Need Advice on How To Avoid Weight Bias by Doctor

[Kylyssa]

I'm fat.  It's just a fact of life.  I have Hashimoto's hypothyroid disease and live with chronic, widespread pain that makes exercising difficult.  Those are not excuses for being fat.  Those are just some of the things I am dealing with.  I make no excuses.  I know being fat is considered a sign of bad character and lack of self-control.  But being fat is not the source of my most serious medical problems.  Being fat doesn't cause lupus or whatever the heck causes me to have fevers as high as 105 or higher.  However, as a fat person, I have found it difficult to get the same level of care that thin people get.

A few years ago, I suffered a concussion, it was not my first.  I was taken to the ER.  Later that week I went to my doctor's office because I realized I was definitely not OK yet and my discharge sheet from the ER had stated I should seek help if the symptoms didn't subside or got worse.  I had driven to work in the morning- to a place I had worked at four years before on the opposite side of town from the place I was then working at.  I arrived without even remembering the drive then threw up for an hour or so in the parking lot and then suffered another patch of lost time.  I had also apparently thrown up inside the car at some point.  So, yeah, scary.  So I went to the doctor's office and saw a doctor I hadn't seen before.  I told her of my head injury that had occurred earlier that same week.  I showed her my discharge sheet.  Guess what she came up with to explain my continued nausea, dizziness, weird memory issues and showing up at the wrong place?  She stated it was caused by obesity.  She wouldn't even take into account the fact that I'd hit my head on icy concrete and had been knocked unconscious as a result.  It was purely due to being fat.  

Recent studies also show that a majority of doctors and other health care providers provide a substantially lower standard of care to overweight patients.  So how do I avoid that?  Please keep in mind that  I have been assigned a doctor so I can't switch doctors if this one is of the same school of thought.

I will get to have a doctor's appointment sometime in the last half of March with an assigned physician.  I'm going to see him because I have fibromyalgia, fevers of unknown origin, possible Sjogren's (my mucous membranes are dry as hell and get ulcers), probable lupus (previous doctors disagreed with each other), a benign but decent-sized brain tumor, seizures, weakness, trembling, dizziness and batshit crazy panic attacks.  How do I get him to treat me like a worthy human being?  Any tips or suggestions?

[KDbeads]

I'm about 40 # overweight, I refuse to say I'm fat because I don't agree with the current BMI bullshit.  When I first met my doc she claimed all my problems were because I was overweight.  Took 2 or 3 visits with me being very stern and unyielding on what I needed from her as a doc but 4 years later I still have her and she's now the best doc I've ever had.  Most of my problems cause me to be overweight, not the other way around.
Make sure they actually KNOW what hashimoto's is because most do not, my doc didn't understand the subclinical hypo thyroid I have, I had to get her to read up on it.  It doesn't matter how much I 'exercise', I don't loose weight until I'm in an on cycle of my thyroid, even with meds and I'm a very active person.  Same for the BP, diet/exercise didn't help, then we found out I don't process potassium properly so it wasn't 'my' fault.

Don't let them tell you you're a hypochondriac either.  Be very stern.  Your health is your priority and it's what you are paying them to help you with.  I'd tell you to be aggressive though I'm thinking that may not be something you would be comfortable with but it's the best way.  You have to make them see past their initial assumption of 'fat whiner' and it takes a couple of visits for many docs.

[joeactor]

I agree with many of the points raised.

BMI is definitely not optimal (really tired of my Wii-Fit telling me I'm overweight).
Doesn't account for factors such as muscle weight or bone density.

... and there is a real bias among the general population.  Heck, I'm sure I'm biased about weight.

The best you can do is find a doctor you like, and be persistent.  Like KD said, it's your health.  Stand up for it!

[LARA]

You don't necessarily have to be overweight to be treated badly by doctors.  Not saying you aren't picking up on things from your docs, because they obviously are centering on your weight issue an awful lot, but want you to know it's not always about the weight thing.  Some docs have egos, get burnt out and just aren't good with dealing with people and every doctor is probably going to mention your weight because it is a health issue. They might not always be considerate of your feelings even though you have hypothyroidism.  Also chronic autoimmune disorders that aren't going to kill you immediately and are hard to treat and a source of frustration for a doctor.  It's not a simple fix like setting a broken bone or giving out antibiotics.

Here's some general advice for anyone on how to have a better relationship with a doctor. This viewpoint has helped me out in my experience as a difficult patient. Doctors don't like to be told a diagnosis.  They want to make that call.  Always tell them what medication you are taking.  Give them the symptoms you are having, as clearly and simply as possible, then let them be the doctor.  It can be hard to trust medical people if you have been treated poorly or had a bad experience, but they do have more medical knowledge than you do so you really don't have a lot of choice. Try to stick with the same doctor so they can get to know your case.  They may not be able to make a call on what the best treatment option is from just one visit.  And the reality is sometimes they can't really help you, or the meds are worse than the illness itself.  If you don't have a choice in medical people, work with what you have. Unfortunately some doctors can be real jerks, but no matter your opinion of the doctor, try to view them as a real person, who gets sick, gets sleep deprived and has a lot on their shoulders.  They have probably seen more people die than they can even remember and it may be hard for them to muster the compassion you deserve.

At any rate, if you are running high fevers you need to be taking your temp regularly with a good quality electronic thermometer and let the doc know the readings.  Try some Tylenol and lots of water and juice.  Get some rest, you might have a nasty cold.  Set the less important things aside for a bit and run down exactly what you might need right now physically; food, water, sleep, medication, a nice bath.

[hismikeness]

Based on the BMI (which I'm told is created by insurance companies, and we all know how honest they are) I should weigh about 210. I'm 6'6" (just under 2 meters you damn foreigners  :upset:

As for how to deal with a doctor trying to claim your issues are because of weight, follow LARA's advice about letting the doctor be the doctor, but I think it is well within your rights to specifically ask how the weight causes those symptoms. Maybe putting the doctor on the spot that way will be a way of determining if they are full of it or not. Who knows... maybe they're right?

[Whitney]

While I do trust modern medicine, I do not trust most doctors.  I think the main reason why they suck is because no one who did well in med school goes into general practice; they specialize because it pays a lot better.

It's not just being fat either....I had a doctor who questioned the cleanliness of the men I was with (not observant enough to see the wedding ring) told him I was married so he asked if my husband showered regularly simply because I suspected I had a bladder infection because it matched the odd symptoms I had had a year before when diagnosed with one.  I decided the doctor was an idiot and have never gone back to him.

In college the bias was towards assuming I was pregnant if anything was wrong (testing for pregnancy, because I couldn't be 100% sure I wasn't is how they found the bladder infection).  I was told I might be pregnant more than once by school doctors.

Clinic doctors in general assume you are trying to just get good drugs and will treat you like an addict if you mention pain (I don't even like the "good" drugs, they make me feel worse in most cases).

The only doctor I like is my gyno because she actually knows what she is doing and doesn't berate patients for bad habits (a good doctor should just tell the patient why they should quit smoking/drinking or try to lose weight then drop it unless the patient wants guidance)

If you can't change doctors then I would second the advice of making your doctor explain exactly why they believe your symptoms are weight related and keep asking questions till you are satisfied that you are getting good care.  I have never heard of being overweight or even obese causing blackouts and nausea...especially not jumping to that conclusion after someone just suffered a concussion.

[KDbeads]

If you already have a diagnosis TELL them what it is and what doc diagnosed it... don't let them try to figure it out, most of them will never get around to figuring it out on their own if they only see you once or twice a year.
I don't deal with ego trips when it comes to docs, they aren't infallible and have NOT heard or read up on everything out there.  I come in prepared with a written list of all my concerns and all my questions, that way I don't forget when they start harping on something.  If you don't agree with them ask for a referral to another doc, insurance/medicad/etc will usually accept a referral.  This is how I finally got my thyroid diagnosis, she referred me to a GYN for something else and the new GYN asked questions, drew blood and diagnosed me after 15 years of my complaints falling on deaf GP ears.

[Guardian85]

If a doctor claims that nausea, vomiting, dizzyspells, fainting and blackouts are caused by being overweight after you specifically informed him/her that you suffered serious head trauma recently, he or she is not doing his job.

I would report that person to whatever organization that licences/monitors helthcare personel in your country. And I sertainly would demand a second opinion.


As for me, I'm overweight. And so is my doctor.

[Whitney]

As for me, I'm overweight. And so is my doctor.

[fester30]

I deal with this all the time in the military health care system.  They often pick and choose among symptoms and give a wrong diagnosis.  My wife is overweight, and she didn't have a cycle in 2 years, and had pretty much textbook symptoms for polycystic ovary syndrome (it's why we don't have kids yet, but we'll be back to working on it when I get home).  She was even diagnosed with PCOS at the VA just before we got married.  The medical records were sent over, and it took several visits and a truckload of tests before the doctor conceded that perhaps she did have PCOS.  Then he said the same thing... it's the weight causing it.  Fact is, while the weight can aggravate it, the weight doesn't cause it, it's the other way around.  The doctor also wasn't familiar with any of the PCOS treatments, and refused to try her on any we suggested, even though she was a perfect candidate for a couple, according to an uncle of mine who is a doctor.

What works best for us is to know something about what all the symptoms could add up to, and if we think the doc is pushing us off, we ask questions, in a non-confrontational, information-seeking way, about these other things and the chances it could be that.  It still often takes us more than one visit, and I occassionally have to be firm with the doc (especially if it is different docs on different days) as to what they've tried before that hasn't worked, and what we would like to try.  You are a customer, after all.  You can suggest things.

The BMI is not a good indication of what your fat percentage is, this is true.  However, it is a decent, while outdated, indicator of long term health effects.  By "overweight" and "obese" the scale is not insinuating that you are fat.  It is just saying you weigh too much for your height.  There are studies that show that if you are a body builder with almost nonexistent body fat but fall into the high overweight or even obese category on the BMI, you will have a higher chance of a whole list of long term medical problems, such as heart, liver, kidneys, etc.  Very similar problems to if your obesity is caused by fat instead of muscle weight.  The BMI scale is outdated, however, because recent studies have suggested that the healthiest people short and long term fall between about the middle of the "normal" scale, and about the middle of the overweight scale.

You have classic symptoms of Traumatic Brain Injury (TBI) which often, but not always, follow a concussion.  I'm not sure if it might also be related to your tumor, but I don't know enough about all that to say.  You need to make that clear to your doctor, so you can be properly treated.  Otherwise, this could lead to many other problems.  We have learned a lot about TBI in the military (although the VA was very slow to catch on).  They teach us these symptoms in case we are injured while deployed.  You need medical treatment and probably therapy to deal with it.

As for how you deal with the doctor when they always want to throw your weight around... let them know that while you understand your weight likely aggravates any medical problems you have, it is not always the cause of them, and you need to know the actual cause so treatment can be combined with attempts at healthier living through diet and exercise.