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.

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?

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.

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.

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.

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

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.

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:

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.

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.

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.

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.

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.

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.

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.

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.

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.