Yesterday, I read an advice column by Carolyn Hax of the Washington Post. The first subject came from a woman who described herself as in her mid 50s and obese. Her question was adapted from an online conversation. Below is what Hax put in her column:
Hi, Carolyn: Will you give me a Pap smear or a pep talk? I am dreading my yearly OB/GYN appointment. My doctor, while very personable, continues to care more about my weight than any other issues. I am in my mid-50s and obese, but I am working out two to three times a week with a professional trainer. Those sessions are quite strenuous.
I am not normally at a loss for words, but my mild pushback during the last physical resulted in an irritated doctor, pushing additional “suggestions” — which usually entail signing up for a commercial weight-loss program, visiting a colleague who is not in my network, tummy tucks, etc. I generally reserve those topics for my yearly visits with my general practitioner and prefer she concentrate on my “woman parts.” Yet I know the first thing out of her mouth during the next visit will be, once again: “You still need to lose weight. Are you still exercising?”
— At a Loss for Words
I agreed with Carolyn Hax’s advice, which was this:
A pep talk, then: Get another doctor. If that’s not practical, then state clearly to this one that you are working with your primary doctor on the weight and will not discuss it in this appointment. It’s your appointment, your care. You say what and when. If you lose your nerve in situations like this, then write it down and hand the note over.
I left a very short comment on the Facebook post for this column. I wrote “Get another doctor or, do what I do and avoid going. ;)”
Now… maybe I shouldn’t have have “joked” about not going to the doctor, since that’s not exactly a health promoting suggestion. I actually wasn’t joking, though, in spite of the winky smilie. I don’t go to doctors unless I’m really sick. I know some people think that’s crazy. In fact, given my educational background, it’s probably very surprising that I don’t visit doctors and get screenings. But if you know my history, it’s a lot less surprising. I had a really bad experience with a gynecologist who traumatized me. I also have kind of a bad attitude about life, most of the time. It’s getting worse by the day.
However… I do think the first part of my comment was sound. I do think that if your doctor isn’t a good fit for you, you should find another one. Doctors aren’t gods. They make mistakes sometimes. And if you’re going to one who upsets and alienates you so much that you don’t want to go see them, that’s a sign that you need to find a new doctor, even if they’re not wrong about advising you to lose weight, or change, or eliminate, some other aspect of your lifestyle.
OB-GYNs, in particular, are examining a very intimate part of the body, and that requires great trust in them. I am a firm believer that any doctor who is putting their hands in orifices where the sun doesn’t shine needs to be very professional and sensitive to their patient’s needs. I feel that way because of that first (and only) OB-GYN doctor I saw, who treated me like a slab of meat, insulted me, and physically hurt me. Then she basically told me to shut up while she continued her exam.
Afterwards, that doctor blamed me for the fact that she wasn’t as thorough as she’d wanted to be, because I wasn’t “relaxed”. As if I, as a virgin on whom she’d just used a large, metal speculum that hurt like hell, could easily relax, under those circumstances. She abused my trust. I left her office in tears, feeling like I had just been sexually assaulted, and knowing that technically, I’d only just had my first pelvic exam. That experience still made me feel extremely violated. Now, I don’t trust most doctors at all. Intellectually, I know it’s irrational to think that all doctors will do what that woman did to me. I’ve even had some good experiences with doctors since that incident. I still find it terrifying to see most physicians… even the ones who don’t require me to get undressed for them.
The doctor in the above scenario sounds like she’s basically competent, but she’s pushing “solutions” that aren’t feasible for the patient and are wasting precious time in an appointment that is probably already too short. So, I don’t think it’s wrong if the patient decides to try another doctor in that case. She may find, after trying another doctor, that she likes the first doctor more, or she may find that the second or third doctor she tries is better for her needs. If she has the flexibility to try different practitioners, I think she should. It’s her body, and her healthcare… and ultimately, it is her LIFE.
I got some likes for my very short comment, on which I didn’t elaborate. One person left me a “sad” smiley. But then, I got a comment from someone calling herself “Winnie Jay”. Winnie Jay decided to blast me and another commenter, then chastised me for “joking” about such a serious matter. She then ended her diatribe by calling me “girl”.
I know it sounds crazy, but Winnie’s comment really infuriated me. Especially, since she called me “girl”, which is a very diminishing and disrespectful thing to do. I mean, she’s not wrong to write that obesity isn’t healthy and is correlated with chronic diseases, and people often lie about what they’re actually doing to protect their health. But does she really expect people to take her seriously when she’s so confrontational and rude? My first instinct, honestly, was to tell her to go fuck herself.
However, instead of firing back at Winnie, who unceremoniously “pooh poohed” on my brief and basically innocuous comment, I wrote “Thanks for your input, girl.” And I left it at that. I didn’t even use a “reaction” or an eye roll smiley. If she has a brain, the fact that I reciprocated by calling her “girl” won’t be lost on her. If you want people to take you seriously and hear what you have to say, you shouldn’t go out of your way to alienate them… which is exactly my point about the doctor described in Carolyn Hax’s column. Fortunately, Winnie didn’t come back, nor did I get any other comments. As of this morning, Winnie is now on my block list; so we won’t run into each other again.
I looked at the responses on the Washington Post’s article itself, as opposed to its Facebook page. Quite a few people were pointing out that the doctor was right to aggressively harp on the woman’s weight at every visit. As a former student of public health, I agree that obesity isn’t healthy, and competent doctors should address it, or at least encourage healthy weight loss. However, physicians should do that with sensitivity and respect, as well as some situational awareness of the patient’s reality. Good people skills are important. Most folks don’t like to be lectured, especially if they’re adults. Chastising adults as if they are children is a good way to get fired.
I realize that asking doctors to have a little sensitivity might be a tall order when you only get about fifteen to twenty minutes for an appointment. But, if the doctor is spending some of that time promoting things like commercial weight loss programs, tummy tucks, or out of network doctors that the patient can’t, or won’t, access, that’s precious time wasted that could be used for coming up with a better, more effective solution, that will fit the patient’s reality and ultimately have more of a chance of success.
Medicine in the United States is a business. People can and do leave reviews for their doctor’s services. I don’t think that is a bad thing, either, because it helps people choose a practitioner who can give them the best care for THEMSELVES and THEIR OWN BODIES. Some people like authoritative doctors who tell them what to do; it gives them a sense of security. Other people prefer a more collaborative approach. Some people like doctors who are very relaxed and calm. Others feel like a doctor that is too calm isn’t doing anything to help them.
Fortunately, there are a lot of physicians in the United States, depending on where you live. Anyone living in the Washington, DC area will have a lot of options for receiving basically good care. So I think Carolyn Hax was right to tell the letter writer to look for another OB-GYN who is more in line with offering her care that is appropriate for her situation and preferences. After all, she’s paying for the doctor’s time and expertise. It might as well be time that is as pleasantly spent as possible, especially since she seems focused on improving her health and hanging around in this hellscape we’re in right now.
As for Winnie… I could have told her off, if I’d felt like it would have done some good. Winnie was likely looking for a fight, and she made some erroneous assumptions about me. She might be surprised to know why I responded the way I did, but instead of being respectful and kind, she decided it was more effective to be hostile and insulting to a stranger.
If I had decided to respond to her, I would tell Winnie that a person could be the BEST trained and most educated doctor in the world, who recommends all of the right treatments and medications and is very highly regarded and respected. None of that will do a single whit of good if a person feels so uncomfortable and alienated that they can’t bring themselves to make an appointment and go in to see the doctor.
Because of what happened to me when I saw a FEMALE OB-GYN, I have a really hard time seeing doctors today. Just the thought of calling one for an appointment fills me with dread and anxiety. I’m smart enough to know that not seeing a doctor is risky, especially at my age. But I also know that I don’t particularly want to grow old, anyway, and spending time talking to someone who is obnoxious, offensive, or oblivious isn’t my idea of a good time. Especially if I’m paying for it.
I also know that I am not the only one who feels this way… I’ve blogged about it before, with links to articles about people who have gone in for a specific medical problem, and the doctor remains hyper-fixated on their weight. That approach really can cause a person to feel like they don’t matter and their actual needs won’t be addressed; and it makes it that much harder for them to ask for medical attention when they really need it.
Again… just my thoughts, y’all. I have an issue that probably should be addressed by a doctor, but my choices here involve either going to a military doc (like the asshole OB-GYN who hurt me), or seeing a German doctor, who may go into lecture mode. Neither option is very appealing.