Doctor negates woman’s experience, doesn’t diagnose problem

Mary D writes:

I am fat, I know I am fat, and what it is to be stigmatized as the morbidly obese cretin unworthy of the health dollar. I live in Australia where the obesity witch hunt is in full flight. It is an area of discrimination sanctioned by government and encouraged by the media. Fat aussie kids are brutally bullied and their parents cruelly accused in the urgency to curb Childhood Obesity. Having worked in television most of my life I am deeply offended by networks grabbing ratings and advertising. I am upset when thin and attractive people of limited qualifications become stars and go unchallenged as they carelessly forecast imminent death to the obese. It is grotesque as they display and torture desperately unhappy fat people, on treadmills and cross country runs, in some televised freak show. It is hardly surprising that despite negligible success or quantified results the multi-million weight loss industry continues to make huge profits or that some surgeons have jumped on the Bariatric bandwagon and are offering high priced loans to desperate podgy patients of limited means as such treatment is not covered by our health service. Despite negligible results the multi-million weight loss industry makes huge profits.

Up until now because of my embarrassment at being fat I have not had the courage to point out that the human rights of the obese must be addressed. After a particularly humiliating appointment with my doctor I felt betrayed and realised I had to act. This is a matter of Human Rights and I have started with this letter:

Dear Dr ****,

I don’t want to offend you but I need you to understand how I feel. If I seemed confused on Tuesday and had trouble expressing myself it was because I was trying to avoid tears. I am very sensitive to the subject of obesity as experience has taught me that the moment a doctor mentions my weight and goes straight to diet he/she no longer sees past my size meaning serious illness might go unnoticed or untreated. The fight or flight reaction kicked in and I became more stressed as the feelings of rejection increased. Ironically, having come to trust and respect you I had made the appointment specifically to discuss my weight and the unusual structure of the fat, on my abdomen and between my shoulders, which is possibly not entirely attributable to Lymphodema but I didn’t have that opportunity.

It seemed to me that you did not believe me when I tried to outline my regular diet. To clear up any confusion: my diet mainly consists of lean meat, grilled fish, smoked salmon or six oysters, eggs (yolk removed after first egg) and various salad leaves (the dressing of which are sugar free and no fat, or plain lemon juice, or Balsamic vinegar) and seasonal vegetables steamed or stir fried in olive oil (mainly English spinach, fresh asparagus, capsicum, aubergine, microwaved mushrooms, spring onions, broccoli, celery etc).

When you pulled up < I felt it as an act of infantalization, as you had formerly treated me as an intelligent and cultured woman. No part of the picture blog, with its demonstration pile of white sugar cubes, applied to me. I do not consume fizzy drinks, fast food or processed foods nor do I eat pizza and would never darken the door of McDonalds or Kentucky fried because surprise, surprise, I am a very good cook and when I was slim and wealthy mostly dined at the finest restaurants in many parts of the world. I was staggered when you said I should replace fruit with a carrot. I eat one small serving of fresh fruit maybe once a day (raspberries, strawberries, red grapefruit, passionfruit etc and tomato) all of which are not much above the carrot in sugar content. I do not have bread, milk, sweets, cake or biscuits in the house. Items like the repellant tins of John West tuna, sardines or baked beans you suggested are quite foreign to my eating experience.

Had you believed me, you would have immediately realised that punitive micromanagement of my diet was not only unnecessary but would be detrimental to our goal. Had you thought about which person you were talking to, you would not have attempted to impose such a grossly culturally inappropriate diet. The approach denied my person, and nullified my own achievements. I don’t understand why you would want to do that.

During our conversation I attempted to say that I thought humiliation was fattening and as a fat woman I feel every cut delivered daily by the media about obesity. The Rudd Center for Food Policy and Obesity at Yale confirms this and the New York Times weighed in, “Dr. Peter A. Muennig, an assistant professor of health policy at Columbia, says stigma can do more than keep fat people from the doctor: it can actually make them sick. “Stigma and prejudice are intensely stressful,” he explained. “Stress puts the body on full alert, which gets the blood pressure up, the sugar up, everything you need to fight or flee the predator.” Over time, such chronic stress can lead to high blood pressure, diabetes and other medical ills, many of them (surprise!) associated with obesity.”

I really felt that stress on the way home when I recalled you saying to me “If you keep going this way you might be one of those people who have eventually to be removed from their house by a forklift truck (sic)” and tears started to roll down my face. Overcome by embarrassment, I fled to the shopping centre in a blur wanting to be comforted, I bought things I have not bought for years. For dinner on Tuesday night I fought against sorrow with two dozen oysters, an entire bottle of decent wine and a whole bar of chocolate. Bring on the forklift truck!

Having no advocate, my normal response would be to creep away, seeking medical help from the hospital solely when catastrophe strikes. I only have to look to my left or my right, to find someone who has never experienced a weight problem, keen to act as a judgmental dietitian. I don’t need them. I know more about weight and diet than most health workers because I live it. What I need is a doctor – I need you, Dr ****, I need the cultured man who reads books and I had come to respect. The doctor who treated me as an intelligent woman who was once a top flight journalist and award winning screenwriter, not merely a cretinous fat blob. Dr ****, I need you as a diagnostician, and it is there that you excel.

I will make another appointment. Do you think we could start again?

Mary D

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15 Comments

  1. FWilson

     /  November 10, 2010

    What a marvellous letter. I really hope it achieves the intended result and I am saddened that you ever had to write it. As a fat woman in Britain it inspires me to stand firm against this sort of shoddy treatment from doctors. I’d like to hear how your doctor responds, if you’d consider posting an update?

    Reply
  2. I hope your doctor reads every word and feels the full weight (no pun intended) of what he’s done.

    Reply
  3. Mary,

    My heart goes out to you for having to have to endure this. Reading that he told you wishes I was there to punch his lights out! Truly and completely how dare he. Your letter goes so much into explaining yourself and your diets, need not so! He does not deserve any explanation on your part. He needs to do the explaining. He has no right to harm your dignity as a human being, he needs to explain why he feels he can talk to you that way. Doubtless though most doctors are firmly entrenched in their own, usually elitist, mind-sets and as such anecdotal evidence to the contrary never suffices. Throw that great (and highly quantifiable) book Rethinking Thin at him. Doc needs a re-education!

    Reply
  4. If you keep going this way you might be one of those people who have eventually to be removed from their house by a forklift truck (sic)”

    You would go back to this person? No way! This is right on par with the comment, “Don’t you want to see your grandchildren” and other tactless, stupid “motivators.” Good God, what a story! Believe me, this trend is in full force here in the US, too–led by the First Lady, who is hardly slim, ditto for the Surgeon General. I have no doctor at the moment. I refuse to get on the scale, don’t want my BMI measured, don’t want more lame advice or disdainful comments, and can’t stand any of this anymore. If people want reducing advice, doctors, give it! Ask them if they do. If the answer is no, drop it! This particular woman wanted advice on weight distribution, she was worried about weird liquid retention…She didn’t need your demeaning BS about forklifts. Does Richard Simmons get a percentage of your income?

    Reply
    • While Richard Simmons is famed for workout videos, I find it necessary to point out that he includes women (and men) of all sizes in his videos, and I’ve always felt the real focus of his videos was fitness, energy, and fun, not getting skinny (or at least not just getting skinny).

      Granted, you seem to have a different interpretation and I haven’t seen much of Richard Simmon’s things post “Sweatin’ to the Oldies”, which I found in my parent’s videos. Has it changed? If so, that’s very unfortunate.

      Reply
  5. Sarah

     /  November 11, 2010

    I’m sorry you had a doctor you trusted and still had to go through this bullshit.

    I too have a GP I trust, but I still hesitate to bring up any “obesity issues” with him because I don’t want that relationship to change. He does have a lot of wrong headed ideas about obesity, but he doesn’t let it impact my care or treat me as less than human, or lacking in intelligence, because of it. And when another doctor was hassling me solely on the basis of my weight he was outraged and went to bat for me.

    I think writing the letter to your doctor is very courageous and I hope it works to educate them and that you can rebuild your relationship. We are all human, even doctors, and they can have bad days, or say stupid things they don’t really mean because of outside influences. If this happens once, and you can discuss it rationally, I believe its worth working on rebuilding the trust. Won’t be easy though and I wish you good luck on fixing things with this doctor, or finding a new one.

    Reply
  6. Um…Star, did you just call Michelle Obama fat? Seriously??

    If Michele Obama were fat, there would be nothing wrong with that. But she looks like this:

    http://www.ma-petite-chou.com/wp-content/uploads/2008/07/michelle-obama.jpg

    Ms. Obama is a woman of medically “normal” weight–or perhaps a few pounds overweight, at most.

    If you’re trying to fight fat-phobia, mendacious body snarking is not the way to do it.

    Reply
    • I said she was hardly “thin.” I don’t care if people are fat–I am. She is almost always photoshopped at the waist and rear in mag pix. It’s customary. I also think her taste in clothes is atrocious–check out this site.
      http://www.michellesmirror.com/

      Snark is my favored form of speech, body or otherwise.

      But thanks for writing.

      Reply
  7. When will people learn that you can’t just shame and browbeat other people, people with lives and feelings, into losing weight to fit an arbitrary and distorted ideal of beauty and health?

    This should never have happened to you, and it’s very sad that Australia is in this witchhunt against those who weigh more than society thinks people should. I hope your doctor responds both gracefully and in a positive manner, if not, you need a new one. Hope it goes well, and don’t give up. You deserve to know what’s going on with the unusual fat distribution (which can be an indicator of serious problems)!

    Reply
  8. Magdala

     /  November 16, 2010

    The first thing I said to the doctor yesterday was “Did you get my letter?” his answer was “Did you get mine?” … I hadn’t been to the postbox in well over a week.

    He then printed me out a copy of the most gracious letter I had ever read from a doctor.
    __________________________________________________________________________

    Thanks for letting me know how badly I misjudged things with my attempted advice to you last week.

    I fear I did not detect the cues that I was upsetting you.

    I do remain worried about the medical effects of your build and the difficulties with hernia, heart disease etc but I will leave the subject alone unless there is a particular issue you want to raise

    I am very happy to continue with your general medical care if you wish. I would do my best but I can’t promise always to get it right.

    Like you I do enjoy the non-medical aspects or our relationship.

    Sincerely,
    ___________________________________________________________

    I thanked him and explained that I gave no cues as most fat people are so accustomed to insults that they simple do not react. But with me it was also shock because I liked and respected his intelligence and felt let down when he had said the same stupid things expressed by doctors of lesser experience and lack of culture.

    I asked him to type my name into Google, suddenly hundred of articles carrying my byline and television screenplay credits scrolled page after page before his eyes. He was astonished and said he would have a good read when he got home. It reminded him that knowing I had made the appointment he had brought me in the book which we had talked about a few appointments earlier. ‘The Slap’ by Australian author Christos Tsiolkas, was shortlisted for the 2009 Miles Franklin Literary Award.

    He agreed to treat my weight as a symptom rather than a disease and understand that had I not been so careful of my food consumption that I could be twice my current weight. He also admitted that many of the drugs proscribed cause weight gain.

    He took the suggestion of Cushing’s very seriously and has arranged for immediate tests.

    I got up to leave feeling light and happy. He glanced at the book and said he hoped I wasn’t shocked by the language in it – I laughed. “See, you hardly f…ing know me”.

    Reply
    • if only all doctors (or all people, for that matter) could be so receptive to constructive criticism. i’m glad this is working out for you, but i’m sorry it had to happen in the first place. i wish you strength and good health.

      Reply
    • FWilson

       /  November 18, 2010

      I’m happy to hear he is a good doctor who put his foot in it once – I hope he does take it to heart and never does it again.

      Reply
  9. No one’s perfect and his response showed that he was a sensitive person who recognized his terrible mistake.

    You shouldn’t have had to go through that experience, but it may have helped that doctor to be more sensitive to other patients in the future.

    Reply
  10. anonymous

     /  December 14, 2010

    “I am a very good cook and when I was slim and wealthy mostly dined at the finest restaurants in many parts of the world.”

    So… what? Does that make you more deserving of respectful treatment than someone who’s never been “slim and wealthy”?

    Oh, and nice jab at people who consume soft drinks or pizza or McDonald’s. THEY deserve to be shat on by their doctors, because they’re not “cultured,” like you are.

    Ass.

    Reply
  11. anon

     /  December 15, 2010

    I have to say that your inclusion of what you “don’t” do implies that people that *do* those things don’t deserve proper medical treatment too.

    I am glad that you were able to have a conversation with your doctor, though.

    Reply
  12. Aubergine

     /  February 4, 2012

    We shouldn’t have to justify ourselves by proving our dietary habits- yet I just took photographs of my kitchen food storage areas because I am so frustrated with the assumptions of doctors. The issue is not that it’s okay to judge people who eat fast food or don’t exercise- it’s that we are subject to such stereotyping. Some black people do eat chicken and watermelon- does that mean no one should get offended when it is assumed those are their foods of choice?

    Reply

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