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Bad encounters may prompt obese patients to doctor-shop (DUH!)

July 30, 2013

Bad encounters may prompt obese patients to doctor shop” is one of those “No shit, Sherlock” headlines, and after reading it, I had a rant and a half on Facebook (one of my friends posted the link to the article). I don’t recommend reading it unless you have a well-padded surface on your desk for the many *headdesk* moments you’ll have.

Negative health care experiences could lead obese patients to switch primary care doctors repeatedly in search of a practice where they feel accepted, said Baltimore internist Kimberly A. Gudzune, MD, MPH.

Such encounters may include off-putting comments, unsolicited weight loss advice and offices with blood pressure cuffs, chairs and exam tables that are not large enough to accommodate obese patients, Dr. Gudzune said.

WT ever-loving F?! I weigh 400 lbs and I’ve never run into an exam table that was too small for me. On the other hand, very seldom have I found a clinic/hospital that has gowns that will cover mTrust Mee adequately. And don’t even get me started on the chairs in the waiting rooms and exam rooms. It’s embarrassing as hell to sit down in a chair and, when you’re called back to the exam room, to get up and find chair is stuck to your ass and tries to come with you (not to mention how painful it is on your hips and thighs). As for the weight loss advice? Yeah, that’s very off-putting for people who have dieted for years and had those diets fail every. damned. time. Oh, and those blood pressure cuffs? It doesn’t matter a hill of beans if they do have one that fits properly if they automatically assume you have high blood pressure simply because you’re fat and pump the cuff up higher than it needs to be (I’ve watched them take my BP and pump the damned thing up to 200, and it’s painful as hell, especially since I also have fibromyalgia).

The biggest problem I’ve had with exam tables isn’t their size, it’s that step that is pulled out so you can more easily get up on the table. Now, if the step that pulls out rests on the floor, no problem. But if it’s one of those that pulls out and is 3 or 4 inches off the floor, I can’t use it. As soon as I step on it, the whole exam table tilts. Pretty embarrassing when the nurse (or doctor) has to hold the table down so you can get on it. Of course, if you’re tall enough, and your legs are long enough, and you’re able, you can always ignore the step and try to hike one hip up high enough to sit on the edge of the table and then scoot yourself over using that step (because most of your weight is already on the table, it won’t tilt; at least, that’s been my experience).

“I was spurred on by the

of whether this is a pervasive issue,” said Dr. Gudzune, assistant professor of medicine in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine in Baltimore.

The study found that 28% of obese adults visited at least three primary care physicians during a two-year period compared with 21% of normal-weight patients.

“There’s something going wrong in these doctor-patient relationships that makes these switches so frequent for this group of people,” Dr. Gudzune said.

Gee, ya think? Could it possibly be the fact that any time a fat person goes to the doctor, they’re told that whatever ailment they have is caused by their fat, and that if they would just “eat less, move more” and lose a fuckton of weight, all their ills would be magically cured? Could it be that every time a fat person goes to the doctor, they’re given a lecture about how their fat is killing them? Or even if they’re metabolically healthy now, every so-called “obesity-related” disease will eventually push them into an early grave? Could it be that doctors show a marked lack of empathy for their fat patients?

As a result, the health of overweight and obese patients who doctor-shop is being compromised. “Because they do not remain with their doctors for very long, they are ending up in the emergency room, likely for things that could have been taken care of in a primary care office,”

It’s not just because fat patients don’t stay with a doctor long enough, it’s also because doctors don’t look past a patient’s fat for the underlying causes of ailments. Some physicians are so sure that being fat is the only cause of any/every ailment, that they refuse to consider any other cause. Many fat patients don’t go back to see their doctor when their ailment worsens because they know what they’ll hear, so they end up in the emergency room.

Dr. Gudzune suggests that physicians ensure that their offices can accommodate obese patients. She also said doctors should take time to think about how they could be more sensitive to that patient population’s needs.

How about asking fat patients what their needs are? I’m a fat patient and I’ll tell you what I would like to see in a doctor’s office.

  1. I want chairs in the waiting room and exam rooms that don’t have arms on them, and that aren’t so low that I have to crawl out of them.
  2. I want exam gowns that will cover all 400 lbs of me. I don’t want to have to use two gowns and a skimpy sheet. I want a gown that will cover me and let me feel secure that I’m not flashing the hallway every time the door is opened.
  3. I want nurses trained in how to take blood pressure with a large cuff on fat arms. My fat arm is not a perfect cylinder, it tapers from shoulder-to-elbow, so they need to know how to adjust the cuff accordingly so my arm fat isn’t pinched. They also need to take the patient’s word for it when the patient says they don’t have high blood pressure and not pump the cuff up as high as it will go because they’re expecting it to be high (fuck, I hate when they do that, it pisses me off, it hurts, and of course my BP is going to be high when I’m pissed and in pain).
  4. I don’t want to hear about the latest diet and how it will definitely make me lose weight if I just follow it faithfully. I don’t want to hear about how my weight is going to kill me.
  5. I do want suggestions for exercise that I can do within my physical limitations.
  6. I also want to be believed when I say my pain, on a scale of 1 to 10, is a 15, or a 20. I’ve been dealing with it for so many years, that I’m used to it. But when it’s bad enough to make me cry, I don’t want to be told to take a couple of extra-strength Tylenol and I’ll be fine. I’m sorry, when 50 mg of tramadol doesn’t even touch the pain I have, Tylenol is as useful as water. And that kind of pain makes it impossible to do most recommended exercise.

I’m sure I’m not the only fat patient that wants these things, and I’m also sure there are things other fat patients want that I didn’t mention.

One way to accomplish this is by “addressing weight with patients in a way that’s engaging and constructive and positive rather than negative or stigmatizing or condescending,” said Adam G. Tsai, MD, MSCE, a Denver internist and chair of the Obesity Society Public Affairs Committee.

For instance, physicians should use respectful terms such as “excess weight,” ask patients about their eating habits and encourage them to replace unhealthy foods with nutritious alternatives, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Oh no, you didn’t even go there, did you? Really? You really think addressing weight by calling it “excess weight” is going to make fat patients feel better about themselves and want to follow your advice? Really? Would you want to be talked to like that? Would you want to be treated like that?

You can ask about eating habits, and you can suggest healthier alternatives if fat patients aren’t eating a healthy diet, but you had better also ask if they have access to those healthier alternatives, if they have storage for them, if they have cooking facilities for them, and if they even have the time to cook them. Because you can suggest all the healthy alternatives you want, but without those basic necessities, it’s not going to do me any good at all. And if they are eating a healthy diet, do NOT call them a liar. That will cost you any confidence they may have had in you.

The institute suggests that physicians consider starting weight-loss conversations by saying, “Your BMI is above the healthy range. Excess weight could increase your risk for some health problems. Would you mind if we talked about it?”

Sorry, but my suggestion is that you not start a weight loss conversation with me at all, ever. Most fat people have been on diet after diet after diet, only to have every one of them fail to keep the weight off long-term. Some of us have not only yo-yo dieted for years, we’ve also had weight loss surgery that has failed to make us thin, given us complications that make our quality of life suck, and we’re fatter than we were before the surgery. We know diets don’t work, “lifestyle” changes don’t work (a diet by any other name is still a diet), and we’re not interested in hearing about them anymore. Oh, and those health problems that my weight supposedly increases my risk for? Thin people get them too. Do you recommend weight loss to them?

Researchers found the odds of seeking a new doctor increased by 19% for overweight patients and 37% for obese individuals compared with those who were a normal weight. Doctor-shopping was defined as visiting at least three primary care physicians in the past two years.

Overweight and obese doctor-shoppers were 85% more likely to visit the emergency department than normal-weight individuals who have regular doctors. They were not, however, more likely to be hospitalized, which suggests that their health issues probably could have been addressed by a primary care physician, Dr. Gudzune said.

“We need to strive to create a safe, judgment-free environment where all patients can receive satisfying medical care,” she said.

I’m sorry, but the cluelessness of this article is just astounding. I mean, I shouldn’t be surprised that they’re as clueless as they are. After all, I fired Dr W and am now seeing Dr D (and he’s not much better than Dr. W). He still believes in the calories in/calories out theory, but at least I’ve convinced him to not talk about weight or weight loss with me anymore. And he did order X-rays of my hip/lower back to find the source of my pain (something Dr W refused to do).

If Dr. Guzune wants to create “a safe, judgment-free environment where all patients can receive satisfying medical care,” then stop talking about how excess weight leads to certain diseases (that thin people also get) and how weight loss is the solution. Have you even bothered to ask fat patients what the problems are, what they’ve tried and how to solve the problems? If you haven’t, nothing is going to improve, fat people still aren’t going to get the care they deserve, and they’ll continue to doctor-shop until they finally find a doctor that isn’t a fat-phobic, bigoted asshat.

Vesta44

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30 Comments leave one →
  1. Twirlgrl permalink
    July 30, 2013 11:12 am

    I was in a car accident almost 20 years ago. I never had any pain before the accident but afterwards, I had back pain so bad I could hardly walk. The insurance denied my claims because the doctor listed the cause of the back pain as obesity. Because of the untreated pain, I gained even more weight.

    Two years ago, I developed sudden onset severe, widespread pain throughout my body in my tendons along with muscle spasms, tremors, weakness, digestive issues and cognitive issues. My official diagnosis? Generalized pain and obesity. Still looking for a doctor who won’t tell me to take Tylenol, go for a walk and eat more vegetables. I feel like I am dying and I can’t get any help because doctors assume everything is because I am fat and lazy.

  2. Diann Johns permalink
    July 30, 2013 11:28 am

    I actually don’t have a problem with a doctor advising me to lose weight. It’s when they are flat out rude or don’t address it all because they think I will burst out crying that is annoying. Most of the doctors I have seen seem very hesitant to bring it up. My most recent issue with a doctor was him screaming at me that I was diabetic based off of one AC1 test of 6.0. I am sorry, but I am not going on meds based off of one test. Here is how the two encounters went:

    First encounter:
    He told me my thyroid was really low and I needed to go on thyroid meds. My entire family is on thyroid so no surprise. He then told me my AC1 was 6.0. I had the results before the visit so I had looked up info on it. 6.0 is in the danger zone for diabetes and this is what he told me. He said “You’re in danger of developing diabetes and I’d like to put you on meds” I declined and advised him that I would rather make changes to my diet and see how the thyroid meds affect my blood sugar. I could tell he was pissed off that I didn’t just blindly follow his advice. Not my problem. My body my decision about what I put into it.

    Second Encounter I went back for my 3 months blood work. Before getting those results he kept asking me:”How are your sugars…your sweets?”. He asked this about 3 times before he would stop talking so I could respond. I said “I have no idea” and he was all exasperated and asked “Why I wasn’t checking them”. Keep in mind at the previous visit at no time did he instruct me use a meter to check my blood. I told him I wasn’t checking it because I wasn’t diabetic. He flew into a little tissy and said “Don’t be in denial about your diabetes and showed me my test results. Which was very funny because he pointed out the range that said 6.0 was normal. It must have been an older chart because I think that’s lower now.

    He gave me a blood meter and told me I needed to go on meds and to check my blood sugar etc. So I checked my blood all week it never went higher than 140 and that was after eating KFC. one hour later it went down to 120 and an hour after that 110.

    My tests came back and my AC1 was 5.9. The nurse good news you’r not diabetic. LOL I went home and made an appointment with an endo because screw going on meds by one test and an obvious prejudice by this dick. The endo told me I didn’t need to be on meds or to be sticking myself and to just make changes to my diet.

    My most recent AC1 was 5.8. My cholesterol 199. My Blood pressure 128/70. My trig 100. My HDL 36 which needs to be higher and my LDL 143 which needs to be lower. My fasting glucose was 103 which is impaired and needs to be lower, but I am still not going on meds. I have switched to drinking water only and will be interested in seeing how the next AC1 results will be affected by this change.

    I weigh 393 lbs at my visit last Sunday.

    So yeah I am very pro-active about my health and if a doctor seems illogical to me or prejudicial I will drop that prick in a heartbeat.

  3. Duckie permalink
    July 30, 2013 11:30 am

    Regarding the BP cuff thing – I have never in my life had high blood pressure. However, I have left the doctor’s office with bruising around my arms from an enthusiastic nurse with a cuff.

  4. July 30, 2013 11:33 am

    I have low blood pressure. And by low they mean normal. Since it is expected it would be higher, its low. My chart shows it. But I get to go through having my arm pinched off twice by first the automatic cuff… which never reads me, and the old cuff, ehich does read me. You can tell by the look of disdain on the nurse’s face that she thinks my arm is too fat. It would be funny if it wasn’t just so cliched.

    I would add “have a digital scale” to the list. Its emotionally draining and embaracing to have to stand on a scale for two minutes while the nurse continues to slide the old weight sliders up and up and up. And old scales often just do not weigh high enough. If doctors can get a digital scale that weighs up to a ton, I feel they are showing inherent disdain for keeping one that only goes to 350.

    • nof permalink
      July 30, 2013 12:49 pm

      I have low blood pressure–I read 90/60 at the doctor’s office, and have read as low as 80/40 at home. Despite very low readings coupled with near-constant tingling in my fingers and bouts of weakness and trembling (I take my blood pressure whenever I have one of these fits, and it’s always extremely low at those times), no doctor has yet seen this as a potential problem. I either get “Your blood pressure is fantastic!” or “You’re probably dehydrated, drink more water.” I can’t help but think if they weren’t so scared of a fatty with high blood pressure, they might have investigated this further.

      • July 30, 2013 2:09 pm

        I think you are right. I’m pretty sure mine is indicative of anemia, which was caught because my family My doctor has a new PA who is really good. She investigates the problems I talk to her about and doesn’t pawn all my problems off on BMI. More than a lot of doctor’s I have has, my PA cares about my health. It’s refreshing. I wish she gave classes on how to adopt her “bed side manner” or whatever you want to call it.

    • BBDee permalink
      July 30, 2013 10:22 pm

      I’ve solved that issue by flatly REFUSING to get on the scale. fortunately my doc isn’t too obnoxious about that.

  5. July 30, 2013 11:55 am

    Amen, Sistah Vesta!
    And here’s another suggestion for doctors and especially surgeons: If you are uncomfortable, unskilled, or inexperienced in operating on very fat people…. then say so from the get-go and recommend another doctor who HAS the experience.

    I’ve recently had the *joy* of dealing with a doctor who made me feel like the D&C she was going to perform on me in a couple weeks time was the most “dangerous” and ‘risky’ operation one could ever imagine! I felt like I was undergoing an organ transplant or open heart surgery! All because of my weight, of course.
    On two different office visits we discussed the procedure thoroughly and even though I’d had this done once before by another doctor, only a few years earlier (and I was just as fat then too) she managed to get me to the point of absolute terror about this upcoming situation!
    I was having freakin’ nightmares! Literally.
    Finally, out of desperation and abject fear, I just blurted out to her; “Doctor, if YOU don’t want to operate on me because I’m too fat, just TELL ME and I’ll go to another doctor. You don’t sound confident AT ALL, and that makes me very, very uneasy!”

    She was taken aback for a moment or two… and then told me very honestly, that it wasn’t the D&C she was worried about, but that she was concerned about the subsequent hysterectomy down the road a ways. (There was a 50/50 chance a hysterectomy was needed – depending on the D&C findings). THAT was the procedure she wasn’t very confident about because she wasn’t very experienced with the Da Vinci (robotics) method that is highly recommended for fat patients. I was like jumpin’ Jesus doc… you scared the shit outa me. (Yes, I told her that!)

    Long story shorter, she did the D&C, and all went well. I came through the “scary” operation like a champ! Certainly way better than anyone expected this fat patient to. No breathing issues, no heart attack or stroke on the table, no problems with BP or the anesthesia. Wow, imagine that… flying colors – from a fatty no less. 🙂

    The hysterectomy is scheduled for September. The senior partner at the dr’s office will be doing the da Vinci operation on me for that. I’ve met him already, and he’s very gentle, confident and doesn’t treat me like a moron. No body shaming either!
    He’s got over 8 yrs experience exclusively with the robotics and with many many fat patients like me. My doctor will be assisting (and learning). I feel much much better.

    But imagine my terror if I hadn’t said anything to my doctor and just went under the knife with full blown anxiety and fear festering inside me?? ugh!! Many times it’s best if the fat patient DOES shop around and find someone who makes them feel confident.

  6. Erin S. permalink
    July 30, 2013 12:00 pm

    Ah, doctors… the only professional providing a service where the *client* is at fault for firing them if they don’t like the quality of the service they are paying for.

    • nof permalink
      July 30, 2013 12:42 pm

      I know, right? If a doctor doesn’t do their job, I am not going back. If a doctor belittles me and treats me like an infant, I am not going back. If they want me to come back, they need to be offering better service. I’m not asking a lot–I just want my concerns addressed in a respectful manner. This is not difficult. Pretty much every other service industry has figured it out.

    • July 30, 2013 2:11 pm

      Well put Erin!

  7. Twistie permalink
    July 30, 2013 12:18 pm

    Mr. Twistie did end up in the hospital recently when his primary care physician assumed that rattling in his lungs when he breathed was heartburn due to his (presumed because he’s fat) overeating and prescribed the World’s Most Expensive Bottle of Prilosec.

    Yes, Mr. Twistie started doctor shopping as soon as he was released from the hospital (with another! bottle of Prilosec). For some reason he doesn’t want a primary care physician who is so obsessed with his weight that he manages not to recognize goddamn pneumonia coming on.

    We’ll see how the next one is, but Mr. Twistie has officially gone through every primary care physician connected with his HMO in this city. He’s now looking for one in the city where he works.

    Doctor shopping is no fun, but we’re hoping it may lead down the road to one who actually gives him reasonable medical care.

  8. July 30, 2013 12:57 pm

    For years and years I had a terrific internist. He was not thin himself, and he never hassled me about my weight, which he described as “just a bit soft around the middle”. He even brought up the pre-diabetes thing without ever using the term. Daily walks took care of that nicely. Then he retired. The new guy’s PA was plainly disgusted by my fatness, and when I had a lump in my left breast she commented: “It’s not surprising that you have such huge breasts, since you’re morbidly obese!” The Doc at my subsequent mammogram, by contrast, was cheerfully professional and even solicitous. On the way out she warned me that I would see the word gynecomastia in her report, and that I should not be unduly concerned by it. The lump turned out to be only a hematoma, and it resolved by itself. I’m approved for a new internist (who’ll take my Medicaid coverage) but have not yet been seen by her. While I no longer resemble the person who so appalled that PA, I’ll certainly make the new internist aware of my history. Her attitude may well be important in the future.

  9. July 30, 2013 1:19 pm

    For those interested in doing a little teaching, suggest to the nurse/doctor to take your BP this way (this does not work with automatic cuffs, request that they do it by hand):

    Put in the cuff.
    Don’t put the stethoscope on the arm right away (just have it around the neck)
    Find the radial pulse (at the wrist) and pump until it disappears.
    Pump about 10-20 mmHg above that
    Put the stethoscope in place and take the BP as usual.

    This is a newer approach and allows the cuff to not be pumped quite as high. It is also more accurate.

    Many offices won’t want to do it because they use the automatic cuffs, though studies have shown that manually talking the BP is more accurate.

    • August 2, 2013 12:43 am

      Do you know why taking the BP manually is more accurate?

      I’ve been very suspicious that the manual was more accurate, though I had no proof outside of my own experiences. I think I’m going to stop letting the nurses, other than the one nurse I really trust take my BP because it’s always high with the small cuff/automatic machine, but normal when the good nurse manually takes it. (I see my GP with the good nurse regularly throughout the year to monitor my thyroid medicine, so my BP won’t go unchecked.)

    • Sparticles permalink
      August 10, 2013 7:20 am

      >Find the radial pulse (at the wrist) and pump until it disappears.
      Pump about 10-20 mmHg above that

      This is the way we nurses had been taught to do it for many decades now. After graduation doctors and nurses get sloppy or rushed and no longer do it the “right” way but instead do it the “fast” way.

  10. purple peonies permalink
    July 30, 2013 7:35 pm

    in light of the increased problems with prescription drug abuse and addiction, “doctor shopping” is now associated with very negative connotations… i see this research as another way fat patients are framed as “bad patients,” because we have the audacity to want to be treated with respect and dignity.

    i find it infuriating that the suggestions for doctors include a) NOT TALKING TO FAT PATIENTS about their needs, and b) another way to rephrase the same tired old diet rhetoric.

    Would it kill doctors to ask fat patients what would make them feel more comfortable at the doctor? that god complex is mighty strong that they’re too damn perfect to ask for input from the people who sign their paychecks.

    the blood pressure cuff issue drives me to drink these days… when I took EMT and CNA courses a million years ago, we were always taught to pump just a bit past where the pulse disappeared… these days EVERYONE goes straight to 200 (or higher), or they use the automatic cuffs that aren’t that accurate. When my BP was around 150, this was pretty miserable, but now that my BP tends to be 112-114, going to 200 or 220 is just excruciating, sometimes numbing and black-and-blue-inducing.

    (oh, and the reason my BP is now so ridiculously low? because i finally started treating my undiagnosed celiac disease…. no medication, no changes to anything except my diet, by way of removing that dangerous-to-me poison from my world. after getting shit from doctors for years because my fatness was making my BP higher, it turns out it was just another symptom of celiac disease. celiac disease that went undiagnosed for most of my 30-something years because doctors were too busy blaming me and my fatness for every debilitating symptom i had, rather than treating me in the same manner they treat their thin patients. so yeah, of COURSE i “doctor-shopped.” i was trying to get adequate medical care!)

  11. Vic permalink
    July 30, 2013 9:59 pm

    I have many “musco-skeletal” issues and have tried to get help for years. When I was young and thin (and had no insurance) I was written off as hysterical or told to man up, as I got older and fat, why of course it was my fat causing the problem. Finally at 59 after being ex-rayed I was sent to an orthopedist. He immediately launched into a disdainful lecture about my bad fat-before even examining me or telling me his diagnosis of my ex-rays. After I twice got up to leave, with the tearful comment that he was wasting MY time, he finally, reluctantly examined me, concluded my pain was primarily soft tissue and he didn’t need to do surgery. But of course he had to then tell me I would someday need a hip replacement, and because of my enormous girth it will be a traumatic and dangerous surgery. After I got home and collected myself, I wrote a letter to be scanned into my medical file, I kept it to one page but explained why I had rejected the treatments he eventually got around to suggesting. Why I do not want him on my medical team, Why I do not want him as a referring Dr., and why I do not ever want to deal with him again. My Dr read the letter, scanned it in and suggested a physical rehab Dr who she felt could give me respectful and competent help. I went to him today and he was all that, he actually looked at me, shook my hand and did not suggest my fibro, and soft tissue issues are the result of my fat. I think my letter got their attention and I would highly recommend trying that when you are tied to a health care system due to insurance.

  12. vesta44 permalink
    July 30, 2013 10:44 pm

    I’ve had severe lower back pain for over 20 years now, and I’ve been trying to get it diagnosed for that long. It’s gradually gotten worse over the years, and nothing I’ve been given for pain has ever even come close to relieving the pain I have.
    However, my latest doctor finally decided that something needed to be done when I told him I could take 100 mg of tramadol and still be in enough pain that I was crying (and he prescribed 50 mg to be taken every 6 hours as needed, so I’m doubling the dose and I’m still in pain). He ordered xrays of my lower back and hips – I have degenerative disk disease, arthritis in my hips, and my last vertebrae is fused to my tailbone. He also ordered an MRI, which I haven’t gotten the results from yet.
    The last time I had an MRI ordered, about 17 years ago, I had to lay on my back for 45 minutes, and then they wanted me to lay there for another 45 minutes (yeah, back then, 30 minutes of laying on my back meant I couldn’t sit up right away, nor could I stand up and walk right away from the pain I was in). I never did find out the results of that one. The technology must have improved immensely in the last 15 years or so, because this time, I only had to lay there, flat on my back, for 15 minutes. I was still in a lot of pain, and I had to sit on the table for 5 minutes before I was able to hobble to my scooter to get out of there (and it’s a good thing I rode the scooter in there, I would not have been able to walk out of there).
    The point to all of this is that I’ve seen 5 doctors in the last 20 years (since I moved to MN in 1993), and this is the first time I’ve had a doctor who was actually willing to look into what could be causing my back pain, instead of automatically blaming it on my fat and refusing to look further (because that doctor who ordered the first MRI 17 years ago never did any follow-up, even though I kept complaining). He’s even willing to refer me to a physiatrist if that kind of therapy will help lessen the pain. I know I’ll have to deal with some level of pain for the rest of my life, but just lessening it would so improve the quality of my life, and this doctor is willing to help me do that (now, if there was just some kind of pain medication that could help in the meantime. . . . ). So doctor-shopping is totally justified in a lot of cases, and in a lot more cases than people would at first think.

    • July 31, 2013 12:14 pm

      Vesta, I find tramadol to be a pretty lame excuse for pain relief. I have also been given Tramadol for the arthritis in my knees. I can take 50 mgs and yeah, sure, it takes the edge off the constant aching pain, but it does nothing for the sudden sharp tweaks and stabs of pain that happen at the slightest twist or misstep.
      I get the exact same relief (sometimes even better!) from taking 3 Tylenol 4 hrs apart.
      The reason they give us Tramadol for ‘moderate to severe’ pain relief? Because it’s “non-narcotic”. In other words, damn near useless for bad pain levels.
      I can not get my doctors to give me percocets or any other “could be addicting” prescription for my pain… Once again, being treated like a 17 yr old drug seeking loser.
      Now of course I can’t specifically blame this attitude from these doctors on being fat, can I? Oh wait, maybe I can…. if being fat is tied into “having no self control”, being a “non-compliant patient”, or perhaps having knee/joint pain ONLY because I’m fat and therefore there’s no real medical ‘issue’ to prescribe for…???
      Yea, it wouldn’t surprise me to learn this (bias) is playing a role in what pain relief we’re prescribed and which we are not.

      • Elizabeth permalink
        July 31, 2013 1:45 pm

        Wow, the pain you experience, Fab and vesta, is so horrible! I have a list of ailments — severe OA, degenerative disk disease, fibro — and I do not experience anything like what you both describe. You make me realize how grateful I should be. I do use narcotics, about twice a week at night, mostly for the excellent relaxation and sleep I get. I use nothing during the day for pain except rest and heat. I feel so bad for you both; I hope you can get some good help.

      • purple peonies permalink
        July 31, 2013 3:29 pm

        studies have shown that women (presumably cis-women) are notoriously undertreated by doctors regarding pain, and their pain is taken less seriously. i suspect this plays a huge role, and that this effect is amplified when the women patients are also fat.

        my pain was undertreated and disregarded for years… i was prescribed NSAIDs (which i can’t take, as they make me violently ill) and antidepressants (also can’t take, as they make me violently manic) and doctors said they “couldn’t help” if these were ineffective. eventually i found doctors who would take my pain seriously and prescribe stronger pain medicines, and I’m doing really well with them.

        tramadol didn’t work for me either. and i also found tylenol was better than tramadol! what a ridiculous drug.

  13. pyctsi permalink
    July 31, 2013 12:08 pm

    I had a great experience with my doctor today, she offered me treatments based on my symptoms, gave me the option of treatment for my Roseca but didn’t push and generally treated me well.

    She checked my blood sugar because bad athletes foot and similar problems can be worse in diabetics but was not surprised when my test was normal. She didn’t panic me or make me feel that any of my problems weren’t worth her time and she never mentioned my weight. She also used the larger cuff when testing my blood pressure and offered to take it again since it was a little high and to come back in a month to test it again, just in case.

    I just wish all doctors could be this good.

    • July 31, 2013 12:17 pm

      ^ That one sounds like a “keeper”, pyctsi!! ❤

    • Twistie permalink
      July 31, 2013 1:24 pm

      I vote that we clone Pyctsi’s doctor!

  14. July 31, 2013 12:58 pm

    Hold the freakin’ phone! Are you telling me it’s not normal for the blood pressure meter to go that high? And other people have their blood pressure taken without the cuff marking up (and a couple of times, even bruising) their arms?

    I legitimately did not know this. I thought I was just a wimp that couldn’t take it. 😦

    *blood pressure shoots up*

    • purple peonies permalink
      July 31, 2013 3:33 pm

      you, my friend, are absolutely positively NORMAL in your reactions. not a wimp at ALL. ❤

  15. August 2, 2013 10:20 pm

    If a doctor wants to start a conversation about weight I recommend, “Obesity can often be a sign of other underlying conditions. Can we have a discussion about your medical history and lifestyle factors to make sure that we aren’t overlooking any hidden untreated conditions?” . . . Maybe then I wouldn’t have gone 15+ years living with undiagnosed severe sleep apnea.

    • purple peonies permalink
      August 2, 2013 10:22 pm

      this comment makes too much sense to have any place in a healthcare discussion!

      seriously though, i think this is worded perfectly AND would more accurately work towards correct diagnoses sooner.

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