
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August 27th, 2005 at 4:29 pm
Yeah. There is an epidemic! EPIDEMIC! Doesn’t that word sound big and scary. Well, it means that we get to treat fat people dehumanizingly. Duh! I mean, its not like people on this thread have disputed that there is an EPIDEMIC or anything. Clearly this is just a given fact that no one can deny. Those people who did deny it just don’t count. Probably too fat to be worth talking to anyway.
Classic arguement. Well, anorexia is bad, but you fatties are also bad so whatever gets done to you is your own darn fault. Size-Acceptance, but only for acceptable sizes.
This comment was written by BStu.Report this comment to the moderators
August 27th, 2005 at 7:01 pm
Again, I am NOT judging fat people. I am noting the fact that, in medical terminology, obesity IS different that merely being fat. Obesity is related to several pathologies. The medical community separates these two just as it draws distinctions between anorexia, thinness, and healthy weight. Just the facts.
Some of these arguments remind me of nursing school. I was taught to notice racial, cultural, and ethnic differences in clients (against the politically correct notion). This may seem prejudiced to some of you, but this tactic helps the client maintain dignity and respect. How? Because doing so can address certain needs of these people. Some cultures are more likely to avoid eye contact. Some have “hot” and “cold” foods. It can also help me with preventive health care. Black people have more HTN and type II diabetes. Native Americans have more alcoholism. Understanding these differences can help me decide what to focus on with my assessments and teaching.
Also, one cannot lessen the disease process without addressing the underlying condition that may cause or relate to the secondary problem. An obese patient with climbing blood sugar will be asked about food preferences, lifestyle habits, but also of family history. Most good doctors try to look at a problem at all angles. Again, the hallmark of the obese patient (rather than just fat patient) is other pathologies.
BStu,
Any researcher can tell you that some amount of bias is present in virtually all research. The job of the author is to address these possible biases and discuss why these do not alter the conclusions drawn. To me, not excluding chronic conditions in sample patients seems like a LARGE bias.
Also, read my comments above for my thoughts on your idea about thin people and cancer. I would feel free to discuss those kinds of cancers with those patients. Any common pathological conditions to any subset of patients is relevant to my nursing care. Honestly, any group of patients can be seen as having a set of complications rather common to that group. But this thread is not about thin people and cancer, so I was not forthcoming in my opinion on that subject.
This comment was written by natural.Report this comment to the moderators
August 27th, 2005 at 8:13 pm
Picomo,
I guess my point is that is doctors aren’t necessarily willing to ask about health history of patients before dispensing advice on weight loss matters to people of an average size. They are probably similarly not listening to people of large size. As noted, this was 6 years ago, and I never went back to that physician. At this point, it’s not worth it to me to file a complaint.
The fat people’s complaints I’ve seen in this thread and in others are 1) that doctors are dismissing symptoms with other causes as caused by fat, and 2) doctors are not helpful in proposing reasonable solutions to improving overall health, such as helping draw up an exercise program or seeing a nutritionist for meal planning advice. Bariatric surgery is not a reasonable solution. Starvation diets aren’t either. Furthermore, people need to want to change enough to make the lifestyle changes they work out with a doctor and nutritionist, and they need support from the people those changes will affect (such as a spouse/partner). There are a lot of places where the process of change can be derailed. I don’t think it’s fair to blame just doctors or to blame the fat individuals. And I think it’s important to allow that fat people, if active and eating nutritious food, can be just as healthy as someone who is average size.
This comment was written by Denise.Report this comment to the moderators
August 27th, 2005 at 10:13 pm
BStu,
This comment was written by picomoo.All the statistics I have seen suggest that there is a pretty dramatic increase in obesity (as percent of population with BMI over 30) over the past something like 20-30 years. (Which is why I used the term ‘epidemic.’) I’m guessing you have access to data showing this not to be the case, so please provide a link.
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August 28th, 2005 at 12:01 am
Gee, do you think there’s a correlation between poor health and the industrial age? Do you think maybe it’s not just about what we eat and whether we exercise? Do you think maybe de-humanization, de-moralization and ridiculous levels of stress required to survive with any dignity in a technocratic, mechanistic, materialistic society might have anything to do with that?
By the way, I’ve lost about 800 lbs on Weight Watchers. If it worked, they would have gone out of business by now. And Jenny Craig is worse.
This comment was written by Korry.Report this comment to the moderators
August 28th, 2005 at 4:09 am
Elena wrote:
Elena, your words crystallise exactly the problem I have when I go to the doctors. You wouldn’t believe me; they wouldn’t either.
But it’s true nevertheless. I weigh nearly 300lbs. If you looked at what I eat in a week, it isn’t all carrots and lettuce leaves, it’s pretty normal stuff, and probably would give the impression of being a food diary of someone weighing 160lbs. Add to that, I exercise plenty (no, not the remote control finger), recently I have been keeping records and these show I exercise between 7-12 hours per week.
So this results in a fundamental problem. I KNOW what my lifestyle is like. Any doctor I go to will not believe that. How can I possibly get decent treatment from a doctor when they think that I am liar, or at best greatly deluded, and they are making recommendations for my lifestyle based on assumptions that aren’t true?
How can I do anything about that? I can’t take videotape of me 24hrs a day and produce it for the doctor and say “Here, watch” to illustrate what I do eat. I once lived in a place where I went to some trouble to go to a doctor where I could be certain that they would be able to confirm independently that I did a lot of cycling. Unfortunately I no longer live there and can’t do the same thing here.
I have not met my current doctor yet; I have fantasties that the man in brightly-coloured shirts that I keep passing on the cycle path in the mornings is really my doctor.
This comment was written by HT.Report this comment to the moderators
August 28th, 2005 at 6:34 am
That’s really it. When fat people do everything right, but as can be expected don’t lose weight, they are belittled by doctors who call them liars. Now, some people will keep doing what they are doing, but can’t you see the demoralizing effect this can have on many people? They do all the right things, their health improves, but the doctors see them and tell them they made it all up and they are as unhealthy as ever. Many will get the message that doing all those good and achievable things aren’t worth doing because they won’t produce the goal they are told matters. The focus on weight may well be producing poor health in fat people, by discouraging healthy activities and encouraging unhealthy ones like dieting.
I’m just about 100lbs “overweight” (a term just as insultingly dehumanizing as obese). Do I starve myself? No. I’ll admit my diet isn’t as balanced as I’d like it to be, but its not like I sit around stuffing myself all day. I miss out on some vitamins, but overall my calories are always right around 2000. Excercise? I walk 40 minutes, 5 days a week. Not excercising myself to death, but hardly a sedentary lifestyle. But some people just won’t believe it. Much more support for looking at fat people as hopeless gluttons who never get off their butts all day. Unfortunetly, for many, it becomes a self-fufilling condemnation. Tell people that’s all they are, all their life, and many will figure they might as well do whatever tells them they are doing.
This comment was written by BStu.Report this comment to the moderators
August 28th, 2005 at 6:53 am
HT has perhaps stated the nub of the problem, typified by hers and Denise’s experience: doctors tell you with supreme confidence that fat is a “medical” issue but they don’t treat it as if it were a medical problem deserving the same type of medical inquiry that they would make of, say, chest pain: looking at the person’s history (were they obese as a child or did they gain weight only after adulthood?); lifestyle (are they exercising, can they bring him a record of what they are eating during a typical week?); how significant is the issue (a little, not really impinging on health at all, a lot, as in accompanied by diabetes or other obesity-related health issues, or is it life altering — needs a wheelchair to get around, limiting work and social activities?).
Instead, they look at that chart and tell you go to a not very reputable weight loss guru. That’s like psychiatrist telling a patient with anxiety about the future to go visit a fortune teller.
If a doctor can’t or doesn’t want to become an expert on weight and health and meight management then he should make a referral to a suitable specialist.
This comment was written by Barbara.Report this comment to the moderators
August 28th, 2005 at 7:44 am
Barbara wrote:
My GP –at my request for assistance– sent me to a dietician/nutritionist who discussed my eating habits with me and explained in detail about portion control, reasonable exercise for someone with certain physical limitations and so on. No pitches for diet plans or gyms, etc. Perhaps because I was vehement about my concerns being the maintenance of my current weight rather than a quest to knock off 50 lbs. Or maybe the GP and the dietician were just decent people with respect for their patients. That shouldn’t be a rare commodity in the medical community, but aparently, it is if you’re fat. :(
This comment was written by alsis39.Report this comment to the moderators
August 28th, 2005 at 8:18 am
The problem is that there isn’t a suitable specialist. There is no magic formula that has been shown to cause people to lose weight. Yet, doctors think its incredibly simple and all you need to do is go to Weight Watchers. So a lot of doctors do look at their fat patients like they are idiots for being fat. And this manner of treatment absolutely betrays that this is really a cosmetic issue, not a health issue.
This comment was written by BStu.Report this comment to the moderators
August 28th, 2005 at 10:23 am
Elena: There is absolutely no uncertainty that this doctor was both a) a jerk and b) an unprofessional jerk. Dollars to donuts he would not tell an overweight male that his sex life was in jeopardy — especially when you can turn on FOX and various other networks and see multiple images of heavy set men getting plenty of “action”. This man’s personal sexual need to objectify women as slim, barely post-adolescent, and appealling to his visual “needs” is interfering with his professional opinion and conduct. Further, he misses the point that most women who are above “average” weight are not going to want to socialize, much less sleep, with men/women who reduce judgement to one based on weight. He thinks and dispenses medical ‘wisdom” as though women just passively exist in society waiting for their shining white fuck to come along. Pity him.
I currently weigh about 225. My girlfriend weighs about 250. We have crazy monkey sex as often as we can get our cloathes off. She is a vegetarian and eats well with reasonable portions. She has been large since infancy (over 10lbs at birth). I’ve put my weight on the old fashioned way: a diet of cigarette and beers and malfunctioning thyroid. **However** at my last physical, I came away with cholesterol and sugar levels, heart rate and blood pressure that the “average” American would kill for. Despite how I look physically, on paper I look healthy as a horse (make that a Belgian). My primary care MD went so far to say that I have NO future of heart disease ahead of me (and I’m not yet 40). I exercise daily, as I have four dogs and no car. I average at least 2-3 miles of walking per day, often with a load of groceries on my back.
And… well, folks can just go screw themselves (literally) if they think sex and health are about how someone looks.
This comment was written by Q Grrl.Report this comment to the moderators
August 28th, 2005 at 10:37 am
BSTu, what I meant was, if the doctor perceives that the patient needs help understanding metabolism, nutrition, exercise, etc., there are people who are trained to understand and keep up to date with these things. Just like a doctor wouldn’t hand you a list of exercises for your bum knee, but would most likely send you to a physical therapist for some professional support — I realize that you think that weight loss is never medically necessary (or at least that’s what I perceive from your posts), but even for many doctors who do think that it would be at least medically prudent, they don’t treat excess weight like the medical condition that they profess it to be. Somewhere in there is the juxtaposition between mediocre understanding of weight management and weight related medical issues, and social conditioning and prejudice: Yeah, it’s a medical issue, but since it’s all your fault it’s your job to figure out what to do with it. Geez, even smokers get the benefit of medical solutions to what is clearly a self-induced problem. A person who presents with lung cancer is still offered a medical, not a moral solution.
This comment was written by Barbara.Report this comment to the moderators
August 28th, 2005 at 11:13 am
Now back to the topic at hand, the doctor was almost certainly a jerk, and probably unprofessional, but he may have also had a point about people who want to be tested and medicated and treated
And so it’s OK to be an unprofessional jerk to those people?
This comment was written by mythago.Report this comment to the moderators
August 28th, 2005 at 12:06 pm
Barbara wrote (talking to BStu):
This misses the point. What is the use of considering whether weight loss is necessary, when it isn’t even achievable in a healthy way, for the vast majority of fat people.
That’s what the problem is with doctors prescribing weight loss so much. Well, one of the problems.
This comment was written by HT.Report this comment to the moderators
August 28th, 2005 at 3:35 pm
HT, this is just a blog, but my short view on this is that, usually, weight loss is the wrong goal. However, that is not just the fault of doctors, though they could lead the way out of the morass — it is often the fault of the patients, who aren’t interested in the other achievable goals that might or might not be accompanied by weight loss if carried through. To a very real degree, many people would rather take a pill or an injection, with whatever risks (both residual and added) accompany that step than to change their behavior. This is not to assign blame but to state a fact — for many people weight loss is the only carrot that resigns them to the “stick” of, say, eating a lot less fast or junk food. Sure, thin people shouldn’t eat fast or “junk” food either (not a steady diet of it anyway), and the fact that THEY perceive no problem with eating it — well, basically, all groups are more interested in issues of appearance than health. (Junk and fast food in my book can be defined as a combination of being light on nutrition and dense in calories.)
I don’t think that weight loss is “impossible” for lots of people (I have no idea what percentage that would be) but it is rarely “achievable” because the hurdles are just insuperably high even when there is a will to change behavior — and this is made evident by the fact that those groups who are most likely to be overweight (low income) face the highest barriers to both good nutrition and the availability of exercise. They also face high levels of stress and inadequate access to medical care, which probably makes not only weight loss but other health related goals very difficult to attain.
This comment was written by Barbara.Report this comment to the moderators
August 28th, 2005 at 3:43 pm
Losing weight creating problems for some may be a result of dieting vs. diet. Restricting food groups and stressing to loose large amounts of weight and bumping back up again causes worse problems. When I was younger I could not gain weight. (assisted by coke and crank…) at 30 though I really put it on and fast, I started having issues with gall bladder etc. I took my recovery and directed it towards what I ate and I slowly lost a good bit and am now happy with a little in the middle, as I do not have the blood sugar issues I did when I was very lean. My vitals are all low at this time. I did not go on a diet; I lowered the amounts of foods that were contributing the most, and increased the variety in whole foods.
What I found helpful is a Neurologist friend, (refers to herself as “a big girl”) we were talking about no fat dieting and things she was seeing in her practice and trends in the lit. She pointed out the brain and CNS is largely lipids and many processes require a variety of fatty acids to function. So, I included reduced amounts but high quality fats in my diet. (Cold pressed oils, nuts, fish oils etc.) Life goes on, I get deeply involved with mental health in addicts, and research showing that Omega 3 fatty acids reduce or alleviate depression in certain populations. I get hooked up with some Drs. Doing the research and we start on a few of my guys with severe depression. (It is no secret that depression and bi-polar disorder people have been self medicated with dope for years creating many addicts.) It does little good to get clean and then still suffer from depression. What we are seeing is by increasing a single group of fats, that significant improvement can be achieved in very short periods of time in both affect and from diagnostics. (Then I go and get transferred…another story) this is all so ground level, but it makes sense to a certain degree. What will we find if we continue to fund research on mood disorders as they relate to diet? Perhaps some obese folks are craving a micronutrient that is oil based? Perhaps they need more of specific foods not less to produce the needed affect? There are far more reasonable questions to be asked than to simply relegate ones appearance (based on pop culture) to the determining factor about health and diet. When we get into the judging thing we destroy any hope of objectivity and create this fear and condemnation thing that is cruel and self serving. I hate to oversimplify, but populations become very easy to manipulate when fragmented against each other. The power of advertising and governments (including big buis.) creates all kinds of demand for themselves when folks are scared. When we look with open eyes and hearts, we see there is no fear and condemnation; when that happens, the folks in power will be in trouble for the chaos they create to stay in power. How ridiculous to reduce how we feel about another human being to something as subjective as weight? That is almost as ridiculous as judging someone for their gender… Blessings.
This comment was written by Rock.Report this comment to the moderators
August 28th, 2005 at 6:38 pm
Bean has nailed it. natural’s attitude of superiority over & condescension towards patients is the reason that I have an exhaustive interview of any potential doctor. It is also the reason I tend to avoid them whenever possible.
The best thing we can do is to educate folks that their doctor is most likely as competent in their profession as their auto mechanic or plumber is at theirs. We need to ask a lot of questions, we need to do our own research & we need to have the ability to direct our own professional care if that is our wish.
I’m not fat (yet), but I’ve experienced similar problems of doctors w/ preconceived & unshakeable views about my lifestyle that were false and, therefore, hindered effective treatment.
This comment was written by Jake Squid.Report this comment to the moderators
August 28th, 2005 at 6:39 pm
Bleah. Should be “medical care” in place of “professional care”. Stupid proofreading!
This comment was written by Jake Squid.Report this comment to the moderators
August 28th, 2005 at 9:47 pm
Bean,
Please reread my earlier post. I did not say that all Native Americans are alcoholics. I stated that, as a medical care team member, I should anticipate certain problems. In nursing school, I learned how to do complete assessments on patients. In the real world, this is impossible with the amount of patients assigned to nurses and the time constraints. When I graduated and entered the real world of nursing, I learned to do the “down and dirty” assessments. In these, I anticipate the problem areas of each patient and can hopefully catch the relevant details in order to help the patient recover or stay healthy. In my current field, I know each patient fairly well as I see most three times a week, so this “patient profiling” is not really necessary for me. However, the great majority of nurses work in acute care settings and need to employ a tactic such as this to help the patients (and stay employed). As I mentioned earlier, you may view this as racially biased or prejudicial. To me, it is practical and in the best interests of the patient.
Jake,
I do not feel I have superiority over my patients. Not all of my patients (in chronic renal failure) are in need of my nursing advice in terms of education or referrals. Many are full team players who come in and tell me what they want and need. These patients sometimes teach me about their conditions. For these patients, all I offer is dialysis administration. These are my dream patients who view themselves as part of the team of health care. I wish all patients felt this way.
Education of CRF and the disease processes involved are for patients who are consistently noncompliant. These patients have problems that need to be addressed. One patient, whom I have routinely counselled on fluid restrictions for two months has just been discharged from the hospital for pneumonia and fluid overload. Another has just now gotten onto the transplant list because he just now started to listen to me about being compliant with his treatment prescription time and his blood pressure medications. You may think that I am being arrogant about what I know about these patient’s conditions. But I contend humbly that, in these cases, my knowledge is a benefit to these people. I will continue to do what I do because it helps the patients. Maybe the first patient will not be back in the hospital any time soon, and the second may get a transplant.
One of my ONLY concerns is good outcomes for my patients. My second concern is maintaining their dignity and self -respect. I have seen nurses in this field who just come in and are task-oriented. They perform dialysis and go home. They do not take the time to help these patients help themselves. I teach many patients on something every day. It may be better blood sugar control, how to keep their shunts in good condition, signs and symptoms of infection and electrolyte imbalances, or consequences of nocompliance. For my dream patients, I still offer my expertise about laboratory values and their meanings or answer questions they have that they forgot to ask their doctors the last time they saw them.
I hate to say it, RN does mean that I may know more about some aspect of health care than some patients whom I see. You read condescension, but almost all of my patients see that I care about them. These patients are at risk for pneumonia, cardiomyopathy, anemia, osteoporosis, hyperparathyroidism, myocardial infarction, and death. And this list is only due to CRF itself. Almost every one of these people have comorbidities that put them into CRF in the first place, such as diabetes and HTN. Nutritional parameters for dialysis patients are also VERY different than normal people, and these may need to be addressed.
This is life and death for these people. Believe me - if every single one of my patients suddenly knew all about their conditions, ate correctly, limited their fluids, took all their medication as prescribed, and became compliant with treatments, my job would become a lot easier. It is all about preventing and minimizing complications. If you don’t like my philosophy, that is your loss.
This comment was written by natural.Report this comment to the moderators
August 29th, 2005 at 4:45 am
bean, it is just possible that there is a big divide among natural’s patient population — that is, a big educational divide. Anyone who has worked or volunteered in a public hospital or other facility that serves a high proportion of indigent patients sees that you cannot approach every patient the same way and that education plays a very big role in patient understanding and compliance. What would indisputably seem like condescension to you and me probably seems like nurturing and compassionate care to others. I read natural as trying to react based on what the patient brings to the table in the way of their own understanding and willingness and available resources to learn more. It is infuriating to meet a doctor or nurse who will not credit your own abilities, but it would also be less than good care to assume abilities and understanding that don’t exist. For instance, many doctors use medical vocabulary when plain English — even obscene English — is the only thing that the patient might understand. That is also a form of condescension, though it is very different from the type of condescension that you are referring to, and it is not easy for professionals to find just the right touch with each and every patient if they serve a diverse population.
Sometimes when I read these threads I feel like posters don’t quite get that all of these diseases and conditions like diabetes and ESRD (or CRF) fall disproportionately on people who don’t read this or any other blog and likely have very little access to the reams of information out there on their disease, not to mention a decent grocery store. I have a feeling that it is this population that natural is tending to, disproportionately, and it seems a little unfair to assign her such negative baggage.
This comment was written by Barbara.Report this comment to the moderators
August 29th, 2005 at 8:55 am
I just don’t get the parallel between telling your patient, “Keep your shunts clean if you want to avoid infection” and “Lose weight or men won’t want to fuck you.” The former is not a value judgement. The latter is.
Is natural claiming a “natural” link between kidney disease and a few extra pounds ? I’ll probably be sorry I asked…
This comment was written by alsis39.Report this comment to the moderators
August 29th, 2005 at 11:48 am
Here is a link to an article on kidney disease that recently appeared in the Washington Post. Washington D.C. has one of the highest rates of kidney disease in the country.
http://www.washingtonpost.com/wp-dyn/content/article/2005/08/22/AR2005082201155.html
This comment was written by Barbara.Report this comment to the moderators
August 29th, 2005 at 1:29 pm
From the WP article:
At no point do they mention that kidney disease can also be hereditary. As someone who aquired it that way, I find it astoundingly sloppy reporting, to say the least.
This comment was written by alsis39.Report this comment to the moderators
August 29th, 2005 at 7:06 pm
Alsis,
My experience is in CRF. I write about it because there are items that I discuss with my patients that are clinical but could be construed as value judgments. Once I told a patient going in for a possible transplant that, if he were to continue doing drugs, he would ruin the chance given to him. If he did more drugs, he would be back in the clinic. “You shouldn’t do drugs” - is this a value judgment? Sure it is. But it is clinically oriented, and I was not judging him for doing drugs. I was warning him of the possible consequences for his unhealthy behavior. I was clinical in my approach. Believe me - he did not take it as a value judgment.
I care about my patients. Judging patients for bad behavior is counter-productive for me, and there is no clear line with respect to a patient’s accountibility for his or her illness. Most in my clinic are here for diabetes and HTN. Is it their fault for having diabetes? Is it their fault for not keeping their blood sugar in control? Is it their fault for being too poor to afford the blood pressure medications? Is it their fault for not eating better? I can’t and won’t answer those questions.
My job as a nurse is not to judge. It doesn’t matter to me one way or the other how or why people have these illnesses. My jobs are to understand the disease processes and to work with the patients to prevent and control them. Values make not factor into the way I do my job.
The main problem I have had in these posts is not because people are upset about what the doctor said. If I were the medical board, I would mandate the doctor take a class on bedside manners as well as do a literature review about obesity (in regards to psychology and mortality). His comments were unfounded and wrong. However, I have a problem with posters not allowing the doctor to connect body functions with illnesses and being overly defensive about it. Obesity in the medical community is described as a disease with connections to other adverse health conditions. I don’t think it out of line for a doctor to have the opinion that the underlying cause for the patient’s complaint(s) may, in fact, be caused by obesity. The good doctors do complete physicals and tests to rule in or out possible causes. But if the doctor’s medical expertise points to obesity, that should be allowed.
The health care process is a team sport. The client is paying the doctor for an opinion and medical skills. If the client does not like the diagnosis or opinion, it is ok to fire the doctor and find someone else. But the client should also check modesty and defensiveness at the door.
Most doctors do not mean to judge behavior. However, some doctors may get frustrated by patients coming in over and over who complain about correctable problems and do not listen to their advice. This doctor was over the top, but to me it seems like he has given up the normal warnings because they didn’t work.
I could be wrong. But I encounter frustration like that every day. I tell some patients that they are killing themselves by their actions. These are not fat people or people who just have CRF. These are people in ESRD (end-stage renal disease) who routinely get their catheter dressings wet, drink themselves into the hospital, and eat 5 tomatoes in one sitting (causing increased serum potassium). I am not passing judgment in the societal sense - “what you doing is wrong and immoral”. However, I am judging the patient on how much the patient wants to be relieved by his or her symptoms.
People on this board continue to write about their experience with being fat and compare it to this obese client. I am merely trying to explain the reason why the medical community makes a stark dilineation between fatness and obesity, the latter being related to other disease processes. I find fault with posters who deny the medical community’s ability to assert that obesity MAY in fact be either a cause or a mitigating factor.
Research is important, but the doctors are in the trenches every day. It is harder to ignore the fact that many hospital patients are obese (meaning they may be sicker) or that the obese patients have a preponderance of certain other illnesses when they see it first hand. Obesity, in some cases, is easier to correct than curing the patient’s insulin resistance, HTN, or
replacing all the joints.
I am not saying that curing obesity will cure all other ailments in our patient populations. But one should not remove a weight loss strategy from the medical arsenal.
This comment was written by natural.Report this comment to the moderators
August 29th, 2005 at 7:37 pm
natural,
I appreciate that you do not intend to come across with an attitude of superiority or condescension. I fully believe you when you say that. Yet, I am not the only one who gets that impression. I don’t mean to be insulting in this comment when I say that, perhaps, you might examine your communication style to see if there is any validity in what I and others are getting from you.
It is truly a good thing that you don’t judge your patients. I wish that there were more medical professionals who did the same.
I want to note that it is not necessarily a bad thing to have a preconceived notion of a patients lifestyle. But it is bad if that view is unshakeable - which seems to often be the case when dealing with fat or obese patients.
This comment was written by Jake Squid.Report this comment to the moderators
August 29th, 2005 at 10:52 pm
natural, even if there are doctors who sincerely believe that weight loss would be a good or essential step to improving a person’s medical condition, that belief is more than counterbalanced by how frankly amateurish most doctors’ efforts are to assist the average patient in such an endeavor, I mean, especially compared to the efforts that doctors make when they are advocating this or that test or drug. The alleged seriousness of the problem is hardly matched by the seriousness of the effort made to address it. It is no wonder that patients are underwhelmed by doctors who advocate that they lose weight.
This comment was written by Barbara.Report this comment to the moderators
August 29th, 2005 at 11:14 pm
Jake -
I am only speaking of patients who need guidance in their health care. My patients who cannot seem to make the connection between their drinking fluids and their shortness of breath are my focus of my teaching. These people NEED someone who can explain the physiological processes of those with ESRD (or diabetes and HTN for that matter). If they don’t get it, I just need to teach them in a different way. The point is that they must somehow understand at some point in time. I cannot be with them 24 hours a day. For these patients, I do know more about these processes. That is why I went to school. I am sorry that you and others do not seem to understand that this is literally life and death for these people. I am paid to keep these patients safe and to try to prevent further morbidity.
I am not calling anyone stupid. On the contrary. Many illnesses are complex in their etiology, symptoms, and physiological effects. I learn about a new apsect of ESRD almost every day at work. Many of my patients are very smart in their respective fields. I often ask their advice during treatments. You should accept that a medical professional is not any different than any other professional. Not infallible, not ominscient, but certainly specialized in terms of knowledge. I would not accuse my mechanic of a feeling of superiority if he had to tell me that I was not changing my oil enough. Just because it is a human body does not make it any different.
Like I said in my earlier posts, patients who are active team members are not victims of my wrath, as you and others like to see it. For these people, I only assess and administer treatments. I do not emphasize it as much because this thread is about a woman who routinely came to her doctor with ailments who was subjected to an assinine lecture. She refused to be assessed (weighed). Obviously she is a patient in need of teaching that she should try to be more of an active recipient of health care.
You and others seem to be active participants in your health care. However, you are not in the majority. I am fortunate that you exist. I may be fortunate enough not to ever see you in my clinic. However, many clients who come in for multiple complaints (including some of my patients) are more passive. They have a problem, and they expect the health care provider to make it better. Take a pill, and you will feel better. For some of my patients, they expect to get a transplant without being compliant. They want to not have to alter their behavior now, not understanding that they will have a detailed regimen of pills and doctor appointments after the transplant. This is the world I work in. This is what I am referring to.
What you and others do not seem to realize is that two of a nurse’s main jobs are to assess and to teach. This is what I do every day. Of course, each patient may need varying levels of both of those things. Some patients need no teaching. Experience helps me to teach what I need to without brow-beating people. If you think that I do that, you are mistaken.
This comment was written by natural.Report this comment to the moderators
August 29th, 2005 at 11:42 pm
Barbara,
I am in total agreement. I often wonder why doctors do not have more pharmacology or nutrition during medical school. That is one (of the many reasons) why Merck (the maker of Vioxx) is in so much trouble. The drug reps come and advertise all the benefits but do not mention any drawbacks or limitations in effects. The doctors could have avoided most of this by simply reading the inserts (or PDRs) before prescribing these to their patients.
I think that nutrition, body mechanics, and exercise physiology are core components of preventive medicine. It is a shame that many doctors are more focused on treating disease instead. Please do not fault those who are really trying, even though they are incompetent. Hopefully they will get better. Most of us in this field are constantly trying to improve our skills and information. It is in the patient’s best intersets that we do so.
The best doctors go out of their way to learn more about these things. Others just give good referrals so the patient does not end up flailing in the wind. That is one reason why I love my job - my close contact with the patients allows me to address some of their concerns when the doctor does not have time. If I can’t help them personally, I usually find someone who can.
Some doctors make recommendations but offer patients no concrete, detailed plan for achieving the goal. Any person who feels that this is the case should demand that they do so or fire them. Again, it is a team sport. If you don’t understand something, speak up . If the doctor doesn’t help you, change teams.
This comment was written by natural.Report this comment to the moderators
August 30th, 2005 at 10:34 am
Did I say something? No, no, I didn’t think so.
natural’s response is a perfect example of the attitude that I have seen in the medical profession. She didn’t actually address what I had written, she took my labeling of her mode of communication (”superior & condescending”) to mean that I said that she was calling people “stupid” and that I saw her writing as full of “wrath.” None of those assumptions are true, she just heard what she wanted to hear. natural just wrote past my comment and went on with why she is right. There is no possibility that there is something in her method of communication that is causing the impression of superiority and condescension that I see, no possibility of self-examination. I just see her as angry and calling people stupid and, so, can be dismissed.
This, natural, is my point about your style of communication and my point about the attitude of most medical professionals with whom I have interacted.
This comment was written by Jake Squid.Report this comment to the moderators
August 30th, 2005 at 10:37 am
If the doctor doesn’t help you, change teams.
What is your attitude if someone comes to see you and, looking at their chart, you find that they have seen 8 different doctors in the last 2 years? Most doctors are immediately certain that this is a “problem patient.” I don’t disagree with your advice, but you don’t mention the probable repercussions of “changing teams” until you find someone who can work with you.
This comment was written by Jake Squid.Report this comment to the moderators
August 30th, 2005 at 9:22 pm
Jake -
I don’t know how you are reading into my comments that I feel that I am better than my patients or that my opinions of them are unchangeable. What part of “a team sport” are you getting that? I am getting tired of having to explain why it is my experience that I cannot treat all patients the same because they are not the same. This thread is about a patient who refused to be weighed. If nothing else, she was noncompliant in that she did not allow the doctor to assess her completely. Being weighed is not only for a number but to see if a change exists from the last visit. My comments were directed towards other noncompliant patients and explaining the health care provider’s POV on health, obesity, and compliance. Nothing more.
Just because you are knowledgeable about your body and try to learn all you can does not mean that everyone else does (or wants to do) the same. My job to reduce morbidity is the same no matter what the patient brings to the table, so if the patients brings less, I have to work more. When they are my patients, I feel that I have a responsibility for their safety. The nursing board in my state agrees.
You write that it is best that the patient learn more. This is definitely true. But it can be common for patients with chronic diseases to not think that this is necessary. It is common that some patients want to exert control over their illness and refuse to alter their behavor. Others have given up thinking about their condition and would rather just have the provider tell them what they need to do from day to day. Luckily, a lot patients learn to take an active part in their condition after their fourth trip to the emergency room for pneumonia. Alas, it is not always the case, and some people will never want to become as active participants on the team as you and I would want them to. Just because you are not one of these patients does not make them not exist.
You write that my interpretation of your comments to me about my thinking my patients are stupid is wrong, yet you write in the same paragraph the very same idea. Now tell me that I was wrong to take your comments that way. I have not been angry, but I am starting to feel that way because you refuse to see it from a health care provider’s point of view. This is the whole reason for my comments on this thread. Sometimes I have to worry more about the patient dying while on dialysis because his or heart is so weak and this person put on 20 pounds of fluid since last treatment. Tell the spouse that although I didn’t try hard enough to convince the patient to stop drinking so much, the heart attack and death was justified because I didn’t portray the feeling of my superiority.
You may despise my “feeling of superiority” to a select few (and only these, I might add), but I can assure you that my heavy-handedness can help. You do not allow me to explain that I know these patients and am only trying this tactic when nothing else works. If the patient is changing his or her behavior only because he or she doesn’t want to hear my lecture again, that is really ok with me. The goal is to reduce morbidity. All my patients know that I care about them, and there is a reson why I am lecturing them for the upteenth time. And don’t think that the health care provider is the only one using this technique so you can label me as having a God complex. Noncompliant patients’ spouses also lecture and scold. So now their spouses are angry and think their husband or wife is stupid? The fact is that I treat patients like people. There are different types of people in this world, and it is wrong to assume otherwise. Some people do not need guidance, but some do.
For the record, I (as a patient) have had a problem with doctors. When I hurt my knee several years ago, 3 doctors told me there was nothing wrong with it. Did I get frustrated? Surely. The third doctor told me that all I had to do was put on a Nike shirt that says “Just do it”, go back to running, and forget about it. To him, it was all in my head. It was an offensive comment but it was also just his assinine medical opinion. As a patient in charge of my own health, I did not get discouraged. I still had pain, and by a year’s time, my leg was starting to stiffen up. I knew that those doctors were wrong. I sought a fourth opinion. This last doctor did not think that I was a problem patient. He examined me and then repaired my torn meniscus.
Your experience tells you that doctors see these type of patients as problematic and refuse to look at the complaints with fresh eyes. My experience (both as a patient and as a nurse that deals with several types of doctors) tells me otherwise. Doctors are people too, and they can deal with this issue differently. Some do dismiss complaints, but not all do that. You may be projecting your bad experience onto the whole medical community. You want doctors and nurses to see you as a unique person and not as simply a problem patient, but you refuse to see doctors and nurses as people too. Many doctors and nurses are quite competent, have the urge to discover a cause for your ailment, and do not pigeonhole patients (even if you think that we do). Please take the time to see that.
This comment was written by natural.Report this comment to the moderators
August 31st, 2005 at 7:29 am
natural writes:
I don’t know how you are reading into my comments that I feel that I am better than my patients or that my opinions of them are unchangeable.
What I read from your comments is an attitude of superiority over all of us on this thread who are not medical professionals. I have no idea whether or not you feel that you are better than your patients, I can only speak to what you have written here. I have never said that your opinions of your patients are unchangeable. What I have said is that many doctors have a preconceived notion of what is wrong with a patient based on first appearance and are unable to change that initial opinion.
I still feel that you have not really listened to what I am trying to say. So I will try to put it into a couple of simple sentences.
Your writing on this thread leaves me (and, it appears, several others) with the impression that you have an attitude of superiorty. “I know what is best and you non-medical professionals have nothing of value to add,” might be a summary of this attitude.
Your writing on this thread has seemed to me (and, it appears, to others) to be condescending.
The condescension and the attitude of superiority seems, in my experience, to be typical of the medical profession.
Your responses to my comments seem to have ignored, for the most part, what I have actually written and, instead, been about how your assessment is correct. This is also, in my experience, typical of the medical profession.
natural writes:
I am getting tired of having to explain why it is my experience that I cannot treat all patients the same because they are not the same.
I never once asked you to treat all patients the same. I did, however, say that I felt you were being condescending in your comments. “Condescending in your comments,” is in no way related to how you treat your patients. Rather, it is how you are addressing us in this thread. I find the condescension to be typical, again in my experience, of the medical profession.
natural writes:
You write that my interpretation of your comments to me about my thinking my patients are stupid is wrong, yet you write in the same paragraph the very same idea.
What? Perhaps you should read that paragraph again. You have misread it. The last sentence was meant to reflect your point of view - what you thought I meant/had written - that is why the end of the sentence reads, “and, so, can be dismissed.”
This is typical of your responses to me - you read what you want to read, not what has been written.
natural writes:
All my patients know that I care about them, and there is a reson why I am lecturing them for the upteenth time.
This is a great example of your attitude of superiority. You know this to be true. It is an unquestionable fact in your opinion. You never, in your writing in this thread, leave open the possibility that you are not 100% correct. How do you know that 8% of your patients don’t know that you care about them but are afraid to say something about your interminable (”upteenth time”) lecturing? The fact is that you don’t. Perhaps you could have written, “I believe that my patients know…” That would have made the same point without trying to establish it as undeniable.
This is what I am trying to tell you. I don’t think that you are a bad person, nor do I think you are doing less than your best for your patients. I am trying to make you aware that the way that you communicate may not be being perceived in the way that you intend it to be.
Rather than say to me, “Gee, I’ve never heard that from anybody before. Maybe I will pay more attention to how I say things and how people/patients react,” you spend your time telling me how I don’t know how you treat your patients and how what you do & how you communicate is correct. You don’t see the attitude of superiority or the condescension in that?
What amazes me about this whole exchange is that when I say, “When you do X, I feel Y,” you respond with, “There is nothing wrong with me doing X, the fact that you feel Y has nothing to do with me.” Your inability to acknowledge the possibility of a connection is yet another example of what I am trying, obviously ineffectively, to say to you may be a problem.
I feel that we are talking past each other and I feel that that is mostly on your part. I think that I have been saying the same thing to you consistently, yet you respond as if I am saying something else. I don’t know what I’m doing wrong in trying to get my message across to you, but I’m trying my best to figure that out.
This comment was written by Jake Squid.Report this comment to the moderators
August 31st, 2005 at 7:37 am
OK, now we have a plethora of evidence that Bennet’s handling of patient care goes beyond the standard physician’s bed-side manner is mis-match to patient needs.
This comment was written by ol cranky.Report this comment to the moderators
August 31st, 2005 at 2:20 pm
natural, I think that what is happening here is a disconnect between your version of professional communication and the one that your audience expects or desires. As a communicator, then–and a great deal of a nurse’s job is to communicate well– your job is to find a way to reach your audience more effectively, rather than to simply argue that everyone is wrong about your intentions, motivations, and attitudes. You probably make these audience-based accomodations all the time “on the floor” without even thinking about it.
Or, maybe you should think about it–especially if you are lecturing a patient on ANYTHING for the “umpteenth time.” If you fail to reach your audience, then perhaps it’s your communication (content or style, take your pick) that needs to change, rather than the audience’s ability to understand the meaning-behind-the-meaning. In a way, I think that the way you assume that the problem is in the (amateur) hearer rather than the (professional) speaker is indicative of the problem that many of us have with the medical community.
And sometimes you guys are just plain wrong. We know it, and that doesn’t help us to feel secure in granting you a cloak of credibility simply because of your profession.
Sometimes, speaking to your audience instead of at them involves acknowledging your own fallibility–even if you are a trained professional. We acknowledge your training, dear, and your good heart. Now, please, acknowledge that the wisdom of the medical community is very “conventional” in many ways and that looking outside the box that we patients are presented with is one of the few ways that we can experience some control. Peace be with you all, no hard feelings, I hope, and I’m glad to join this thread.
This comment was written by ceres.Report this comment to the moderators
August 31st, 2005 at 9:33 pm
Hey, now. If this doctor offering racist commentary makes one fat person feel awful about themselves, then he’s done his job. Why, this man deserves a medal. Perhaps a nomination can come from the crew above who were so gleeful about excusing his invasive “advise” when it was “merely” sexist. Surely, if sexist fat bashing is allowed, so is racist fat bashing. Its all just because he cares, don’t ya know.
This comment was written by BStu.Report this comment to the moderators
August 31st, 2005 at 10:18 pm
Actually, I am constantly trying to alter my communication style with the patients. It is my job to attempt to reach them. However, some of you don’t realize that some people with chronic conditions have this need to control their situation. They miss treatments because they despise having to come in 3 days a week for the rest of their lives. They do not check their blood sugar regularly because they feel fine (and then they may have to actually inject themselves with insulin if the readings are too high). The list is exhaustive for these patients. It is frustrating to hear their complaints after their fingers or legs were removed when they should have been compliant with their diabetes regimen. I have trouble reaching them. You try it.
I completely agree that those of us in the medical community can be wrong. Lord knows that this doctor in question was. However, I attest that sometimes patients must allow us the possibility that we are right, even if our answers are not what you want to hear. This is what I was reacting to. I hear so many people question the medical profession more than other professions. Maybe I am just more sensitive. But I do not see these people jump on the lawyer for professing more knowledge about the law because these people watch Court TV.
The internet is a valuable resource for knowledge, but not everything in it is correct. Surely a wise patient should check in on it to help ensure his or her health care provider is on the right track (or make suggestion because the said person is completely wrong). If you think the doctor is not fulfilling your needs or right in the diagnosis, please speak up. Most doctors will respond respectfully. The ones that will not treat you with dignity do not deserve you as a client. But do not be so quick to jump on the doctor because he or she doesn’t really know anything or is certainly wrong.
I feel that this society is very complex in its structure, encorporating many niches of knowledge. The mechanic knows a heck of a lot more than the average person about a car’s transmission. An engineer knows more about Fluid dynamics. And a doctor knows more about the human body. I realize that, since everyone has a body, he or she has some basic understanding. But please allow the doctor to state that, from school and experience, obesity may be related somehow to the complaint you are coming in with.
Jake -
If I had said that “all my patients love me” or that “100% of my patients know…”, I could be totally on board with your objection to my comment. However, I made a generalization. A generalization does not imply “every” with regards to a parameter. Why did I make a generalization like that? Because I work with these same people for 4 hours, 3 days a week (until recently). I get to know their children’s names, know what they did over the weekend, and their anxieties about their upcoming surgery. How can anyone “know” about what other people think? By actions. Patients call when I am not there, ask for me, and hang up when they find out that I am not working that day. Others find out my new schedule and call me on the days that I am at work. When I told the other shift that I was going to cut back my hours, many expressed a dismay that now who would help them. Not every patient. And I am not the ultimate nurse that everyone flocks to me. It is just that they trust me more than the other nurses to help them. Should I put a qualifier like “I feel that” before that statement? Maybe, but maybe it is not necessary.
An amount of certainty is valuable in any profession. How else can one be expected to do a job that one doesn’t feel confident in one’s abilities? In health care, confidence is very important. If a patient was told that the doctor was kinda sure of a diagnosis but not positive, would that patient see that doctor again? Most assuredly not. If the patient did not object to running a whole host of unnecessary tests because the doctor was clearly grasping for straws, bet that their insurance carriers would drop them faster than you can say “medical incompetence”. There are inherent ramifications for being wrong. State medical and nursing boards have been put in place to address that issue. Courts are filled with cases brought by patients or their survivors. Some of you have deep animosity towards our “cockiness”, and some of it is well-deserved. However, I assert that doctors and nurses are often reared to be that way. Do not exault the confidence when “the doctor knew right away what was wrong with me” but remark how condescending the doctor was under your breath when you think that he or she is wrong.
This comment was written by natural.Report this comment to the moderators
August 31st, 2005 at 10:38 pm
Thanks to ol cranky for the link. It is a poor excuse for a practitioner to not understand medical literature (and I have never run across a peer-reviewed study of black men’s attraction to fat women). It is a poor excuse of a professional to make the patient feel bad about him/herself. But most importantly, it is a poor excuse of a human being in the 21st century to insert race into an issue when it is inflammatory and unnecessary. My only question is how this man has gotten away with this behavior for so long.
This comment was written by natural.Report this comment to the moderators
September 1st, 2005 at 6:25 am
ceres writes:
Good point, Ceres. In my opinion, if a doctor or other medical professional should NOT be giving a patient a medical lecture on anything for the umpteenth time. If he/she does find him/herself about to give a lecture after the point has been made to this patient several times already, then the professional should stop a moment and think “Hang on, I’ve said this before, if I just repeat the same lecture it’s unlikely to have any effect except to make the patient feel nagged. Is there a better way?”.
For example, a doctor might say something like “I remember saying to you a few times before about the importance of …. in order to avoid …. but I see you haven’t been …. this time either. Is there some problem that prevents you from ….. ? …. Is there anything I can help with to help you do …. because I sure hate to see you with these problems. The patients that do manage to do …. only 5% of them have recurrences.”
In other words, there’s a different in approach between
“Bad non-compliant patient! Have a lecture”
and “Is there some way we can improve the situation here”
natural writes:
Your description sounds so innocuous, but there is a big range of patient experience with doctors mentioning obesity, from the innocuous to the very upsetting/harmful.
For example, suppose someone is fat, and comes to see the doctor with a bad knee.
Some doctors may take the “lose 100lbs and call me in the morning” approach, that is, they put the ball firmly back in the patient’s court, and refusing to contemplate any treatment except weight loss.
Some doctors may take an obesity-mentioning approach more like “Well, being heavy can exacerbate a bad knee, but losing weight is extremely difficult and thin people can get bad knees too, so let’s examine your knee and see exactly what the problem is and see what feasible treatment options there are.”
The problem with doctors isn’t really that they describe how obesity is related to medical conditions, it’s that they insist on weight loss as a primary/only form of treatment when it’s not practical for the patient, and they treat the patient with disrespect.
Most doctors probably don’t think they treat their fat patients with disrespect, but I believe that any time they think the patient isn’t telling the truth about their lifestyle, or they assume things like the patient has an eating disorder, or doesn’t care about their health, or doesn’t exercise, or is making excuses, … that comes through in how they treat the patient. Sure, they probably won’t say it out loud explicitly. They probably think they are being kind and professional to the patient. But every time a doctor has a lack of respect for the patient, I believe it will come through and a patient will know it.
I can’t work out which is more infuriating, doctors who insist that weight loss is feasible and practical and any reasonable person ought to be able to do it (hello? haven’t they read any medical literature on the long-term weight loss success rates?), or doctors that acknowledge that long-term weight loss is nearly impossible but still insist that you have to do it anyway.
This comment was written by Sharon.Report this comment to the moderators
October 27th, 2005 at 9:55 am
Here’s what I say about Dr. Bennett and the First Amendment:
http://christopher-king.blogspot.com/2005/10/youre-so-obese-only-black-men-will.html
Let’s get a grip, here folks. Dr. Terry Bennett’s comments, in lilly-white New Hampshire, are not the same as a doctor telling a skinny black woman, “you’re so skinny only white boys will like you,” and if you can’t see that, or comprehend why it’s different in a context like this, you may be cursed with another physical ailment beyond the Good Doctor’s bailiwick: Myopia.
Having dated leggy blondes to short brunettes and women of many body compositions between 4′10″ to 6′2″ and in between, I appreciate all sorts of women. But apparently some white professionals in the “Live Free or Die” state don’t appreciate black men appreciating white women in that way because he used it as a scare tactic. Well that’s pretty scary to me, folks, so I’m gonna file a complaint with the Seacoast Branch of the NAACP later today. Peace.
PS: His speech is not entirely protected by the First Amendment, as mine was and is in Jaffrey, New Hampshire. He relinquished a degree of his First Amendment Rights by agreeing to be subject to a regulatory board — and he may even be governed by commercial, rather than general, Free Speech doctrines. I, on the other hand, was exercising a Fundamental right as a free negro (or caucasian) citizen to seek redress for a man who faced three (3) drawn guns, arrest and a body cavity search from undercover police who rousted him and eventually charged him with “loitering,” which he beat. See my 16 Oct. blawg, “Open Complaint to NAACP Legal Defense Fund,” which still has not been answered substantively.
-c
This comment was written by christopher king.Report this comment to the moderators
October 28th, 2005 at 10:26 pm
I’m a widow. And I am fat and ugly. Yes fat is ugly. I agree. But I’d like to know why these doctors think we have to have a man in our life? If a man chooses to dislike me because I am fat, oh well his loss! I like my independance. I totally enjoy doing what I want when I want without having to answer to someone else. And if a man is more worried about the cover than the book, then he is very shallow and not worth my time.
This comment was written by Lorraine Carrington.Report this comment to the moderators
November 29th, 2005 at 12:38 pm
Dr. Bennett must have been, at the very least, very frustrated by this patient. Yes, he’s blunt, but to make such a statement he must have been at a point where he couldn’t think of anything else to get through to her. That’s his job. To get through to patients and make them healthy. So what’s the problem here. He’s my doctor and I think he’s great. He tells it like it is. Like “quit smoking or you’re going to die”. I find it very hard to believe he said anything about a black man. He was just trying to get through to her, that her life was in jeopardy. Were any of us in his office when these things were supposedly said? No! Is there a recording of any of this? No! Do we believe everything we hear? No! Just because it’s in print is it the truth? No! Is it the job of the board to punish a doctor for his bedside mannner? No! It’s time this silly case ended and that the board got back to more serious business, such as getting rid of doctors that are “actually doing harm to patients”. Does the board take into consideration that this “terrible” doctor probably doesn’t make any money in his practice because he treats you whether you have insurance or not? Does the board take into consideration that he is available 24/7, whether you have insurance or not? Does the board take into consideration that this doctors office is almost always full? Terry is probably one of the most intelligent people I have ever met. He doesn’t say these things to hear himself talk. He is genuinely concerned about our health and will do just about anything to get through to us even knowing that it will hurt us emotionally. I would rather be a little offended by what he says than to die because he didn’t do whatever was necessary to get through to me. If your that thin skinned, don’t go to him. If you want a good doctor who knows what he’s talking about, go to him. As far as I’m concerned this woman is just looking for an easy buck and to get her eqo stroked. Personally, if I were overweight I’d do everything possible to keep myself out of the limelight and to lose weight. Maybe if she lost some weight she wouldn’t be quite so sensitive. Dr. Bennett has been in practice for 40 years and this is only the second time he’s had a complaint filed against him. That should tell you something about what kind of doctor and person he is. This country has become sue happy and because of that it is becoming increasingly harder for a doctor to pay for malparactice insurance, which is causing the number of people becoming doctors to decrease. Can we afford for this to happen? Definetely not. This insanity must stop and this case is a good place to start.
This comment was written by Audrey.Report this comment to the moderators
November 29th, 2005 at 6:11 pm
My neurologist recommended that I lose weight after doing a meylogram and two MRI’s to confirm the ruptured disks in my back. After he performed the surgery and I’d recovered, we had a long conversation about maintaing my back to prevent further injury. One of the things he mentioned (after proper lifting, and exercise) was that I needed to maintain a healthy weight. He stated openly that the guidelines used to guage this were not exact, and that my pre-injury weight of 143 was a good goal for me.
My gp has mentioned to me that carrying extra weight can often aggravate knee injuries and he mentioned a book that advocates a balanced diet with “good fats” rather than bad, portion control, and a moderate exercise routine. That was how I lost the weight originally.
The doctor in the article used poor judgement, but to say that in all cases that obesity is a cause of health problems is just as wrong as the statements I’ve heard that obesity isn’t a mitigating factor in some diseases and health problems.
I’m thankful that my doctors think enough about my health to risk my getting offended in pointing out what I should already know. And both of these men never made mention of my appearance, dating, or social life. They were more concerned with my current eating habits, what exercise I had been doing since completing my PT, and how I was planning on handling my return to work.
If you aren’t happy with your doctor or doctors then change. And you don’t have to tell the new doctor about any previous physicians.
This comment was written by Mendy.Report this comment to the moderators
November 29th, 2005 at 10:42 pm
Excuses, excuses, excuses. Its amazing how much can be excused with a little fat hatred, isn’t it?
But that’s right, the doctors who look at the evidence and realize that the conclusions drawn have no factual basis are just as wrong as those who threaten patients with sex with black men. There is little cause to think you are open to these issues, when you equate disagreement with you, Mendy, with the kind of bigoted and hateful remarks of this nutjob.
This comment was written by BStu.Report this comment to the moderators
November 30th, 2005 at 3:29 am
BStu,
I don’t hate fat people, I don’t hate anyone for any reason unless their actions give me reason to. I’ve stated before that I understand that fat people are rountinely discriminated against. However I cannot understand how weighing 700 pounds and being physically unable to walk is healthy for an individual (Admitted this is my opinion, if you have a study that states I’m wrong then I will admit I’m wrong.)
That being said someone who weights 90-120 pounds can be more physically unhealthy than a person who is overweight. I never admitted anything else.
I’ve not seen any studies that state that the modern conclusions are incorrect. I’d like to see some of those studies. I personally don’t equate your disagreement with me, but with the idea that in *any* circumstances could a persons weight be a mitigating factor in their health. Notice I said a mitigating factor and not a primary cause. And I can’t speak to everyone, but I’ve been told by people a lot larger than me that if I’d lose a few pounds I’d feel better.
I’ve enjoyed reading the thread, but I can’t continue to participate.
This comment was written by Mendy.Report this comment to the moderators
November 30th, 2005 at 4:20 am
I’ve done some research. I must say that the experts are about evenly divided over obesity as a cause and obesity as a mitigating factor. The three studies I’ve read and the four articles suggest that BMI alone isn’t an indication of premature death unless other factors are already present: high blood pressure or a family history of diabetes.
So, I would think that being over weight and “fit” would be better than being “thin” and a couch potato.
I also need to clarify my position on what the doctor in the original post did. His behaviour was unproffessional at best and bigoted at worst. The patient was well within her rights to contact the state regulatory board and complain.
The doctor was wrong, period!
Most of the research I’ve seen in the past hour or so seems to indicate that being overweight in the presence of existing hypertension, pre-disposition of caridiac disease, or tabacco use, the the weight can be a mitigating factor in the expression and results of these disease pathologies.
My biggest complaint is the inconsistant methods we use to judge “normal” versus “non-normal” weights. BMI isn’t reliable as a very fit person will have an abnormally high BMI. And just using weight isn’t a good measure either. In conclusion, I do not feel that being fat by itself is an indicator of bad health. But being big when there is predisposition for high-blood pressure, cardiac diesease, or diabetes — then it isn’t the weight that causes the illness, but acts as a mitigating factor to how the illness presents.
BStu: I’m not striving to be thin, but only to be healthy. If I’m healthy at 170 pounds, so be it. I don’t eqate disagreement with me personally, as being anywhere close to what the doctor in the article said to that woman. Had I been his patient, I would have called him on it and let everyone in his waiting room know he was a bigot.
However, when dealing with this issue along with others it can become personal. I’m not trying to make any conversation personal, beyond the fact that I can only speak to my personal experiences. (Note: my experiences are not everyone’s, nor are they to be considered normative.)
I may have misunderstood you, BStu. Are you saying that in no instance does weight ever play a role in a person’s health?
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November 30th, 2005 at 8:06 am
I’ve long lost my patience for faux-middle grounders who claim to object to both sides of the debate when that’s not what they are doing at all. They are objecting to the entirity of one side and only extreme rhetoric on the other. What they suggest as compramise really only gives the hate mongers everything they want. Just without the explicit hate monger. Kinder, gentler fat prejudice is still fat prejudice. All the faux-middle grounders are doing is fighting for the status quo. They middle ground they claim is squarely on one side of the debate. But still they insist on the appearance of being “above it all” while their stance betrays them. Insisting on one side give up everything they believe in if the other side just tones down the hate a little is not genuinely trying to find a consensus. Constantly adopting the stance of “well, surely you don’t mean that” is not something I can respond to. If you see fat acceptace as the equivilance of vicious and racist fat hatred, then I don’t know how you can expect me to be able to justify myself to you.
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November 30th, 2005 at 3:39 pm
I don’t expect you to justify yourself to me. Here’s the deal: The middle ground you say I’m not standing on exists, because I am squarely on it. I asked for cites to the studies that state that being fat is not bad for you. I asked for more information, and all you can do is attack me for not blindly following along behind you.
That’s fine. I don’t hate you for any reason. I do not hate fat people, because I myself am fat as is most of my family. You don’t truly want a consensus, you just want to rant.
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December 22nd, 2005 at 1:21 am
scary performance as The White Witch. I’m not sure if it passes The Mo Movie Measure or not; it depends on whether or not discussing a deceased male God counts as discussing a man. Lose Weight Or You’ll Be Forced To Date Black Men! Back in August,Kim posted about the anti-fat diatribes of Dr. Terry Bennett. Now it turns out his standard speech also includes a racial component:
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