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Author Topic: The Importance of Finding Body-Positive Physicians  (Read 3088 times)

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Offline TriesteTopic starter

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The Importance of Finding Body-Positive Physicians
« on: December 23, 2011, 03:50:59 PM »
How many of you are overweight?

How many of you are underweight?

How many of you have precisely the numbers, diet, exercise, and test results that your doctor says you should have?

How many of you have avoided seeking out a primary care physician because of these things?

How many of you feel that your physician doesn't take you seriously because they perceive you as being noncompliant with your health plan?

How many of you have gone to the doctor to address a concern unrelated to weight and had it brushed aside with a, "Now let's talk about that number from the scale..."?

Think it's just your imagination? Doctors have biases, too. Stigma and Discrimination in Weight Management and Obesity

For me, this article highlights the need for more progressive health care approaches to weight management, and much less reliance on shame.

Offline DudelRok

Re: The Importance of Finding Body-Positive Physicians
« Reply #1 on: December 23, 2011, 06:33:23 PM »
People are stupid.

Doctors are people.

Q.E.D.

Doctors are stupid.


Of course I don't mean this intellectually.


Anyway, yeah... less worry about the size of my tummy and more worry about the ulcer in it, thanks. If I thought my weight was a "problem" I'd... I don't know, do something about it? XD

Never really an issue with me as I'm not exactly the most quiet and polite of people... but I'd like the entire world to stop putting focus on the physical, period. Especially people who are supposed to hold objective stances on the matter (Like Doctors).

Offline Oniya

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Re: The Importance of Finding Body-Positive Physicians
« Reply #2 on: December 23, 2011, 08:09:27 PM »
We had pediatricians crawling up our butts about the fact that the little Oni was 'below the weight curve'.  We drove ourselves nuts trying to get her to eat more - until we realized that she was still a very active and intelligent child.  This was something that wouldn't be happening in a state of deprivation.  She's still just as active, just as bright - and just as relatively small compared to her age-range.  That's not the reason that we've stayed away from doctors as long as we have (lack-o-funding), although it is something that made my gut twist when we were going more regularly.

Offline rachelongaku

Re: The Importance of Finding Body-Positive Physicians
« Reply #3 on: December 23, 2011, 08:57:44 PM »
While I'm glad to say that I'm losing the weight (50 lbs down and 50 to go!), I did spend most of my childhood with obesity. My doctor was to focused on telling me to lose weight to get healthier than anything else.  If I was ever sick, it was simply blamed on my weight. At one point of time I stopped getting my period, and it was blamed on my weight (It was pregnancy since I hadn't had sex before then). It wasn't until last year and I went to a different doctor that they started looking for other possible problems. I was glad I went to that doctor. I found out that I had hypothyroidism and that it was pretty bad. I'm definately still with the doctor that found my hypothyroidism, since she obviously thinks instead of blaming everything on my weight!

Offline Aoife

Re: The Importance of Finding Body-Positive Physicians
« Reply #4 on: January 17, 2012, 01:06:10 AM »
As a health care professional, it's very safe to say that no Doctor is perfect.  I myself have made a number of mistakes.  In an average day I get anywhere between 9-25 patients, each with their own medical history and specific concerns.  If there's even one error in book-keeping, or the patient answers me dishonestly, I'm very likely going to make a mistake.

There are health standardized guidelines that are remarkably well drawn out, as well as general health benchmarks (blood pressure, BMI, blood sugar) that re relatively consistent.  There are always exceptions.  Obesity is one of the most notable endemics because the vast, VAST majority of obesity is directly at the fault of the patient. Hyperthyroidism, and a number of other ailments cause weight gain, but the most endemic cause is lifestyle choice.  I can completely agree with a prevalent bias of educators, health care professionals, and employers against the obese. One could even call it systematic.  The reason is societal perceptions which stretch throughout all strata of society, not just those of us with positions of responsibility.

Primarily, shame is not a motivator, if anything, it pushes people to more self-destructive activity.  But, by and large, we as health care professionals cannot do much for individual's personal weight problems unless it is specifically caused by an abnormality.  It's just the way things are.  It's not a happy truth that the overweight and obese are largely to blame for their weight but it is, nonetheless, ultimately their responsibility. I can draw up a dietary and exercise plan for you, but I can't make you follow it. How you choose to live your life is ultimately your decision.

Offline TriesteTopic starter

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Re: The Importance of Finding Body-Positive Physicians
« Reply #5 on: January 17, 2012, 09:27:22 AM »
That's all fine and good, but there is a point at which it crosses a line. Patients should not have to go in for an ear infection and hear, "So about your weight". If a patient goes to the doctor concerned about sudden weightloss uncharacteristic of their body's normal behavior, that needs to be addressed rather than getting an answer of, "Great, keep it up, you can stand to lose it anyway!" Some doctors do this and some do not. What annoys me is that some people assume the doctor is not the one with the problem, and they put up with it. This is unacceptable.

Offline OldSchoolGamer

Re: The Importance of Finding Body-Positive Physicians
« Reply #6 on: January 17, 2012, 12:48:54 PM »
I think we're finding out more and more that obesity has its roots in biochemistry and evolution.

Simply put, the human body evolved optimized for low-calorie, high-exercise environments.  Thanks to technological growth, we now have a high-calorie, low-exercise environment.  And that's not going to change.

(Warning--semi-rant ahead)

Myself, I've been told I could stand to lose about fifty pounds.  And, unfortunately, medical science really hasn't come up with jack-shit to help.  So not only am I on my own, I have to fight a body that has evolved to hang onto every calorie and every ounce of fat.  Everything that's "healthy" and low-cal tastes like shit patties excreted by an elephant fed a diet of straw and cardboard, and everything that I enjoy is bad for me somehow.

Diets?  Yeah, good luck with that.  Try being productive as a writer and manager when you're hungry every minute of the day.  And even when you manage to resist the urge to eat--when you successfully delay breakfast until the early part of the afternoon, eat a tiny lunch around quitting time, and skip dinner--and lose weight, guess what?  Your body just reacts and eventually you give in and gain all the weight back.

http://www.buckapound.com/blogs/dr-art-ulene/homework-why-fasting-does-not-work

Exercise?  A fine concept, but it doesn't help nearly as much as we would like to think.  You just can't burn enough calories at it to count.  And, just like with diet, your body works against you.  It WANTS to be fat and unhealthy.  Say you go to the gym first thing in the morning, and burn off 600 calories (a pretty good workout).  Then you go to the office.  Well, as soon as you settle into your chair to actually do work you get paid for (as opposed to wasting time you could get paid for making up for the fact the human body is craptastically designed to fail), your body goes into a sedentary mode where it does what it does best: turning calories into fat.

http://www.time.com/time/magazine/article/0,9171,1914974,00.html
http://lifehacker.com/5800720/the-sitting-is-killing-you-infographic-illustrates-the-stress-of-prolonged-sitting-importance-of-getting-up

The bottom line here is that I'm not going to quit my job as a project manager so I can chase gazelles or be a hobby farmer.  And I can't work if I'm hungry all the time.  I can do the starvation thing for a couple weeks, tops.  And as we've already established, it doesn't work over the long run. The Body goes "WTF?!?! You want me to NOT have a stroke or a heart attack?  Fuck you, Mind.  I WANT to be obese, so I'll make you gain all that fat back and then some!"

So when it comes to weight loss, I quit.  Fortunately, it seems like medical science is finally starting to treat obesity like the evolutionary/biochemical issue it is rather than "you just need to act like a hamster a couple hours a day and punish yourself by starvation around the clock."

http://articles.latimes.com/2011/nov/10/health/la-he-drug-fat-loss-20111110

So, for those of us not into self-flagellation, meth, or a return to the Bronze Age, there is hope.

Offline Daggermouth

Re: The Importance of Finding Body-Positive Physicians
« Reply #7 on: January 17, 2012, 04:12:16 PM »
This doesn't happen as much to blokes as girls, I don't think; my Mum and ex girlfriends have complained that their doctors are always talking about their weight, presuming that they need or even want to do anything about it. Then again, I have friends who could stand to lose a good fifty pounds who don't even really register that they're overweight, and their doctors don't seem to be cluing them in.

However, shaming someone for random arbitrary reasons is highly uncool, and taking potshots at their self-confidence is hardly going to motivate anyone to get healthy.

I know this is a serious topic, but OldSchoolGamer's masterful summary made me laugh a lot:

Quote
The Body goes "WTF?!?! You want me to NOT have a stroke or a heart attack?  Fuck you, Mind.  I WANT to be obese

Offline Oniya

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Re: The Importance of Finding Body-Positive Physicians
« Reply #8 on: January 17, 2012, 04:54:42 PM »
I saw this posted somewhere else, and had to track down the original link.  The whole 'body-positive' idea isn't saying 'Your weight (or lack thereof) has nothing to do with your condition, (even if you're under 95 lbs and amenorrheaic, or over 300 lbs and short of breath)' but rather acknowledging that maybe the condition isn't entirely due to the patient's body-shape.

http://kateharding.net/2007/07/12/fat-hatred-kills-part-one/

Offline Pumpkin Seeds

Re: The Importance of Finding Body-Positive Physicians
« Reply #9 on: January 17, 2012, 05:50:45 PM »
First, I would like to state that shame and humiliation are not the proper or effective ways to treat a patient.  Such methods can lead a patient to depression and giving up on their care.  Hope is always something that should be given to patients, even in the bleakest and more dire moments.  From hope people can rise, even if the battle is already lost.  So I am a big advocate in giving patients hope and a positive outlook on their condition.

That being said, doctors and nurses are not going to ignore the condition.  If a person comes into the clinic to have their ear infection treated and they are obviously obese, then there will be a discussion.  Physicians take whatever time they can with their patients to place emphasis on healthy lifestyle choices and assistance.  Help is always offered and encouraged.  The same is done with smokers as you will find pamphlets to quit smoking in a dermatologist office.  Healthy lifestyle choices are at the very fabric of medical care and preventative medicine.  This is where our healthcare needs to progress.  Instead of treating the ulcer in the stomach, better that   ways to reduce stress and encourage a diet that does not lead toward such a condition is discussed.

As for the crux of medical conditions being responsible for obesity, this is simply not true.  There are conditions, medications and other factors that cause obesity.  This is true.  People do suffer from actual medical problems that cause them to gain and retain weight, certain people do have genetic predispositions to holding onto weight and there are medications that cause weight gain.  That applies to a small percentage of people that are obese.  Consistently defending poor lifestyle choices with "just my genetics" is an abuse of science and a way to avoid doing the work needed to be healthy.  Medicine is not there to make life easy.

As for evolution, certainly the body wants to retain energy stores.  The body is not designed though to weigh in excess of 400lbs as evidenced by the degrading of the cartilage in the knees and hips.  The body did not evolve to sit in front a computer 18 hours a day with no exercise.  Methods are being designed to work with the body in order to maximize weight loss and diet, that is true.  Just because the body wants something does not mean the body should get that something.  Patients don't want to get out of bed after surgery, but I am there telling them to walk.  Why?  Because I am pushing for them to get better where their body is wanting the easy route.

As for a weight loss pill, that would be great.  The purpose of the pill is to allow obese people the relief to go out and exercise.  The pill would give them the confidence to make the healthy choices as they feel pride in the weight dropping off.  Such a pill is not a miracle cure.  Poor diet is not just about the "size of the tummy."  A weight loss pill would not address high sodium intake, cholesterol problems, poor muscle growth, weakened hearts from lack of exercise, etc. etc.

Offline TriesteTopic starter

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Re: The Importance of Finding Body-Positive Physicians
« Reply #10 on: January 17, 2012, 10:10:50 PM »
And there is no reason for that. It's akin to having someone say to you every time you see them, "Hey, I see that mole hasn't gotten any smaller". The mole might be benign. It might also turn into cancer. That doesn't mean that the person needs - or wants, or deserves - a reminder every time they see you. Knowing that you are going to hear "Oh, and you're fat" if you go in to get something unrelated looked at is not going to spur someone to a healthier lifestyle (assuming they don't already have one, by the way). It is instead going to make the person avoid getting proper care, and that is a failing. And it is a failing on the part of the medical professional that has perpetuated the behavior.

Like it or not, we live in a culture where simply calling attention to someone's weight can be deeply embarrassing. There are many women (and possibly also men; I'm less in touch with the male perspective on this) in this country who find it a shaming activity to simply be put onto the scale at the doctor's office. So by continually beating on that drum, health professionals are shaming their patients, and they are indulging in behaviors that lower the quality of care for some of the people that apparently need them quite a bit. While their intentions might be good, this essentially places health professionals on the same level with that nagging aunt that you can't avoid seeing because she's at every Thanksgiving meal. Except that patients can avoid their health professionals much easier than they can avoid Aunt Marla, and they will do so if going to the doctor only makes them feel frustrated and helpless.

Like it or not, health professionals do need to realize these things, and take them into account when attempting to treat patients. This is, of course, also assuming a fairly empathetic health professional. There are health professionals who will accuse their patients of lying about how much they drink, whether they smoke, how much they exercise, and what their diet is like. I won't even begin to go into the damage that causes, because I'm sure it's pretty obvious.

Offline Kilgore Trout

Re: The Importance of Finding Body-Positive Physicians
« Reply #11 on: January 17, 2012, 11:24:04 PM »
I've lost and gained weight a lot. I'm six foot with a large body frame. If I go by the standard medical charts, I shouldn't weigh more than 190 pounds. Well, when I have gotten down to that weight, my friends become concerned and ask if I'm sick.

I've gone between 190 and 220 pounds a lot these last 20 years. What I've concluded is that for me it's all about muscle mass. Muscle weighs a lot more than fat. I've looked a LOT better at 220 than at 200...just based on how much time I've spent at the gym.

I think the weight factor has a lot more to to with how you feel, how well you fit in your clothes, and how good you feel about yourself instead of the charts. The medical charts are a good guideline, but I don't think that they work in every situation.

Offline RubySlippers

Re: The Importance of Finding Body-Positive Physicians
« Reply #12 on: January 18, 2012, 07:40:32 AM »
Your missing the biggest cause for obesity, money or more seriously lack of it. Look at things if your poor you can spend $10 to make five burgers OR go to BK spend half that and save money. High quality beef is not cheap folks neither is wheat buns and cheese and veggies its simply cheaper to eat out with the dollar menues all over. Take my favorite places to eat buffets for $6 or less you can eat all you want that means one meal a day covers you and you leave full. And its the one chance to get a salad and other good things to to eat.

Another place I like Taco Bell you can get $2 meals there a burrito, nacho chips (small bag) and soda and add a dollar more get another burrito. You fill up for half the day on $3 and change.

Most staples are expensive milk, fruit juice even fresh fruit is a treat blueberries which I love are $2.50 a pint in my area and I do buy them when I can but that to me is alot of money.

Let me ask if you had $8 a day to eat with and had to have a balanced diet as per the guidelines figure out how to do that I can't short of the Buffets and eat up. And don't mention government help I for one refuse to go there, I can feed myself there are others that need the help with families to feed.


Offline Pumpkin Seeds

Re: The Importance of Finding Body-Positive Physicians
« Reply #13 on: January 18, 2012, 08:13:55 AM »
The average person sees their doctor when something is wrong.  One of the biggest problems with the American medical system is reactionary medicine.  This means that a physician will likely see their patient when they come in for pain or discomfort, such as from an ear infection.  Doctors and nurses need to take that time to address as many issues with that patient as possible because they may not see them for a long time.  Not presenting options, advice, facts and information to the patient during that small window of time is failing the patient.  Suppose that stance was not taken.  That individual may not realize there are options they could do, people they could talk to about improving their health and information they could obtain in order to change their life.  All this information andthese  life saving alternatives denied to them for fear of embarrassing them.

Embarrassment is part of medicine.  The nature of medicine is dealing with the human body which many people, not just obese patients, find embarrassing.  Yet the job of a healthcare professional is to find a tactful and compassionate way to continually broach those topics.  Healthcare professionals are the ones asking the teenager if they are using condoms, how a person got that bruise and if someone is doing illicit drugs.  Personal, embarrassing and uncomfortable situations for both healthcare worker and patient are expected in that relationship.  Shying away from the needed topics and questions is failing the patient, is failing in the duties entrusted.  Asking someone charged with looking after the health and welfare of another to not address healthcare issues because of embarrassment is not right.

Now I agree that healthcare workers can learn to be more sensitive about the subject, but if someone is going to avoid medical care because the doctor addressed their obesity than the problem is the patient's.  In that relationship there can be no "off topic" issues when the patient's body is concerned.  Start drawing lines over appropriate discussions and things get missed.

Offline Lilias

Re: The Importance of Finding Body-Positive Physicians
« Reply #14 on: January 18, 2012, 08:38:30 AM »
Let me ask if you had $8 a day to eat with and had to have a balanced diet as per the guidelines figure out how to do that I can't short of the Buffets and eat up. And don't mention government help I for one refuse to go there, I can feed myself there are others that need the help with families to feed.

I've fed a family of four on such a budget. Granted, for short stretches of time, when things got really difficult, but it's doable, because I'm as far from a domestic genius as a family woman can be, and I still did it.

Not sure if the difference is in the culture, but during such stretches, we wouldn't as much as pass outside a fast-food place. The more mouths you have to feed, the less cost-effective fast food becomes. I've pinched pennies to make sure that at least milk, orange juice and bananas would never be missing from my pantry. We are an ordinary family, with a mortgage and utility bills, without any tax credits or other aid. The pinch was felt, but that's why it's called making do.

Offline TriesteTopic starter

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Re: The Importance of Finding Body-Positive Physicians
« Reply #15 on: January 18, 2012, 09:18:21 AM »
Embarrassment is one thing, shame is another. Does a health care provider really think they are telling a 400-lb person anything they don't know by bringing up the fact that they are clinically obese? I don't think so. Patients do have a right to dignity with their care, and it is most certainly not the patient's problem if they choose not to see a doctor who does not respect that. While health care providers are professional experts in their field, they are still working for the patient. The patient pays them, or pays the insurance which then pays them. It is not the provider's right to make their patient feel shame. It is not the provider's right to ignore concerns that the patient might have in favor of pursuing the topic they think is more appropriate.

The fact that most people don't have a proper primary care physician, access to yearly physicals, or funds to see a doctor for preventative care does not provide an excuse for health care providers to take what little chance they have to shame their patients. And it is certainly not the patient's problem if they choose not to spend their already-limited funding on a doctor that doesn't listen to their concerns and instead talks about their weight. Additionally, it is not the patient's problem if their health care provider outright refuses to believe them, as happens a fair amount in medicine. I have a doctor who knows that I will be honest about the amount of time I spend in the gym, but not everyone is quite so lucky. A school friend of mine went to her doctor because she was spending an hour every single day in the gym, practicing portion control, consulting with the school's nutritionist, and still not losing weight. The doctor kept asking her, "Are you sure you're not eating more? Are you sure you're not sitting down with a bag of chips at the end of the day? What about sodas?" and so on. This is an example of the bias to which I've been referring, but it's only a blatant example. It's the equivalent of a doctor asking their patient, "Are you sure you're not just PMSing?" because the patient is female, or something equally discriminatory.

Again, not all doctors are this way, but it seems like many are, and the original article provides evidence that it can be systematic. It is a health care provider's responsibility to try to rein in their personal biases during treatment, and that is not happening.

Offline Oniya

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Re: The Importance of Finding Body-Positive Physicians
« Reply #16 on: January 18, 2012, 09:47:51 AM »
Case in point:  My roommate has been suffering for two years with an ankle injury.  It was caused by a fall on a stairway that was 'lit' by a motion detector - that failed.  She went to an orthopedic doctor who put her in the wrong brace for six months - he's currently under investigation for malpractice.  After six months of not listening to her say that the physical therapy wasn't giving her any improvement, he sent her to a new doctor who gave her the correct brace. 

On good days, movement is awkward.  In the winter, walking is excruciating.  One of her pain management doctors told her - his words - that he had a 'magic pill' that would help her lose weight. 

'Magic pill'.

The first thing I've seen on every 'quack-buster' site is that there are no 'magic pills'.  There are also no magic earrings, magic bracelets, magic teas, or magic Zentai suits. 

She has asked for help regarding weight loss from her current doctors - for a referral to a nutritionist, for an exercise program that won't further damage her ankle (and now her back, since she's been walking lopsided for almost two years).  The fact that she has gone from fairly active (when I first met her) to sedentary due to the accident isn't apparently enough of a causal link for her case manager to connect her inability to loose weight to the accident, so it's 'So sorry, you're on your own.'

Offline Pumpkin Seeds

Re: The Importance of Finding Body-Positive Physicians
« Reply #17 on: January 18, 2012, 03:46:39 PM »
Patients have a right to dignity, not ignorance.  There are alot of things people do not know about their own bodies.  One of the primary lessons taught is to never assume a patient knows or understands anything unless explicitly educated.  Most people would make the assumption that a pregnant girl knows that she became pregnant by having sex with her boyfriend.  Believe it or not, I've heard of cases where the girl did was not aware of that little bit of knowledge.  A 400lb obese person may not understand things like portion control, proper exercise and how to read the labels.  They may say they are doing these things, but they may not have an understanding of what these things entail.  Every moment with a patient is a teaching moment.

Medical personnel do work for the patient and that is an important thing for any patient to realize.  At the same time healthcare professionals answer to their licensing board, ethics committees and to their own professional peers.  A healthcare worker does not give in to the demands of the patient if those demands/desires would harm the patient.

As for your friend, those questions are good ones.  Someone healthy enough for physical exercise comes into the office of a doctor she has not visited before, claiming that she is not losing weight despite exercise.  The most rational and likely explanation is that she is doing something wrong.  Many people do not equate soda with weight gain, because they think of soda as a drink and not food.  Snacking is a big thing that healthcare providers have to go after because people do that activity without thinking.  Hence one of the reasons why a food diary is such a big help.  The other question about eating more is a logical one because when people exercise, they burn more calories and are often more hungry.  Not everyone understands balancing calorie use and gain, assuming they do is dangerous.  Your friend takes that as the doctor believing she is lying because she is fat, but in truth he is trying to rule out the most common reasons.

I agree that bias is part of medicine and invoking shame is a practice that some providers still utilize.  Neither of these things should exist and should certainly be pursued.  I do not believe this means that medicine should simply ignore the patient's condition because the patient might feel embarrassed.  I do not believe providers should avoid questioning a patient further about their habits.  Providers cannot take people at their word, cannot assume that patient's understand or have the right knowledge and cannot avoid asking the tough questions.  Such is the profession.

Offline TriesteTopic starter

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Re: The Importance of Finding Body-Positive Physicians
« Reply #18 on: January 18, 2012, 04:00:53 PM »
I believe I wrote that she went to her doctor. As in, one that she's seen before.

In addition to a nutritionist.

So even though the situation has been written out for you, explained in clear English, you inferred the worst out of it anyway (that she's gone to some random doctor and hasn't bothered to educate herself about how to stay healthy). But it's the patient inferring the wrong things about the kind of questions she was being asked. It's the patient's problem that she doesn't like being repeatedly asked about her eating habits despite being in consultation with another professional. Clearly the patient is in the wrong, here.

If that's your worldview, I don't think we have anything more to discuss. I'm all set, thanks.

Offline Pumpkin Seeds

Re: The Importance of Finding Body-Positive Physicians
« Reply #19 on: January 18, 2012, 04:57:40 PM »
Well, for one there was no mention of a nutritionist.  Also, as I pointed out, to assume that someone educated themselves properly and adequately is a mistake in the medical profession.  Now as for seeing "her" doctor, I did not see that part.  Still, you did not state how often she sees the doctor or how long the has been considered "her" doctor.  Do not launch into a defense that your language was in perfectly clear, explained English in an effort to make this seem as if a poor assumption was made.  Claiming that someone sees their doctor does not, to me, carry the assumption that the doctor knows them very well.

I can only state that the questions were valid, I cannot comment on how they are asked or the state of mind your friend was in when those questions were asked to her.  As I have said repeatedly, healthcare providers need to avoid invoking shame in a patient but that does not mean the questions do not need to be asked.  Though I will say that if your friend did not want to be "repeatedly asked about her eating habits despite being in consultation with another professional" then she probably should not have gone to her doctor to discuss problems with weight loss.

I do not feel that she was "wrong" for being offended just as I do not believe the doctor was "wrong" for  asking those questions.  I believe she had every right to be offended by his questions and if she wanted a second opinion about her condition then she has every right to seek out a doctor that addresses her issues as she sees fit.  I do not believe the doctor was wrong for asking valid, medical questions about her condition.  I do not believe the doctor is wrong for investigating her eating habits considering she came to the doctor about weight loss troubles. 

Medicine has gone down that path before where assumptions were made about people's education, they were considered to be responsible for their own knowledge and they were not told things because a healthcare provider was worried about upsetting them.  That system did not work, unsurprisingly.  If your view on medicine is leaning that way then I am very sorry to inform you that medicine will not return to those roots.  Asking healthcare providers to not do their jobs and protect the lives of their patients because they might be embarrassed is wrong.  There may be better ways to approach the topic or handle the sensitive subject, but the questions still need to be asked.

This is not my worldview.  This is preventive healthcare and protecting the patient.

Offline TriesteTopic starter

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Re: The Importance of Finding Body-Positive Physicians
« Reply #20 on: January 18, 2012, 05:50:24 PM »
Well, for one there was no mention of a nutritionist.  Also, as I pointed out, to assume that someone educated themselves properly and adequately is a mistake in the medical profession.  Now as for seeing "her" doctor, I did not see that part.  Still, you did not state how often she sees the doctor or how long the has been considered "her" doctor.  Do not launch into a defense that your language was in perfectly clear, explained English in an effort to make this seem as if a poor assumption was made.  Claiming that someone sees their doctor does not, to me, carry the assumption that the doctor knows them very well.

Um, what?

A school friend of mine went to her doctor because she was spending an hour every single day in the gym, practicing portion control, consulting with the school's nutritionist, and still not losing weight.

Though I will say that if your friend did not want to be "repeatedly asked about her eating habits despite being in consultation with another professional" then she probably should not have gone to her doctor to discuss problems with weight loss.

She was there on the advice of the nutritionist, specifically because she was doing everything 'right' and still not losing weight. Standard practice with a nutritionist is keeping a food journal, by the by. I'm not sure if you were aware of that.

I'm not advocating making assumptions about the patient's education, I'm not advocating anything less than listening to the patient and treating them with respect. But I'm not going to continue to discuss it with you when you clearly don't read what I'm posting. It's frustrating, pointless, and a waste of both of our time.

Offline Pumpkin Seeds

Re: The Importance of Finding Body-Positive Physicians
« Reply #21 on: January 18, 2012, 05:57:53 PM »
I do apologize for not reading the post properly.  I still stand by the statement that the questions were valid ones.  The physician was right to ask them and investigate into the problem of her weight loss.  Better to seek a little bit of embarrassment and give her a proper treatment, then to prescribe tests and medications for the wrong item.

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Re: The Importance of Finding Body-Positive Physicians
« Reply #22 on: January 18, 2012, 06:05:21 PM »
The point I have been trying to make is that it's counterproductive to look at someone who is heavy, overweight, underweight, etc, and say, "This person is clearly not eating/eating too much/not exercising" etc. What makes more sense, and what is more fair to the patient, is to look at the evidence presented - e.g. the nutritionist's notes, the food diary, whatever - and say "What's wrong, here?" Essentially hounding someone because the doctor assumes that they are living an unhealthy lifestyle is judging someone by what they look like instead of what they do or what other diagnostic tools say. It's like looking at a thin person and saying, "You couldn't possibly have high blood pressure. Your BMI is perfect!" Rather than looking at someone's body and making assumptions, there needs to be a push toward looking at a person's numbers, overall health, and lifestyle.

That is the point that I have been trying to make.

Offline Pumpkin Seeds

Re: The Importance of Finding Body-Positive Physicians
« Reply #23 on: January 18, 2012, 06:45:59 PM »
What I am saying is that making the assumption that a patient is following the regime is dangerous as well, especially when that could lead to a lot of expensive and perhaps unhealthy tests.  What is the more likely scenario, that your friend is failing to follow the plan set before her by the nutritionist or that she has some physical condition unrecognized or diagnosed in the past?  The more common and likely case is that she is violating her diet in some way.  Perhaps not maliciously, but there is some deviation from the diet.  The first step in diagnosis is to rule out.  I do not see the body assumption here. 

The evidence looks like this to a doctor.  Patient told to consult physician by nutritionist for failure to reach weight loss goals.  Patient states following diet and exercise.  No past medical history of note.  Patient weighs X amount, patient states following activity and diet plan.  Patient previous weight is X amount, no loss of weight despite stating that she follows activity and diet plan.

If we look at the numbers here.  Patient has X problem, intervention Y is implemented by professional nutritionist with expected result being Z.  X+Y = X, something is wrong.  The variable is the Y.  The physician could question the nutritionist, but would originally assume the nutritionist is doing their job since they are a specialist.  Even if the nutritionist notes are presented, the physician is reviewing the plan of care set out by the nutritionist.  The nutritionist, unless directly observing the patient at all times, has no way of knowing if the plan of care is being implemented properly.  The physician can question other medical reasons such as past medical history (none to date I assume), current prescription medications (none to date I assume) and whether the plan of care (Y) is being implemented properly.  Following the numbers, as you stated, what is the most likely scenario?

A lot of that information is patient states, which means the primary source of information is the patient. That means the primary source of information here is subjective and needs to be questioned and investigated for authenticity.  An actual medical problem is far less likely than a lifestyle one.  A doctor cannot assume the less likely option simply because the patient says they are following their diet.

As I have stated, the problem may be in the presentation of the questions but not in the questions themselves.  What is being seen as an assumption is the process of elimination and ruling out the most likely causes. 

Offline Aoife

Re: The Importance of Finding Body-Positive Physicians
« Reply #24 on: January 19, 2012, 12:44:56 AM »
As a brief note Trieste, remember my, at this point, much earlier point. As a physician, I see around 15-20 different patients a day.  If your friend sees me once every 6 months, the chances of me remembering their specific medical history (often a few dozen pages of technical information) are very low.  Even as their regular physician, I might remember their name and some relevant details, but not the intricacies.  I need to establish a baseline of physical condition, as well as lifestyle.  In turn, Pumpkin Seeds is correct in naming the fact that I simply cannot assume that people actually understand anything.  I have seen everything get misconstrued from basic knowledge, alternative medical practices that are downright dangerous, and simple ignorance.

If your friend is continuing to show a patent inability to lose weight, then there are a few courses of thought:

1: The patient is not performing as instructed, and is lying about their adherence to the program. Medical literature chalks this number close to 70% of patients.

2: The patient is performing as requested, but has non-standard lifestyle practices that are directly affecting the progress of the program. This generally is a combination of alcohol, smoking, or another substance.  One particularly memorable patient made a habit of chewing aspirin like pez, not knowing they lead to water retention and a slowed metabolism. Personal experience makes this number out to be about 20-25%.

3: The patient is performing everything as requested, and has no significant non-standard lifestyle practices. This last percentage is between 5-10% of patients.

Now, in the former two cases, this misinformation is, the vast majority of the time, unintentional.  But it happens so regularly that I simply can't avoid asking the same questions over and over again. The reason for this is to see if the answers change consistently, because if so, I can assume the patient is too embarrassed for honesty.