Tag Archives: Nebraska

healthcare, mental health, psychology

“Please, Doc, don’t weigh me unless it’s really necessary!”

Yesterday marked the first day of National Eating Disorders Week 2022. Fittingly, a few days ago, I read an interesting article in the Washington Post about a new trend in U.S. healthcare. It involves special cards that one can hand to a physician. See below:

I like this idea.
From the More-Love.org Web site.

I haven’t seen a doctor since 2010. One of the main reasons I don’t visit doctors is because I once had a very traumatic and unnecessarily physically painful and humiliating experience with one. I did see doctors a few times after the traumatic experience, but as I’ve gotten older, it’s gotten even harder to make the phone call for an appointment. I know very well that this isn’t the greatest policy for promoting my personal longevity. I could definitely use a check up. However, for many reasons, visiting medical people causes me a great deal of stress. One of the main reasons it’s stressful is because of that goddamned scale, and my long history with eating disorders. No, I don’t mean the obvious ones that might put a person in the hospital. There are actually a lot of eating disorders out there, and most don’t get diagnosed. But they do exist, and I’ve struggled with them for years. I have less of a problem with them now, mainly because I have a very loving and understanding husband who doesn’t body shame me. I would be lying, though, if I said those problems have gone away entirely. There isn’t a day that goes by that I don’t think about it.

I know I usually have less of a problem going to see a doctor if I know I won’t have to be weighed. For instance, in 1999, I had facial cellulitis that almost put me in the hospital. I had to see an ear, nose, and throat doctor for treatment. He was a great doctor, but one thing that I especially liked about him was that he didn’t force me to get on a scale. He simply looked at the mess on my face and prescribed antibiotics. The family practice doctor who sent me to the ENT guy was kind of an all knower, but he actually reassured me that my weight wasn’t that bad. At that time, it wasn’t that bad, since I was waiting tables and lost a lot of pounds because of that. However, I was never so sick, so often, as I was in those days.

Although I know weight is an important measure for some health issues, I think it’s pretty cool that someone has realized how absolutely mortifying getting on the scale is for some people. The above cards were offered at Element Primary Care in Omaha, Nebraska. A 30 year old woman named Dani Donovan, who is an attention deficit/hyperactivity advocate and suffers from binge eating disorder, happened to see the cards at the office. Donovan reportedly avoids going to see physicians because of the stress of being weighed. She happened to find a practice where, apparently, the staff recognizes this issue, and how it prevents people from seeking care. According to the WaPo article:

“I didn’t even know that saying ‘no’ to being weighed was a thing you could do,” said Donovan, 30, an attention-deficit/hyperactivity disorder advocate who has a binge-eating disorder and often avoided doctor’s appointments because being weighed was so stressful. The card led to a good conversation with her doctor, Donovan said, that helped build trust and make her feel empowered.

Donovan took a photo of one of the cards and posted it on Twitter. It’s caused quite a stir.

These cards were developed in 2019 by a Los Angeles area eating disorder coach named Ginny Jones. Jones is a survivor of several eating disorders, including anorexia and bulimia. Jones came up with the cards after many experiences she had when visiting physicians. A lot of them would praise her for losing weight, even when it was noted in her records that she has had eating disorders. She now offers the cards for sale on her Web site. When Jones was contacted for a statement about her cards, she said:

“I wish I could say I was surprised by the ‘controversy’ around the cards. I created them to address weight stigma, and it’s basically fatphobia to jump to conclusions and say blanketly that asking not to be weighed is unhealthy.”

Personally, I think these cards are great, although I can’t imagine presenting one to any of the military doctors I’ve seen in my lifetime. But then, again, I haven’t been to see a doctor in about 12 years. My blood pressure shoots up whenever I’m in a military healthcare facility, and they usually take one look at me and assume I have any number of health issues just by my appearance. I have found that a lot of doctors aren’t good listeners, either. That is especially true with military providers, in my experience.

In 2007, before we moved to Germany the first time, I actually wore an ambulatory blood pressure monitor for 24 hours to prove that I didn’t have hypertension, because my blood pressure readings were so high in the office. As soon as I stepped out of the military hospital, my blood pressure was completely normal and stayed that way. I came back to the office the next day with a bruised arm and documentation in my file that I have white coat hypertension. That may no longer be true today, given my family history, but the way the providers acted during that last visit put me off of going back, even though the person I saw was actually very kind to me when I told her what had happened to me at the hands of an Air Force gynecologist back in the 1990s.

The Air Force gyno I saw back then gave me my very first (of two in my entire lifetime) gynecological exams. It was so painful and distressing that I left her office traumatized and horrified, and actually felt violated on the level of sexual assault. Besides really hurting me with her instruments and not apologizing for the pain she caused me, this doctor also fat shamed me and predicted that when I went to Armenia, I would gain tons of weight. In the 90s, I was dealing with eating disorders more acutely than I do today. Today, I seem to have replaced eating issues with drinking issues. Again… not healthy, and I probably should see a doctor, but I just can’t bring myself to do it. Even having these cards probably wouldn’t get me into the office, although I do think they would help, if I found a kind and understanding physician who was sensitive to these issues.

According to the Washington Post article, as well as my own anecdotal experience, there are a lot of physicians who have a bias against obesity. They seem to take obese patients less seriously, especially if they’re women. The article reports, “one piece published in the British Medical Journal found that weight stigma actually led to increased mortality and other chronic diseases and ‘most ironically, (weight stigma) actually begets heightened risk of obesity.'” There have been a number of articles about how the medical community tends to focus on weight, even when a medical issue is clearly not related to the patient’s weight. Like, for instance, someone comes in with a broken arm and gets told that weight loss would benefit them. There’s no doubt, weight loss would be beneficial, but that’s not why the person came in to see the doctor. In that sense, I can see how these cards could be useful. If you’re going to see the doctor for a specific issue that has nothing to do with obesity, perhaps it wouldn’t be a bad thing to skip the scale, at least for that visit.

Of course, some physicians will never be onboard with avoiding weigh-ins. In the WaPo article, a physician named “Umbereen S. Nehal, a former chief medical officer for Community Healthcare Network in New York and a board-certified pediatrician,” reported that she strongly believes patients must “be weighed every time, regardless of when they were last weighed or why they are in the doctor’s office.” The doctor claims to be have sympathy for patients like Donovan, but she’s not convinced that avoiding the scale will improve healthcare outcomes. She says, “Is the hypothesis that somebody who is obese, let’s say, if we don’t weigh them, fatphobia will go away? Those visual cues will not go away. So my beef with this is that it disrupts processes in the system for efficient data collection and that data are used for a variety of things.”

My answer to Dr. Nehal is that a lot of people avoid the doctor entirely because of this issue. She may be getting more data when she weighs patients at every visit, but a lot of people won’t even come see her because of the mortifying prospect of being weighed, the psychological stresses that come from that experience, as well as the potential humiliation that comes from a fat shaming doctor. Seriously… if you’re feeling fine, and you don’t want to deal with the discomfort of being weighed, how likely are you to schedule screenings? Is that the outcome Dr. Nehal wants? For people not to come in to see her at all? Then she won’t get ANY data, and the person will show up in the emergency room instead. And that will not only lead to poorer healthcare outcomes, but it will also lead to much higher medical bills.

Another doctor who was quoted in the article, Fatima Cody Stanford, an internist who specializes in obesity medicine, also insists that weight is an important measure. She notes that U.S. medical schools do a terrible job teaching students about weight, and that many people don’t visit their doctors very often. Stanford says she would tweak the card to something that says:

“I’m happy to get weighed but please do not provide any negative or derogatory comments associated with my weight.”

That way, the doctor gets their data, and the patient doesn’t have to deal with fat shaming. I would add, though, that in my case, it would not be true that I am “happy to get weighed”. I hate being weighed every time. It causes me a lot of distress, and that’s why I avoid doctors unless I’m about to croak. So I think Dr. Stanford might want to rethink that wording, although I appreciate that she recognizes how upsetting being weighed is for some patients.

I looked at Element Primary Care’s Web site, and it appears that their approach to care is different on many levels. For instance, I notice they offer telemedicine appointments, focus on keeping their practice small, and it appears that instead of using a traditional insurance model, they provide care for a monthly fee. This eliminates co-pays and insurance deductibles, and allows patients to access care when they need it. The direct primary care membership plan can be combined with a high deductible/less expensive insurance plan which would cover hospital care or other unforeseen care needs that still use the traditional insurance model. I have heard of a growing number physicians’ practices eschewing traditional insurance coverage, which allows them to be able to make medical decisions that don’t have to go through third parties at insurance companies. I think it’s a great idea, although it will probably take some time for it to catch on nationwide. Change can be slow, but I do think overhauling our health insurance model could be a game changer for a lot of people.

At Element Primary Care, about half of the patients decline to be weighed, but some will weigh themselves at home and report their weight that way. Or, if they have a condition that requires their weight to be monitored, the patient can turn backwards on the scale, which is how many eating disorder patients get treated. That way, they don’t have to know that number, and it won’t affect their psyche. The cards allow the patients to advocate for themselves and be more of team member in their healthcare. It may also make them feel “safer” from judgment and humiliation. Personally, I don’t weigh myself at all anymore, and when I have gone to see the doctor, I don’t let them tell me how much I weigh. I know from personal experience that knowing the number can lead to distress.

I think the pandemic has caused a lot of issues with weight and mental health. I recently read that a number of young people have developed eating disorders during the pandemic. Even President Biden is addressing it, which is very fitting, since National Eating Disorders Awareness Week begins today. Kudos to Mr. Biden for bringing this up, since I know Trump doesn’t care about helping people with eating disorders. I recently read that doctors are seeing a lot of adolescents in emergency rooms, dealing with eating disorders. There’s also a lot of depression and anxiety being reported, due to the pandemic. I think any measure that makes seeking help easier is commendable.

While it may not always be medically appropriate to skip stepping on the scale, I like the fact that some healthcare professionals are noticing and addressing this issue. And I think it’s amazing that some people are empowering themselves by presenting these cards, although I would not be surprised if some people get lectured by their doctors for not being weighed. I would like to see less lectures from doctors as a general rule. People need to take ownership for their own health, and physicians need to stop seeing patients as people who need to be given orders or lectures about taking care of themselves. Especially if they are competent adults.

Anyway… I probably won’t be going to see a doctor anytime soon, and in fact, I hope I don’t live to be super old. I think it’s overrated. But I definitely think the cards are kind of cool, even if I’m sure they don’t always go over too well with more traditional physicians. I know that if I had given one to my ex psychiatrist, for instance, he probably would have laughed me out of his office. And he never weighed me once– but he did fat shame me quite a few times before I told him to stop. He also gave me a prescription for Topamax off label, hoping it would slim me down. Is it any wonder why I hate seeing doctors?

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healthcare, Military, Trump

Some Trump supporters finally turned blue…

This morning, I read about how some folks in Omaha, Nebraska ended up having to visit a hospital after spending several hours stranded in below freezing weather. Why did this happen? Because they decided to attend a late night Trump rally at Omaha’s Eppley Airfield, a site served by a two-lane road. There were so many people there that the demand for shuttle buses was very high and people had to wait, apparently unprepared for prolonged exposure to the frigid temperatures.

According to The Guardian, there were thousands of people waiting for shuttle buses hours after Trump’s plane had already departed the area. Some people attempted to walk to the distant parking lots where their cars awaited, about two or three miles away from the rally site. Then, once they got to their cars, they were stuck in snarled traffic for hours. Many of the people who were at the rally were elderly people, and several of them were so badly affected by the cold that they needed urgent medical attention.

I imagine a scene much like the one Bill and I experienced after we saw Elton John in concert in Stuttgart in May 2019. He happened to be performing at the same time as the 2019 spring festival, so traffic was hellish. It took a couple of hours to make it the few kilometers to our hotel, but at least we weren’t freezing cold. I just remember really having to pee.

In a Washington Post article about Trump’s rally, Johnathan Sundat, a 19 year old attendee from South Dakota who had driven four hours to the rally with his girlfriend, posted a tweet demanding an explanation from the Trump campaign. Sundat is quoted:

“There’s this belief that Donald Trump is for the common people, and that’s part of the reason why he won in 2016. But the reason why I wanted to tweet it is because I do believe in part of his message; I believe in some of the things he said that night, and it was kind of disappointing that a campaign would treat you like that.”

Interestingly enough, when I tried to read Mr. Sundat’s tweet, it had been deleted. I kind of wonder if maybe he got some backlash for daring to question Trump after being quoted by a major newspaper. Other people also tweeted their dismay that they were literally left out in the cold by Trump just days before the election. Add in the fact that all of these people were gathering during the pandemic, and a lot of them weren’t following social distancing guidelines. According to The Washington Post, there were about 25,000 people at the rally. And although the campaign staffers took temperatures and provided face masks, many people didn’t bother to wear them. Instead, they all crowded on risers. When the event was over, some of the people who attended were still waiting for a bus back to the parking area 3.5 hours after Trump had left on Air Force One.

Frankly, I think this event nicely illustrates what Trump has done since 2016. He’s figuratively left a lot of people “out in the cold”. And I think Mr. Sundat was quite astute when he realized that Trump’s image of being a plain speaker like the “common folk” was not actually based in truth. I hope that means Mr. Sundat will reconsider voting for Trump next week, but somehow, I have my doubts that he’s learned from his own newly acquired insight. Indeed, in the article, Sundat was quoted as saying that his feet were a little numb, but he’d probably do it again:

“Like I said in my comment, it was pretty disheartening,” he said. He added that he didn’t blame Trump himself: “It’s probably not him scheduling the buses.”

No, it’s not him scheduling the buses, Johnathan, but it is his event and ultimately, it’s his image on the line. People hired on his behalf to set up this rally let down you and thousands of other people. He’s been doing that for years now. Haven’t you learned? And those people who needed medical assistance will be stuck with the bill, not Donald Trump. The buck should stop with Mr. Trump, but you want to give him a pass because he’s not scheduling the buses? Why didn’t he expect his people “scheduling the buses” to foresee this disaster and avoid it? Why isn’t he concerned about the people who came out in the cold to support him, at great personal and financial risk?

My husband spent thirty years in the Army. He’s often told me what the Army expects of its leaders. For example, in the early days of Bill’s career, he had a company command. That duty entailed leading enlisted Soldiers in training, rather than sitting behind a desk. Bill told me that in the Army, good leaders make sure their followers get their needs taken care of first. For example, after a full day of training, everybody’s tired and hungry. But as an officer in charge of a large group of young Soldiers, it was Bill’s duty to see that they all had a chance to eat and drink. That meant waiting until every last man or woman was served, and potentially not getting any food or being stuck with whatever was left. A good leader also never asks anyone to do anything that he or she is unwilling to do.

Trump literally left those people who came to support his re-election standing out in the cold. It’s the kind of thing he’s been doing for decades. Why his supporters can’t see that, I will never know. And now, some of those people had to visit a hospital, which is especially risky right now, thanks to the pandemic. And some of them will end up with hefty medical bills that they may not be able to pay– bills that they would have avoided if they had simply stayed home. And the longer Trump stays in office, the more emboldened and reckless he seems to get with other people’s lives and livelihoods.

Sadly, I think a lot of people just plain don’t understand what a good leader is and what should be expected of them. Just this morning, as I was waking up, I read an article in the Military Times about how medical personnel from the United States are being flown to the Czech Republic to help take care of people with COVID-19. The virus is overwhelming the medical system in the Czech Republic and there is a critical shortage of medical personnel and equipment there. Many of the people taking care of COVID-19 patients in countries like the Czech Republic and Poland are getting sick themselves, compounding the shortfall.

I read some of the comments on the Facebook page for the Army Times, which is where the article was posted. Many people, who had clearly not bothered to read the article before commenting, were opining about “socialized medicine” and how it’s “so bad”. First of all, anyone who has been in the military and received treatment from a military facility ought to know something about what socialized medicine is. Yes, we have it in the United States, although it’s only for a certain segment of the population. And secondly, socialized medicine has nothing to do with the spread of COVID-19. It’s a very contagious virus about which we still know very little. Even before the pandemic struck, there was a shortage of medical personnel in parts of Eastern Europe. One commenter had this to say:

You didn’t see the US having other countries come in to help with our surge….🤷‍♂️

However… quite a lot of healthcare providers in the United States come from other places, too. And some of them are undocumented immigrants who have been at risk of being deported, thanks to Trump’s draconian anti-immigrant policies. So… actually, YES, we in the United States do depend on people from other countries to take care of our healthcare needs, too. Moreover, I saw a lot of ignorant comments made by people who have either clearly never lived abroad, yet spouted propaganda about socialized medicine that doesn’t reflect reality, or are tragically misinformed about what the healthcare systems in other countries are like.

I got quite a kick out of a German woman’s comments to an ignorant poster who believes that Germany’s healthcare sucks because he thinks it’s government run. First of all, it’s obvious that this fellow hasn’t the foggiest notion about Germany’s healthcare or how the United States compares to other countries in terms of healthcare quality. Let me put it this way– despite the idea that “you get what you pay for” (which is literally what one uninformed guy wrote)– that ain’t necessarily so when it comes to healthcare delivery. According to a nice, America friendly, U.S. based layman’s source, US News & World Report, as of January 2020, the United States ranked 15th in the world for the most well developed public health system. Given our response to COVID-19, which dates after this article, I’m sure the U.S.’s reputation has slipped. Wanna know where Germany stands on that list? Number 5. Yep… the guy who wrote this:

you get what you pay for. Exactly why The US leads in medical innovation. 
I would be scared to live where health care is free and you wait months on end for a visit while you die. And the “authorities” decide if you “deserve “ treatment… Dear God that is horrid. The VA not much better… mostly treats symptoms and sends you on your way…

clearly has no idea of what he writes. Yes, we spend a lot more on healthcare, but that doesn’t mean our healthcare is the best. In fact, it surprises me that someone who clearly identifies as a political conservative would believe that “throwing money at healthcare” will make it better. Aren’t Republicans the ones who criticize Democrats for spending money to solve problems rather than taking a more restrained fiscal approach?

The German woman who took the above guy to task wrote this to two different commenters who think they know what German healthcare is like:

I am literally laughing. You served? Got some Tricare, eh? What do you think that is? Paid for by WHO? 
Dude, I am from Germany. I had universal healthcare all my life. You know how great it feels when you are REALLY sick and don’t have to worry about how to pay the medical bills, if your house gets foreclosed, or if you still have a job once you get better? 
No you don’t. Go sit down in the corner somewhere. 🤣🤦🏻‍♀️

Guess she’s married to an American serviceman or retiree. She added this comment later.

I am about to fall off my couch. Typically you get way better care at a german hospital. Why? They don’t kick you out 3 days after heart surgery, because ‘insurance won’t cover it’. 
Oh you don’t feel good? Well, too bad…later. 🤣🤣🤣
You get the 250,000$ bill in the mail. 😏

And then she added this for the guy who thinks the US system is better:

what makes you think healthcare is free? We all pay for it. We just are smart enough to understand that getting ill can happen to everybody. 
Who do you think, picks up the bill of american uninsured folk who, when they really can’t take it anymore, show up at an ER. WHO? 😏
Anyways, I understand pretty much everybody who has big opinions about other countries universal heathcare has NEVER experienced it and is clueless about how it works and what the actual benefits are. 😏
Btw ‘made in Germany’ still means something way better than ‘Made in the USA’. 
Where do you think, do 90% of all surgical instruments come from? 😎
You too, go and sit down somewhere.

She’s absolutely right, too. In fact, Bill has an American colleague whose wife was recently diagnosed with stage four colon cancer at Landstuhl, the American military hospital located about 90 minutes from where we live. You would think a diagnosis like that would inspire healthcare workers to want to get cracking on treatment. But no… she couldn’t get a timely follow up appointment from Landstuhl to address the cancer, so she ended up calling on the local system. The German doctors told her to get her ass to the hospital within a couple of hours because they were ready and willing to take care of her NOW. Moreover, the treatment costs less, although since Landstuhl is a military hospital, the cost factor would depend on a lot of things. I’m not sure if her husband is a retiree, for instance, and whether or not she would qualify for free “space available” care at Landstuhl as a family member.

I noticed the guy came back with a smart-assed answer to the German woman who took him to task. I could try to take him to school myself, but I’ve gotta go wash my hair. In any case, it’s clear that he doesn’t know what he’s writing about and has no clue about what constitutes “good” medical care. He would prefer the American system because that is what he knows, and he is convinced that paying a fortune for basic care is what makes medical care in the United States superior to that of what you can get in Europe. It’s a myopic viewpoint that costs people their lives and livelihoods. The fact is, the United States has comparatively poor outcomes, especially considering how much money is spent. Moreover, we have a lot of unhealthy people who can’t access care because they can’t afford it. What good is all that so-called “medical innovation” if you can’t access it? This, my friends, is a topic in my wheelhouse. If I weren’t an “overeducated housewife”, I might have been using my master’s degree in public health to research this stuff.

But anyway… I have already rambled on long enough. I’m glad it’s Friday. Bill will come home later to telework as we gear up for another partial lockdown. Meanwhile, I’m going to pursue making myself a better and more interesting person by practicing guitar. Ciao, y’all.

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