Battling medical bullies has a story out today on ‘medical bullies’ – medical professionals who browbeat patients, ignore questions, act impatient, insult patients and/or colleagues or even yell, cuss and throw things.   Now the Joint Commission, a national hospital accrediting agency, warned that there’s mounting evidence that such disruptive behaviors are tied to medical errors that can cause patient harm — and called on hospitals to adopt a no-tolerance policy.

Starting in January, the agency will require hospitals to establish codes of conduct that define inappropriate behaviors and create plans for dealing with them. Suggested actions include better systems to detect and deter unprofessional behavior; more civil responses to patients and families who witness bad acts; and overall training in “basic business etiquette,” including phone skills and people skills for all employees.

The AMA has had a policy calling for zero tolerance for disruptive behavior for all workers for years.  The Joint Commission standards and suggestions will offer hospitals a clear model for establishing guidelines and consequences that will help decrease disruptive behavior.  Official warn that it could take years however for a major culture shift.

The MSNBC story includes a sidebar on bullying behaviors.  How many reader submissions featured here echo the very same behaviors listed?

Welcome WFPL listeners

Welcome listeners of Louisville-based radio station WFPL 89.3.  If you’re accessing this site in response  to the State of Affairs segment today on fat acceptance and weight-based discrimination, here’s an introduction.  The site was conceived after a blogger wrote a three-part special entitled Fat Hatred Kills.  The response to Thorn’s poignant story was an onslaught of similar stories of weight-based discrimination in health care.  This site strives to provide an outlet for people to share their experiences with hopes the stories will prove to be self-empowering and work to change the discriminatory landscape prevalent in too many doctor’s offices and hospitals.

The stories here are heartbreaking in their brutal honesty: Scores of fat people denied adequate and competent health care from medical professionals who couldn’t see past their fat to diagnose and treat the problem.  This is, in fact, one of the primary reasons why more fat people don’t go to the doctor until, in some cases, it’s too late – they don’t want to be bullied by those who’ve taken an oath to “First, Do No Harm.”

This site was borne as a way for people to speak out about the discriminatory treatment they’ve received.  If you’ve been the victim of fat-discrimination in health care, find out how to lodge a complaint here or send us your story here.   You are not alone.

‘No Hope Hospital’ for patients of size

The BBC reports on a case of size-discrimination in health care from across the pond. Gary Barton is a 6-foot 6-inch father of four who weighs in at about 266 pounds. The former steelworker is registered disabled, suffers from diabetes, arthritis and peripheral neuropathy, which means he has no feeling in his feet or lower legs and walks with a cane. He went for an MRI scan at his local Good Hope Hospital, where he was given headphones during the procedure. The two female radiologists didn’t turn off the intercom and this is what Barton heard:

“I got up onto the table on my own no problems but once I was up there they were getting me to move around a bit. I’m not too bad but I do suffer with arthritis so I wasn’t exactly jumping around,” he explained. “They gave me headphones to relax me but I think they forgot to turn the intercom off because I could still hear them chatting.”

“The nurse said, ‘Oooh, that was a bit of a struggle wasn’t it’, and the radiographer said, ‘Yeah, I thought he was going to break the bed’. I was stunned and immediately shouted, ‘I heard that’.”

Mr Barton said the embarrased radiographer apologised but her colleague “was in fits of laughter”.

He added: “It is outrageous and it isn’t what you expect from medical staff. I won’t lie, I wasn’t too hurt and upset and I can see the funny side of it but I was shocked by how unprofessional and vindictive the staff were. I’m not as big as they made out and even if I was, you expect a certain level of care from medical practitioners, not scorn. That hospital ought to be called No Hope, not Good Hope.”

Barton rightfully complained to the hospital and in a letter to him, the trust said it apologized “unreservedly” for the incident and that “The member of staff involved deeply regrets having made the comments and is fully aware that her behaviour was both totally inappropriate and professionally unacceptable.” The radiographer would have faced disciplinary proceedings but Barton insisted that no further action be taken against her.

Eating ‘yer veggies will cure congenital spinal curvature

Catherine writes…

There is congenital spinal curvature in my family.  Every female member, no matter what her weight, has it.  This includes me.  Mine is “three-way,” meaning that I have an abnormal twist from side-to-side (scoliosis), an abnormal twist from front-to-back (lordosis), and a rotational twist (kyphosis).  This means my back muscles are constantly working much harder than they should.  It naturally follows that I can throw my back out easier than most people, and I’ve had bouts with pain so debilitating I could barely walk.

A few years ago I went to a doctor complaining that the back trouble was worse than usual.  The doctor did not even look at my back but rather told me that the cause was that my extra weight was pulling the spine out of place. He suggested that if I just “ate right” I’d lose the weight and all my problems would go away.  He didn’t even suggest any exercises to help the muscles even after I mentioned that it’d been some time since I’d been in physical therapy.  He only suggested over-the-counter naproxen.

Three weeks later, I was in so much pain that I could not even stand up straight.  At the age of twenty-eight I was walking with a cane and I could not even dress myself.

I went to another doctor who took one look and immediately prescribed strong muscle relaxants, prescription pain relievers.  I was walking normally in three days; once the immediate problem settled he was happy to give me information about strengthening exercises.  It was then and only then he brought up my weight — and it came by way of asking if he could take some blood in order to check my thyroid function.

I stayed with that doctor for years.

A big, fat welcome to our new editor, Vesta44

The rising popularity of this blog and the number reader-submitted stories necessitated some additional help.  So, please welcome Mariellen a.k.a. Vesta44  to the editorial team here at First, Do No Harm.

Mariellen is the blog author of the fat acceptance blog Big Fat Delicious and has been an active commenter here.   She previously shared her experiences with weight-based discrimination in healthcare after having weight loss surgery in a guest feature on Shapely Prose.

Please keep your submissions coming.  The high number of entries received may mean a delay in your story being posted, but we value all submissions and 99 percent are eventually posted on the site.  Thank you for helping spread awareness of weight-based discrimination in healthcare.

When galling doctors attack

Alisha writes…

Until this last year, I avoided going to the doctor like the plague. I remember hearing “lose weight” every time my mom took me to a pediatrician.  By the time I was old enough to decide when I wanted to go to the doctor, I more often than not opted not to, even if I was sick.

When I was about twenty, I started experiencing terrible stomach pains.  The pains came out of nowhere; I was drinking a smoothie and suddenly felt like I was going to throw up. It was a hard pain to describe; it would come and go, and was both a burning and a cramping. It felt like it was at the top of my stomach. The first time it happened, I thought it was heartburn; I took a handful of Pepto Bismol and slept until it went away.

But it kept coming back. I discovered that if I either took a lot of Pepto Bismol or ate a lot, of anything, the pain went away. After a few weeks of this I went in to my university medical center and saw one of the doctors there. (more…)

New treatment plan: ‘Scared’ weightless

Christine writes…

When I was 16, I caught a cold that developed into a nasty respiratory infection.  Our family GP was out of town, and his office referred me to another doctor who was covering his patients.  My mother took me.  The first thing the nurse did was weigh me and take my vitals.

As soon as the doctor came into the exam room he started berating me for being fat and having high blood pressure – nothing about the respiratory infection that had brought me to his office. I tried to tell him that I had never had high blood pressure before, but he wouldn’t listen.  He went on and on about my weight, my “high blood pressure” and how I was a heart attack or stroke waiting to happen.  “It can and does happen, even to people your age when they’re as big as you are.”  (I was about 190 at the time.)

My mother also told him my blood pressure had always been normal and perhaps – just perhaps – it was high at the moment because I was sick and feeling nervous about seeing a new doctor. (She has “white coat hypertension” herself, so it was a valid concern.)  He was just as rude and dismissive of her.  He told her she wasn’t helping me by “protecting me from the truth”, and that he was doing us a favor if it “scared some weight off” me because it would save my life. He was absolutely vile to both of us.

He then grudgingly wrote a prescription for antibiotics and cough syrup, and sent us off with a standard 1,000 calorie diet from a tear-off pad.  He even told us to make a follow-up appointment with his nurse and he’d get my “health under control.”  As if.

I left the office in tears.  My mother, normally a mild-mannered, non-confrontational sort of woman, was furious.  When we followed up a week later with our regular GP, he confirmed that my blood pressure was back to where it had always been – perfectly normal.  He said my temporary high blood pressure could have been caused by any number of things, including the OTC cold medicines I’d been taking to treat my symptoms.

So why did Dr. Scaremonger apparently never consider this possibility? Raised blood pressure is a well-known side effect of the most popular decongestant, which is why those with actual hypertension can’t take it.  You’d think this would occur to a doctor, right?  Apparently not when treating fat patients.  To him, I was in denial, a liar, and on death’s doorstep at 16, all because of the fat.

A fat-friendly doctor may now be just a click away

Sorry for the lack of updates here, folks. Many of the editors who run this site also maintain other blogs, and have professional careers and families that demand our time and resources. Please continue to send in your submissions and they will be posted eventually. Your voice is important.

In the meantime, I wanted to quickly let everyone know of a new way to voice health care complaints in a broader context and also a resource to help locate fat-friendly health care professionals. I’m a member of Angie’s List, a membership service that compiles consumer ratings of local service companies and contractors in multiple cities across the United States. Until now, Angie’s List offers reports of primarily home-related services like roofing and plumbing, but they’ve recently added an online medical ratings system. According to my monthly newsletter, the program allows patients to submit reviews on more than 150 different health categories, from dentistry to pediatrics, oncology to plastic surgery. And according to the newsletter, “Angie’s List wants all the details you think are pertinent to your experience.”

The program is only available to paying members, sorry – membership fees here. (In new cities where the company is building the list, members can join for one year free.) But with more than 600,000 members and growing, Angie’s List’s online medical ratings program has the potential to be one of the most comprehensive and wide-reaching online systems to date and it’s one we can use to our advantage to voice our concerns about shoddy health care received and to also help others avoid those practitioners who can’t see past weight to treat the individual.

If anyone does use it, please report back and tell us what you think. Keep in mind, your health insurance company probably offers an online rating system, too, although my company’s system doesn’t allow space to fully articulate one’s experience in even minor detail.

It’s not a tumor – You’re just lazy and eat too much

Lilacsigal writes…

At the start of 1998, I was a large but healthy postgraduate student, aged 24 – I was a pear-shaped 90kg at a height of 169cm, (a BMI of 31.5) I didn’t own a car and cycled everywhere, and had no health issues. Over the next few months, I started to feel depressed and lethargic, and started to gain weight, despite eating less because I was too tired to eat. I exercised less, as I was too tired to cycle, and was gaining huge amounts of weight.

I went to the University Health Clinic again and again, telling them I was exhausted and depressed, and after six months of three doctors telling me I was just overweight (and one telling me that if I didn’t lose weight I would die), the doctor I saw most often put me on antidepressants and sent me to the counselling centre. By the end of 1998 I was so exhausted that I would spend days at time in bed, unable to move, and was still gaining large amounts of weight. At this stage, I had gained 35kg – over a third of my body weight again – in less than a year. According to the doctors, this was because I ate too much and didn’t exercise.

They referred me to a dietician, but I couldn’t take her advice because I was too tired to shop or cook. By now, I had to put my government postgraduate scholarship on hold and go onto sickness benefits, as I could no longer read more than a few pages at a time without sleeping – previously I had been reading between 2 and 4 books a day. As 1999 went on, I found an antidepressant that helped me not have bouts of suicidal thoughts, though I was still exhausted and hopeless. I had now developed severe dizziness on top of the weight gain and lethargy and was spending most days in bed.

I would emphasise that at no time did I disagree with the doctor’s assessment that the weight gain was my own fault – I thought that I was being lazy and obviously eating too much.

My parents and friends (with the exception of my girlfriend) were also concerned about my weight and thought that I should exercise more. With the dizziness and extreme fatigue, this was impossible, and by early September 1999 I weighed 135kg (a BMI of 47.5). The doctor thought I might have Chronic Fatigue Syndrome, but at this point, she became concerned with my dizziness and sent me to an audiologist to have my middle and inner ears checked. The audiologist checked my hearing and performed a few basic tests, then was so concerned about my dizziness that he sent me for a test to see if I had a brain tumour. This test was negative, and the audiologist performed more balance tests – in the process, he put his hand under my ear, his thumb touching my throat, and noticed that I had a swelling on my thyroid.

The audiologist – the only health professional not focused on my weight – was the only one to notice that I had a 4cm palpable growth on my thyroid.

Back to the doctor for a thyroid hormone test – the results came back as abnormally low. Low thyroid hormone produces fatigue and weight gain. She then sent me to have an ultrasound, which revealed the growth, and I was referred to a thyroid specialist. This specialist did not focus on my weight, but was very professional and helpful – I had further tests, including a nuclear medicine scan and several biopsies, all of which were inconclusive. On December 30th, 1999, now weighing 145kg, the left half of my thyroid was removed. It turned out to be a malignancy, which had grown a full centimetre in the 12 weeks since the first scan. Fortunately, further scans and biopsies showed that the malignancy had not spread beyond the left half of my thyroid, so I did not have to have radiation therapy.

The specialist told me that if my treatment had been delayed another five weeks, the tumour would have expanded past the thyroid, and from there it is a lot more difficult to treat.

It’s taken me a long time to recover from the anger and suspicion of this treatment, and I moved to a new town with my girlfriend and saw new doctors who had no problems with my weight – they were focused on my health, instead, which was a pleasant surprise. I still have to have blood tests, thyroid palpation, X-rays and ultrasounds at regular intervals to make sure that the cancer hasn’t returned, and it’s taken years to get my thyroid medication right, but I am again in good health. I’m still on anti-depressants, though, and now have no contact with the friends that were pleased to find out that I wasn’t just fat, I had a “real disease”, and am still angry at my parents for thinking that my weight gain was a fault of mine, rather than supporting and helping me when I was seriously ill.

No service, no payment

I was reminded of all the grave medical errors committed in the name of fat prejudice upon reading this story, “Who foots the bill for medical mistakes?

Spurred by federal and industry moves to cut payments for avoidable mistakes, hospitals across the country have joined a growing movement not to charge patients or their insurers for serious, preventable errors.

Since last fall, hospitals in 10 states have agreed to waive fees for certain rare errors dubbed “never events” because safety experts say they should never happen at all.

Still, that leaves 40 states — including Iowa — where patients can expect that they, or their insurance providers, still may be billed for errors that one association leader called “no-brainers.”

The National Quality Forum has identified 28 such events, and while its highly unlikely that fat-based discrimination is among them, as the reader-submitted horror stories on this site reveal, it ought be.

I’m specifically thinking of patients like Emily, whose doctor told her she needed to just “shut her mouth every once in a while” when in actuality, she had either PCOS or a tumor on one of her glands.

Or people like Katydid, whose eating disorder became so serious she vomited blood, but because of her weight, was encouraged to lose even more weight and to try Weight Watchers – the bloody vomit issue was never addressed.

I also think of people like Kate, whose doctor dismissed her excruciating abdominal pain and said it would be magically cured by weight loss. It’s a good thing Kate sought out a second opinion, because as it turns out, she had a potentially cancerous tumor which, because of the time lapse caused by the original doctor’s incompetence, required the removal of one of her ovaries and fallopian tube.

And there’s Christina, who went to the emergency room for appendicitis, and was advised to try Weight Watchers.

I could go on and on but you get the idea. In each case, all women were billed for medical “care” that was anything but responsible, competent and ethical care. In fact, they have a word for the type of care these women received: malpractice.

Health care is a service industry; if we do not get the service we ask for and require, we should not be expected to foot the bill.