How Iatrophobia Became a Problem

We have been looking at the ways in which trying to get health care extracts a high emotional price from some patients. Iatrophobia, or an intense fear of doctors, is sadly founded in reality. A person might need months to accumulate the courage to even make an appointment. They show up to find their worst fears realized: a medical professional disregards everything they say, and declares that all problems originate in the extra weight they are carrying.

Writer Solar Bean collected some more horror stories, like that of a woman who sought help for a sinus infection and instead got scolded for her weight. Another was condescendingly told that her years-long severe cough was weight-related “when in actuality, her lung was rotting.”

An overweight but consistently active woman was told by a doctor that she would just have to live with her chronic knee pain forever, and then was fortunate enough to connect with a personal trainer who worked with her to banish the knee pain within six months. Another, who was tired of being told that her severe exhaustion was caused by her weight, avoided doctors until anemia sent her to the hospital for an emergency blood transfusion.

Fifty shades of betray

Hopefully, the sweet-treat custom has died out by now, but in the past, a surprising number of children instinctively recognized the cognitive dissonance involved in being rewarded with a lollipop at the end of their appointment with a pediatrician. An overweight teen girl wrote of being repelled when her doctor came up with the clearly inadequate response of suggesting that she dance in her bedroom at night.

Another writer, Michael Hobbes, noted that people are sensitive enough to pick up on clues, like when fat patients are allotted shorter appointments because a doctor can save a lot of time by just saying “Lose weight. Next patient, please.” They feel the lack of emotional rapport, and understand what it means when a health care professional won’t make eye contact.

They certainly feel it when a physician believes that shame is the most effective way to motivate weight loss. Shame-based medicine can have devastating long-term effects. Overweight and obese girls grow into women who avoid pap smears, mammograms, and other routine screenings because of embarrassment.

Here is a depressing quotation from Tracey Folly:

The thing my doctor didn’t realize was that I’ve been working out regularly for years despite being obese for most of my life. My doctor couldn’t tell I was active by looking at me because my body doesn’t look like the body of an active person. I am certain my doctor knows a body can be both active and fat. However, I do think he assumed my body was inactive and fat, and that’s a problem I’ve been working to solve for as long as I can remember.

Of course, being ignored and patronized can turn a person off even if they don’t wind up in the ER through what can only be described as neglect. Sometimes, the patient feels victimized by simple disrespect, the sense of not being listened to or believed. Sometimes, the patient has innate awareness that all they are getting is what, in polite society, is called baloney. That kind of treatment gets old real quick. That sort of emotional abuse, while technically not malpractice, is certainly far from best practice.

Your responses and feedback are welcome!

Source: “The Reason You Hate Fat People Isn’t Because You Care About Their Health,” Medium.com, 02/09/20
Source: “Everything You Know About Obesity is Wrong,” HuffingtonPost.com 09/19/18
Source: “What My Doctor Doesn’t Know About My Obesity,” Medium.com, 02/26/20
Image by Neelesh Bhandari/CC BY 2.0

The Fat Tax, Both Tangible and Invisible

Many obese people have made the same point in various ways, like Devika Menon:

Even when you go to a doctor for medical aid, some of them will point out that whatever illness you’re going through is in your head and it will all get better when you lose some weight.

Yesterday’s post recounted two obese people’s negative experiences with the medical world, and the literature contains many more. The prolific Aubrey Gordon (aka Your Fat Friend), who has weighed as much as 400 pounds, has written many articles describing the judgment, rejection, disrespect, bullying, and outright disdain she has been subjected to. She also provides readers with facts like these:

62% of fat women report that they’ve experienced inappropriate or stigmatizing behavior at the doctor’s office.

The American Journal of Public Health concluded that anti-fat bias leads to “serious risks for psychological and physical health, generates health disparities, and interferes with the implementation of effective obesity prevention efforts.”

Even seeking treatment for ear infections has led to lengthy weight loss lectures from my providers.

That seems to be a common complaint. Of course, if it’s a weight-loss clinic or an obesity specialist, the patient’s size is fair game. But a person who shows up to, for instance, have a severed finger reattached might not want to talk about their Body Mass Index on this particular day.

Your Fat Friend has spoken of what she calls the Fat Tax, a fee that is both tangible and metaphorical. Being disbelieved and discounted are items on the psychic “fat tax” list, parts of an extra layer of difficulty that the obese need to overcome in order to obtain life-saving help. She writes,

The fat tax finds us in health care too. If we see a doctor who doesn’t dismiss our symptoms out of hand, brushing them off with a simple “just lose weight,” many of us will be required to seek care out-of-network and pay out-of-pocket just to access the same health care as thinner people.

The writer points out how travel might be necessary to find an MRI or CT scanner that can accommodate a large body. Insurance does not cover the extra expense. For a fertile woman over 175 pounds, the “morning-after pill” will probably not work. Wheelchairs, walkers, and crutches for overweight patients are very expensive. Life insurance costs more if it can be gotten at all, and an oversize casket might cost twice as much as a standard one.

Your responses and feedback are welcome!

Source: “Woman Loses 75 Pounds So That Doctors Would Finally Diagnose Her Instead Of Blaming Her Weight,” GoMcGill.com, 02/26/21
Source: “10 Requests from a Fat Patient to Her Health Care Providers,” Medium.com, 02/10/20
Source: “The Fat Tax Is Real — and It’s Getting Worse,” Medium.com, 04/09/19
Image by Sergio Santos/CC BY 2.0

Blinded by the Fat

Far too many people have refused to interact with health care providers because they have experienced misdiagnosis by doctors who have gotten hold of the idea that when an obese patient shows up, every problem is directly traceable to the patient’s weight.

In the world of “anecdotal” health reportage, Reddit.com is a useful platform for people to share their horror stories. Recently, correspondent u/YukiBean recounted how…

[…] every single thing I went to a doctor for, it got blamed on my weight. Severe cramps? Weight. Feeling sleepy during the day? Weight. Numbness in my fingers, headaches, memory problems, balance problems? Weight.

She worked hard to lose 75 pounds, which took a year. On her return to her doctors’ they ordered tests appropriate to her various symptoms, and found a chronic pain-causing brain condition called chiari malformation; and narcolepsy; and so much endometriosis…

I lost both of my ovaries and a portion of my colon and lower intestines. If it had been taken seriously a year ago, I might not have lost them.

In another publication, Laura Fraser wrote:

Several studies have shown that many physicians consider the time spent with obese patients a waste, and they don’t hesitate to broadcast their biases in the examining room. Fat people are less likely to seek medical treatment because they know the stigma and lectures that await them.

Fraser used to have a sister, Jan, whose obesity caused concern. When she lost 60 pounds, the occasion seemed to call for congratulations — except that it didn’t.

Jan had not been making an effort to reduce her weight but had been eating less for a while because her appetite was suppressed by pain, and over-the-counter medications did not help. Her gynecologist did a routine exam but, as Jan described the experience, “He just saw me as a fat, complaining older woman.”

She took proactive measures, cutting down on dairy products and gluten, but that didn’t help. At her sister’s urging, she made an appointment with an internist where she was examined by a physician assistant who apparently had read a bulletin from the DEA or something, and concluded that this was a case of drug-seeking behavior, and refused to write a prescription for effective painkillers. Laura writes,

Jan arrived at the visit weak and wracked with pain. She came out of it in tears, with no answers and no relief.

But the internist, like any good mentor, reviewed his PA’s work, and consequently called Jan the next morning and told her to go to the emergency room. Turns out, she had cancer. A gynecologic oncologist removed “the largest endometrial tumor he said he’d ever seen, the size of a volleyball. It had peppered her pelvis with cancer, infiltrating her bladder and other organs.”

Chemotherapy was tried, but it was too late, and Jan only lived another six months, wearing a wig and looking sick. But, as she lost another 100 pounds, people complimented her reduced size!

Your responses and feedback are welcome!

Source: “I lost 75 pounds so doctors would stop blaming everything on my weight,” Reddit.com, February 2021
Source: “My sister’s cancer might have been diagnosed sooner — if doctors could have seen beyond her weight,” StatNews.com, 08/15/17
Image by Tony Alter/CC BY 2.0

Obesity and Iatrophobia

Doctors and other medical professionals make tremendous sacrifices and devote years of their lives to learning the necessary skills, to achieve the credentials they seek in order to serve humanity. And yet they often “miss the boat” when it comes to dealing with patients who are obese or headed toward obesity. Too often, the result is that patients stay away from the very people who are ostensibly there to help them.

Sometimes, all it takes is one traumatic experience to turn a person off for years, to the point where they will put up with any amount of pain and dysfunction rather than make an appointment to strip down and put on an exam gown. For Tracey Folly, the first painful incident in her youth was not even the doctor’s direct fault, but an adjacent complication.

The first person to officially label her obese was a pediatrician who referred her out for testing, to see if her thyroid was in good working order. When the lab bill came, her mother was understandably upset by the expense, and of course, a child feels guilt for contributing to the family’s financial burden. But the insurance company was adamant, because “obesity is not a disease.”

Once burned, twice shy

For that and other reasons, as soon as she reached 18, Folly took advantage of her adult status to swear off annual checkups for many years. When romance entered her life, she went to see about contraception. The exam started, reasonably enough, with a pap smear. This procedure brought on a truly phobic reaction of “complete and total breakdown during the examination… crying, screaming, and hyperventilating.”

Documenting a patient’s vital signs is important, and the alert follower of Childhood Obesity News will recall, from yesterday’s post, how another writer advises putting off the blood pressure reading until the end of the visit, when the patient has had a chance to calm down. But in Folly’s case, on that particular occasion, after a 24-carat panic attack, it was the exact wrong thing to do:

[S]ince they didn’t check my blood pressure reading until after the exam, the nurse practitioner declined to give me birth control pills, which were the one and only reason I had subjected myself to such humiliation and torture in the first place.

Of course, this resulted in her adopting less reliable methods, which could have led to an unplanned pregnancy that would have created a whole new set of problems. The boyfriend situation was already precarious and anxiety-producing, since he was of the controlling type and liked to keep a tight rein on every aspect of his girlfriend’s life, except, oddly enough, her eating habits. All the resulting recent stress had been channeled into even more pervasive food abuse, and a 50-pound weight gain. Clearly, the needs of this vulnerable young woman came nowhere close to being met.

Your responses and feedback are welcome!

Source: “What My Doctor Doesn’t Know About My Obesity,” Medium.com, 02/26/20
Image by Jeff Eaton/CC BY-SA 2.0

Obesity Problems That May or May Not Go Away

Today’s essay actually belongs in a time capsule. The previous post suggests that the coronavirus pandemic will inevitably change the practice of medicine in ways we are not even able to foresee at this moment. While it would be futile to make predictions, it will be interesting to revisit this list of problems at some future time, and marvel over how much things have changed. So, what are some of the discouraging obstacles that obese patients face?

One, obviously, is making the decision whether or not to even go to a doctor. But why on earth would anyone hesitate? Maybe because they know that the Patient History notes entered into their medical charts will include negative vocabulary like non-compliant, overindulgent, and weak-willed.

Maybe they have heard rumors that medical personnel in the operating room will take advantage of the opportunity to make rude remarks about the zonked-out patient’s body. And why not? There are enough recorded instances of doctors saying inappropriately judgmental things to conscious patients. Why be sensitive toward someone who is unconscious?

Journalist Michael Hobbes spoke with a patient whose doctor had asked her, “How could you do this to yourself?” and one whose surgeon had pointed to the image from her MRI scan, saying, “Look at that skinny woman in there trying to get out.” Hobbes also quoted an incriminating line from obesity counselor Ginette Lenham:

A lot of my job is helping people heal from the trauma of interacting with the medical system.

Another interviewee, a teenager with stomach pain, had consulted a doctor who managed to incorporate both fat-shaming and a racially-tinged insult in the same sentence, by suggesting that her problem was eating too much fried chicken. Unfortunately, he overlooked the dangerous inflammatory condition in her internal organs.

Shaunta Grimes, in a piece subtitled “This is Why Fat People Don’t Go to the Doctor,” told of visiting a chiropractor for help with her back pain after an exhausting pregnancy. This sweetheart took one look at her size and said, “Well, of course your back hurts.” While she was on the table having her spine manipulated, he remarked, “This would be a whole lot easier if you weren’t such a whale.”

The same author also mentioned times when she had gone in to be examined “for strep throat or a sprained ankle or a fever and left with a xeroxed low-carb diet.”

Like police officers, realtors, and members of other professions, medics also invent disrespectful slang terms for the civilians they deal with. Probably everyone has heard the acronym “gomer,” which stands for Get Out of My Emergency Room. During one office visit, Grimes was less than delighted when a technician dictated, “The patient is a 33-year-old obese.” That is not a bad word in itself, as the adjective, it is meant to be — but when employed as a noun, it is inexcusably offensive.

Your responses and feedback are welcome!

Source: “Everything You Know About Obesity is Wrong,” huffingtonpost.com 09/19/18
Source: “That One Time my Doctor Called Me a Whale,” medium.com. 02/19/19
Image by 2il org/CC BY 2.0