Skinny Daily Post

Invincible.

Montreal is a beautiful city, and it’s been home base for me this week as I’ve covered the International Continence Society annual meeting for a client. It’s been interesting, to say the least. There have been several major themes here, notably the need to listen to the patient and take the patient’s goals and expectations seriously, along with the inevitable jockeying for position among products and strategies.

Guess what… obesity is a risk factor for incontinence. You knew that, I’m sure you did. You’re probably living it.

But what you didn’t know is the contempt with which some of these urologists and gynecologists view us. One young woman physician from The Netherlands presented a poorly designed study of risk factors for incontinence among women, and included cartoons of obese women in her presentation. Not only did she think them appropriate, she also concluded that ‘women need to take charge of their health,’ which she used as a euphemism for ‘stop smoking and lose weight or else.’

Isn’t consulting a physician when you’re ill considered ‘taking charge of your health?’ Not a single word about how she could help the situation, of course.

There was another poster, a floor display, that featured a cartoon of an obese woman as the background. The findings once again noted – as a single line item – that obesity was a risk factor. That single line item finding made up the entire design theme.

But perhaps the worst was the distinguished British physician who stood up and proclaimed that ‘obese people scared him,’ that ‘every time he had to examine one, he wasn’t sure that he’d get his hand back,’ and that the process was just ‘too difficult.’ His comments were met with laughter and agreement. Not a single word about developing techniques that would make the process comfortable and respectful for all parties. Nothing about having special equipment to make the obese among us comfortable, and to obtain the information needed to make the right diagnosis.

Now, I’m sure that there were physicians in this group who disagreed with these views, yet they were silent. There’s no real reason, of course, for them to speak up in this forum.

But I’m leaving you all with the warning that we have to be very, very careful with our medical care. It’s all too easy to find physicians who will treat us with contempt, who will not take us seriously, and who will make no effort to help us. Contrary to the conference theme of listening to patients, a significant proportion of them will turn their backs on us, and be pleased that they upheld their so-called principles.

Brains aren’t enough. Compassion and sensitivity need to go into the mix as well.

18 thoughts on “Brains aren’t enough

  1. Blader says:

    Let’s say you take a portion of the population and ignore many of their complaints. Let’s say you then treat them with disdain and offer simple solutions without considering whether they can be applied. Then let’s say you tell these same people, in many subtle and some obvious ways that they are victims of their own making and deserve what they get. Let’s say many of these people now hesitate to go to a doctor with any complaint until it becomes much, much worse.

    Do you think the statistics will show that the population in question is more at risk of every disease and condition possible to an aging human? Would the statistics show that the population is more likely to die from their ailment once it has finally been caught?

    I’d say the population in question could be obese people. It could also be poor people. (can’t believe what is happening in New Orleans)

  2. stretchy says:

    Many doctors do have the so-called “God Complex” Some doctors never see me a second time, because I found them unhelpful, arrogant, bad listeners, or all of those things. I gained my weight after age 45, & lost it two years later. Most of my bad doctors treated me when I was skinny.
    One OBGYN argued with me over absolutely nothing. I was fine with my chosen birth control but she wanted to perform surgery to remove my healthy reproductive organs. I was happy & healthy and did not need that surgery! She became irate and angry–she told me she was a SURGEON as well as an OBGYN and actually called me ignorant. “Why bleed every month? ” she asked, My periods were not a problem at all! , but she refused to listen.
    We moved a lot, and had kids, so we met many many doctors through the decades.
    I am a QUIET SHY person, easy target. Doctors treated me with distain and disrespect. I even had one doctor tell me I shouldn’t have a second child when I was young and poor, because he said,:
    “Poor people should not burden society with more of same.”

    I told him I’d come from a large, dirt poor family, and that my kids wouldn’t be knocking on HIS door for any financial help.
    He walked out of the room while I was saying this, so he didn’t hear half of it!

    I don’t know anyone that does not have at least a few “doctor related horror stories.”

  3. Elizabeth Crowe says:

    Jane-
    These doctors’ attitude, that all illnesses are directly linked to a patient’s obesity, contributes to our common dread of going to the doctor. A friend of mine who had been diagnosed with MS had the same complaint- “even when I have a terrible sore throat, the doctor immediately chalks it up to my MS without considering that I might have contracted strep.” It’s hard to make yourself go when you know you aren’t being taken seriously as a person interested in maintaining health.

    Panda

  4. Mercury says:

    A few months ago, I spoke to a cowoker’s wife, who happens to be an ob-gyn. She said that her job is physically much tougher than it used to be because expectant mothers are so much heavier now, and it’s just harder to get the baby out. She’s a nice woman, but she told me how she had just delivered a baby for a 300 lb mother, and she definitely seemed disgusted (she herself is quite trim). Of course, a lot of doctors don’t take their own advice, and overeat and smoke.

    Don’t know how useful this is, just thought I’d share.

  5. Jeanne Masters says:

    Jane,

    Why didn’t YOU speak up? Does being outnumbered by arrogant doctors render your opinions invalid? Were you waiting for someone else to do it?

    The only sensible thing I’ve ever heard Oprah Winfrey say (which I think was borrowed from Maya Angelou) was, “We teach people how to treat us.” If you accept rude, condescending, ignorant treatment from anyone, including your doctor, you’ll get more of the same. If all of you who left your doctors after one bad visit did so without telling them WHY you were leaving, they won’t put two and two together and realize that they were at fault. They’ll be like that doctor in New Hampshire who’s about to be disciplined for making inappropriate remarks to an obese female patient. His take is, “Fat people are in denial.” I’ll bet no one ever rebuked him to his face for his inappropriate remarks.

    At the very least, being non-confrontational in life just gets you stepped on. When it comes to your health, it could get you killed.

  6. Michelle says:

    This is the very reason why I’ve postponed my “annual” GYN checkup for 3 years. Intellectually, I know I need to go to take good care of myself regardless of my weight. Nut emotionally, I’m crippled by the perceived judgement and the same old speech lose-wieght I get from the whippet thin doc.

    Oh, and yeah, I knew that about incontinence. Believe me, I know.

  7. Denise says:

    Yep. Doctors don’t always have the best people skills. But, I’ve been thin most of my life, (and was fat/obese for “only” about 6 years in my adult life) and thin people will tell you that many/(most?) doctors put their feet in their mouths ALL the time with ALL people – not just overweight ones.

    I developed a whole bunch of health problems when I gained weight – asthma, hormonal issues, incontinence, high cholesterol, etc., etc. I wasn’t motivated to lose weight because I just got tired of donuts and the #3 McBreakfast and wanted to eat lots of healthy meals. Believe me. I like donuts for breakfast way better than oatmeal every morning. But, I wanted my good health back.

    Quote from Jane: “One young woman physician from The Netherlands presented a poorly designed study of risk factors for incontinence among women, and included cartoons of obese women in her presentation. Not only did she think them appropriate, she also concluded that ‘women need to take charge of their health,’ which she used as a euphemism for ‘stop smoking and lose weight or else.’ ”

    I don’t agree with the cartoons… That is neither necessary nor sensitive. But, at the risk of being politically incorrect… (Sorry. The “poor me – I’m obese and the world just doesn’t understand me and doctors are all insensitive and I’ve got a big chip on my shoulder” tone here is getting to me.) I do agree that “women need to take charge of their health” and *&^%-ing big deal if it IS an “euphemism for stop smoking and lose weight or else.” It is still true.

  8. Goddess Jessica says:

    I’m blessed. I have a loud mouth. I speak my opinion – especially iff we’re talking about my health.

    I remember walking into a doctor’s office and asking about trying to lose weight. He immediately started writing a prescription and I said, “No. That’s not what I’m talking about. I need something more than that.” He confessed he’s never been overweight so he didn’t understand my struggle.

    I’m really lucky. I can appreciate how hard it is to say, “Wait a minute! Listen to the words coming out of my mouth first.”

  9. jane says:

    very interesting comments here. from the start of this, i’ve been planning the best course of action to deal with this. speaking up at the meeting was not an option as i was there with clients, and could not do anything that would call attention to myself [it’s part of my job – corporate spying!]. but i think that the president of the association is going to hear about this issue. i CANNOT let it drop.

    and it seems as if i failed to communicate an important point. we all must – each and every one of us, heavy or thin, green or red, short or tall – be responsible for our health. however, going to the doctor when there’s an issue is part of taking care of ourselves, and the disdain and contempt that we often meet can easily derail us from that mission.

  10. okla sunshine says:

    I enjoy the two new writers, but I sure do miss your thoughts and ideas, JuJu. Come back. You are missed!

    Another thought…

    Since I only started reading the skinny daily last year, (upon the great advice of a friend), I started reading the archives when you stopped writing as much JuJu. It became pretty obvious that your writing was a big part of helping keep your “weight loss head” on straight. You are so right! Writing it all out, works! So I couldn’t help but think, even if you’re not up to writing your blog at skinny daily, because life has gotten in the way, DON’T STOP YOUR WRITING! I am hoping YOUR PERSONAL body log/journal is still a priority! With what all is going on with you and your family, it would be very easy for that to take a back seat. But you owe it to yourself to help yourself keep the weight off by keeping up with what’s worked in the past –by writing it all out — your personal thoughts, feelings, notes to self…
    Sometimes, it is the only way we can keep our weight loss heads on straight!

    Wishing you all the best in keeping all that weight OFF through trying times!

    Sunshine

  11. Melissa says:

    You know, as a physician who IS interested in helping with obesity, and women’s health, and exercise, etc etc, I have to express my frustration with reading this site. Yes, no question, many physicians have a tough time working with/understanding/coping with obese patients. Part of it is individual personality, part of it is lack of education. There is only so much time in medical school and so many topics to cover, that unfortunately not every topic, including nutrition, gets the time it deserves.

    In the past, this site has been a wonderful, uplifting, educational place to visit as someone also trying to lose weight (yes, we get fat too). Lately, however, it seems to have turned into a health care bashing, “what can we complain about next” mentality that is very disappointing, and really gets us nowhere.

    Instead of griping about how little we doctors seem to know about helping obese patients, how about some positive ideas about what you WOULD like? Yes, I can recommend an eating plan, yes I can refer you for WLS, yes I can give info on exercise. At the end of the day, though, YOU STILL HAVE TO DO IT! I still have to do it! It is hard! But I’m doing it. What can we do so that you do it too?

    Frustrated Doc

  12. Heather says:

    Dear Frustrated Doc,

    I imagine that if you did a content analysis of this site, you would find only a couple of posts about health-care professionals– having read the site for about four months, I have the impression that most posts are about exercise, portion control, getting more veggies and fruits, mental tools for staying on program… it is understandable that you are sensitive to criticisms of the health profession, but I think you are being unfair when you say that this site has turned into a doctor-bashing site.

    That said, you asked what we would like from our doctors. What I would like is a doctor that approached me in a sensitive yet no nonsense way, rather than treating me like I am stupid as well as fat. The number of times I’ve had a doctor say “Are you aware you have a weight problem?” is staggering. I have started answering, “Oh, my God! You’re right! I’m huge now but when I woke up this morning, I was a size 8!” I had one OB-GYN say, just as she was about to insert the speculum, “how did you get so fat?” That really made me relax for the Pap smear.

    So what would I like? Someone who can say something like “I know you know you have a weight problem. I am concerned that your weight is going to affect your health. I would like to recommend some programs that can help you learn how to eat more healthily and incorporate exercise into your life. I fear that if you don’t adopt such habits, you will dramatically shorten your life. Can I provide that information?”

    FYI, I had one doctor who approached me in just this way, and I have now lost almost 100 lbs through diet and exercise.

    Heather

  13. stretchy says:

    corrected post

    I agree with Heather’s post 100%. I was lucky to find 1 doctor out of dozens who treated me with respect. He gave me a list of diet books to look at, and that helped me get started. I am not “griping” when I said a doctor told me I was ignorant to not get surgery I didn’t need or when I told of the doc who said I was NOT good enough to reproduce! these are just facts. I could tell worse true stories about doctors, but I held back. Getting through Harvard Medical School is impressive indeed, but it doesn’t automatically make you a supreme being, docs are people too, it is a shame many of them are appalled by “ignorant” patients.

  14. marianne says:

    Dear Frustrated Doc,

    What are the best strategies to approach your colleagues? I’m sure that some are just insensitive, overworked, frustrated, etc (happens in all walks of life) and others who may not even be aware of how something sounds to someone else.

    That said,
    If we do experience rudeness, insensitivity or are ignored, what can we do?
    *Should we confront the doctor during the visit? (hard for us shy folks)
    *Should we write a letter to the doctor after the visit? Does that have any effect?
    *How do we constructively share our concerns with the medical community that we feel ignored or belittled, but are willing to find solutions that help us both?

    Marianne

  15. jonquil says:

    “Frustrated Doc” needs to walk a mile in the patients’ shoes before he (I think it’s a “he”) makes a judgment. I have been in and out of hospitals many times in my life, never related to my weight, and I have several relatives and friends who are nurses. I have to say, the sum total of those anecdotes and experiences is not good. There are some really heroic doctors out there, but in my experience it’s about 25%. The rest are doing a job they don’t really like, or milking the insured to cover the uninsured, or just plain out to get rich.

    I have had doctors prescibe medicines without reading my chart, diagnose me without proper lab tests, fail to consult or listen to specialists, I have had them try to bully me into taking pills or even having operations I did not need. I have had doctors who never examined me, just foisted me off on assistants, undergraduate students, or even the insurance clerk– for diagnosis and treatment! But the worst thing, by far, is to watch a doctor’s eyes glaze over in the few minutes he or she does give me. I might as well not even bother. It’s as if doctors were conditioned to disbelieve every word I say.

    Honestly, if “Frustrated Doc” wants to help, I’d suggest he partner with an opposite-sex reporter (to get the full picture), pose as patients, incognito, and write an expose on how people are really treated by the medical profession. Go in there as an ordinary patient, not as a fellow doctor. You’ll see.

    And while you’re at it, read the growing literature on the corruption of the medical industry, too. Oh, and research the process of “disease creation and marketing” by Big Pharma. (And that’s not even getting started on doctors who are just. plain. criminal. Or the good-old-boy AMA, which shields them.) Much of this literature is produced by government, academia, and the insurance industry. Even a few medical people are starting to speak out. Is this all “doctor bashing?”

    It’s widely believed that we need a massive reform of the medical care delivery system, both in America and around the world. And the patient-doctor relationship is at the crux of the issue. If “Frustrated Doc” wants to help, he needs to accept that there is a system-wide problem here, it’s real, it’s not griping. Patients are conditioned to defer to doctors, not “bash” them. Look at the many posts here, where patients have kept quiet when they are being disrespected or abused.

    But then, denial that an issue is real is a major part of the toolkit of disempowerment, and entrenched power blocs are not motivated to listen or change. So maybe what’s needed is a “radical power-ectomy operation” to curb the corruption, arrogance, money, and excessive political influence of the whole medical industry. Starting in America.

    Just relax. This won’t hurt a bit.

  16. Less Frustrated Doc says:

    Thanks, Marianne and Heather. That was some helpful info. I’m always looking for better ways to talk to my patients, and I plan to add a bit of that to what I say in the office.

    With regards to how to talk to your doc, I can honestly only speak for myself. I would hope that patients coming to see me would feel able to talk about anything on their minds, but I also know what it is like to be a bit tongue tied at the doctor’s office too (used to happen to me lots as a kid, but is a bit better now:)). I always read any letters written to me by patients I have seen, as it was important enough for them to take the time to write it and send it to me. A few have actually changed my approach in talking to people, as they pointed out something I could do better.

    I am saddened to read from all of you the awful experiences you have gone through. Yes, looking after obese patients creates some unique challenges, but does not mean you should get treated with any less respect than anyone else. It’s shameful in this society that it still happens. Some of what you have written about borders on harassment, and you can write to your local state licensing board to complain. Only by speaking up will these physicians be brought to task.

    I guess the only thing I have to add is that if you are not impressed by a physician that you have seen, and cannot talk to them or come to a consensus in any other way, switch. Keep looking until you find someone that works. This is hard, what with HMO’s and such, but worthwhile. There are lots of good people out there. You are important enough to search until you find one.

  17. Amy K. says:

    For what it’s worth, my Nurse Practitioner in Ann Arbor, MI has been my favorite doctor so far. Not rushed, willing to listen. Didn’t lecture about my weight, but recommended that I start an exercise regimen.

    My new doctor is a Doctor, rather than an NP, but never has time to listen. I have to keep reminding him what I need, and he’s always a half hour to an hour behind for the 10 minutes I get to spend with him. He’s a nice guy and does seem to have a genuine concern for me, but I’m still switching doctors for my next annual.

    What could he do better? Schedule fewer patients per day, and more time per patient. Jot down my questions, rather than just listening, then promptly forgetting them. And it would be nice to do the routine bloodwork (cholesterol, fasting blood sugar, whatever) beforehand, so we can go over the results together rather than sending me a letter saying “looks good,” when I don’t have a chance to ask questions.

    I had the NP when I was overweight verging on obese. I was never treated with disdain, never made to feel inferior. They had to use a larger speculum. I realized later that it was because I had too much fat, but it was never an issue at the OBGYN, they had everything handy. I guess embracing the whole spectrum of “normal” is really what I would hope from the medical community.

  18. Jax says:

    Good heavens. I’ve been struggling with bladder issues for years–not incontinence, thank gods, but horribly recurrent bladder infections. It hadn’t occurred to me that they could be related to my extra weight (I’m not obese, but do have weight to lose). I suppose they might not be, but ANYTHING I can do to make them stop…one more motivation for weight loss to add to the list!

    Unfortunately, those doctors just show that it’s possible to be both educated and ignorant…

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