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So they say it’s unhealthy to be fat, but have you considered the role of weight stigma?
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@rheddmobile Assuming it’s true that it makes sense for doctors to suggest weight loss to address shortness of breath, it doesn’t make sense to suggest only this without investigating the symptom first.
Regarding the dietician who didn’t believe you would follow through and your sense that her belief was based on experiences with previous patients, it might be worth taking into account the idea of self-fulfilling prophecies, such that perhaps what began as a bias affected the way this dietician approached her delivery of care, resulting in less adherence.2 -
@tomteboda Thank you for responding. You expressed it so well.0
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‘Shortness of breath’ is a non specific subjective symptom.
Asthma or COPD can cause shortness of breath, but does the patient have an expiratory wheeze?
Aortic stenosis can cause shortness of breath, but does the patient have abnormal heart sounds?
Coronary artery disease can cause shortness of breath, but does the patient have ECG/EKG changes of elevation in cardiac specific enzymes?
Heart failure can cause shortness of breath, but does the patient show clinical signs of heart failure such as peripheral odema?
Obesity can cause shortness of breath, but is the patient obese?
.........
The reasoning for suggesting a patient lose weight as primary treatment does not happen in isolation. Scenarios such as those few I mentioned are taken into account and considered/excluded.
I doubt many patients appreciate the process of elimination/examination a good doctor will go through before giving a clinical opinion.
.........
Of course - general disclaimer - there are good doctors and bad. Always seek a second, or third etc opinion if you feel you’re getting inappropriate advice. Blah blah blah.
@distinctlybeautiful please note my quoted post. In my years of working alongside doctors the ‘lose weight’ suggestion doesn’t happen in isolation.
Most likely the physician has considered and ruled out more serious causes of whatever symptoms.
Some doctors are bad at their jobs. Most doctors I have and currently work alongside are very particular about finding and treating to actual cause of a symptom.
Often that actual cause is obesity. Not a simple fix, but certainly not one that can be medicated away or even treated medically in many cases.
I do see the point of your post, however I feel like it represents a simplistic single sided view.
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distinctlybeautiful wrote: »@rheddmobile Assuming it’s true that it makes sense for doctors to suggest weight loss to address shortness of breath, it doesn’t make sense to suggest only this without investigating the symptom first.
Regarding the dietician who didn’t believe you would follow through and your sense that her belief was based on experiences with previous patients, it might be worth taking into account the idea of self-fulfilling prophecies, such that perhaps what began as a bias affected the way this dietician approached her delivery of care, resulting in less adherence.
The patients who were more likely to be recommended to lose weight were VIRTUAL patients, meaning they didn't exist and could not be examined. Without more information it's impossible to know how this setup worked. But exploring lifestyle changes before medication isn't malpractice, it's absolutely the standard practice. Patients with a comorbity - obesity - were more likely to receive instructions concerning obesity than patients who didn't have it. That's only a bad thing if you're determined to believe, against scientific evidence, that obesity isn't harmful.5 -
@rheddmobile The study said the virtual fat patients were more likely to receive lifestyle change recommendations than the virtual non-fat patients. It doesn’t say they were given instructions concerning obesity. There was an assumption that fat people were likely doing something that caused their shortness of breath. There was no such similar assumption with the non-fat people, despite that non-fat people could just as easily be neglecting their health.1
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@lizery I take note of your experience and don’t discount it. While the article does present just one side of the story, it’s an important one to share, as it’s not commonly heard. I think it’s pretty typical to assume everyone receives the same quality of care, as the experiences of marginalized groups are just that - marginalized.3
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distinctlybeautiful wrote: »@Aaron_K123 Assuming your premise that fat people have not prioritized their health is true, yes, we can still absolutely fault doctors for working under the assumption that these patients are less likely to adhere to health-related advice, if this assumption is decreasing the quality of care they provide. Do you think it’s fair for people who smoke to receive a reduced quality of care because doctors work under the assumption that patients who smoke are less likely to adhere to health-related advice? I don’t see a difference.
I agree the same level of care should be provided, but that is what actually matters. Doesn't matter what the doctor assumes about you because of your appearance. I mean honestly I'd think if a doctor assumed you had issues adopting health strategies they would spend more time on you not less. I think it is a leap to assume I'll intent here, all I was saying is it isn't a stretch to assume a morbidly obese person doesn't prioritize their health and it's a bit silly to act aghast that a doctor would think such a thing. We aren't thought police.11 -
distinctlybeautiful wrote: »@rheddmobile The study said the virtual fat patients were more likely to receive lifestyle change recommendations than the virtual non-fat patients. It doesn’t say they were given instructions concerning obesity. There was an assumption that fat people were likely doing something that caused their shortness of breath. There was no such similar assumption with the non-fat people, despite that non-fat people could just as easily be neglecting their health.
This makes no sense at all. Of course the instructions concerning lifestyle changes were to exercise and lose weight - what else would they be? And by definition the obese people were neglecting their health - they were eating too much for their expenditure. That's not an assumption but an observation.3 -
Aaron_K123 wrote: »distinctlybeautiful wrote: »@Aaron_K123 Assuming your premise that fat people have not prioritized their health is true, yes, we can still absolutely fault doctors for working under the assumption that these patients are less likely to adhere to health-related advice, if this assumption is decreasing the quality of care they provide. Do you think it’s fair for people who smoke to receive a reduced quality of care because doctors work under the assumption that patients who smoke are less likely to adhere to health-related advice? I don’t see a difference.
I agree the same level of care should be provided, but that is what actually matters. Doesn't matter what the doctor assumes about you because of your appearance. I mean honestly I'd think if a doctor assumed you had issues adopting health strategies they would spend more time on you not less. I think it is a leap to assume I'll intent here, all I was saying is it isn't a stretch to assume a morbidly obese person doesn't prioritize their health and it's a bit silly to act aghast that a doctor would think such a thing. We aren't thought police.
But you're a piss poor doctor. Most people who are obese didn't wake up that way one day. They may very well have woken up with shortness of breath or joint pain, or whatever brings them to the doctor. And many fat people I know are meticulous about other areas of their health because they already know obesity puts them at higher risk of complications. Being fat doesn't make you stupid. And of course it matters what the doctor assumes IF HE'S MAKING HEALTH CARE DECISIONS BASED ON HIS PREJUDICES ABOUT FAT PEOPLE.17 -
maryannprt wrote: »Aaron_K123 wrote: »distinctlybeautiful wrote: »@Aaron_K123 Assuming your premise that fat people have not prioritized their health is true, yes, we can still absolutely fault doctors for working under the assumption that these patients are less likely to adhere to health-related advice, if this assumption is decreasing the quality of care they provide. Do you think it’s fair for people who smoke to receive a reduced quality of care because doctors work under the assumption that patients who smoke are less likely to adhere to health-related advice? I don’t see a difference.
I agree the same level of care should be provided, but that is what actually matters. Doesn't matter what the doctor assumes about you because of your appearance. I mean honestly I'd think if a doctor assumed you had issues adopting health strategies they would spend more time on you not less. I think it is a leap to assume I'll intent here, all I was saying is it isn't a stretch to assume a morbidly obese person doesn't prioritize their health and it's a bit silly to act aghast that a doctor would think such a thing. We aren't thought police.
But you're a piss poor doctor. Most people who are obese didn't wake up that way one day. They may very well have woken up with shortness of breath or joint pain, or whatever brings them to the doctor. And many fat people I know are meticulous about other areas of their health because they already know obesity puts them at higher risk of complications. Being fat doesn't make you stupid. And of course it matters what the doctor assumes IF HE'S MAKING HEALTH CARE DECISIONS BASED ON HIS PREJUDICES ABOUT FAT PEOPLE.
Every human being makes decisions based on observational prejudices. Pretending they don't or demanding they shouldn't isn't going to make it so.
Yes, doctor's should provide appropriate care and we should demand that of them....but demanding they don't make observational assumptions is rather ridiculous.
Do you have some real world example of a doctor guilty of malpractice due to mistreatment of obese people or is this all a hypothetical. If there is such an example then yes I would not condone malpractice for any reason. But I'm also not going to be ridiculous and claim doctors shouldn't have assumptions like they are robots or something.11 -
Medical diagnosis is looking at a patient physically, listening to them describe their symptoms and then making assumptions based on the collective experience of the field garnered from your education plus your own observational experience. Are diagnoses 100% accurate, no of course not....mistakes will be made. But to get angry at a doctor who made an incorrect diagnosis solely because he did so on the basis of observational assumptions is kind of missing the point of what it is to be a doctor.
It is frankly silly to tell a doctor to not make assumptions, making assumptions on the basis of observational experience is basically what their job is. You sitting on a couch judging their decision process in that matter isn't that helpful or endearing.
A doctor who makes observational assumptions is not a "bad doctor" come on. How exactly is a doctor supposed to diagnose a patient without making some kind of observational assumption?14 -
Aaron_K123 wrote: »maryannprt wrote: »Aaron_K123 wrote: »distinctlybeautiful wrote: »@Aaron_K123 Assuming your premise that fat people have not prioritized their health is true, yes, we can still absolutely fault doctors for working under the assumption that these patients are less likely to adhere to health-related advice, if this assumption is decreasing the quality of care they provide. Do you think it’s fair for people who smoke to receive a reduced quality of care because doctors work under the assumption that patients who smoke are less likely to adhere to health-related advice? I don’t see a difference.
I agree the same level of care should be provided, but that is what actually matters. Doesn't matter what the doctor assumes about you because of your appearance. I mean honestly I'd think if a doctor assumed you had issues adopting health strategies they would spend more time on you not less. I think it is a leap to assume I'll intent here, all I was saying is it isn't a stretch to assume a morbidly obese person doesn't prioritize their health and it's a bit silly to act aghast that a doctor would think such a thing. We aren't thought police.
But you're a piss poor doctor. Most people who are obese didn't wake up that way one day. They may very well have woken up with shortness of breath or joint pain, or whatever brings them to the doctor. And many fat people I know are meticulous about other areas of their health because they already know obesity puts them at higher risk of complications. Being fat doesn't make you stupid. And of course it matters what the doctor assumes IF HE'S MAKING HEALTH CARE DECISIONS BASED ON HIS PREJUDICES ABOUT FAT PEOPLE.
Every human being makes decisions based on observational prejudices. Pretending they don't or demanding they shouldn't isn't going to make it so.
Yes, doctor's should provide appropriate care and we should demand that of them....but demanding they don't make observational assumptions is rather ridiculous.
Do you have some real world example of a doctor guilty of malpractice due to mistreatment of obese people or is this all a hypothetical. If there is such an example then yes I would not condone malpractice for any reason. But I'm also not going to be ridiculous and claim doctors shouldn't have assumptions like they are robots or something.
My aunt with bladder cancer with hip pain that the doctors blamed on her years of obesity and a worn out hip, even though her pain didn't really present as arthritic in nature. Too late for her to find another doctor. Not obesity related, but my mother's meniscal tear the doctor said was arthritic and old ladies should expect knee pain, even though she had a clear event that caused her knee pain. Also not obesity related, but the time I went to the doctor because I thought I had strep throat (2 kids at home on antibiotics for it at the time) and I had to insist on a throat culture because the doctor said as a smoker, of course I had a sore throat. Sorry buddy. Doctors don't get to be "people". They need to leave their prejudices at the door and be objective and treat their patients. Do any of these rise to the level of "malpractice"? I'm not sure I would be willing to say that.11 -
@rheddmobile Recommending that a person exercise is not an intervention solely relevant to fat people and their fatness, and losing weight isn’t an intervention at all but rather the possible result of other interventions. A non-fat person is just as likely to benefit from such lifestyle change recommendations, but doctors were much less likely to prescribe these things for the non-fat patients because they assume a person’s fatness is indicative of poor health behaviors while a person’s non-fatness is indicative of adequate health behaviors. This is problematic. It’s an assumption affecting the type of care given and resulting in possible misplaced blame instead of accurate assessment of a situation.5
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maryannprt wrote: »Aaron_K123 wrote: »maryannprt wrote: »Aaron_K123 wrote: »distinctlybeautiful wrote: »@Aaron_K123 Assuming your premise that fat people have not prioritized their health is true, yes, we can still absolutely fault doctors for working under the assumption that these patients are less likely to adhere to health-related advice, if this assumption is decreasing the quality of care they provide. Do you think it’s fair for people who smoke to receive a reduced quality of care because doctors work under the assumption that patients who smoke are less likely to adhere to health-related advice? I don’t see a difference.
I agree the same level of care should be provided, but that is what actually matters. Doesn't matter what the doctor assumes about you because of your appearance. I mean honestly I'd think if a doctor assumed you had issues adopting health strategies they would spend more time on you not less. I think it is a leap to assume I'll intent here, all I was saying is it isn't a stretch to assume a morbidly obese person doesn't prioritize their health and it's a bit silly to act aghast that a doctor would think such a thing. We aren't thought police.
But you're a piss poor doctor. Most people who are obese didn't wake up that way one day. They may very well have woken up with shortness of breath or joint pain, or whatever brings them to the doctor. And many fat people I know are meticulous about other areas of their health because they already know obesity puts them at higher risk of complications. Being fat doesn't make you stupid. And of course it matters what the doctor assumes IF HE'S MAKING HEALTH CARE DECISIONS BASED ON HIS PREJUDICES ABOUT FAT PEOPLE.
Every human being makes decisions based on observational prejudices. Pretending they don't or demanding they shouldn't isn't going to make it so.
Yes, doctor's should provide appropriate care and we should demand that of them....but demanding they don't make observational assumptions is rather ridiculous.
Do you have some real world example of a doctor guilty of malpractice due to mistreatment of obese people or is this all a hypothetical. If there is such an example then yes I would not condone malpractice for any reason. But I'm also not going to be ridiculous and claim doctors shouldn't have assumptions like they are robots or something.
My aunt with bladder cancer with hip pain that the doctors blamed on her years of obesity and a worn out hip, even though her pain didn't really present as arthritic in nature. Too late for her to find another doctor. Not obesity related, but my mother's meniscal tear the doctor said was arthritic and old ladies should expect knee pain, even though she had a clear event that caused her knee pain. Also not obesity related, but the time I went to the doctor because I thought I had strep throat (2 kids at home on antibiotics for it at the time) and I had to insist on a throat culture because the doctor said as a smoker, of course I had a sore throat. Sorry buddy. Doctors don't get to be "people". They need to leave their prejudices at the door and be objective and treat their patients. Do any of these rise to the level of "malpractice"? I'm not sure I would be willing to say that.
Yeah, misdiagnosis happen...that isn't malpractice. Doctors literally are people...you apparently wanting them not to be isn't going to change that.
Observational assumptions are what medical diagnoses are. Incorrect diagnosis are based on observational assumptions that is true....but you seem to be ignoring the fact that correct diagnoses are also based on observational assumptions which involve physical observations such as obesity. It makes no sense to demand doctors don't make observational assumptions...it is literally their job to do that.12 -
@Aaron_K123 It becomes problematic when doctors can’t get past the initial observation of a person’s fatness. Doctors - or anyone for that matter - can’t avoid observing a person’s body size. It’s constantly on display. It allows for snap judgment, making it easier for doctors, especially those with weight bias, to jump to a diagnostic conclusion without doing the extra work they would naturally do for a non-fat person. Yes, diagnosis is not always an exact science and relies on observation, but when the depth of investigation on which the observation is based is less for fat people, something is wrong.8
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distinctlybeautiful wrote: »@Aaron_K123 It becomes problematic when doctors can’t get past the initial observation of a person’s fatness. Doctors - or anyone for that matter - can’t avoid observing a person’s body size. It’s constantly on display. It allows for snap judgment, making it easier for doctors, especially those with weight bias, to jump to a diagnostic conclusion without doing the extra work they would naturally do for a non-fat person. Yes, diagnosis is not always an exact science and relies on observation, but when the depth of investigation on which the observation is based is less for fat people, something is wrong.
A doctor who consistantly makes bad diagnoses would be a bad doctor yes. But that wouldn't be because they make observational assumptions including ones regarding obesity...good doctors who have a track record of good diagnoses do that too.
Both good detectives and bad detectives come to conclusions on the basis of observational assumptions and doctors are no different. You can certainly judge them on the basis of their track record of success but to tell them it is "bad" to make observational assumptions is ridiculous. That is all I am saying.6 -
Can anyone give an example of a medical diagnosis that does not involve observational assumptions?5
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Two doctors. Both diagnose patients.
Doctor A considers obesity as a potential factor in their diagnoses. Occasionally they get a diagnosis wrong because they are not 100% accurate. Now and again their incorrect diagnosis is due to an assumption they made about obesity.
Doctor B refuses to consider obesity as a potential factor in their diagnoses. Ocassionally they get a diagnosis wrong because they are not 100% accurate. Now and again their incorrect diagnosis is due to not taking into account the patients obesity.
Am I to understand that in this example Doctor A is the "bad" doctor and Doctor B is the "good" doctor? That seems to be what some are saying but that doesn't make a lot of sense to me.
Personally I'd think the measure of how good a doctor is would be based on how many accurate diagnoses they gave as a percentage and it would have nothing to do with whether or not they happened to consider obesity as relevant or not.
If you are claiming that Doctor A will always have more misdiagnoses than Doctor B you are going to need to back that up with some tangible evidence.10 -
Aaron_K123 wrote: »Can anyone give an example of a medical diagnosis that does not involve observational assumptions?
I hope to god you're not a doctor. No one is saying a doctor's observation isn't part of how they make a diagnosis. Using your logic, if a person of color presents with pain, it's ok to assume they are drug seeking because they are black. Or if a woman presents in the ER with nausea and heartburn it's ok to send her home with a tums because you know, a woman. Maybe the fat person's hip pain is because of arthritic changes in the hip. Probably it is. But if you give them treatment options for the hip pain based on their obesity and ignore any symptoms that don't fit your preconceived notions, or if they come back a month later and they've followed your instructions (in my aunt's case, anti-inflammatories, and limiting weight bearing by using a cane, my aunt wasn't fat anymore, she was fat when she was young, so losing weight wasn't necessary or appropriate) and the pain is the same, you move on to the next step. You don't continue to blame the hip pain on her past obesity. (And my aunt was BIG) Women die from heart attacks all of the time because they aren't taken seriously. People of color have their pain dismissed all of the time, because they aren't taken seriously. What do these things all have in common?8 -
maryannprt wrote: »Aaron_K123 wrote: »Can anyone give an example of a medical diagnosis that does not involve observational assumptions?
I hope to god you're not a doctor. No one is saying a doctor's observation isn't part of how they make a diagnosis. Using your logic, if a person of color presents with pain, it's ok to assume they are drug seeking because they are black. Or if a woman presents in the ER with nausea and heartburn it's ok to send her home with a tums because you know, a woman. Maybe the fat person's hip pain is because of arthritic changes in the hip. Probably it is. But if you give them treatment options for the hip pain based on their obesity and ignore any symptoms that don't fit your preconceived notions, or if they come back a month later and they've followed your instructions (in my aunt's case, anti-inflammatories, and limiting weight bearing by using a cane, my aunt wasn't fat anymore, she was fat when she was young, so losing weight wasn't necessary or appropriate) and the pain is the same, you move on to the next step. You don't continue to blame the hip pain on her past obesity. (And my aunt was BIG) Women die from heart attacks all of the time because they aren't taken seriously. People of color have their pain dismissed all of the time, because they aren't taken seriously. What do these things all have in common?But you're a piss poor doctor.
I have a doctorate and practice in the field of public health but I don't deal with patients as a general practitioner or medical doctor. Can we avoid the personal insults and keep this civil please, if you cannot do so I would rather end the conversation.
Correct me if I am wrong but you are saying it is wrong for a doctor to come to a conclusions on the basis of someones obesity...which is diagnosing on the basis of observation is it not? It is okay to make assumptions on the basis of medical history and statistics because that is what diagnosis is. On the one hand you are demanding that doctors "not be human" and on the other hand you are demanding that they be really sensitive towards PC culture and societal norms when they make their diagnoses. If there is an actual statistic based on observation that states that people of race X are more likely to suffer from condition Y then yes they absolutely should take that into account and not worry that they are making some sort of non-PC "judgement" based on race.
Your example of being "Drug seeking" doesn't qualify because that isn't a medical diagnosis is it. Doctors are to make medical diagnoses, not social judgments. If however the doctor, knowing the medical literature, new that black people are 400% more likely to suffer from strokes and a black patient was showing symptoms that could be either related to having a stroke or a different condition then yeah I think it would be appropriate to take the patients race into consideration. Are you saying in that scenario the doctor, even knowing that, should push such thoughts out of their minds because it would be "inappropriate" to "judge" someone on the basis of race?
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