I have a wonderful doctor, who has never made me feel anything but cared about and supported; every patient deserves this from their medical professionals, whether it is their first appointment with a doctor or their fiftieth. Unfortunately, not all patients are the recipients of thoughtful and appropriate communication from their physicians.
A few weeks ago, I received a telephone call from a woman who is very important to me. Our conversation went something like this:My friend: “I have a sinus infection and I needed to get in to see the doctor. They couldn’t see me at my local clinic, but their clinic one town over could get me in this afternoon, so I went. I was sitting in the exam room when the doctor, whom I’ve never met or seen before, walked in. He looked me up and down, even walking around me and looking at my backside. Then he said, ‘I’ve got to say, when I read your chart and saw your height and weight, I walked in here expecting to see Jabba the Hut. Congratulations, you carry your weight very well.’ “ Me: “Oh my God! He actually said that?” My friend: “Yes. Jabba. The. Hut. At first, I didn’t think I heard him right.” Me: “What did you do?” My friend: “Nothing.” (She starts to cry.) “I was so embarrassed and humiliated. I didn’t know what to do or say so I just sat there.”
Our conversation went on for quite a bit longer – with many attempts on my part to reassure my friend that she didn’t deserve to be spoken to that way and with tears of self-recrimination and hurt on her part. There was quite a bit of colorful language with the word “douchebag” liberally thrown around, primarily by me.
Let’s unpack what was going on here. The doctor, seeing that he had a patient waiting for him, read her chart – that’s a good thing. Noting her height and weight, that she is overweight and, let’s face it, short, an image came into his mind. Mental images happen, it means he’s human. However, here’s where the event went terribly wrong.
The image that came into his mind was of a grotesquely slimy, filthy, amorphous blob of a character from Star Wars. A character meant to represent indulgence in all of the most gross sins of the flesh. A character enfleshed by creative artists such that one look at him tells you all of this. (If you don’t believe me, check out images for Jabba the Hut on google). And this image was brought to the doctor’s mind by two numbers – as if that horrid character was simply created from the intersection of two statistics. As if it was perfectly reasonable to extrapolate from those numbers that he would find a real Jabba the Hut waiting for him behind the closed exam room door – because all short, overweight people embody the same qualities that the Jabba character possesses, don’t they?
Instead of Jabba the Hut, the physician found my friend waiting for him. She is beautiful from the inside out, hence his insulting “congratulations”. She is funny, loving, witty, and has the best and most contagious laugh I’ve ever heard. She is a loyal and loving wife and mother, works hard to support her family and to offer her children every opportunity. She has weathered many difficulties and storms in her life. And on the day she visited Dr. Douchebag, she was low with both a sinus infection and a difficult month of family problems, her self-confidence at low ebb. His comment cut straight to her heart and made her feel ashamed and diminished.
If we are willing, for the sake of argument, to agree that this doctor has the right to think what he chooses, I believe we can also agree that VERBALIZING it in this case was COMPLETELY UNACCEPTABLE. Even though he couched it as a backhanded compliment, he might as well have said “Your stats are those of someone whom I would naturally find to be completely grotesque and repulsive. Congratulations, you’re not as gross as I feared you would be.”
Physicians need to check their inappropriate prejudices at the door. Patients are often at their most vulnerable – they are sick, possibly afraid, often worried. They are there seeking help, which for many is not a preferred activity. I would love to say my friend’s experience is an isolated incident, however, I hear stories all the time about doctors telling their overweight patients inappropriate things (“it just takes a little self-discipline”), including incorrect and/or unhealthy dietary advice (“you could stand to live on iceburg lettuce for a few weeks”). Get any group of obese adults in a room and ask. You’ll hear story after story about the disrespectful, prejudiced and hurtful things said to them in doctor’s offices, emergency rooms, clinics, pre-surgery. One friend actually heard doctors arguing about which one had to “deal with the fat one”.
As physicians you ascribe to the precept of “do no harm”. (While there is no legal obligation to take the hyppocratic oath, approximately 98% of medical school graduates take some form of oath regarding the level of care they will offer patients). I am certain many physicians take this concept seriously, and are able to practice this in both word and deed. For others, there are certain groups of individuals about or to whom you would never speak in the manner my friend was spoken to – groups based on race, ethnicity, gender, sexual identity*. Your consciousness, and your business sense, have been raised enough to understand that discrimination and prejudice of this nature are harmful – to people and to your pocketbook. Unfortunately, there are still large numbers of you who don’t include obese patients among those deserving of sensitivity and respect.
What Dr. Douchebag did was harmful to his patient. Since he didn’t know her, he couldn’t know what effect such words would have on her – nor did he have any idea of her robustness or fragility on the day of her visit to him. Finally, he clearly made a priori judgements about her based only on her height and weight. In doing so, he reduced her to less than human. Does it matter that he found her “better” than his expectations when he entered the room, and that he consequently voiced that? No. My friend felt the very depth of his initial judgement to her core.
Dear physicians, I know you’ve got lots to think about and remember in order to do your difficult jobs well. Please consider sensitivity to your obese patients one of those important concerns. I know, from personal experience, how working with both an insensitive doctor (one who told me it was unpleasant for him to examine me) and one who is caring feels. My current physician is an example of the latter. At my last physical, knowing how I have worked to change my life (and seeing the evidence of my improved health), she apologized, saying, “I’m sorry, I still have to list you as obese on your chart. But you are doing everything right – it’s just a chart. You should be so proud of yourself.” And I knew she was sincere. I left her office feeling affirmed, as I have every time, even when I was at my heaviest weight. Her acceptance of me at every stage helped me to feel that getting, and being, healthy was within my reach. It doesn’t mean she hasn’t been honest with me about concerns, just that she voiced them with sensitivity and care. Shouldn’t every patient leave the doctor’s office feeling like they have an ally?
Jenion*Please note, I am not suggesting that there aren’t physicians who may discriminate or give less sensitive care to members of these groups. Only that there are many who would not and yet continue to treat their obese patients in this manner. To my readers: I don’t know whether there are any physicians who read or stumble across my blog. Please feel free to share this post with any you know or any you feel might benefit from it. I plan to share it with my doctors – past and present.