Dear Primary Doctor,
6 months have passed. It’s probably a lifetime of flus and strep and ongoing illnesses for you. I don’t really expect you to remember me. That was a 40-minute conversation that I’ll never forget, though.
You are the problem, Primary Doctor. You and other doctors like you. Did you know that if you search “effect of weight discrimination in medicine” you find a really cool article written by a bunch of doctors. In the article, they talk about doctors ignoring fat people’s legitimate health concerns, just like you did.
“Finally, 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. In one study involving medical students, virtual patients with shortness of breath were more likely to receive lifestyle change recommendations if they were obese (54% vs. 13%), and more likely to receive medication to manage symptoms if they were normal weight (23% vs. 5%) [23].”
Basically, doctors like you see fat people like me and fail to suggest diagnostic testing. You know, sort of like how you decided I didn’t need to look into anything that could help me. You abused my trust.
My concerns about MS? “Bad luck” and “not genetic.”
My concerns about always being exhausted? “Line up ten moms and they’ll all say the same thing.”
Concerns about my sinuses and my headaches? Totally ignored. “Go take an OTC allergy medication.”
And I did.
For almost 4 months.
Until I went to the nurse practitioner for the sinus cold that wouldn’t go away. She gave me an antibiotic and the name of an ear, nose, and throat doctor.
He was amazing. He stuck a scope up my snout and told me my sinuses were pink and healthy. He suggested migraines. He didn’t just see me as some kind of Adult Adipose (aka big fat blob). He saw me as a person with health issues and sent me for an MRI to double check the sinuses.
Then the MRI came back. Not sinus problems. He suggested a neurologist.
She was super amazing. She rolled her eyes about your 40-minute weight lecture. She explained that the MRI looked like MS. We decided to do the lumbar puncture since someone in my immediate family has MS so there was a higher chance.
Wait. Did you see that, Primary Doctor? Rewind. You told me that there was no chance. That it was bad luck. You stole my agency by treating me as neurotic. You made me feel crazy. You made me think that I was overreacting. You caused me to second guess my own health. I trusted you as a medical professional. All you saw was fat.
You.
Were.
Wrong.
You were wrong because you didn’t listen to me or think about my actual health. Your wrongness delayed my diagnosis. Had the ENT not intervened and suggested the MRI? Your dismissiveness could have led to years of my going undiagnosed because I would never have brought my concerns up to you again.
After an MRI and spinal tap, the test results confirmed an MS diagnosis.
You: Bad luck. No genetics. All moms are tired. I’m fat.
Reality: Multiple sclerosis.
Doctors like you do not consider treatment other than telling fat people like me to lose weight. Kind of like how you told me to eat fewer high-calorie bagels and go take OTC allergy meds.
All I know, Primary Doctor, is that I don’t want anyone else to have their health placed at risk because of the attitude you had towards me. I have a voice. I will use my voice. My voice will shout to the rafters because I have the opportunity to stand with and for others whose health is compromised by people like you.
You ignored my health concerns about the latter because you judged me based on the former.
You did harm, Primary Doctor. You judged a neurological and autoimmune issue based on cellulite. You ignored a patient you felt wasn’t worth your time because you made assumptions.
I am fat. I am a person with multiple sclerosis. I deserve the respect of being seen as a person and patient instead of as a number on a scale.
You dumß $#!+. Thank you for validating my past 25 years of struggling with weight loss since the age of 10. Let me crawl back into my hole of worthlessness because you understand ALL THE THINGS about weight loss. I have the metabolic rate of a camel. I have a normal diet free of bread and sugar. I eat vegetables. I don’t drink soda. I work with a nutritionist. I still gain weight. I get about 10k steps a day. I still gain weight. I’m sorry, but take a long walk off a very high cliff. I would like to walk a mile in your shoes so I can understand you, but I just can’t. At least when you complain, I won’t be able to hear you. I’ll be a mile away, in your shoes.
Great, now it seems my reply is all weird, because I can no longer see the VERY FIRST COMMENT, about the person who said its really not that hard to lose weight.
Weight loss and weight gain are very personal experiences for a lot of people. I intended to only explain that professionals need to understand their complicitness in the heath outcomes that can arise from their biases. I will say that you outshine me in both your commitment to your health as well as your commitment to exerise.
I think the very first comment was a spam post.
I think suggesting that you lose weight is a great start off point. No doctor is going to suggest the most invasive thing first. I feel like the reason why the NP rolled her eyes at the lecture and she did something else is because you essentially ruled out it being something more basic by coming back 4 months later and saying, “hey, this hasn’t helped, I think more is going on.” It’s always important to rule things out first. Sorry you had a bad experience, and I do feel there are some less-than-caring doctors out there, but maybe weight DOES account for a ton of health issues. Most people would indeed feel better after losing weight/eating healthier/exercising, you just happened to be an exception. I think your piece is more dangerous in that you’re basically telling other large people that being fat isn’t the issue. It is AN issue and continues to be despite your other diagnosis of MS.
I don’t think that the post was suggesting that weight wasn’t/couldn’t be an issue. The problem is the delay of necessary testing becuase of the assumption that weight is almost always the issue. The doctor should have taken her concerns seriously and run the appropriate tests first just like they would have done with a thinner person. It’s not like losing weight is an instant process, meaning that a person has to suffer and worry for months so that weight could be taken off the table and other options considered. There’s a bias here and it’s keeping people from getting timely treatment.
Well, I’m sorry you had a bad experience and double-sorry you have continuing health issues. I’m glad you got a diagnosis and found health care professionals willing to treat you as a person.
This article reads like a LiveJournal post, though. It’s not an article, even; it’s a very personal rant written as an open letter to someone who is never gonna see it (not here, anyway), and doesn’t work as journalism. This isn’t good content.
It’s bringing in comments and traffic and starting a discussion; feels like good content to me!
Opinions vary. That’s good.
I wonder if this sort of issue contributed to my *daughter* not getting a real diagnosis for 4 years? — That because I’m fat, providers discounted all of my collected data and concerns as a neurotic mother, etc?
I am a physician whose practice is focused 100% on the prevention and treatment of obesity and its adverse health consequences. I am saddened to read your story but not at all surprised. There are numerous studies documenting the shortcomings of physicians when it comes to our being adequately trained to treat obesity effectively and compassionately. Furthermore, it is a fact that obesity stigma and bias are widespread in our society and the medical profession is no exception. While it does seem that at least in your case, it may be time to look for a new primary care doc, even some of the very best physicians and advanced practitioners who may be very well educated, extremely knowledgeable, empathetic and compassionate may not know how to best help patients who are struggling with obesity. Obesity is a complicated, mutifactorial disease and until major changes are made in our medical education such that all providers are appropriately trained, it is probably best to seek out care from a physician certified by the American Board of Obesity Medicine.
Clearly, you’ve never had a major health issue. I’m a nurse and part of my job is patient advocate. Karen is an amazing exemplar of someone who has advocated for herself in difficult circumstances and this article will help those who haven’t been able to do so, or can’t, realize they aren’t alone and that things can be different. That they have a right to be heard. If you can’t see that. Lucky person you’ve never found yourself in a situation where you’re made to feel less than you are. Perhaps you can find something more worthwhile to do with your time than criticize those who are crafting beautiful language to describe something ugly.
this was in response to an earlier comment but didn’t post correctly, not in response to Karen’s article.
I’m assuming you were responding to me. You’re right in assuming I enjoy fanastic health. My son, however, had a prenatal stroke and has had health issues his entire life. My wife has a genetic disorder that causes her serious health problems. We spend a lot of time at the hospital.
I feel it’s worth my time to criticize because I respect the site and don’t want to see it degenerate into personal blog posts. I donate to their Patreon because I believe in their content. I put my money where my mouth is as a reader, and I’m not afraid to speak my mind when I feel like the content is subpar. So there you go.
I appreciate all the comments. In fact, what everyone here is saying is true – obesity is multifactored, treatment by professionals depends entirely on the professional, self-advocacy is important.
I also would like to thank everyone who’s provided suggestions for the future. I will be getting a new doctor – as soon as I hit the 1 yr mark, my insurance will cover a new annual physical so am locked into this office until then.
My health is being compromised by doctors who are waiting for me to magically overcome my lifelong weight problem and lose 20 to 40 kilos before they will remove my gallbladder which is chock full of gallstones which cause me chronic pain, and regular attacks of acute pain. They lecture me about my weight and diet, and send me home with a handful of pain killers. I can’t care for my young children when I am in acute pain or adequately doped up to manage the pain. It’s not safe, it’s not sustainable, but they won’t do anything about it. My thin father, however, had his gallbladder out when he was younger than I am. He did not get lectures about how his diet caused the problem so he would just have to live with it or change his ways. My thin sister got her gallbladder out without being harassed and disregarded the way I am. The medical staff were sympathetic and consoled her for having bad luck and unfortunate genetics, as most of my aunts and uncles have also had their gallbladders out. But because I am fat, I am blamed for my condition and treated as though I am a sinner who must do penance and demonstrate repentance by losing lots of weight before I become a surgical priority. The only justification they have is that overweight people are at higher risk of problems when under anesthetic. But that makes little sense in light of their willingness to give me an anesthetic for other surgeries I have had in the last few years. And because I know that one day I will need emergency surgery, and that’s how I will get my gallbladder out. For safety’s sake, I would much rather not have the added risk involved in having an infection or organ failure while having the surgery. And if the medical folk were serious about being concerned about surgical risks, they would be scheduling me for surgery before my health is further compromised.