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So they say it’s unhealthy to be fat, but have you considered the role of weight stigma?
Replies
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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.
Yes it would be problematic if doctor's didn't do their due diligence. If they didn't they would have a poor track record when it came to diagnosis and would probably have an unsuccessful practice or would be accurately refereed to as being an bad (in the sense of skill) doctor.
That is different than saying it is inappropriate for doctors to make assumptions based on a patients obesity though. Telling all doctors "you shouldn't make assumptions about obesity" would not be helpful here as issues with dilligence and follow-through aren't the same as "doctors who make assumptions" which honestly is all doctors.5 -
Aaron_K123 wrote: »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.
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.
Except they do make social judgements based on race and assume that people of color are drug seeking rather than presenting with legitimate pain, which gee whiz, might require a little work to suss out. "Drug seeking" may not be a medical diagnosis, but ignoring symptoms based on an assumption WILL make a doctor miss an actual diagnosis. And when I said you're a piss poor doctor, I meant any doctor who can't see past obesity, race, or whatever. I had no idea if you were personally a doctor. Did I say anything about PC culture? That says way more about you than it does about me, buddy. I don't think it's PC to insist that doctors DO THEIR JOBS.11 -
maryannprt wrote: »Aaron_K123 wrote: »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.
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.
Except they do make social judgements based on race and assume that people of color are drug seeking rather than presenting with legitimate pain, which gee whiz, might require a little work to suss out. "Drug seeking" may not be a medical diagnosis, but ignoring symptoms based on an assumption WILL make a doctor miss an actual diagnosis. And when I said you're a piss poor doctor, I meant any doctor who can't see past obesity, race, or whatever. I had no idea if you were personally a doctor. Did I say anything about PC culture? That says way more about you than it does about me, buddy. I don't think it's PC to insist that doctors DO THEIR JOBS.
Well I agree that is wrong, but that isn't as all the same as coming to a medical diagnosis upon the observation that someone is obese because there is evidence that obese people are much more likely to suffer from that condition. That isn't the same thing so it doesn't work as an analogy.
The analogy would be a doctor taking into consideration that their patient is black when coming to a decision about whether or not they are going to diagnose the issue as being related to stroke when blacks on the whole suffer from stroke 400% higher than other races. That would be the actual analogy so what do you think they should do in that scenario? Avoid taking into consideration that statistic because it happens to relate to race or consider it as part of their diagnosis?8 -
eliciaobrien1 wrote: »Obesity can cause a variety of health issues. I don't think we can blame a doctor who would chalk up "shortness of breath" to being overweight.
i would. idk anything much about asthma, but i'm going to assume that it can be identified by more t han just its observable symptoms. how long does it take to test someone for it? how much weight can they lose in that length of time? refusing to eliminate some of the causes while waiting for someone to fulfill the slowest pathway - merely because that pathway is one of the possible reasons why someone can't catch their breath - seems negligent to me.I don't know about the diagnostic process of rheumatoid arthritis but I can't blame a doctor if he/she says "lose some weight and then we'll see".
my point wasn't about that, actually. r.a. is an inherent and systemic thing that you eitehr have or you don't regardless of how much you weigh. my point was a sort of parallel, i.e. that once people find out you have it, then just like with obesity, they tend to default to the easy answer of 'your r.a. causes' whatever i'm trying to get some help for. and since they have such an easy answer right before them, i can't always get people to take seriously the idea that maybe what's bothering me has a different cause. or has treatment pathways that are NOT about whatever i'm doing to manage the r.a.
if i were obese i think it would be the same thing. by the way, rheumatoid arthritis is a completely separate thing from obesity, medically. it is a systemic aberration of the immune system, and it is inherent to someone whether it's active or not, and whatever they weigh. that inherent atypicality is not a side-effect of being too fat. it can be found by a simple blood draw in a lot of cases. when a person is sero-negative it gets diagnosed by a rheumatologist with a checklist.
the damage it does is permanent, debilitating and not directly related to mechanical stress (although having it does make you more vulnerable to mechanical stress). an aggressive case of r.a. can do permanent, irreversible damage in the course of a couple of months. you don't fix the problem by losing weight. so again, how is it acceptable to ignore a diagnostic procedure that could get the thing controlled almost immediately, on the grounds that 'just maybe your joints are hurting because you're too fat'? it just isn't.
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@maryannprt I notice you keep using "ALL CAPS" in your posts. I would typically interpret that as yelling which would make me assume that you are being emotional about this. If you are getting angry would you rather just stop this conversation? I have no particular interest in upsetting you.7
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And when I said you're a piss poor doctor, I meant any doctor who can't see past obesity, race, or whatever. I had no idea if you were personally a doctor.
Does that make it somehow better? Are you saying what you are saying about doctors you would not actually say to a doctor?6 -
"The major criticism of the epidemiological studies has been the basis of diagnosis of asthma. Obesity impairs ventilatory functions i.e. forced expiratory volume in one second (FEV 1), forced vital capacity (FVC), total lung capacity and expiratory reserve volume.5 Besides, it may reduce respiratory muscle strength, decrease thoracic cage compliance and impede diaphragmatic excursion, especially when it is massive and central. The resultant increase in work of breathing may lead to the perception of increased respiratory effort i.e. dyspnoea. The latter may be confused as asthma. Thus, there is a risk of over diagnosing asthma in the obese. Further, it is apprehended that the correlation between obesity and asthma may not be causally related but may be due to existence of common risk factors."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853040/2 -
Aaron_K123 wrote: »@maryannprt I notice you keep using "ALL CAPS" in your posts. I would typically interpret that as yelling which would make me assume that you are being emotional about this. If you are getting angry would you rather just stop this conversation? I have no particular interest in upsetting you.
Using caps for emphasis is not yelling. You don't upset me at all, but it's obvious that you are upset as you are abandoning the discussion to make comments that have nothing to do with it. Like I disagree with you, so I must be upset. And yes, I would say to a doctor they were piss poor under those circumstances. Does being a doctor somehow make them magically good at their jobs? I've been lucky with my own doctors and don't feel discounted or ignored. (The strep throat story was an urgent care doc, not my regular) in part because I'm willing and able to advocate for myself. Not everyone is capable of that, and they shouldn't receive sub standard care because of it.13 -
maryannprt wrote: »Aaron_K123 wrote: »@maryannprt I notice you keep using "ALL CAPS" in your posts. I would typically interpret that as yelling which would make me assume that you are being emotional about this. If you are getting angry would you rather just stop this conversation? I have no particular interest in upsetting you.
Using caps for emphasis is not yelling. You don't upset me at all, but it's obvious that you are upset as you are abandoning the discussion to make comments that have nothing to do with it. Like I disagree with you, so I must be upset. And yes, I would say to a doctor they were piss poor under those circumstances. Does being a doctor somehow make them magically good at their jobs? I've been lucky with my own doctors and don't feel discounted or ignored. (The strep throat story was an urgent care doc, not my regular) in part because I'm willing and able to advocate for myself. Not everyone is capable of that, and they shouldn't receive sub standard care because of it.
No I did not assume you were upset because you disagreed with me I assumed you were upset because of your use all caps and the personal insults like I said. I thought it only polite to offer to back down if you were becoming upset, that is all.
I think the measure of the quality of a doctor is how accurate they are at diagnosis and not the means by which they diagnose. I care much more about the outcome of the diagnosis leading to successful treatment than I do about what observational assumptions based on my race, gender, weight etc the doctor utilized to get there.
If you can objectively define what makes an observational assumption prejudice then I think it would be easier to discuss. In other words what criteria are you employing to seperated a reasonable observational assumption used appropriately for diagnosis from a prejudicial one? I hope you have an answer for that it is not rhetorical.7 -
I've given you several antecdotal examples, which I realize are just that. When a doctor assumes a person of color coming in for back pain is drug seeking (this happens, they've done studies, people of color are prescribed pain meds less often than their white counterparts... which is maybe a good thing, but that's a different discussion) When a fat (or formerly fat) person has symptoms that don't resolve using standard treatments, and the doctor continues to treat as if their initial diagnosis doesn't need to be reinvestigated. When women are literally sent home with a Tums when in reality they are having a heart attack, but a man with indigestion is given a full cardiac work up. I personally had a coworker who made different recommendations to a patient because she was trans and the therapist was uncomfortable and wanted her out of the office ASAP. The whole point of this article (and I realize they weren't "real" patients) is that doctors dismiss health concerns of the obese. Just like they dismiss the concerns of the elderly, of women, of people of color, etc. Of course, obesity raises your risk of certain illnesses or conditions. SO WHAT? Because someone is fat, does that mean they can't develop rheumatoid arthritis? Or MS? Or ankylosing spondylitis? Or COPD? or the literally hundreds of illnesses people develop every day that may be exacerbated by obesity, or may even share symptoms in common with other illnesses? I'm not saying a doctor needs to do an MRI the 1st time a fat person comes in with knee pain. It's probably arthritis, it's probably related to their obesity, and losing weight, along with meds, reduced weight bearing (i.e., using a cane or other assistive device) some exercises specific to their knee is probably appropriate. Is that what the doctor suggested? Or did he/she just tell them to lose some weight and send them off without any other interventions, which is what this study suggests. What this study really says to me, is we need another study. And I don't know how you would design such a study. You're in public health. How would you do it? How do we get doctors to take health concerns of their patients seriously? I've worked in healthcare most of my adult life, and it can be very frustrating for providers when their patients don't do what they are instructed. But I'll tell you, in my experience, someone's weight has very little to do with their compliance.
Also, I'm going to apologize if any of my comments sounded overly personal to you, and remind you (and myself!) tone and intent don't always come across clearly in this type of a format . I certainly intended no offense.4 -
When a doctor assumes a person of color coming in for back pain is drug seeking (this happens, they've done studies, people of color are prescribed pain meds less often than their white counterparts... which is maybe a good thing, but that's a different discussion)
Again I agree that this is wrong. It is wrong because it is not a medical diagnosis. Deciding someone is there to lie in order to obtain drugs to satisfy an addiction is not a medical diagnosis and doctor's should be making medical diagnoses. This is not somehow comparable to a doctor deciding a person is likely diabetic based on their symptoms coupled with the fact that they are morbidly obese. If a doctor uses race to inform an actual medical diagnosis then I don't consider that to be wrong, for example utilizing epidemiological studies that show that blacks are 400% more likely to suffer from strokes plus the race of their patient to help inform their diagnosis. That is fine. I hope the distinction there is clear. If a doctor looked at an obese person and figured that obese people are just after pain meds and dismissed their claims of pain without an appropriate level of investigation then that would be wrong too.When a fat (or formerly fat) person has symptoms that don't resolve using standard treatments, and the doctor continues to treat as if their initial diagnosis doesn't need to be reinvestigated.
A doctor who fails to treat someone effectively is being, at that moment, an ineffective "bad" doctor. That is a given isn't it? But again that is because they are failing to accurately diagnose a patient which is the actual criteria here, the obestiy is just a circumstance. This scenario could be constructed for any reason, it is not specific to being fat. What matters is if doctor fails to diagnose and treat a patient then they are failing as a doctor at that moment. Putting the focus on obesity is just applying a personal bias.The whole point of this article (and I realize they weren't "real" patients) is that doctors dismiss health concerns of the obese.
Which amounts to someones opinion based on hypotheticals and nothing else. Someone had the belief that doctors dismiss the concerns of obese people. Okay. I'm not going to take action or suggest actions be taken on the basis of that.Of course, obesity raises your risk of certain illnesses or conditions. SO WHAT?
So then it is appropriate to consider obesity when making a medical diagnosis. That is what.Because someone is fat, does that mean they can't develop rheumatoid arthritis? Or MS? Or ankylosing spondylitis? Or COPD?
No it doesn't mean that. Which doctor claimed it did? What it means is your chances of certain conditions increase and if the symptoms of those conditions match the patients symptoms then whether or not the patient is obese increases the likelyhood the doctor will consider that the likely diagnosis. If the symptoms the patient is suffering match both diabetes and rhumetoid arthritis and the patient is a thin 70 year old the doctor will probably make the assumption it is arthritis. If the patient is a morbidly obese 30 year old the doctor will probably make the assumption it is diabetes. That is just the application of medical knowledge in a logical fashion. What is wrong with that? Was taking the patients weight into consideration wrong? If so was taking their age into consideration also wrong?How do we get doctors to take health concerns of their patients seriously?
I'm honestly not convinced by this study that they don't. Doctors will misdiagnose people, attributing to that animus or prejudice is just someones opinion. I mean all we can do is in medical school teach that the role of a doctor is to diagnose illness as accurately as possible and apply the recommended treatment for that illness while maintaining a respectful relationship with their patients as human beings. I do not however think we should teach doctors it is inappropriate to come to conclusions about a patience diagnosis by relying on factors such as obesity or race. But if everytime a doctor misdiagnosis or mistreats a patient we look at their assumptions with an eye towards what "predjudicial" decisions they made based on age, gender, obesity, race etc I don't really consider that to be particularly objective or fair.
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If a doctor looks at a patient, sees that they are obese and without any effort or attempt to dig deeper declares them to be diabetic and sends them away with insulin even though that diagnosis was in fact wrong then yeah that doctor is being a bad doctor. Conversely if a doctor looks at a patient, sees that they are obese and decides it is inappropriate to take that into account and decides without any effort or attempt to dig deeper declares them artharitic and sends them away with methotrexate even though that diagnosis was in fact wrong then that doctor is equally a bad doctor. Whether or not one takes into account the appearance of the patient isn't the thing that makes a doctor good or bad, it is the level of effort and appropriate actions taken. If anything the first doctor at least applied some sort of criteria.
Are you claiming that if doctors were blind to race, gender, age, weight and just ordered the exact same lab tests for everyone that that would be ideal? Because if that is the case why even have doctors? Why not just have automated labs that dole out tests based on patient symptoms? The entire point of having a doctor is so they can apply observational biases to a patients symptoms in order to deduce what the most likely cause is. They are detectives and observational assumptions are their main tool. There job is literally to look at you and then jump to conclusions based on what they see coupled with their education and experience. Obesity is part of that, as is race, as is gender, as is age. That isn't automatically prejudice.
Inappropriate prejudice would be bringing in personal stereotype beliefs that are not epidemiological based at all into it and being dismissive of a patient because you don't like their race/gender/bodytype w/e and assume they are lying or are overly disrespectful. That would be wrong yes, but do we need a study to say that is wrong?6 -
Also, I'm going to apologize if any of my comments sounded overly personal to you, and remind you (and myself!) tone and intent don't always come across clearly in this type of a format . I certainly intended no offense.
Apology accepted and understood, intent and tone are difficult to interpret in an online text-based discussion no doubt.1 -
Aaron_K123 wrote: »If a doctor looks at a patient, sees that they are obese and without any effort or attempt to dig deeper declares them to be diabetic and sends them away with insulin even though that diagnosis was in fact wrong then yeah that doctor is being a bad doctor. Conversely if a doctor looks at a patient, sees that they are obese and decides it is inappropriate to take that into account and decides without any effort or attempt to dig deeper declares them artharitic and sends them away with methotrexate even though that diagnosis was in fact wrong then that doctor is equally a bad doctor. Whether or not one takes into account the appearance of the patient isn't the thing that makes a doctor good or bad, it is the level of effort and appropriate actions taken. If anything the first doctor at least applied some sort of criteria.
Are you claiming that if doctors were blind to race, gender, age, weight and just ordered the exact same lab tests for everyone that that would be ideal? Because if that is the case why even have doctors? Why not just have automated labs that dole out tests based on patient symptoms? The entire point of having a doctor is so they can apply observational biases to a patients symptoms in order to deduce what the most likely cause is. They are detectives and observational assumptions are their main tool. Obesity is part of that, as is race, as is gender, as is age. That isn't automatically prejudice.
Inappropriate prejudice would be bringing in personal stereotype beliefs that are not epidemiological based at all into it and being dismissive of a patient because you don't like their race/gender/bodytype w/e and assume they are lying or are overly disrespectful. That would be wrong yes, but do we need a study to say that is wrong?
I specifically said a doctor shouldn't order labs or imaging, just because. If someone comes in complaining of excessive thirst, urination, appetite, etc. I expect a doctor to order a lab for possible diabetes, whether the patient is 100 lbs or 300. If I don't have any complaints, I don't necessarily expect the doctor to do that lab work. (I think my doctor does it routinely every 5 years or so if I had other risk factors, a family history, gestational diabetes, a different race, maybe she would do that test more frequently, which would probably be appropriate) If I go in with knee pain, (which I recently did) I don't expect my doctor to dismiss this new symptom and in fact, she didn't. She wanted to order x-rays (which I agreed to) and she wanted to refer me to an orthopedic guy. I said no, I'm confident it's arthritic changes at 57 and being fat most of my adult life, my knees are wearing out. We discussed meds, exercises etc. X-ray showed arthritis and joint effusion, a couple of months of anti inflammatories, exercises, and losing a little weight, my knee pain is mostly resolved. (At least it's not waking me up at night) This is what I expect from my healthcare provider, and it's been my experience, even as a fat person. If my knee pain didn't resolve with these conservative measures, I would expect her to kick it up a notch. I know as an ex-smoker some doctors absolutely have prejudices they have a really hard time getting around, and I'm perfectly willing to believe the many, many people who say their doctor didn't take them seriously or look deeper because of their obesity. I understand these stories aren't really "evidence" and this study is fundamentally flawed in that they aren't looking at real live patients. It's very possible if the patient was standing in front of the doctor, they would get very different treatment from this hypothetical.
You keep saying doctors are human, too. And I certainly understand that, and even agree with it up to a point. But frankly, I expect more from my doctor. My life is literally in your hands. You're probably smarter than me, and definitely better educated than me, and I'm paying you lots of money to take me seriously. I'm also able and prepared to advocate for myself, and perfectly willing to pitch a fit, complain to your supervisor or get a different doctor, as appropriate. I check my prejudices every day. Did I make assumptions about Aaron because he's a man and men tend to dismiss women's arguments as hysterical? I did. Is that true about you? Maybe not. And I'm willing to give you the benefit of the doubt. I don't think it's too much to ask that our healthcare providers do the same.4 -
maryannprt wrote: »Aaron_K123 wrote: »If a doctor looks at a patient, sees that they are obese and without any effort or attempt to dig deeper declares them to be diabetic and sends them away with insulin even though that diagnosis was in fact wrong then yeah that doctor is being a bad doctor. Conversely if a doctor looks at a patient, sees that they are obese and decides it is inappropriate to take that into account and decides without any effort or attempt to dig deeper declares them artharitic and sends them away with methotrexate even though that diagnosis was in fact wrong then that doctor is equally a bad doctor. Whether or not one takes into account the appearance of the patient isn't the thing that makes a doctor good or bad, it is the level of effort and appropriate actions taken. If anything the first doctor at least applied some sort of criteria.
Are you claiming that if doctors were blind to race, gender, age, weight and just ordered the exact same lab tests for everyone that that would be ideal? Because if that is the case why even have doctors? Why not just have automated labs that dole out tests based on patient symptoms? The entire point of having a doctor is so they can apply observational biases to a patients symptoms in order to deduce what the most likely cause is. They are detectives and observational assumptions are their main tool. Obesity is part of that, as is race, as is gender, as is age. That isn't automatically prejudice.
Inappropriate prejudice would be bringing in personal stereotype beliefs that are not epidemiological based at all into it and being dismissive of a patient because you don't like their race/gender/bodytype w/e and assume they are lying or are overly disrespectful. That would be wrong yes, but do we need a study to say that is wrong?
I specifically said a doctor shouldn't order labs or imaging, just because. If someone comes in complaining of excessive thirst, urination, appetite, etc. I expect a doctor to order a lab for possible diabetes, whether the patient is 100 lbs or 300. If I don't have any complaints, I don't necessarily expect the doctor to do that lab work. (I think my doctor does it routinely every 5 years or so if I had other risk factors, a family history, gestational diabetes, a different race, maybe she would do that test more frequently, which would probably be appropriate) If I go in with knee pain, (which I recently did) I don't expect my doctor to dismiss this new symptom and in fact, she didn't. She wanted to order x-rays (which I agreed to) and she wanted to refer me to an orthopedic guy. I said no, I'm confident it's arthritic changes at 57 and being fat most of my adult life, my knees are wearing out. We discussed meds, exercises etc. X-ray showed arthritis and joint effusion, a couple of months of anti inflammatories, exercises, and losing a little weight, my knee pain is mostly resolved. (At least it's not waking me up at night) This is what I expect from my healthcare provider, and it's been my experience, even as a fat person. If my knee pain didn't resolve with these conservative measures, I would expect her to kick it up a notch. I know as an ex-smoker some doctors absolutely have prejudices they have a really hard time getting around, and I'm perfectly willing to believe the many, many people who say their doctor didn't take them seriously or look deeper because of their obesity. I understand these stories aren't really "evidence" and this study is fundamentally flawed in that they aren't looking at real live patients. It's very possible if the patient was standing in front of the doctor, they would get very different treatment from this hypothetical.
You keep saying doctors are human, too. And I certainly understand that, and even agree with it up to a point. But frankly, I expect more from my doctor. My life is literally in your hands. You're probably smarter than me, and definitely better educated than me, and I'm paying you lots of money to take me seriously. I'm also able and prepared to advocate for myself, and perfectly willing to pitch a fit, complain to your supervisor or get a different doctor, as appropriate. I check my prejudices every day. Did I make assumptions about Aaron because he's a man and men tend to dismiss women's arguments as hysterical? I did. Is that true about you? Maybe not. And I'm willing to give you the benefit of the doubt. I don't think it's too much to ask that our healthcare providers do the same.
"Did I make assumptions about Aaron because he's a man and men tend to dismiss women's arguments as hysterical?" Whoa lol7 -
maryannprt wrote: »Aaron_K123 wrote: »If a doctor looks at a patient, sees that they are obese and without any effort or attempt to dig deeper declares them to be diabetic and sends them away with insulin even though that diagnosis was in fact wrong then yeah that doctor is being a bad doctor. Conversely if a doctor looks at a patient, sees that they are obese and decides it is inappropriate to take that into account and decides without any effort or attempt to dig deeper declares them artharitic and sends them away with methotrexate even though that diagnosis was in fact wrong then that doctor is equally a bad doctor. Whether or not one takes into account the appearance of the patient isn't the thing that makes a doctor good or bad, it is the level of effort and appropriate actions taken. If anything the first doctor at least applied some sort of criteria.
Are you claiming that if doctors were blind to race, gender, age, weight and just ordered the exact same lab tests for everyone that that would be ideal? Because if that is the case why even have doctors? Why not just have automated labs that dole out tests based on patient symptoms? The entire point of having a doctor is so they can apply observational biases to a patients symptoms in order to deduce what the most likely cause is. They are detectives and observational assumptions are their main tool. Obesity is part of that, as is race, as is gender, as is age. That isn't automatically prejudice.
Inappropriate prejudice would be bringing in personal stereotype beliefs that are not epidemiological based at all into it and being dismissive of a patient because you don't like their race/gender/bodytype w/e and assume they are lying or are overly disrespectful. That would be wrong yes, but do we need a study to say that is wrong?
I specifically said a doctor shouldn't order labs or imaging, just because. If someone comes in complaining of excessive thirst, urination, appetite, etc. I expect a doctor to order a lab for possible diabetes, whether the patient is 100 lbs or 300. If I don't have any complaints, I don't necessarily expect the doctor to do that lab work. (I think my doctor does it routinely every 5 years or so if I had other risk factors, a family history, gestational diabetes, a different race, maybe she would do that test more frequently, which would probably be appropriate) If I go in with knee pain, (which I recently did) I don't expect my doctor to dismiss this new symptom and in fact, she didn't. She wanted to order x-rays (which I agreed to) and she wanted to refer me to an orthopedic guy. I said no, I'm confident it's arthritic changes at 57 and being fat most of my adult life, my knees are wearing out. We discussed meds, exercises etc. X-ray showed arthritis and joint effusion, a couple of months of anti inflammatories, exercises, and losing a little weight, my knee pain is mostly resolved. (At least it's not waking me up at night) This is what I expect from my healthcare provider, and it's been my experience, even as a fat person. If my knee pain didn't resolve with these conservative measures, I would expect her to kick it up a notch. I know as an ex-smoker some doctors absolutely have prejudices they have a really hard time getting around, and I'm perfectly willing to believe the many, many people who say their doctor didn't take them seriously or look deeper because of their obesity. I understand these stories aren't really "evidence" and this study is fundamentally flawed in that they aren't looking at real live patients. It's very possible if the patient was standing in front of the doctor, they would get very different treatment from this hypothetical.
You keep saying doctors are human, too. And I certainly understand that, and even agree with it up to a point. But frankly, I expect more from my doctor. My life is literally in your hands. You're probably smarter than me, and definitely better educated than me, and I'm paying you lots of money to take me seriously. I'm also able and prepared to advocate for myself, and perfectly willing to pitch a fit, complain to your supervisor or get a different doctor, as appropriate. I check my prejudices every day. Did I make assumptions about Aaron because he's a man and men tend to dismiss women's arguments as hysterical? I did. Is that true about you? Maybe not. And I'm willing to give you the benefit of the doubt. I don't think it's too much to ask that our healthcare providers do the same.
Honestly didn't even know you were a woman, didn't consider who you are to be relevant to the points you were making.
If I consider someone to be smarter or more knowledgeable about a topic than I am I tend to give that person the benefit of the doubt. If a doctor comes to a conclusion about my health I hadn't considered or I even think is wrong I tend to assume I am the one who is mistaken because a doctor's expertise is in evaluating patients and diagnosing their ailments and mine is not. I might ask the doctor questions to better understand their diagnosis but I'd assume they know things that I do not that are informing their decisions. I do not understand the attitude where someone feels that if another person is more knowledgeable on this topic than they are it is therefore their job to second guess that persons advice and motives.
If I believed I new more about my own health than a doctor then why would I go to a doctor? Why not just self diagnose and order the appropriate drug off of the Sigma Aldrich site?
I have had the experience where I doubted a doctor's diagnosis but trusted their expertise and followed their instructions the letter and do you know what...they were right. If they ended up being wrong I can't imagine my reaction would be to assume they misdiagnosed me due to some active personal prejudice.7 -
I have put a lot of thought into this topic.. because I was morbidly obese my entire life.
There was some things wrong with me more often then not. But what i found was, the care i got from doctors, be it my family doctor (which changed 3 times before i found a good one), the emergency clinic or a walk in clinic, when i was obese, to my current weight now, my care changed based on my attention to my own personal care, mostly in regard to my diabetes and my weight.
Depending on what my issue was, which could of been anything, body pain, chronic headaches, chronic yeast infections, depression, anxiety, when asked about if i was diabetic or not, as soon as they heard that i had diabetes, i felt like the attention was strictly focused on that only.
During the process of becoming aware that i actually had binge eating disorder and was struggling with it badly, my eating disorder left me in that constant battle of choosing where to allocate my money. I was eating so much that the food i would buy never lasted long enough for me to make it through to my next pay day, spending money on insulin made that reality of paycheck to paycheck even harder.
From time to time i would do my best to pay for my insulin.. If the doctors asked if i was taking medications for my diabetes and i responded yes, their questions would usually follow with what have your sugars been like, etc. Since my sugars were never good even when i took the insulin, that alone took priority over everything.
An example would be... I developed a skin condition from my diabetes. They bare very close resemblance to diabetic ulcers visually. While i had 3 in total, one of them in particular had a habit of opening up with a deep hole in the center and weeping fluids when i got sick with a cold or something. Normally though I would tend to this issue on my own, bandages, getting my self better from being sick and just waiting it out.
One time tho i happened to develop a staph infection inside of it. Besides being so weepy with fluid the bandages needed to be changed quite considerably, it was also getting harder for me to walk due to the pain. So I walked over to the walk in clinic (Since my family doctor was a week to 10 days to make an appointment for) and the walk in clinic was just across the street. When the doctor on duty came in to see me, i rolled up my pant leg and showed him this incredibly infected leg, I cried and begged him to please help me, since i didn't know what it was infected with.
He bent down to look at it, used a q-tip swab to poke the hole a bit that had grown in the middle of it but he never told me what was wrong with it, never offered any medications, no advice other then that i need to get my sugars under better control. I left upset and frustrated, but i knew there was something wrong, when i got back to my building, i asked my supers to please drive me to emergency, so when i got in, after the 4-5 hour wait, they immediately hooked me up to IV to distribute the medications faster to get to the infection.
I was appreciative of this extra medical care that i was getting considering that i was sent on my way with nothing from the walk in clinic, After treatment from the hospital with the IV, the advice remained the same though, get your sugars under control.
I think for a long time medical professionals probably just thought i was young and irresponsible and just didn't understand the sheer magnitude of what having diabetes can do. They were kind of right... but.. not in the direct way they probably put it.
With the struggles with my eating disorder consuming me I did often have to block the fear and reality of my diabetes out of my mind a lot, especially during the times that i had to choose between eating and insulin. Sometimes I would have moments where i would feel like something was getting worse and worse and it would scare me enough to make another attempt to take my insulin and try hard to be better to myself.. But it only lasted so long, the eating disorder always won.
2 family doctors, several visits to emerg and attempts with different walk in clinics... when i came to the conclusion that unless someone helped me with my eating, I was never going to get off insulin and i was never going to get my sugars under control. It was a vicious circle for me, I would of either kept not taking it due to my eating or if i was really backed into a corner with food and needing the insulin at the same time, I would often sometimes steal food from work, borrow money from my parents, whatever i needed to do to get food, I almost felt like I would of found ways to eat myself into even more obesity, making the insulin i was taking even less effective.
Even after all those visits to different medical professionals, no one seemed interested in the mental part of my struggles, it was always just get your sugars under control, take your insulin, take your insulin. It just seemed like no one cared about the mental aspect of it.. it was like i was just some fat girl who obviously didn't care about my health enough to change.
Eventually, I did find help with my eating disorder.. it took years and years and years.. but... I finally got help with it.
So.. now that I have lost all my weight, I have had the opportunity to see what losing weight changed for me in regards to any of my health issues and how i am treated when i need care now.
A lot of my health issues were directly connected to my diabetes.
The diabetes was directly connected to my weight.
The other things that were not connected to my diabetes such as depression and anxiety were more so connected to my weight as well and the years of emotional, physical and verbal abuse that i took between the early ages of around 5 to the present year. Once i had been admitted to seeing a psychiatrist at the eating disorder clinic, over time spent with me he established that i also had borderline personality disorder, which connected with another often frequent doctor visit, as i was always talking about having a hard time controlling my anger or would just cry for no reason. when i had an episode of depression or something went wrong, i just could not dig myself back out.. it just snowballed. Those visits were often associated with the diagnosis of depression or anxiety, however I have discovered that the depression and anxiety came after the fact based on my actions during my episodes, especially if i was at work, it also came with a lot of paranoia as well. The body pain and fatigue i was experiencing, was probably a combination of my weight (300lbs) and the emotional up and down state i was constantly in and out of bringing myself to the point of emotional and mental exhaustion, as well as physical as well as i was often up for nights straight just drinking excessive amounts of caffeine, watching TV and just eating all night long, then go to work for 12 hours, and go home and do it all again.
So in the abstract side of that.. every doctor who told me to get my sugars under control, essentially they were correct.
But none of that became possible until a doctor finally listened to me that my eating was beyond my control anymore and i needed help with it. And maybe that could be due to the fact that the mental health system here is a joke. Its not a priority for funding like traditional medical care. You can get good mental help if you have the money to pay for it but as far as free/low income help, its a very long wait list for very short term help.
Since getting my help and being at a normal weight, i have found that doctor visits are different now. I don't even get asked if i have diabetes. Even though there are plenty of people within a healthy weight range who have the disease. Any current body pain i am experiencing now has been met with MRI scans, Xrays, Medication options, referrals for free physiotherapy, clinics for specializing in pain management. And while it did turn out that the body pain i was going through was weight related at the time, the pain i have now and the pain i had then really don't feel any different. Pain is pain, and considering all the non medication options i was offered this time, i do wonder why none of those options were given to me when i was obese, other then the fact that they just assumed one was connected to the other based on previous experiences with other patients in their time.
Health care can be a real struggle for some, especially for some who are over weight.. The amount of times i had to keep getting the strength to keep going to find someone who would listen to me, that alone would discourage probably a lot of people and keep them right where they are.
If a doctor has a disinterest in a patients health due to obesity, then every obese patient is going to be painted with the same brush by that doctor, even though there are some people that are obese simply due to needing a lifestyle change (and those people may or may not want to change even after given suggestions) but there are others who really struggle with a mental aspect that can directly impact their ability to change to a healthier lifestyle no matter how much they truly want it and want to listen to the advice they have been given, when you paint someone with the same brush you miss the opportunity to help the few who could actually take that help and run a marathon with it.
If we don't treat each patient as an individual basis, the ones who probably would of changed, will eventually become part of the group of people who never change and seemingly just don't care enough about their own health right now. I danced on that line so many times.. but not everyone has a personality like mine and if i didn't I could be dead now, have no legs from amputation.. who knows what another 3 years of sugars between 25-30 would of done to me, or the weight i would of gained would of done to me.
5 -
@YepItsKriss with all due respect to you needing to get control of your mental health issues as a priority, from what I’ve read from another lengthy post you wrote about your diabetes management (or lack thereof) you did a pretty dismal job of complying with medical treatment.
While doctors of course need to exercise compassion and do their best to identify any co-morbid conditions that might be contributing to poor health the patient also has a heavy onus resting on themselves.
A lot of what you write seems to me to be contradictory ... you frequently write about eating you want within limits then add that you couldn’t manage this until receiving psychiatric treatment to address the cause of your over eating. You state doctors dismissed your pain as weight related but then concede that pain *was* weight related. The doctors advice that you needed to lose weight was correct. The doctors advice that you needed to get your sugars under control was also correct, and by your own admission related again to your obesity.
So the advice you got from the doctors doesn’t seem all bad despite this last post implying that they should have done more to look at why you weren’t losing weight.
Yep, it was > calorie in than out, duh. But the problem lay in the psychology of why you were eating so much right? Not quite as simple but something the doctor is apparently at fault for not picking up? Despite your lengthy history of non compliance and the advice to lose weight and sort out sugars is actually good medical advice?
Where the difficulty lay - going by your own posts - was that for you (with an undiagnosed binge eating disorder) you couldn’t simply count calories and eat less until you had some treatment ...
Its a shame for you it took so long to identify the mental health issue, but it’s possible to be obese and manage illnesses such as type 2 diabetes with tight control. That responsibility is shared between the health care provider and the individual patient (or their career).
It’s reasonable to expect people to take some responsibility for their own health.
6 -
eliciaobrien1 wrote: »canadianlbs wrote: »i can't speak to the bad attitude about obesity, but this statement about preconceptions of futility mirrors my experience as a person with rheumatoid arthritis. it's like a rug that a lot of things can get shuffled under. so pushing to get the same care and diagnostic attention as a 'normal' person has definitely been a factor since i got diagnosed.
i've been seeing it lately too, as i try to advocate for my father who is in his nineties. 'la la la mr x, you're just old, too bad. next!' it comes down to not being taken seriously.
"physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight"
Obesity can cause a variety of health issues. I don't think we can blame a doctor who would chalk up "shortness of breath" to being overweight.
I would blame any doctor who makes diagnoses based on taking one look at a patient and making an assumption that anyone in the general public would make. Why should we be paying for their supposed expertise if they don't actually take a medical history and administer the appropriate diagnostic tests?
It used to be that if a woman went to a doctor for anything they couldn't diagnose visually (say, a compound fracture), they just chalked it up to "women troubles" or (worse) assumed it was all in her head ("hysteria" = mental problems caused by having a uterus).Even as an asthmatic the only thing the doctors can do for me is prescribe me a puffer that will probably reduce inflammation in my airways.
So you think someone who is overweight who could benefit from an inhaler to help them breathe should be denied one because they're overweight?I don't know about the diagnostic process of rheumatoid arthritis but I can't blame a doctor if he/she says "lose some weight and then we'll see". That seems like the first step in the diagnostic process. I'm sure some doctors are absolutely terrible, but how many doctors get obese patients complaining about all the symptoms of being obese. Must be frustrating.
So, basically, you think doctors should deny treatment to people if it's possible that their medical problem could in any way be caused by their behavior?
"Nope, no chemo, radiation, or surgery for your lung cancer until you stop smoking. Maybe the cancer will go away."
"Nope, we're not going to treat your broken bones until you give up all your dangerous skateboarding, skiing, and mountain biking hobbies."
"Well, of course you're having balance problems. You're 82. No reason to send you for any diagnostic testing to see if it's an inner ear problem."
6 -
Aaron_K123 wrote: »
No it doesn't mean that. Which doctor claimed it did? What it means is your chances of certain conditions increase and if the symptoms of those conditions match the patients symptoms then whether or not the patient is obese increases the likelyhood the doctor will consider that the likely diagnosis. If the symptoms the patient is suffering match both diabetes and rhumetoid arthritis and the patient is a thin 70 year old the doctor will probably make the assumption it is arthritis. If the patient is a morbidly obese 30 year old the doctor will probably make the assumption it is diabetes. That is just the application of medical knowledge in a logical fashion. What is wrong with that? Was taking the patients weight into consideration wrong? If so was taking their age into consideration also wrong?
But in the study, the thin patient was sent for diagnostic tests to discover whether [in your example] the symptoms were caused by diabetes or RA, and the obese patient was just told to go lose weight (which, even if the doctor's assumption was right, would be inadequate treatment for diabetes, and could lead to unnecessarily premature death compared to providing diabetic education, instruction on testing glucose, etc. -- because even if the assumption of low adherence in obese patients is correct, are we now assuming that 100% of obese patients are noncompliant? Or that the benefits of correct diagnoses and education for whatever percentage would be compliant aren't worth wasting the doctor's time on those that aren't compliant?)
Honestly, I think you've created a straw man, because you keep wanting to argue about whether doctors should be allowed to observe someone is obese and take that into account in determining the most likely diagnosis, when what the study showed was that once the doctors decided on the likely diagnosis for an obese patient, they went no further, whereas for thinner patients, they ordered tests to confirm and attempted medical follow-up.
And you still haven't addressed the issue of doctors ignoring women with symptoms of a heart attack because women's symptoms and men's symptoms differ.5
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