I’ve had exactly one good doctor in my life. I’ve had numerous unhelpful ones.
I am reluctant to generalize and say that they were simply bad in a holistic sense, that their inability to administer thoughtful and sensitive medical services was universal. They may have been spectacular doctors for other patients. They were not for me.
There is a reason for this: I am fat. I am not fat in any kind of gentle or subtle way; I am aggressively fat. I am the type of fat that is unignorable. I am sizable the instant I walk into a room.
Especially if that room is a waiting area in a new doctor’s office, where I found myself this week. I moved last fall, from one New England state to another, and although the move was only an hour away, I had to change my health insurance. I managed to cajole prescription refills from my old doctor for a few months, but at a certain point I had to face the inevitable: I needed to find a new primary care physician.
Here are some of the things not-good doctors have done for me: My pediatrician became fixated on my weight when I was 8 years old, which made me fixated on my weight, even though I was only slightly above average for my age and height at the time. This was when I began dieting. When I was 8.
This continued for many, many diets and a lot of self-imposed starvation and disordered eating during the period when most kids were far more concerned with collecting the coolest slap bracelets or memorizing the “Animaniacs” state capitals song. I was the sad 12-year-old amid the middle-aged moms at Weight Watchers and Jenny Craig. Multiple times.
When I was 21, my doctor thought my blood pressure and weight were slightly higher than she’d like; her response was to placidly threaten to take me off the pill “unless I could get those numbers down.” She offered no information on how to do this, but I did walk away from that interaction in terror of losing my birth control and with a brand new case of white coat hypertension that has stuck with me ever since.
I have been prescribed weight loss as a treatment for everything from gallbladder disease to a shoulder injury. I have been asked if I’ve ever considered bariatric surgery during a pelvic exam, and by “during,” I mean while the doctor was scraping my cervix for a cell sample ― TWICE.
I have been misdiagnosed left and right ― or simply diagnosed as fat, even in the midst of describing specific symptoms, in doctors’ offices and in the ER; I have been informed that I had symptoms I did not have; I have been offered medication I did not need; I have been outright denied treatment for health issues unrelated to my weight until I lost some of it. I have also experienced doctors’ unconcealed disgust during annual physicals and pelvic exams.
This is what happens when you’re fat and you seek regular preventive care; you accept the risk that you are going to be mistreated. You either learn to advocate for yourself or you just give up and stop going.
As much as I hate dealing with the medical establishment, I have never done without it, as a lot of fat people understandably do. I got my first pelvic exam at 18 and have not missed one since; my commitment to annual physicals is unimpeachable. My family has a strong hypochondriac streak, so as much as I have hated doctors, not getting regular preventive care has never been an option.
When I enrolled in my new insurance, I selected a primary care physician literally at random from a list on the internet, the deciding factors being “Will someone answer the phone?” and “Does the doctor take my health insurance?” I managed to find a nurse practitioner (I avoid M.D.s whenever possible — too many bad experiences) with an opening two weeks away. Which meant I now had two weeks to craft an elaborate and mounting anxiety.
I should pause here to make a startling assertion: Not all fat people suffer medical maladies related to their weight. Most of the obesity terror research you read is of a sort that finds that fat people are statistically more likely to have a particular problem but that does not find a direct connection between fatness and the issue in question. And there are numerous reasons fat people might be more likely to have a health issue ― reasons that are not clearly attributable to weight.
Analogously, recent research has found that, compared with white women, black women are three times as likely to die from complications after childbirth. However, this increased mortality rate is not attributable to their skin. There are numerous related factors that might contribute ― such as the stress of living under racism and increased difficulty accessing quality bias-free health care in a racist culture; black women even at higher income levels are dying at higher rates. All these are issues are related to race, but it is not race that causes the problem. The problem is caused by racism.
Obviously, racism is a very different mechanism from cultural fat hatred and has much deeper and more insidious roots, so I am not saying the two are exactly the same. But in a similar manner, it is impossible to know how many of the medical problems faced by fat people are a result of actual weight or of far-reaching social consequences of life in a fat body and of a medical bias that delays diagnosis, ignores symptoms and in many cases prevents fat people from seeing a doctor at all.
I am aware that many people will knee-jerkily insist that fat people are desperately ill. Why? Because we just know they are. Why? Because they are, and everyone knows that. Why? Because it’s just common knowledge. This circular reasoning is fueled by the same vast cultural loathing for fat people that makes it difficult for them to get good treatment in medical environments in the first place. And individual fat people’s health is none of your business anyway.
That one good doctor I knew? He didn’t do anything particularly special. The good doctor simply listened to me and trusted me with my body and included my perceptions of my health and well-being in his assessments. He treated me with the same respect and consideration he would have given any other patient. He valued my input and did not make assumptions. If he had questions, he ran tests, and he did not guess at answers. That was all. From him, I learned that I deserve quality care, that I ought to expect it, that I can demand it.
Still, I am carrying a lot of baggage every time I hit up a new medical venue. When I see a new doctor or specialist now, I must figure out how to draw firm boundaries while not coming across like the legendary Noncompliant Fatty.
A 2003 University of Pennsylvania study of 600 doctors found that half see their obese patients as awkward, unattractive and noncompliant and a third also see them as undisciplined and lazy. As a result, doctors spend less time with their obese patients, communicate with them less and are less likely to refer them for diagnostic tests.
These are facts I must contend with from the moment my doctor enters the examination room, and the work begins weeks ahead of time, as I start bullet-pointing and rehearsing my speech detailing my extensive dieting background and the numerous failures thereof. That rhetorical groundwork laid, I work on segueing into the manner in which I would like my health care situation to be conducted. It comes down to “Let us consider my body size to be settled law and pursue treatment under the assumption that safe, permanent weight loss is not an option.”
I quit dieting in my early 20s ― that was nearly two decades ago ― and since then, my weight has been predictably, boringly stable at one (fat) size. This information tends to calm doctors who assume that I am constantly getting fatter, but the fact that they immediately assume I must be gaining weight at an exponential rate, even without inquiring, is itself a problem.
Since I started delivering this speech to my new medical folks, my outcomes have been vastly improved, because as the saying goes, if you want something, you need to ask for it. My doctors have respected this boundary, clear as I have made it.
Still, there’s always the worry. What if this one pushes back? What if I have to make the dreaded “Thank you for your time, I will look for another physician” exit? I’ve had to do that only twice as an adult, but many of my friends have gone through that multiple times.
All we want is to be treated like individuals. All we want is for medical professionals to assess our health and our needs based on our reported experience and our exam data and our lab results and not to be laden with dozens of inaccurate assumptions the moment we walk into the waiting room, assumptions that can distort our care and in many cases, delay or prevent diagnoses that could save our lives. This, like health care in general, should be a basic human right.
This time around, my new doctor listened to me, asked pertinent questions and seems game to meet me where I am. He even expressed relief when I stated that I am categorically not interested in weight loss surgery, because apparently he does not enjoy managing the lifelong nutritional deficiencies that his post-weight-loss-surgery patients have to contend with. I am hopeful that we can build a beneficial relationship.
But odds are strong that the only reason this happened is that I did so much preparation, because I go in ready to advocate for myself in ways that not everyone is aware of or has the resources for. It is an outrage that I and others like me have to do so much extra labor to get medical care that so many thinner people take for granted; it is an even greater outrage that so many fat people simply stop seeking care at all, and it is impossible to argue that this common choice to avoid doctors and preventive visits does not have an impact on fat people’s overall health, as well as outcomes for the treatment of disease.
Still, no one blames the medical community and its rampant bias; responsibility is always placed squarely on the fat patients who have often been neglected, misdiagnosed and dismissed by the institutions sworn to promote health and well-being. Fat people are more likely to blame themselves for the bad treatment they receive, in spite of its institutional ubiquity and the truth that these failures are the result of rampant unexamined bias throughout the medical community. And that is the greatest outrage of all.