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Let’s Hold Doctors Accountable. A New Form of Activism?

December 17, 2014

Battle of the Santas Big

Jean proposes a new form of activism. With an upgraded site and sustainable content, we will have the ability to experiment with more forms of new activism. Please donate to any denomination to our $2,000 website fundraiser.

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Trigger warning: Discussion of physicians recommending weight loss and weight loss surgery.

I was noodling around on the Health at Every Size® (HAES) Facebook page the other day and a woman was expressing dissatisfaction with a primary care doctor who had been pushing weight loss surgery on her even though she’d already explained previously that she wasn’t in the market for that. A variety of people commiserated and a few offered their own doctor stories, or mentioned the First Do No Harm site or Lesley Kinzel’s #DiagnosisFat.

The woman wasn’t planning to follow up with the doctor, who in any case was about to close her practice and go off to… I don’t know what. Something else or somewhere else. But I didn’t want to just drop it. PM the doctor’s address Chartto me, I said. I’ll write to her! I won’t mention your name; if she does this to you, she probably does it to a lot of people, not all of whom are protected by an HAES philosophy.

I pictured how it could be: the doctor would get a polite letter, postmarked from out of state, just chatting her up about the risks of weight loss surgery as compared to the risks of being fat, with a reference or two, and inquiring why she feels so comfortable recommending drastic interventions even in the absence of comorbidities, even to patients who haven’t broached the subject. Since she wouldn’t be able to connect the communication with any specific person, she’d think twice about how she treats every fat patient, forever into the future. Well, the woman didn’t take me up on the offer. I’d have done it though.

What if, instead of always just coaching people to individually advocate for their own healthcare against the opposition or indifference of prejudiced health providers, what if some of us who feel especially confident or cantankerous started taking the fight to the doctors? We could start letting them know that there is a movement out here ready to hold them accountable for how they treat fatties; that something more is going on here than just the idiosyncrasies and disgruntlements of individual patients (whose judgment they already perhaps don’t hold in terribly high esteem anyway).

I think it could be a thing. It could be a new form of activism. It could have an impact. It would be a little like how cops now are starting to realize that their actions don’t always take place in a private little bubble — that a cell phone might be recording them, that the public at large is becoming aware of larger demographic patterns, not just this or that isolated tragic event.

I’m just fantasizing, here, thinking out loud. What if there were a website that matched up volunteer letter-writers with people who have had issues with fat-phobic healthcare personnel? And/or a library full of sample letters that you could download?

Or even — as long as I’m dreaming, why not? — a full-fledged nonprofit organization with an impressive-looking letterhead that would take action on specific cases of fat-related medical malpractice? Kinda like the American Civil Liberties Union (ACLU), you know? When somebody gets a letter from the ACLU, it may or may not prompt some soul-searching or policy changes, but you can bet they don’t toss it indifferently into the trash. They take notice.

We have lists of HAES-recommended doctors. Would it be in any way legally problematic to create a database of doctors who have demonstrated their anti-fat bias? To send warning letters to doctors that they are in danger of being included in such a database?

Once upon a time I was about 30 years old and around 225 pounds and I’d been having some problems with wrist inflammation for about a year. I wanted my GP (“Dr. V,” I’ll call her) to give me a referral to a carpal-tunnel specialist, which I needed to get coverage under my HMO. But Dr. V was reluctant. She kept minimizing my actual problem and just wanted to talk about losing weight, although I’d explained in the past that a) my food and exercise habits were already as healthy as I could make them and b) I wasn’t pursuing weight loss, just health.

After a particularly frustrating consultation in which Dr. V used up the entire 15-minute appointment refusing to deal with my actual concerns, I went home and wrote her a letter. I didn’t say anything very different from what I’d said in person, but I laid out the case methodically and logically with dates and facts and told her what I wanted and why, and what I didn’t want and why. The wrist thing had been going on for a year and I had already followed all her recommendations for ice, stretching, resting, good posture at the desk, etc., and they hadn’t made any difference.

Since Dr. V wasn’t there while I was writing, I didn’t get rattled or upset and she couldn’t derail me. Maybe (just maybe) since I wasn’t bodily present while she was reading, she wouldn’t go into obstinate-fat-patient information-shutdown mode but could connect with the substance of what I was saying. That was my hope.

Next time I checked in for a 15-minute appointment I was very nervous: did the letter provoke Dr. V, make her even more entrenched in her position? Would I have to start over from scratch with a new doctor? Wearily, she came into the examination room and opened up my chart. I saw that my letter was the topmost piece of paper in it. Her manner changed when she saw it. “Oh!” she said, “You’re the one who wrote me the letter.” She didn’t even know who I was, by name or by sight.

I was shocked. I had been thinking in terms of a relationship in which I felt misperceived because of my fat. Now I realized I hadn’t been perceived at all. We didn’t have any relationship. Every other time Dr. V had seen me, she’d been interacting only with her mental image of a generic fat person. But now she was falling all over herself to please. “Yes, we definitely need to get you referred to a specialist,” she said. “This problem has been going on for a year and it’s affecting your livelihood.”

It was almost pathetic to see how quickly and completely Dr. V caved in. I understood that my letter had scared her. She recognized that here was a person who had some cultural capital: education and a hefty sense of White, middle-class entitlement, and the will to continue pursuing what she felt entitled to despite initial opposition. Dr. V wasn’t going to tangle with that.

Since then, I’ve been involved intimately with a doctor and a nurse practitioner, and I know that even the arrogant-seeming doctors can feel quite vulnerable to the fear of official censure. Doctors aren’t all alike, of course. Maybe some of them really would have gotten their backs up by a letter like mine, and at that point all possibility of future cooperation would be over. Maybe some (A few? I hope?) would actually reconsider some of their existing biases. But a pretty fair number, I think, would react the way Dr. V did, with an uh-oh and quick backpeddling, followed by treading more carefully in the future.

It’s better than nothing, right? It’s a start, right? Let the medical profession know that there are people and organizations out here with the will to hold them accountable for the careless dismissiveness that comes from prejudice.

Jean Braithwaite

13 Comments leave one →
  1. December 17, 2014 10:31 am

    This is a great idea. Challenging the norm by fighting the apathy that some doctors feel toward properly treating fat patients is so necessary. Helping those that may feel intimidated or unable to fight back on their own, and doing it in an educated and respectful manner, can do so much to move the cause forward. Yes, yes, and more yes!

  2. December 17, 2014 10:47 am

    I would love to have access to a library of sample letters. It’s so easy, when you’re sitting in the exam room, to feel flustered and intimidated and not say what you came to say (or if you do, not be heard).

  3. Twistie permalink
    December 17, 2014 10:59 am

    Certainly there are various patient advocacy groups already going, so I’m sure you could get a lot of good ideas from seeing what they do and how they do it. We definitely need such a group for fat patients.

    Organization always makes entrenched power take something more seriously.

  4. Duckie permalink
    December 17, 2014 11:55 am

    I will take you up on your offer. My current primary care provider pushed weight loss and suggested surgery for me even after me being very clear that I was not at all interested in that. I’d told her before that I ascribe to a HAES paradigm and I told her again after she was suggesting weight loss. She told me basically that HAES isn’t really a thing and it doesn’t work…. not sure what her conception of HAES is or what “work” means to her. I was so flabbergasted, I just had to give a hard end to the discussion. I don’t ever plan on going back to her, which means I need to get a new PCP, which I haven’t done because of the annoyance of the process and the fear of having to get to know a new provider and possibly going through the whole emotional trauma again. I will totally let you write a letter to my PCP.

    • Duckie permalink
      December 17, 2014 11:57 am

      Jean B, how can I contact you privately to give you the contact information? (assuming you want it)

  5. vesta44 permalink
    December 17, 2014 12:07 pm

    This sounds like an awesome idea. I ended up firing a doctor who totally ignored me and kept telling me that weight loss was the “cure” for all my ills and wouldn’t treat my actual problems. I wrote her a two page letter, telling her exactly why she was no longer my doctor because every time I saw her, she pissed me off so much that I ended up incoherent. One time, I got so upset that I walked out of the exam room while she was going through another one of her “revise your WLS, that will help you lose the weight you need to in order to be healthy” spiels and slammed the door. I walked through the waiting room and didn’t really see anyone who might have been there, mumbling curses under my breath the whole time. That was the last time I saw her and that was when I wrote her the letter. It took me two years to get up the nerve to look for another doctor. At least when I went to see him, I told him up front that my weight was NOT up for discussion, if he wanted to be my doctor, then he had better treat my ailments and NOT my fat, that my fat wasn’t a disease and it wasn’t going to go away. That I had had WLS, it failed just like all the diets had failed to make me permanently thin, and I was NOT going to give surgeons another chance to kill me with WLS – they’d already had their one chance. While he’s not perfect, he at least did listen and understand that talking about my weight was going to make me get up and walk out.
    But it took 4 years of shitty treatment by the first doctor for me to finally find the power to decide she had to be fired and that I didn’t have to put up with her fatphobia. So something like what you propose could be very beneficial for people who aren’t comfortable with telling their doctors they don’t like the way they’re being treated.

  6. Adele Hite, MPH RD permalink
    December 17, 2014 5:31 pm

    Yes yes yes! While your at it, I can think of a few public health professionals that need some letters coming at them too.

  7. December 19, 2014 1:02 pm

    This sounds amazing! I’ve had various doctors that did this to me…thankfully the most recent one (a PA at the pain clinic I go to) now doesn’t work at the clinic any longer so I know that I never have to deal with her incredible fatphobia.

  8. Jennifer Hansen permalink
    December 29, 2014 6:04 pm

    I could use a letter asking a certain physican I have had trouble with how he can support his assertion that fat women are incapable of giving birth without forceps due to having fat vaginas, seeing as how fat women who have seen him professionally have gone on to labor successfully outside a hospital, and also how he justifies telling fat women and only fat women that their fundal heights and so forth are abnormal when the commonly accepted charts show the same figures as average. Unfortunately I am stuck with this guy until I am out of my fertile years, because his practice is the only one in my network that I can reach without a plane ticket, so I am leery of doing this directly–if I get pregnant again, I’ll have to see him at least once, and if I have to do a hospital transfer and get him on rotation, I don’t want him to have an excuse to punish me. Yes, he’s that kind of doctor.


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