Fat Prejudice at the Neurologist’s Office

Adrienne writes:

I was diagnosed with epilepsy at the age of 21. Though I took anti-convulsant medication for the first several years after my diagnosis, I stopped just a little under two years ago, when it seemed as though my condition had stabilized. I started a PhD program in August, however, and the stress and sleep deprivation that comes with such an undertaking seems to have triggered my seizures again. So I made an appointment with the local neurologist this week in order to get back on my old meds.

As a fat woman, I generally feel the need to psych myself up every time I have to go visit a general practitioner. But it doesn’t occur to me that I may need to do the same for a neurologist. Why would I have to bother? My seizure disorder has exactly nothing to do with my weight, and I assume that sort of thing is completely outside my neurologist’s jurisdiction. Apparently, I assumed wrong.

The neurologist begins by asking the standard questions: how long I’ve been having seizures, when I was diagnosed with epilepsy, what kind of seizures I have, tests I’ve been subjected to, prescriptions I’ve used, and so on. All in all, the questions, plus a cursory test of my reflexes, take him about 10 minutes. Then, once he’s done, he gives me this appraising look that makes me extremely uncomfortable.

“How much do you weigh?” he asks, and I’m completely taken aback. First of all, his nurse weighed me on my way in, so it’s not like he can’t consult his own chart. Secondly, my weight has exactly what to do with my epilepsy? But I give him the benefit of the doubt and tell him, assuming that there may be a good reason for him to ask. Maybe my medication dosage depends on my weight, or something.

He gives me another one of his appraising looks, and tells me, “I’m going to put you on a new medication. One of its side effects is weight loss. You’ll like that.”

And for a few seconds, I am just speechless with rage. I’m not sure what to attack first: the assumption that weight loss is something I want, or his obviously cavalier attitude toward my health. I came to him because I’m having seizures, not because I’m fat. I want him to prescribe a medication because it is the most effective available medication for stopping seizures, not because it’ll make me thinner– and hey, maybe if I’m lucky, I’ll stop having seizures, too. I want the medication I used to take– the one that worked, and didn’t give me any side effects. I don’t want the shiny new medication with its unknown barrage of side effects, which may or may not work for me. I don’t want to play Russian Roulette with my health just because I might get thinner in the process.

It’s too early, and I’m too enraged to really express myself, but I manage to choke out: “Actually, I’m happy with my body. I’m not trying to lose weight. I want the medication that works.” And he prescribes the new medication anyway, because that other medication? The one that worked? It’s a little old and out of date. Apparently, I should be more concerned with whether or not my meds are new and trendy (and by extension, whether the neurologist will get a bonus from some pharmaceutical company) than with whether or not they will, you know, keep me from having seizures.

I did finally call him back later that day, tell him I was not comfortable trying the new medication, and that it made more sense to me to stay on the old one unless it stopped working, rather than try new meds just for fun and possible weight loss. And he ultimately relented. But the whole thing just completely ruined my day. Until today, I never even thought I’d have to talk about my weight to a neurologist, and now every time I visit one, I’ll worry that they’ll decide coaxing me to lose weight is more important than making sure my brain is in full working order.

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16 Comments

  1. bloomingpsycho

     /  October 8, 2009

    Plus, the new medication probably costs more than the old one. You know your body and know what works. I remember when Prozac was all the rage and I was under a lot of stress, but what I went to the doc for was a sinus infection and he tried to prescribe me Prozac, not even listening to me about the sinus infection. I think that the doctors get some sort of kudos from the drug companies every time they sell another drug.
    And the neurologist’s comments about your weight were completely unnecessary.
    Maybe one day we’ll have a health care system that really involves CARING, not lecturing and judging.

    Reply
  2. Doctors always ask for weight. They always do me, even if my weight has nothing to do with why I’m there, along with other vitals. It doesn’t bother me. I understand it’s something they may or may not take into consideration.

    Now I do think his “You’ll like that” comment was assuming of him to say. Just to try to see things from his point of view, he probably just thought that since most women are unhappy with their weight. Still, he shouldn’t have said that. Your response to him was very well stated.

    Reply
  3. writerwriting

     /  October 8, 2009

    Ashley, her point was that the doctor could’ve looked at his chart to get her weight instead of asking her for it out-right. And not all doctors take weight along with blood pressure and pulse.

    I’ve never understood why some doctors don’t read the charts they are holding in their hands. Nine times out of 10, the answer they seek is right in front of them.

    Reply
  4. Erin

     /  October 8, 2009

    ive jsut started telling every doctor i see that “im a recovering bulimic” and i flatly refuse to get on a scale…it seems to stop all diet talk cold…and if they do talk to me about it all i hace to say is “i know i am heavy…u find a way for me to lose weight without puking up everything i eat and i will”…and boy that shuts them the hell up.

    Reply
  5. Electrogirl

     /  October 8, 2009

    Wow. The sad thing is, I can totally see this happening, and I wish that were not true.

    Did he try to prescribe you Topamax? That was one of the meds I tried. Sure enough, I lost weight. This is because I skipped a lot of meals because I wasn’t hungry, and ended up triggering more seizures. My neurologist prescribed something else once it was clear that the appetite suppression wasn’t going away. Thank goodness he monitors my seizures and not my weight… doing his job of treating a neurological disorder rather than freaking out about my BMI, what a novel concept! /sarcasm

    If there are other neurologists in your area that are covered by your insurance, I would recommend that you find a new one. There are good ones out there who will treat you as a whole person, not just numbers on a chart! It will probably take some shopping around, but a competent, caring neurologist can make all the difference. Good luck!

    Reply
    • Adrienne

       /  October 14, 2009

      Electrogirl – He did try to prescribe me Topamax, and if what you say about it is true, then I’m really glad I made a nuisance of myself and got him to prescribe my old medication. And I will be asking my general practitioner if there are other neurologists in the area.

      Reply
  6. Good post! I’ve fortunately not had that issue despite being a fat woman myself and having to see a neurology, albeit not for seizures. Perhaps the neurologist is pushing the new drug because of kickbacks from the drug company. Working in healthcare, I see this all the time.

    Reply
  7. Gail

     /  October 9, 2009

    Doctors don’t just get kudos, they get major prizes from the drug companies. And I don’t mean like some stupid toaster, they get golfing trips and the like. The older drug you were on probably comes in a generic (just guessing) and the newer drug probably doesn’t yet.

    I’m so sorry this happened to you. What a crap-headed thing to say to somebody. I don’t care where he thought he was coming from, that was way out of line.

    Reply
    • Adrienne

       /  October 14, 2009

      When I picked up my prescription (for my old medication, thankyouverymuch) from the pharmacy, it was all of $1.35. So yeah, I think you’re probably right– I would have been paying a lot more for new meds, and all to fund this jerk’s golfing trip.

      Reply
  8. “You’ll like that”? What an arrogant fuck!

    Reply
  9. al in pa

     /  October 9, 2009

    I think it’s unfair to say all docs get “paid” by big pharma to prescribe the latest & greatest drug. It depends on where you get seen–many university hospitals have rules in place to try to decrease, if not completely eliminate the influence of pharma representatives in the corridors of the hospital/clinics.

    Regarding the neurologist asking about your weight, they do get one year of intense training in adult internal medicine so they are fully qualified to take care of general medicine/preventative issues.

    Reply
  10. vesta44

     /  October 9, 2009

    al in pa – Not all drs get paid to prescribe the latest and greatest in drugs, that’s true (mine doesn’t, I’ve seen what she gets paid by Big Pharma, I looked it up online). But, when a doctor refuses to listen to a patient who requests a drug that has worked well for them in the past and persists in prescribing a new drug without regard for side effects/cost to the patient, then it does tend to make one wonder how much that doctor is getting paid to prescribe this new drug over older, tried and true drugs, especially when the patient is fat and weight loss is one of the side effects of that drug.

    Reply
    • Adrienne

       /  October 14, 2009

      vesta44 – How did you look up what your doctor got paid online? What site did you use?

      Reply
      • vesta44

         /  October 14, 2009

        In Minnesota, that information is online. I got one of the semi-monthly newsletters from my clinic with the url in it and went online to check what my doctor got paid in the last year by pharmaceutical companies (it was under $10).
        Not all states do this, I think only 2 or 3 right now, but there is legislation being worked on so that this information will be compiled nation-wide on all doctors and be available online. But who knows when, or even if, it will pass.

        Reply
  11. Erica

     /  October 18, 2009

    I went to a neurologist because I may have a sleep disorder, and after having spent most of 2008 with bad and untreated hypothyroidism (a whole other story) may have developed sleep apnea too. Since apnea and weight seem to be related (though the jury is out on which causes the other the most), I didn’t mind discussing my weight, and made it clear that I don’t have any intention of dieting, even if mythically-achievable weight loss would help my apnea, if I turn out to have it.

    I was pleasantly surprised that the neurologist immediately agreed with me that given my active lifestyle and healthy diet, there are no changes I could make that would cause me to lose weight. I was shocked, though, that instead he wanted me to consider taking… an epilepsy drug. One that apparently causes weight loss as a side effect, and that hasn’t been approved for use as a weight loss drug.

    I am guessing it’s that same drug your neurologist wanted you to take. I was taken aback, and declined the offer, but he insisted that I ‘think about it.’ I’m seriously considering choosing another neurologist, even though everything else about the visit was great and he seems completely on top of my sleep issues (you know, the actual reason I was seeing him.) Why on earth would I want to put myself at risk for side effects or unforeseen complications for a drug designed to deal with something as complex as seizures, on the off chance of losing a few pounds? Oh, and since unsurprisingly the weight comes back if you discontinue the drug, this doctor wanted me to start a lifelong regimen of a completely unnecessary drug, just because my health would be “better” if I were less fat.

    Reply
  12. Maryjane Heyer

     /  December 16, 2009

    Topamax does indeed have some nasty side-effects, including one that affects vision and it can also build up in the system potentially causing organ damage.

    Reply

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