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This is the way it should be

December 2, 2011
by

This week my family has insurance for the first time in several years.

Just in time for me to need a couple of immunizations before I can start school at University of Nevada, Reno in the spring. Great timing, right? Shots for a $10 co-pay instead of $150 at the health department. I’m there.

Only, when you’re fat, going to the doctor is like walking through a mine field. Especially if you have an HMO, where you have to choose a primary care doctor before meeting them, and you’re new in town, so you don’t really have anyone to ask. I did my best to research when we were signing up for insurance, choose a doctor that had good reviews on Yelp and hoped for the best.

My experience with doctors has been iffy at best. We had a decent doctor before we moved to Reno. He took excellent care of Ruby when she had pneumonia last winter. He’s treated me for several sinus infections. He studiously ignored my weight, even when I flat out told him I was concerned. But then I started learning about Body Acceptance and HAES and I stopped asking him.

But I’ve had doctors who blamed sore throats, allergies, and a long history of stomach issues on my fat without doing tests, or offering any kind of treatment or advise beyond eat less, move more — one gave me a mimeograph about what to eat to lose weight when you have type A positive blood, and another referred me to a weight loss surgery clinic while giving me a pap smear (that was fun.)

I’m different now, though. I’ve not only come to terms with my body, I’ve learned to appreciate it. Still, I practiced in the shower this morning what I’d say if this doctor thought immunizing me against measles, mumps, rubella and lock jaw was the perfect time to tell me I should go on a low-carb diet.

Her nurse was a young man named Kevin. He took me into a bathroom and told me that he was going to weigh me. I said something like, “Okay.” Then he got all apologetic. “I know it sucks, I’m sorry.” He seemed a little startled when I just shrugged and said not to worry about it.

So, he weighed me. And then he pointed out that I was wearing my shoes and jacket, so he’d take a few pounds off for me. (He did, too. Four pounds.)

I think that a year ago, this whole thing would have mortified me. Being weighed in a small room that required Kevin to be in my personal space. Having him make statements about lying on my medical records about my weight. His obvious embarrassment about being there and being required to weigh this fat lady. He was pleasant, even genuinely so, but uncomfortable for those few minutes.

Now we come to the real reason I’m writing this. There are a lot of stories out there about fat people being treated badly by doctors. Scary badly. Criminally badly, even. (A chiropractor called me a whale when I couldn’t figure out how he wanted me to turn on his table, and once I went for an ultrasound where the tech kept saying, “You’re an obese, so this is really hard.” My stories are mild.) But maybe there aren’t enough that talk about how a fat patient should be treated.

The short answer, of course, is a fat patient should be treated like a patient. With respect and courtesy.

But if you’ve always been fat, maybe you don’t know what that looks like. I didn’t realize until today that I didn’t.

The doctor who saw me squeezed me into her schedule. I’d shown up on the wrong day (my appointment was next Wednesday) and when she heard that I needed the shots to enroll in my classes, she said she could find the time. She wasn’t even my doctor, but my insurance would pay still because she was in the same group.

I’ve never seen a doctor who didn’t rush in, half-listen to whatever concerns I had, talk over me about how whatever it was would be cured if only I’d lose some blubber, and rush back out.

Literally, never. Not even when I was pregnant, all three times.

This doctor sat down. She asked about my family history. When I told her my mother died of breast cancer at 48, she looked at my chart, saw that I’m 40, and wrote me an order for a mammogram. She asked about what kind of vitamins I took, my pregnancies, and about 10 minutes of other questions. She listened with patience.

And then she asked me if I had any other concerns. Remember, she wasn’t even my doctor.

So, I told her the one concern I’d been going back and forth about bringing up. Even though I haven’t been trying to lose weight, it has caused me some pause that despite adding a considerable amount of exercise and changing my diet (no binging, no gluten, etc.), I hadn’t lost any weight at all this year.

I’m not on a diet or anything, I told her. But I’m worried that there might be some medical issue that’s affecting… I don’t know, my metabolism? I have eight thin siblings and thin parents, I told her. So, maybe there is something I need to be worried about?

She didn’t ask me what I ate. She didn’t ask me if I was really exercising as much as I told her I was. There was no question about how much soda I drank or bread I ate. Instead, she ordered blood tests on my thyroid and some female hormone levels, and said she’d talk to me about it more in a month when I came back for the second part of my MMR, and she had my tests back.

She took me on as her patient, even though she wasn’t taking on new patients.

I left her office feeling good. That has never, ever happened to me before.

Is this how thin people always feel when they go to the doctor? Cared for. Treated. Not traumatized.

I told my husband we can never leave Reno. Unless my new doctor does, in which case we’re following her. It’s a damned shame that finding a good doctor when you’re a fat woman feels like a flat out miracle, but it does.

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14 Comments leave one →
  1. December 2, 2011 11:16 am

    You are incredibly lucky. My current doctor will be retiring soon and I am absolutely dreading having to search for a new one.

  2. Fab@54 permalink
    December 2, 2011 12:22 pm

    I swear, I’m actually misty-eyed over your experience! If, when you see that doctor again in a month, you still feel the same (cared for, treated respectfully and with patience) I think you need to give her a big ol’ HUG and a thank you – so that she knows her manner and graciousness is appreciated.
    I hope some day I can have a doctor visit like yours… I hope some day EVERYONE can, no matter how big they are.

  3. Mara permalink
    December 2, 2011 1:33 pm

    Finding a new primary doctor is very scary for a fat person. I’ve used Hanne Blank’s letter as a starting point for my own letter. I’ve found it very effective in either enlisting the doctor’s assistance in my health care, or eliminating them quickly. Here’s the link:

    http://fatfriendlydocs.com/hanne.html

  4. Marija permalink
    December 2, 2011 1:43 pm

    That is truly wonderful. My doc is very similar although I know she is concerned about my weight (I’m barely in the obese category), she doesn’t bug me about it enough to really irritate me. Yes, we fats get more crap, but you know, when I was solidly in the “normal” category, I can still think of at least a few times when I was told my problem was related to my “weight”. And that chiro that called you a whale? GRRR, I would’ve loved to be there.

  5. vesta44 permalink
    December 2, 2011 2:13 pm

    I am so glad you’ve found this doctor, she sounds wonderful. Those doctors who don’t listen to fat patients and think all our problems would be solved if we followed the Nightmare On ELMM Street should take a few pages from her book.

  6. December 2, 2011 4:11 pm

    I enjoyed hearing about your recent experience, and I love the way you shared it. (The mean doctor stories make me shudder. How can they think of themselves as “care providers?”)

  7. Kala permalink
    December 2, 2011 4:16 pm

    Sounds like a nice doctor, I’m glad that your family has got insurance coverage (probably the student discount insurance?).

  8. December 2, 2011 4:36 pm

    I’m so happy to hear about your good experience. You are absolutely right, everyone should feel the way you did, every time they leave the doctor’s office: treated with respect and care. And their concerns and problems…treated (or in the process of.)

    I have had some wonderful doctors, but mostly very negative ones. I think *some* younger doctors, especially women, are becoming much more understanding of the problems with weight criticism and advocating weight loss. I’m definitely finding more young doctors have heard that dieting can cause bingeing and cravings for less-healthy foods.

    I think a good part of the credit goes to you, for doing research as best possible under the circumstances, on Yelp! Smart thinking, and way to go, taking your healthcare into your own hands by doing so.

    I will check out the letter to docs Mara posted above – thank you, Mara.

    Also, I bring a binder filled with plastic sleeves of good HAES articles and bulleted summaries I’ve written, about how weight criticism and undereating cause the starve/binge cycle and less healthy eating, and show this to docs, nurses, medical assistants, receptionists, phlebotomists, etc.! to spread the HAES word and create supportive healthcare environments. I also use it when tabling or speaking about HAES, eating disorders, etc. I encourage everyone to start their own HAES information binder to share with docs and the public. Also, please check out my new (it’s still in process) HAES web site, socohaes.webs.com, for the beginnings of a library of links to HAES articles for healthcare practitioners in my area. Please when there, become a member and post a comment in the forum, to show your support for HAES to healthcare providers.

    Thanks for your uplifting story and good news, Shaunta.

  9. December 2, 2011 6:43 pm

    Can we clone her??!!! It’s so hopeful. I’m curious if you know how old she is? Is she a sign that newer younger docs have shifted into a less fat biased approach? Or is she a menopausal woman who understands that each woman is different and hormones carry a lotta clout? Either way, I am thrilled for you!!

  10. KatieDid permalink
    December 2, 2011 11:36 pm

    “I’ve never seen a doctor who didn’t rush in, half-listen to whatever concerns I had, talk over me about how whatever it was would be cured if only I’d lose some blubber, and rush back out.

    Literally, never. Not even when I was pregnant, all three times.

    This doctor sat down. She asked about my family history. When I told her my mother died of breast cancer at 48, she looked at my chart, saw that I’m 40, and wrote me an order for a mammogram. She asked about what kind of vitamins I took, my pregnancies, and about 10 minutes of other questions. She listened with patience.

    And then she asked me if I had any other concerns. Remember, she wasn’t even my doctor.

    So, I told her the one concern I’d been going back and forth about bringing up. Even though I haven’t been trying to lose weight, it has caused me some pause that despite adding a considerable amount of exercise and changing my diet (no binging, no gluten, etc.), I hadn’t lost any weight at all this year.”

    Fat or slender there are a lot of bad doctors who see sick people as cash vending machines or customers instead of patients. Among all populations many of the money making diseases are on the rise and from a public health POV the medical community is doing nothing to prevent disease and why should they? It’s not profitable. Bad medicine if far more lucrative that good medicine.

    Obesity is a result of many environmental factors and it is not in the best financial interests of the food lobbies, the doctor lobbies and the drug lobbies to prevent any disease. Think about it. What disease had modern medicine eradicated in the past 50 years?

    This doctor in the article sounds like the exception to the rule. She sounds like she had some sensitivity and humility that is so lacking in today’s doctors. They harp on fat people about losing weight yet the medical industry has had no success in lowering the obesity rate and I don’t think the really want to. It is not in their financial best interest and besides doctors are on a power trip and humiliating their patients/customers while fleecing them is too much fun.

    If I had relied on the help of doctors to lose weight I would not be lean and healthy today. They don’t know and they don’t care to know what we face in an environment designed to keep people fat and sick. All I know is this is one girl who has been off all her meds for 9 years and the less money the medical profession can syphon form me the better it like it.

    • lisa permalink
      December 3, 2011 3:41 pm

      ” What disease had modern medicine eradicated in the past 50 years?”

      Polio. Smallpox. And along the same lines some forms of breast cancer have become manageable as long-term disease rather than short-term fatal. Ditto HIV. Lifespan for T1 diabetics has increased dramatically.

      Should we go on?

    • Mulberry permalink
      December 3, 2011 7:14 pm

      I am delighted to live in an environment supposedly designed to keep people fat. My ancestores emigrated to the US because they lived in an environment designed to keep people thin. Poverty can do things like that.
      In this environment “designed to keep people sick”, people are living longer than ever. Older people tend to be sicker. We have wiped out or greatly reduced the incidence of many acute diseases, therefore it’s the chronic ones that show up more. Would you rather live longer with a chronic disease or die fairly young from an acute one?
      These days, medical science is helping us live more comfortably and productively with diseases that are not currently curable. Diabetes is one example. Just delaying its effects by a few years can make a huge difference. I myself have a disease which would have killed me within a few short years if I’d come down with it thirty years ago (within my lifetime). Back then, they could diagnose it but not treat it. And while treatment can at times be painful and bloody, it is still preferable to suffocating to death.
      There are plenty of social problems in the way health care is delivered; no one is saying otherwise. But it’s really not fair to slam all medicine and doctors because the system doesn’t work as well as it should.

  11. December 3, 2011 3:47 pm

    Great post! It’s regrettable you’ve had to live much of your life dealing with healthcare providers who don’t get it–but great you found someone who does–and have the insurance to cover it!
    You’ll find from today’s post on doctors and non-compliance that there are a few more of us healthcare providers that get it!
    http://dropitandeat.blogspot.com/2011/12/what-your-healthcare-team-needs-to-know.html

  12. December 5, 2011 8:10 pm

    “Even though I haven’t been trying to lose weight, it has caused me some pause that despite adding a considerable amount of exercise and changing my diet (no binging, no gluten, etc.), I hadn’t lost any weight at all this year.”

    Isn’t that covered by HAES though? The idea that if you exercise regularly and eat well, yes, you may lose weight, but you probably won’t? It sounds like you may still expect exercise and eating well to equal weight loss.. which is a big part of what fat acceptance tries to debunk. Of course, considering that your entire family is thin then you definitely have reason to question why you’re fat and they aren’t since weight is largely genetic, I just think that getting rid of the idea that exercise and healthy eating equals weight loss is necessary in the FA movement.

    Sounds like you have an absolutely fabulous doctor. I actually do have thyroid disease but when I moved and had to get a new doctor, she decided to completely ignore it (i saw her right after a thyroid attack which can make your TSH- the hormone they use to diagnose thyroid disease- plummet even though you’re not actually better). 7 years of symptoms and previous tests just out the window! I’m planning on trying to find someone new, but trial and error is difficult! I do, however, have the *best* physical therapist! I have arthritis in one knee and she’s never mentioned my weight and when I mentioned how other doctors would treat me she had the good graces to talk about how ridiculous it is because thin people get arthritis all the time (and i have hypermobility syndrome which put me at a higher risk so that’s what we’re treating). Anyway, yay for awesome doctors!!! good for you!

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