“You’re fired.”

Tricia writes…

My annual physical exam last year was something I had actually really been looking forward to. Not that I have some kind of weird speculum fetish or something. Just that I’d been making some really positive changes in my life and I was expecting that those changes would show up in discernibly improved health and some empirical validation would be nice.

You see, all my life people (including my pediatrician at age 4, one of my earliest memories) have been telling me I’m fat. This is really stupid, because I was never more than a little overweight. In my first year of university, though, I started moving from really not fat at all, to slightly fat. When I hit 150lb, I panicked, and went to Weight Watchers, and stuck to their regimen assiduously, and got down to 120 lb (WW said my goal should have been 110). I also shot my metabolism to hell, and developed a habit of bingeing under stress, driving around town in the middle of the night to different drive throughs and having three or four super-sized combos from different McD’s and throwing out the wrappers in garbages far from home so there’d be no evidence, then feeling so awful about myself that I wouldn’t eat the next day, causing… more stress. I suspect that the disordered eating was the result of the group dynamic at WW, where there was a lot of good food vs bad food rhetoric going on, a sort of confessional atmosphere that seemed to rely a whole lot on food guilt and feelings of shame if the number on the scale wasn’t moving inexorably downward. Plus of course not eating nearly enough to be well can wreak havoc on any body.

Not surprisingly, I didn’t stay at 120lb for long. In fact, a year later, I weighed 180. A year after that, I weighed 210. I discovered that as long as I ate as much as I wanted, whenever I wanted, I could avoid the binge cycle, and for several years, as long as I was able to exercise, my weight was stable. And then there was the knee surgery and the time I couldn’t exercise, and by the end of 2004 I weighed 230lb and felt really unwell. I started to get scared about what I was doing to my body and that I was going to die by the time I was 40.

So I set out to lose that weight. I made a lot of positive changes: I started exercising again – slowly at first, but then more and more, and I discovered it made me feel fantastic. At first I restricted my calories too much, but when that was unpleasant I started focussing instead on getting all my servings of fruit and veggies and lean dairy, and eating vegetarian as much as possible. Is there a word better than fantastic for how good I was feeling by the time it got to be time for my physical? I’d lost 20lb, but by then that was secondary to just plain feeling good. Also worth noting is that I was eating about 2300 calories a day, not 1600, and the pounds were melting away.

The doc was relatively new to me, since my usual doc had suddenly moved to Vancouver and left me in the lurch. I’d only seen Dr. X a few times previously, for help with my knees when I’d pushed them too hard by doing too much new exercise too fast, but I had really liked and respected him during those visits. Which is why what happened was such a shock to me.

We got off on the wrong foot right away, when he took my pulse and blood pressure (fast and high, respectively), and commented, “You obviously haven’t been getting any exercise.” I know better than to expect him to remember everything about me, because I know he has a lot of patients, but the last thing in my chart before the physical would have been that I came to see him because I was having pain and swelling in my knees that was interfering with my exercise regimen. He was holding my chart while he said it. So I’m curious why he just went straight into berating me for being out of shape. Would he have said that if I were thinner, or would he have assumed I was feeling anxious and tried to say something to put me at ease? Do people whose BMI is greater than 30 suddenly not have sympathetic nervous systems? What about feelings?

Then I told him that I had in fact been exercising, alternating swimming and weights. If he hadn’t interrupted me, I would have told him that in a good week I’ll go six times, but four or five times is pretty usual, that my swimming speed and endurance has increased dramatically, and that I still do cardio on resistance training days. But he did interrupt me, and rather than saying something positive like, “That’s great that you’re committing to getting fit,” what he said was, “Don’t do weights.” I was so flabbergasted by that, that I didn’t get a chance to ask why on earth should I not be doing weights?

I don’t remember the exact order of what happened next, but somewhere in there he launched into a stern lecture about how dangerous it is to be overweight and all the bad things that will happen to me if I don’t lose weight and so forth. I was trying to tell him(and if he’d referred to my chart he would have already known) that I don’t need to be scared or shamed into losing weight. Not only am I already scared out of my wits, I’m scared enough that I’m doing something about it, and I’ve had a modest amount of success at it. But I couldn’t get a word in edgewise and there he was going on and on like I have no idea that being 5’3” and over 200lb is bad for me, and I’m just obliviously sitting my fat ass on the couch eating deep-fried cake. I would have liked to have talked to him about the plateau I was stuck on, and the emotional ups and downs I’d been having where some of my disordered eating seems to be slipping back in, and that as far as I can tell it’s only because of the exercise that I haven’t gained everything back plus extra. I would have appreciated some encouragement, and some constructive advice for getting out of the rut. I got neither.

Then he asked me if I’m married, and whether I’m sexually active. Now, that’s a perfectly reasonable question to ask a patient, because marital status is a major determinant of social supports, and of course you need to know if I need my prescription for birth control refilled. But my level of trust at this point in the visit was so low, that my first thought was, “Oh no, he’s some kind of religious nut who’s going to refuse to provide me with contraception,” and my second thought was, “What, fat chicks can’t get laid unless they roped someone in back when they were skinny?” He also neglected to ask whether I was in a mutually monogamous relationship and whether I thought it would be a good idea to be tested for STDs.

Then he launched into a lecture about the risks of being on the pill for obese women who are getting close to 30 – which I tried to tell him I knew, but he just went on and on anyway, again as if I am oblivious and/or ignorant of the risks of my weight. I had really been hoping we could have a constructive discussion about birth control, because the risks of being on the pill really do concern me and if I have other options (besides abstinence or having a baby every year until menopause) I would be interested in pursuing them. But the way he was going on, I was afraid he wasn’t going to give me any contraception at all, so I just asked him to refill my existing prescription because I didn’t feel up to fighting.

At some point we talked about diet, and I got a mini-lecture about not eating fried foods. I was able to interject there that I was in fact making a serious effort to eat a healthy and balanced diet, but I was feeling so frazzled and picked-on by this point that when he asked what I meant by eating healthier, my brain went absolutely blank.

When I couldn’t tell him specifically what I was doing with my diet, he told me to go to Weight Watchers. He refused to listen to me when I told you what an awful time I had with them. And then when he finally let me get a word in edgewise, he dismissed my concerns. “Well I’ve never heard of that.” Like since he’s never heard of it, my experience can’t possibly have happened.

Here I’ve taken reasonable and effective action on my own to get healthier, and here he is insisting that I participate in a program that’s required by law to say “*results not typical” in all its advertising, and that I already had an awful experience with. I thought he was supposed to be on my team helping me get healthy.

So after my appointment I went and sat in my car and cried for a while, then I went to the pool and swam a bunch of laps and I was still angry, so I got out of the pool and rode the stationary bike and pumped some iron and I was still angry after that, so I went and wrote a strongly-worded letter, and left it with his secretary, asking if we could discuss it when the results of my bloodwork came back.

After telling me that all my bloodwork was in the ideal range, he told me he didn’t want to be my doctor any more. That he remembered being in a rush, but didn’t remember any of the appointment that way and clearly I need a better doctor than him. Which, evidently, I do, because I don’t need a doctor who sees my size and then saves time by kicking in a stupid-fat-person heuristic.

So the question now is, how do I find a new doctor, when that letter will be with my chart if they get my old records. And then maybe that doctor won’t like me either.

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12 Comments

  1. Tanya

     /  August 19, 2007

    It is deceptively easy to change doctors.
    1. Ask anyone that you know who is more than 20 pounds overweight.
    2. A clinical dietician (at your local hospital) will have referrals.
    I have had better luck with female doctors on weight issues.
    Doctors are given only the minimal training in weight management, dynamics of weight loss, etc..and most are extremely fat biased.
    If shame made you lose weight we would be a nation of skinnies.
    It took me going to 4 different doctors before I found the one who treated me with respect.
    As far as the letter. and the doctor not liking you… Tell your new doctor on the first meeting about your experience with your former doctor. Ask him/her his opinions on weight loss…etc. If you do not like the answers, thank him for his time and move on the another doctor. It seems like a pain, but a caring supportive medical caregiver is a big portion of any weight loss program.
    Your former doctor is correct. You DO need a better doctor.
    When you insist on healthcare professionals treat you with dignity and respect, that is what you eventually receive.
    Good luck and keep us posted on your success.

    Reply
  2. Oh my GOD, what an experience. I would report him. That’s discrimination, and that’s unfair. I hope that you find a doctor that you like and feel respected by – the best way is to ask around, see who people you know go to and really like. Bedside manner is so much of what’s important about a doctor, and I don’t care how “rushed” this guy was, the way he treated you is ridiculous – he’s so far up on his high horse of “I am doctor!” that he’s not even listening to your concerns. He needs to BE a better doctor.

    Reply
  3. To that letter being in your records for anyone who’s going to treat you in the future, I say — GOOD. Let them see upfront what your expectations and issues are, and what constitutes for you a horrible healthcare experience. Maybe it will give them a clue before they enter the room, shake your hand, and then wash theirs.

    *harrumph*

    ~ hb33, another righteous fattie struggling to “get fit” ~

    Reply
  4. sweetpearl

     /  October 10, 2007

    I am so THRILLED to read that I am not alone in my experience with the medical profession (not to mention society in general)–though I am sad to think that another woman had to go through the same crap. I AM SO TIRED OF HATING MYSELF and trying to explain to people/doctors/classmates/family that:
    –Yes, I’m aware of the health risks associated with carrying excess weight
    –Yes, I know it doesn’t LOOK LIKE I’M TRYING/GETTING FIT/WORKING HARD/LOSING WEIGHT but I work harder on this than anything in my life
    –It’s possible that I will never be a body-type that meets with your approval but I will be healthy

    I’ve been putting off my trip to the Dr. because I just don’t want to have to fight again for a moment of respect……After reading Trish’s piece, I FEEL LIKE A WARRIOR!!!!
    Maybe that’s because I am!

    Reply
  5. Debbie Beukema

     /  October 25, 2007

    I understand how sad, angry ,and frustrated you are from that experience (above and beyond countless others). And even though I think you are completely justified in being pissed, I can’t see how that is gonna do you any good. I say that because at least in my own experience, when I have been justifyably pissed at someone I’ve always ended up taking it out on myself. Eventually my brain goes from being mad to wanting a type of revenge and that has always lead to me saying “screw you… if I can’t win by doing all the positive stuff, then I’m just gonna eat this {insert forbidden item here} and you can go f_ck yourself!” KNow what I mean?

    Can I suggest doing for him what he failed to do for you? Just give him the benefit of the doubt. Whatever reason you can come up with… for instance: maybe he has been told to be forthright with patients and lacks communication skills. Maybe he’s really left brained and doesn’t have an empathy bone. Maybe he’s naturally at 11 when he should be at a 5 – dude needs to dial it down. Who knows? I say give him the benefit of the doubt – not because he deserves it but because you do. And then go take control and find a doctor who gets you.

    Hang in there babe!

    Reply
  6. Debbie, I’m all for letting go of anger that’s only eating away at you, but in this case, I think anger is pretty much the only appropriate response.

    Reply
  7. Debbie Beukema

     /  October 26, 2007

    Agreed, Kate. Have the anger. Be furious. It’s totally justified.Be angry any way you need to be. And then be done with it and do something proactive to change the current situation. My biggest concern for the blogger, being an emotional eater myself, is that she deals with the justifyable anger and then lets it go. I know if I don’t find a way to get zen and let it go, it always comes back to me in the form of self-sabotage, you know? So when I’m around a total asshole, after I’m mad, I do a little thought exercise. On one hand, he may be empirically the biggest jerk ever and completely undeserving of any understanding. Or maybe he was having a shitty day. His cat died and he took it out on the first person he saw. Maybe he’s a great doctor on paper but totally ignorant in this area. I mean, even the best of us have acted lame in certain situations. When I do this thought exercise, it just allows me to get beyond it. I dunno. I find it hard to explain and hope I’m not rambling too much. In the end, I feel so proud of the blogger for doing what she is doing despite all the obstacles, and would hate to see this situation get her down further, you know?

    Reply
  8. wriggles

     /  November 6, 2007

    What these docs need is a sting, an undercover fatty could register and make up an ID and then post it on Youtube or something. Now that would be cathartic!

    Reply
  9. apricotmuffins

     /  November 12, 2007

    debbie,she could give him the benefit of a doubt and go back and recieve more of the same shameful treatment. Or she could drop her anger, move on, find a different doctor and be totally done with the one who treated her so badly. I think it would be a very bad idea to go back to someone who was so disgustingly prejudice against her. all he saw was a fat woman who was lazy, stupid and ate a lot of fried foods. I mean, he lectured her on eating FRIED FOODS? thats as bad as lecturing her on ‘stuffing her face with donuts’. Its a stereotype, and a terrible one at that. Even if he were having a bad day, it does not excuse his behaviour. His whole mindset was wrong to begin with.

    Reply
  10. catrinad

     /  November 17, 2007

    I’ve had a doctor tell me not to lift weights because I would “gain weight”. It basically told me that the fact that you are building muscle does not count. All that counts is the numbers on the scale. I was about 13 at the time. Of course that visit left me in tears because I was trying so hard to lose weight and it just was not happening. I was not losing weight because I was on steroids for my asthma but that connection was never made.

    Reply
  11. Tricia

     /  December 21, 2007

    This is the OP – Good news: I found a new doctor who treats me like a human being, who supports my diet and exercise efforts without being shaming or blaming (although my efforts haven’t been that great lately due to all sorts of factors), who takes me seriously if I’m not feeling well (rather than just telling me to lose weight) and who I totally trust and like.

    Good doctors exist! Thanks for restoring my faith, Dr. F.

    Reply
  12. Sandy

     /  February 7, 2008

    “…I’ve had a doctor tell me not to lift weights because I would “gain weight”. It basically told me that the fact that you are building muscle does not count. …”

    Wow. That is crazy since the more muscle you have the more fat you burn since it takes a lot of calories for the muscles to work. *shakes head*

    That is great Tricia! Now if we all can find a doctor like that!

    Reply

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