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Medical care as a fat person: the trust problem

April 28, 2010

It is hardly revolutionary for me to point out that doctors are dickheads to fat people.   I just want to observe breifly that no matter how prepared you are to deal with medical BS upon visiting a doctor, it still REALLY REALLY Sucks.   And part of why it sucks is that as a fat person it is I think even harder to just trust your doctors.

My boyfriend Mr. I who has congenital hypothyroid FINALLY went to the doctor last week.  After two years with no insurance and a sixweek wait for an appointment we were finally there.  He was finally going to get the medication he needs to feel fairly normal.  My optimism levels were high.

So it was pretty crushing to find out that his doctor spent about 10 minutes trying to figure out WHY Mr. I didn’t have joint pain, since y’know, he’s a fat fat fatty, therefore he SHOULD have joint pain.   This was heartbreaking because it meant his doctor was probably going to treat him like a fat guy instead of, y’know, a patient.  And it is frustrating because even when you are aware that this happens and ready to deal with it you still wish that maybe this time the doctor wont be a total jerk and you’ll just be able to get the medical care you need.  Maybe this time you will get medical care with out having to prove that you are indeed an individual capable of independent thought while simultaneously questioning everything your doctor does to determine whether it is motivated by an actual desire to treat you as a patient or whether they are treating your FAT.

But whatever, y’know, doctors are jerks sometimes as long as they write the perscription things will be fine, right?

So bloodtest results come in and they call tell him that his hypothyroid is sub clinical so they will not be treating it they tell him he will have “enough to worry about” with treating his apparent diabetes.  Now this diagnosis of Diabetes is based on one blood test, ONE, before which he had not fasted all night but had in fact stayed up until about 3am eating ice cream and drinking soda, and then failed to sleep all night.  The doctors then listed a ton of diabetic symptoms he should have, of which he has none, but his sugar levels are like OMG WHY ARENT YOU DEAD YET high, so we’re going with it.

The doctor and the dietician ordered him to eat no carbs and no sugar of any kind until he got in to see them. And even though this is probably a rational medical response to someone with insanely high sugar levels, as fat people it was kindof like “So, you’re putting me on the Atkins diet? Really” (I actually wrote a post over the weekend about this but since I hadn’t had carbs in like 2 days it made even less sense than normal.  The general gist, WHY WOULD ANYONE DO THAT TO THEMSELVES ON PURPOSE?  I had to start eating normally just so he and I would not kill each other, which is especially bad considering we argue about once a year.)

So here we are again, are these doctors (Totally different doctors by the way, from the first one he talked to) actually treating him the patient, or him the fat guy?

He’s going today to see the doctor and get medication for his Diabetes and a Glucose meter and then meeting with a Registered Dietician.  ( If he gets through the RD appointment without making her cry, I will be happy.  Reasons he will probably make her cry 1. he hasn’t eaten carbs in a week and is an angry panda 2. he went to culinary school and took a ton of nutrition and anatomy classes so really doesn’t enjoy being treated like he knows nothing 3. she proudly announced to him that milk has sugar in it as though it were not obvious to everyone, thus displaying mental weakness to the raging predator that is my boyfriend.)

I am hoping that these meetings will go better, and I am hoping that they will be able to discuss important issues like how his Hypothyroid might affect his ability to manage his sugar levels and how leaving it untreated may not be the greatest idea anyone has ever had.

I am hoping, but I am not hopeful.  I don’t trust these doctors because I don’t feel like they trust their patient.  It doesn’t seem like they believe or are even listening to the things he says.  It seems like we are just supposed to go along with them because they have the word doctor in front of their name, they aren’t trying to earn his trust or treat him well.  (The doc who told him he had Diabetes kept being all “I fell like I’ve just dropped a bombshell on you”  well maybe you should be a little less worried about YOUR feelings here Doc, hmm?)

I think people who are not fat as well as many medical professionals are unaware of the serious trust gap between medical professionals and fat people who’ve been told that their rash/pain/infection/brain tumor will go away if they just stop being fat.   Studies have shown that medical professionals do not trust fat patients.  But I think it is also important to point out that some of  their fat patients don’t trust them either, and for good reason.

Being a trained medical professional is not proof of infallibility or impartiality.  That is not enough for everyone,  some people want to actually understand why you are making this diagnosis, and to be treated like an adult.  Some of us want you to prove that you are right about things so that we know you aren’t diagnosing our fat instead of our medical problems.

Some of us end up wishing we had never gone to the doctor in the first place.

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  1. KellyK permalink

    I always boggle at the doctors who want a patient to stop being fat and don’t want to treat their hypothyroid. (I had one, I don’t see her anymore.) I definitely have some trouble trusting doctors after that experience, and after feeling like crap for a long while with no one wanting to actually help me.

    I hope your boyfriend can get the care he needs.

  2. Stupid idiot doctors. I was told a week or so ago that I’m “pre-diabetic”, also because of one blood sugar test where I too had stayed up until 3ish eating ice cream and then didn’t sleep! I’m ignoring it. 🙂 Good luck dealing with all this, I know it’s incredibly discouraging to deal with closed-minded doctors.

  3. lora permalink

    i thought I ws prepared for the BS from the midwife but no, I didn’t see this one coming. Despite my being perfectly healthy and previously having a healthy pregnancy/baby she is refusing to care for me if I choose to have a home birth simply because, “If something happened, you’re so big that it would be really hard for anyone to get you into a different position.” My husband informed her that he could move me (he can, it’s really cool) so now she thinks he’s a lying craphead just like me. Since she’s just as lovely in all other areas of my care we’re now shopping for a new midwife.

  4. Carol Gwenn permalink

    It pains me so to hear stories like this, but also reminds me of what I was taught by a really great pediatrician, as he tried to prepare his patients for the day when we’d be responsible for arranging our own medical care. The basics: A doctor is your EMPLOYEE; let him know that UP FRONT, that he’s the help hired to repair something that isn’t working properly. What you look like has no bearing on that; this is NOT a case of form over function. If a new-to-you doc seems to have a problem understanding his place in the scheme of things, find someone else. Face it: it a mechanic messes up while fixing your car, you find another one. THE OTHER BASIC: Doctors are REPAIRMEN. Period. You are giving them the privilege of entering your home to repair something that’s broken, and ultimately, it’s YOUR call, not theirs, as to what gets repaired and how it’s done.

    Let your new employee know these ground rules before you even go to his office, and if he’s unwilling to follow simple directions, HIRE SOMEONE ELSE. Your self-respect is a HUGE contributor to your mental & physical health, and NO ONE should be allowed to mess with it.

  5. tombrokaw permalink

    Indeed, fat people don’t eat any differently than thin people. Yet, so many of them eat tons of ice cream until 3am right before a doctor’s appointment, thus explaining the unfair rash of diabetes diagnoses from idiot doctors.

    LOL. You people are too easy.

    • Sarah permalink

      She didn’t say anything about her weight. Now who’s the idiot? tombrokaw!

      • tombrokaw permalink


      • Yes tom, no thin person in the history of the universe has ever stayed up late eating icecream. EVER. Nope, never happend. They never have trouble sleeping or feel depressed about going to the doctor and take comfort in food. Never ever.

        I assumed that your comments were directed at ME, but it is not cool for you to jump on other commenters in this thread. If you want to insult me or my boyfriend or my dog or my ancestry or whatever, that’s fine, because I value your opinion about as much as I value the bag of cat poop I threw out this morning. But it would be good if you could not be a dick about other people, that is where I draw the line.

  6. tombrokaw permalink

    And btw I’m glad you won’t let that comment through, thus proving that you realize how you fatties contradict yourselves on the most important tenets of FA. Thanks for proving me right!

    • Hey Tom, Sorry I was a bit late with the mod queue I was, y’know AT THE DOCTOR WITH MY BOYFRIEND. I have no problem letting you sound like a bigot.

      • Sarah permalink

        tombrokaw is a well-known troll on the FA blogs. Next, he’ll tell you about his super-svelte girlfriend, and how she stays in shape JUST FOR HIM! I’ve yet to see him post anything of substance or value.

  7. Wait a minute: he’s diagnosing diabetes on the basis of one blood test sans fasting??? I could easily test out diabetic that way, and I’m not. And then he refuses to treat a well-documented thyroid problem???

    I wonder if Mr.I can switch doctors, and how much it would improve the situation, if at all.

  8. Dee permalink

    Diabetes cannot be diagnosed from one blood test! It requires two fasting blood glucose tests as well as a glucose tolerance test to definitively diagnose diabetes. I would get a new doctor if I were you… these ones don’t seem particularly committed to providing unbiased care.

  9. We’re definetly getting a new doc, all the actual doctor said was “lose weight” fortunately the nutritionist was actually pretty cool. She said “some people are just big, and you seem like one of those people.”

  10. inge permalink

    Elevated blood sugar or blood pressure seems to just short-circuit doctors’ brains. You can come into the office bleeding like a stuck pig and they will keep their cool, but give a high blood pressure reading and all common sense leaves the room. E.g., if a patient who you’ve known for 15 years and who always had low blood pressure and a bit of a temper comes into your office in a fury, ranting about your idiot innumerate receptionist, you don’t take her blood pressure at that moment (even if you usually take it when she comes in), and when it reads above standard, you don’t tell her she has to get her blood pressure down, nor go digging for the anti-hypertension drugs. If for no other reason than that she’s already on a roll and might rip you a new one while she’s at it.

    • UGH, I hate that. Plus half the time the nurse uses the wrong size cuff. I think they do it just so the docs can say “your blood pressure is a little higher than I’d like it so I think you ought to try to lose some weight.”

      • vesta44 permalink

        Or they think you have high BP just because you’re fat so they pump the cuff up really really high and then get upset when you get mad because you’re in pain from a really too-tight BP cuff (my BP runs 132/74 usually, and the nurse always pumps the cuff up to at least 180 or 200 – not something that feels good when you don’t have fibromyalgia, and is horribly painful when you do have fibro). I’ve started taking my wrist BP cuff with me and telling them to use that, it’s what I use at home to check my BP and it’s pretty accurate.

      • You mean getting your BP checked isn’t supposed to hurt like that? WTH, now I’m pissed.

      • lilacsigil permalink

        Shinobi – no, when your blood pressure is taken correctly, with the right sized cuff, it should be firm but not painful, like a firm hug. My endocrinologist has the right sized cuff for my big arm; my GP clinic does not and wanted to take my oral contraceptive pill (used for PCOS control) away based on one high reading in 10 years, with a wrong-sized, painful cuff. Bastards.

    • Lori permalink

      I find that another thing that tends to set doctors off is a history of any sort of anxiety disorder. I’ve had the opposite issue, which is having doctors take seriously high blood pressure readings because I do have panic disorder and at times it does make my blood pressure read high. But, I know the difference. When it’s 110/65 at home, and then I go into the doctor and it’s 140/70, well, that’s the white coat hypertension kicking in. My OB saw my blood pressure drop my entire pregnancy because the more comfortable I got at the office, the lower it was. She trusted me that it was normal at home, and that was confirmed when, after about three or four months of visits, it started reading at the same levels I got at home.

      But, about a week after my daughter was born, I had a horrible, horrible headache, and I was talking to a friend who’s an RN, who suggested she take my blood pressure. It was 160/100. That was incredibly high for me. She sent me off to the ER thinking I should be checked for preeclampsia (which you can apparently still get after you have a baby). I had a terrible time being taken seriously, and was initially just written off as being anxious, even though I know when I’m anxious (and I wasn’t), I know what a normal blood pressure for me while I’m anxious is (my top number goes way up but my bottom number stay well within the normal range), and I know that having my blood pressure spike to 160/100 is not at all normal for me. Finally they ran some tests, saw I was spilling a bit of protein, and send me off with a postpartum hypertension diagnosis. Thankfully it fully resolved itself within about two weeks, and my bp has been back down to normal since then, but it’s amazing how doctors will often fall back on the easiest explanation (I’m not that fat, so I guess anxiety is an easier explanation for whatever I come in with, once they see my chart) for a condition even before they run all the tests.

  11. Thyroid patient permalink

    I’m now on my 10th doc trying to find the right treatment for my thyroid. Don’t get me wrong — i was diagnosed as hypothyroid by the first doc, who just insisted on treating the TSH lab results rather than symptoms. While you’re looking for a good doc, check out the Yahoo Groups. There are several for thyroid patients. The NTH board (Natural Thyroid Hormone) is a good one and has a list of good docs, as do some of the other sites. You can even post and ask for a doctor recommendation in your state/area. When the new doc tests the TSH, make sure you get a copy of the labs. The new recommendations are that your TSH levels be lower than 3.0, but most labs still use the old range that goes up to 5.0. With the right treatment and some important supplements, your boyfriend will start feeling better pretty quickly. Good luck!

    • Yeah I think his TSH was something like 6.4 on the old range, and his T3 and T4 were the lowest possible value in the “acceptable” range. So they said he didn’t need to be treated. (Which explains why he was on thyroid meds for like 10 years… WTH.)

      Thanks for the yahoo groups advice, I will check it out!

  12. Agreed with nobody should be diagnosed with diabetes without a couple of fasting blood sugar readings and an HbA1c. If a thin person came in with a high nonfasting, that’s what they’d do. I guess if thin people stay up all night getting drunk night after night it’s okay, but gods forbid fat people should have a bowl of ice cream at 3 AM, ever, even once. (epic eyeroll)

    And I thought even Atkins said diabetics shouldn’t follow the Atkins diet. You know, because of the risk of diabetic ketoacidosis. Sheesh.

  13. La di Da permalink

    Gah. I had a few blood glucose readings a while back that set all those alarm bells ringing and various doctors were all in a flap over TEH DIABEEETUS. Turned out I had mild insulin resistance, which was diagnosed when I went to a doctor who actually gave a shit about treating my thyroid. She said the insulin resistance would improve and the BG readings would return to normal once I had adequate thyroid replacement hormones. And B12 shots for that deficiency, and fixing my vitamin D deficiency. And lo and behold, now those things are fixed, I have no sign of any kind of glucose problems. Crappy thyroid will mess with your whole system.

    I wish you luck with finding a doctor who is able to actually help with the thyroid. Could be worth looking up the “top thyroid docs” list and seeing if there’s anyone in your area or insurance who could help.

    • This is pretty much exactly what we think the problem might be. We’re hoping another doc will help. I just wish it didn’t take so freaking long to see one.

  14. It’s like my doctor WANTS me to have Diabetes, high cholesterol and high blood pressure.

    When I went in for my last appointment, I said I wanted to look into what was going on, because I had been gaining weight with no change in diet or exercise, except for the fact that we’d cut out High Fructose Corn Syrup because of my husband’s diabetes. I’d gone in the Saturday before to get the blood drawn for the tests, because they’ll let you do that at my clinic (thankfully, so I don’t have to try to get through a whole day sans coffee).

    She leapt on this saying, “See! Your blood sugar is… normal… Well, your cholesterol is… low, and but your blood pressure! Your blood pressure is… low.”

    Me: “So I’m gonna drop dead any minute, yeah?”

    Then she announced that I needed to see a nutritionist and keep a food journal, to which I said, “No.” I’m in recovery for an eating disorder (anorexia, exercise bulimia and the favorite catch all of Eating Disorder Not Named). Food journaling causes relapses. Bad relapses, because I won’t LIE in the damned journal. So, if I think I MIGHT be eating too much, I quit eating.

    She used to be relatively reasonable, but with the creeping weight gain (again with no change in diet or activity level), I hit the mythical 300 lbs and am now considered morbidly obese, even though everyone on the planet guesses my clothing size around 16-18 rather than 22-24. She wants to treat me for PCOS, but I’m reasonably convinced that like most syndromes, it’s a label they put on you when they don’t really know what’s wrong with you and can’t be assed to find out.

    • Ugh! I hate that feeling. It is like they just cannot deal with the fact that a fat person is reasonably healthy. So obnoxious.

  15. rena permalink

    Staying up until 3 am eating ice cream and drinking soda (or drinking anything else, for that matter), is not healthy for anyone, so this is hopefully not a regular occurrence. As for doctors, I have learned over the years that whatever the problem is, you need to educate yourself, and then stick to your guns. The squeeky wheel really does get the grease, so don’t allow a doctor to bully you. While your doctor (hopefully!) “knows” more than you do overall (unless you are also a dr.), you are not his/her only patient – and therefore you know more about you than he/she does. Again, educate yourself, and be persistent. (By the bye, that does not mean you should not listen to your doctor – even with an open mind…)

  16. Alexandra Lynch permalink

    We ran into something similar this last week with my husband.

    He is one of those lucky people who, when he gets a head cold, is very prone to ear infections. This time it appeared to be settling into both ears and sinuses. So off we went to the doctor.

    The doctor noted that he had high blood pressure (of course, his face and ears were killing him) and asked if he smoked. He does. He proceeded to rant about how Smoking Will Kill You and is the leading cause of debility and death in most of his patients, and et fucking cetera.

    1)He’s heard this before.
    2)He is working on getting the smoking non-habitual in certain settings.
    3)Until we can afford to put him on antidepressants, he is probably going to smoke.
    4)He needs an antibiotic prescription, not a lecture.

    Two days later with me he got the antibiotics, which meant two extra days off work (how very helpful to the budget…) and when he followed up, he got Asshole Doctor instead of Intelligent Nurse Practitioner, who did at least give him his own prescription of pain pills so he could stop taking mine. And asked, as his first question, “Are you still smoking? Also said that his knees hurt because Husband is fat. (No, Husband’s knees hurt because Husband has had his kneecaps broken a few times.) We now are going to have to remember Asshole Doctor’s name, so that if either of us go in, we can avoid being seen by him.

    • Why do doctors insist on lecturing about unrelated things when you come in for a specific issue. I definitely had an urgent care doctor lecture me about my blood pressure when i’d been sitting for two hours with a UTI listening to screaming children who wanted to be at Disney Word while I was supposed to be on vacation. I may have actually yelled something like “OF COURSE MY BLOOD PRESSURE IS HIGH GIVE ME THE DAMN ANTIBIOTICS.”

  17. Darian permalink

    Oh.. i’ve got one that’s even better. I was diagnosed with hypothyroidism and my dad’s boss wanted me to see a specialist – just to make sure treatment was on the right track. Now this guy is supposed to be an endocrinology god of sorts, right? So we go through all the numbers and the meds and then he starts in on my weight and no lie says, “you know, you’re never going to find anyone to love you while you look like that”. I was dumbstruck that this stranger and supposedly highly educated man would be such an asshole. I’d like to say I ripped him a new one for being such a major douche, but unfortunately I was so shell shocked that I just left and took it all out on my dad later in the day. I still wish that he was still around so I could give him a piece of my mind. This was nearly 20 years ago and I still remember it like it was yesterday.

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