Tuesday, March 02, 2010

There are never good answers.

I'm still doctor shopping and recently talked on the phone with a nurse practitioner whom I thought I wanted to see. I have a little list of questions and which of those I ask depends on what the other person says.

At one point the NP brought up my weight and without ever laying eyes on my medical history asked right away if I wanted to get started with some prescription(s) to "help me on my road to health."

My first question was why would I want to do that if I am right now basically metabolically healthy?

Her answer was, well you'll look good and feel better etc etc.

I asked if the lifelong health issues that I am really concerned with right now would be altered if I lost weight now as opposed to the times I have been far thinner in the past?


I rephrased and asked if a condition that never improved with weightloss as a factor in the past would somehow magically transform into an "obesity" related illness and thus be "cured" by weightloss.

I pressed and the answer was no.

At one point I asked if basically no matter what my actual issues and concerns are if the first treatment is weightloss she said yes. I said thank you for your time and hung up.

This represents a HUGE part of what is wrong with how fat is looked at in our society. We are so quick to assume that if you're fat of COURSE you have high cholesterol and of COURSE you have high blood pressure and of COURSE you can't sleep and of COURSE you can't be at all fit and of COURSE you can't be at all healthy.

Fat-being fat is not an illness in and of itself.

Fat in and of itself is not some kind of moral failing.

Fat in and of itself is not a reason to put the onus of the cost of health care onto a group of people.

The above conversation (which at this point I've had with multiple health care professionals) is one of the things hugely wrong with health care as it exists today.

If the health care industry did in fact care about changing the health levels of fat people, as a whole the industry would make moves to make certain that that population gets appropriate care. That it is made clear that this fat person is treated in a manner congruent with how a physician might treat a triathlete.

What I mean is this.

Let's say that I have been doing triathlons and I go to the doctor because my knees swell and I have a lot of pain and have been limping in the morning.

The health care culture as it exists today would not fault me for my pain. The doctor might give me a congratulatory take it easy, or advise me to wear braces or give me a prescription for an anti-inflammatory etc.

However if I am fat it is automatically percieved that my pain must be caused by my fat and I am sent on my way with the note that I am a recalcitrant patient who refuses to adhere to the doctors recommended treatment of losing weight.

The doctor then (because doctors are human beings and not immune to biases) has treated me vastly different.

Now if (as I said in my last entry) it is assumed that everyone can and should be trying to lose weight if they are fat and therefore any health problems they do have are their own fault and should be treated accordingly.

If I was a triathlete why wouldn't that be my own fault as well?

If I refused to stop doing my triathlons would the doctor label me as yet another recalcitrant patient?

Odds are probably not.

Now if you ask 100 fat people of varying weights, i would be willing to bet my lunch money that most of them will have stories of being treated like some lazy jackass by health care professionals.

Some of them will have had situations that turned very bad.

Some of them you might not get to speak to because they died.

Some of them may have not been to a doctor for anything in decades because of how they have been treated.

I have YET (seriously ever) to find a single reasonable explanation as to how it is at ALL a good idea to treat people badly and then expect them to keep coming back for more.

I'll give you a for instance from my personal life where it was my race and age not my weight that was causing issues.

Once upon a time yours truly had no health insurance and really needed to see a gynecologist.

I made my appointment at a local clinic and when I went I sat with a nurse who asked me a bunch of questions. Of those, I was asked repeatedly how many abortions I'd had, how many children I had. I was asked probably ten times inside of the interview. The nurse would ask and I would answer no abortions no kids every time. At some point she leaned over frowning and said, "You HAVE got to be honest about this"

Now, I felt bullied. I got the impression that I had done something to wrong these people and I didn't like it. Later I saw my chart and there was still a question about whether or not I'd had an abortion or children.

I asked a few other women I knew who'd been to that clinic around the same time, all of whom were white women about my age and not a single one of them had the same treatment.

Not. One.

Not on their first visit, not during any subsequent visits. They were not grilled about their theoretical crack habits which I was. My friends had not had that experience.

Now we were all in the vaguely same demographic, had similar sexual histories, similar economic status. The only huge difference was race.

I did not go back to that clinic and if I'd been a different girl at the time it might have been a long time after that I wouldn't be comfortable going to any doctor much less that one.

Now back to fat.

If my fatness is of such epic concern for the medical industrial complex to the point that my weight precludes treatment for things that are entirely not weight related I want no part of it.

To steal my own phrase, I don't believe you.

I don't believe that you (the big You here is the medical industry, diet industry people, even exercise industry people) have anything in mind except for your own wallet and the inability to move beyond your personal biases to give me the treatment that I pay for and deserve.

All this is not to say that I have never had a good doctor. I have had some doctors who were right there with me in terms of what health issues I have that are related to my weight (one way or the other) and the most healthy for me ways of dealing with those.

However that experience has been the less frequent when it comes to my healthcare as an adult.

And that my friends is yet another reason I call bullshit on a large amount of news etc about fatness.

That is why I keep saying:

I don't believe you.

That's it.

Homo Out.


Anonymous said...

At one point I asked if basically no matter what my actual issues and concerns are if the first treatment is weightloss she said yes. I said thank you for your time and hung up.

This is so spot on. Thank you for this.

Snotty McSnotterson said...

Great read - I like how you organize your thoughts. I agree with so much of this, but don't advocate for myself as much as you. I will definitely take your lead.

Anonymous said...

Reminds me of the time we had a gas leak in my office, and I had to go get checked out. The doctor completely ignored the fact that I was complaining of symptoms directly related to, yanno, inhaling gas, and started lecturing me about walking in circles in my room to lose weight. Forget about the facrt that I walked to work every day at that time. Five miles there, five miles back. He didn't bother to ask me about any of this. I was annoyed. Seriously, asshat? Let me see your skinny behind haul it ten miles daily. I doubt you could.:P

At any rate, I, too, call bullshit. I am fat. However, I am not automatically unhealthy. Wierd thing is, I have been told, consistently, that my bloodwork is bright, sparkly, and shiny. I am disgustingly healthy. My current nurse practitioner has never once brought up my weight. The only time we discussed it was when /I/ brought it up. And she reccommended I try eating healthier meals. Which I admitted to not really doing, but she didn't lecture. She actually had more to say about me smoking, which /IS/ bad for me.

Haddayr said...

I really wish you lived in my town. I have a great nurse practitioner who is one of only two Western Medicine practioners I've gone to who weren't obsessed with fat.

This makes me rage, as does the astounding racism you've experienced.


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