I got a rather late start this morning. Or, it was late by my standards. I usually get up between 5:00 and 5:30 AM most days. Today, I got up at about 4:00 AM to answer the call of nature, went back to sleep, and didn’t wake up until almost 7:00. It was pretty nice, actually. I don’t have a real need to be up at 5:00, but I often wake up then, because that’s when Bill gets up most days.

After almost 21 years of marriage, I’ve come to follow his patterns because it’s easier. I’m also pretty productive most mornings. I like getting things done early in the day, so I can fuck off later… or maybe do something musical. I did make a video yesterday, expressly for Alex. I posted it last night, but had to repost this morning, because I somehow neglected to get the very beginning of the song. I think it’s because I was getting tired. I had the song about 85% nailed within a few minutes, but I can be a perfectionist about recordings. I think the take that finally made it to video was #30. I’m not sorry about that, by the way. It kept me busy and distracted.

Below is the link to the edited video without the missing opening measures.

So… about today’s topic…

As I was looking at my Facebook memories, I found an intriguing post from 2018 about how some doctors have a tendency to focus too much on a person’s weight when they present for examination. Below is a screenshot.

Because I’m a masochist with too much time on my hands, I decided to look at the comments on the original post. I wasn’t surprised to find the usual belittling, insulting, victim blaming, shaming, arrogant, condescending, armchair psychoanalyzing, and all of the other shitty behaviors that comes at people who dare to comment on posts such as the above one. What’s especially funny about this post is that it’s from before the pandemic, when everyone and their brother had gone to the Google School of Medicine and Public Health. I’m surprised I survived the worst of the COVID era… although it’s entirely possible that we haven’t even been through it yet. You never know what the future holds.

Lots of people– mostly women– were sharing their personal stories of being dismissed, lectured, and treated with condescension by healthcare providers. And as they tried to relate to the cartoon, they got more of the same shit from perfect strangers with “correctile dysfunction”. It’s a waste of time trying to have a meaningful dialogue on social media, since so many people feel the need to show their metaphorical asses to everyone, rather than be courteous, and have basic empathy and kindness for their fellow man. I’ll admit, it’s easy to fall into that pattern of behavior, especially when someone is egregiously obnoxious.

I read quite a few posts before I got to one that made me stop in my tracks…

This is all I ever hear. I am severely overweight. I need my knees replaced but insurance won’t do it till my BMI 35 or lower. I can’t walk or stand very long due to the pain. I cant do water aerobics because I cant get out of the pool by myself and the gym is not allowed to help me. I cut my fat, cholesterol and amount of food I eat but I’m still not losing. I know it’s the lack of exercise but my doctor just keeps telling me to try harder. No help declined my request for physical therapy where I can get help in and out of the pool. My depression is so bad I am thinking of ending it all.

I really felt empathy for this woman. I don’t have problems like she does. I can still walk, and get up and down stairs. Hell, I recently explored several caves, which required some stamina. The first one, which had 456 steps going down, then up again (so 912 steps), was pretty difficult for me. But I still managed to do it without any ill effect. My knees are still good. I don’t have bad ankles or hips, either. I do have some lower back pain, which I know would be helped if I lost weight and got a new mattress. But overall, I have a pretty resilient body that has historically been ridiculously healthy. I think I inherited my parents’ strong constitutions. Dad died at 81, in spite of being an alcoholic and having Lewy Body Dementia. Mom is still going strong at 85 years old.

I’ve gotten away with not seeing doctors for many years, and I will admit, I mainly avoid them because I don’t want to waste time or money being lectured about a complicated problem that can’t be immediately solved simply because a doctor ordered it. I’m not stupid. I know it’s unhealthy to be overweight. But when I visit a doctor, I expect immediate help with the specific problem that brought me to their office, not lectures and shaming by someone who doesn’t really know anything about me other than what they see.

If I’m sitting on an exam table with a problem that needs to be addressed immediately, I expect it to be addressed ahead of lectures about my weight. Especially if the doctor doesn’t actually have advice that will work, and isn’t based on actually knowing something about me, and my lifestyle. It’s not helpful to simply tell someone to eat less and move more. If it were that simple, we’d have a lot fewer fat people.

I could identify with this woman’s predicament. I certainly don’t know what led her to be as heavy as she is/was in 2018. The simple answer is, she somehow took in too many calories for her body and didn’t exercise enough to burn them off. But what caused her to consume too many calories? What caused her not to get enough exercise? What is the best way to help her get back into balance? How can she be helped in a way that isn’t demeaning, insulting, and self-defeating? How can she be convinced that she’s worth helping, rather than just giving into despair and “ending it all”, as she put it.

There were a lot of comments on this particular cartoon post. Some of them spawned separate threads of their own with a bunch of responses. They were often tit for tat, “let’s compare qualifications” types of comments, that were unhelpful. I’m sure you’ve seen those types of comments yourself. They have a lot more to do with a person’s ego and personal biases than actually offering anything helpful to the conversation. But, if you’re unclear on what I mean, have a look at this exchange …

During my recent pregnancy, I gained very little weight and my OB told me I obviously led a very healthy lifestyle, but I also had to have extra ultrasounds and was considered “high risk” because of obesity. The disconnect between weight and perceived health is real.

A guy who doesn’t know this woman at all wrote this response:

what disconnect? The more weight you have on you the harder your heart has to work, it’s basic a&p, there is a very distinctive line on what your weight should be according to your structure (height, muscle fitness, genes ect) and if it’s not within those parameters (that medical professionals studied and developed for longer than you have been alive) then yes by medical definition you are overweight, and there’s not a single person in the world that’s overweight and is healthy, it’s medically and physically impossible.

A different person took him on, writing this response:

Considering how little information is on your profile it looks like you’re not a medical professional. You need to stop acting like one. As someone who’s actually studying nutrition and psychology none of what you said is true. Infact most healthy people are overweight. Being in peak shape with little extra body fat has been proven to make you less able to fight disease. There is morbidly obese, you can start having health issues due to weight at that point. But do you know what the number one indicator for chronic disease actually is? Prolonged stress.

Bold guy came back with this comment and a link:

I hope you’re joking, you went digging into my profile, which is private, and you determined I wasn’t a medical professional because my profile is private, excellent use of brain cells. 

I’m not going to respond to rest of the gibberish, as this article singlehandedly dismantles the said gibberish, I suggest you read it before you plan your next stupid internet excursion.

***I’d like to point out that you control what’s public on your profile. Whatever is publicly posted on your profile for people who aren’t your “friends” is not “private” information. If you don’t know that, you probably shouldn’t be on the Internet, let alone working with people who have medical problems. I’d also like to point out that I don’t think this guy has ever helped anyone, if he has, in fact, ever worked in healthcare. ***

Italics person wrote:

a Heath line article lmao, yeah you’re probably not a professional otherwise you’d mention creditials other than just working in a hospital and bring up something literally any idiocy could Google. I’ve been a CNA going on 7+ years. Working in homecare, LTC acute care and a rehab unit. Stop spreading misinformation. I’m using real science. I’m studying for a PHD at MNSU. Getting into research not the clinical side of healthcare. Having little body fat does not a healthy person make. BMI doesn’t take into account muscle mass and nutritionists don’t like using that as a form a measurement. How someone feels should be the determine factor for health. Flexibility, good eating habits and overall strength and mental well-being are signs of good health and healthy people come in all shapes and sizes. People who push their body to limits to fit into strict guidelines aren’t going to be any more healthy than an overweight person, who is active, gets good rest and good nutrition. Infact that person putting their body through intense stress in order to be aesthetically easing may be less able to fight off disease and might be prone to injury. If you actually care about those you take care of, check yourself.

Bold guy– a supposed “seasoned” physician’s assistant, came back with:

I’m not going to read this bs story, I’ve been an ER PA for 3 years, prior to that I was a paramedic. (Count in the 5 years of school in between) 

It’s not pushing your body to “limits” it’s eating healthy food and exercising. The less weight you have on you, the less your heart has to work, are you just not understanding that aspect of human anatomy? Do you not understand that your heart is the most important muscle in your body, and you destroy it by poor diet.

That article provides FACTS, Percentages… pulled directly from government statistics (please see sources before you just throw away important information just because it doesn’t agree with your rhetoric) if those OBJECTIVE SCIENCE backed statistics still don’t change your mind, then go on eat like shit, be happy, and I’ll see you in morgue before age 50, have a nice day, I’m not going to argue with a CNA who claims to know more than doctors.

***I’d like to know what drew this guy to work in healthcare. Was it just the paycheck? He doesn’t seem to care about people.***

Italics person wrote:

what Nutrition education do paramedics have? My professor for my emergency classes was taught stuff by me about both diabetics and my own personal congenital heart defect. You work in acute and emergency care you aren’t qualified to speak about chronic conditions

More from bold guy:

“insert 5 years of school” Why do you think it takes a few month to become a CNA and a minimum of 5 years to become a PA and that’s extremely fast. Do you see how stupid you sound? Go on and find a provider at your hospital, tell him what you told me here, show them this convo, you will be slayed.

***Really? Why is he in healthcare? I want to know.***

Italics person wrote:

 7+ years experience accounts for more than a few months don’t you think? Also read, I’ll be in school a lot longer than 5 years to complete my degree. I’ll I had to explain to my GP what the phrase neurdivergent meant. Y’all need to see people for people. Your patients are individuals.

More from bold guy… If he really is a PA, he shouldn’t be.

wtf dude you are delusional, I have already completed my school, and my fellowship… you’re a CNA…you assist nurses in completing my orders and clean up shit… and you’re trying to explain medical ethics to me… just blows my fucking mind, the audacity

More from italics person…

again seriously fucking read, I’m a PHD candidate and I should show this shit to your employers if you can’t respect the people who do your fucking grunt work you shouldn’t have a position in healthcare. I have other coworkers who are in medical school and do the same job as me.thinking I’m unintelligent because I’m a CNA..It’s pretty shocking that I do have to lecture you about ethics. You should know better.

Bold guy continued:

good grief…. I don’t have to respect idiots that spread misinformation because they’re obese and want to fit in, you don’t think we have those? Fucking HR nightmare; funnily enough they are always doing some “masters or PhD program” it’s like literally the same story. And they never win and always get fired, because they say stupid shit and talk back to providers. 

You keep living in your fantasy world that in 5 years you’ll graduate or do whatever, that’s a long time, and you ain’t done shit yet, because you’re just a cna, that’s it, those are your qualification, and end to your scope of practice, and your knowledge as far as I am concerned. 7 years ago I was still and EMTB, not even a P, now I’m a PA-C, and you’re telling me I should listen to you 

Response from italics person:

Just a CNA, like I don’t hold the hands of patients while they die. Ive had a career for nearly a decade and “I haven’t done anything yet”. Nice dude. I feel so fucking sorry for anyone in your care. I’m screenshotting shit and finding out your employer. I am an HR nightmare. I bet they would be really interested to hear about your neglect of obese patients and disrespect of your coworkers. Just because I didn’t have the money to go to school till recently doesn’t mean I’m not any less valuable in an emergency situation. I’ve saved many a life and helped many people cross over because I’ve worked in both hospice and acute care. Been a scheduler too, that’s some shit. I’ve had on weeks on call and worked shifts that are 24 hours and given CPR and both lost and saved a life. I’ve held people waiting for paramedics in pools of blood trying to stop bleeding after finding a bad fall, been a first response for people having seizures or strokes on and off the clock. Just cause I don’t make as much money as you doesn’t mean I have less knowledge or less experience. I can’t do things out of the scope of my practice because of my license that doesn’t mean I just wipe ass and if that’s something you turn your nose down on you arent fucking qualified to do your job. 

You are what is wrong with healthcare. Some young ass bro of a PA, the seasoned RNs that work with you most likely think you’re useless. That’s like saying you don’t know shit cause you don’t have a PHD.

And italics finished with:

Basing your medical opinions of the very strict parameters of BMI isnt in line with current nutritional standards. Maybe you need to go back to school too. Overall weight doesn’t account for muscle mass and looking at a obese patient and thinking that what they need to do is simply lose weight without trying to assess what caused the weight gain in the first place is setting you up for some malpractice, and any good clinician right now shouldn’t have the fucking time to argue on Facebook

I wasn’t going to include the entire above exchange because it’s so long. However, I think it’s a good example of what I mean when it comes to these kinds of conversations people have on social media. Notice these two supposed healthcare professionals quickly devolved into personal insults and “sword comparisons” of their supposed qualifications. Neither of them seem very professional, although if I had a problem, I think I’d rather deal with the CNA who is getting a PhD.

—You can be the greatest clinician in the world, but if your personality is so arrogant and insufferable that I can’t even stand to listen to you, you can’t help me. Moreover, if the PA is calling people names, using profanity while citing credentials, and demonstrates general disdain toward people who need help, he is not someone I want to waste time seeing, let alone paying for medical help. He is immature, abusive, and just plain doesn’t care. With his crappy attitude, maybe he should work in a laboratory, instead of with patients.

There were a number of tit for tat arguments like the one above, and they got a bunch of comments. Yet here was this comment from a poor woman who actually needed REAL HELP. Not only was she suffering physically because of her weight and the negative health effects obesity has had on her body, she was in so much emotional and physical pain that she was thinking of “ending it all”.

Her post got six replies, one of which came from one of the “experts” who were arguing above (the CNA, who wrote of needing breast reduction surgery, rather than offering concern or empathy). Only one person (not the CNA) offered to listen to the lady who expressed her desperation about her situation, and even with that offer came unsolicited advice with some well-meaning encouragement. The rest of the commenters offered diet tips and medical advice, even though no one even knew her personally, and it did not appear that any were actual healthcare professionals beyond being a CNA. Unsolicited advice is almost always uniformly unhelpful.

I didn’t even read all of the comments on this cartoon. I was led to the conclusion that asking for healthcare is a crapshoot. It made me wonder what the point of it all is. We’re all going to die sometime, anyway. And if you have the choice between being lectured, shamed, belittled, and discounted and then PAYING for that treatment, when you are certainly going to die at some point, anyway, and just getting on with life for as long as possible, free of charge, albeit in pain– well, I can certainly see why some people avoid going to doctors.

I just think it would be so much better if people would just be kinder and more empathic, and less focused on trying to show everyone how “smart” they are in comment sections on social media. I don’t know the woman who posted about wanting to end it all, but I’ll bet there are people in her life who love her and would miss her if she died. I’m sure they want her to live and thrive. I’m sure she’d rather live and thrive, too. What she needs is actual help from people who care about her welfare, not more discounting, and arrogant comments about how she just needs to lose weight– with absolutely NO real help with how to accomplish that end.

Well, this post is way too long, and I’ve got other stuff to do. So I’m going to end here, until tomorrow. Hope you have a nice Thursday.