Tuesday, 10 October 2017

Lying to Doctors for Healthcare

Bad DoctorI talk a lot on this blog about how to advocate for yourself with healthcare providers – facts and figures that you can use, and phrases that help etc.  I want to make sure I’m clear that fat people shouldn’t have to do any of that, and that the ability to do it is a privilege and a luxury that not everyone has.

I talked about this recently on Christy Harrison’s fabulous podcast Food Psych. I have a lot of privileges that allow me to stand up to doctors – I’m white, cis, currently able-bodied and neurotypical, currently have “good numbers,” and am typically assumed to be hetero which, because of racism, transphobia, ableism, healthism, and homophobia gives me a ton of privilege. Add to that,  I good memory for facts and figures (if not for names and dates!) an education in research and statistics, a lot of doctors to choose from (thanks Obamacare!) and the ability in these situations to be furious and remain calm and logical (which, because so many doctors have screwed up ideas of which patients should be listened to and respected, gives me a better chance of being listened to and respected.) That’s a lot of luck of the draw stuff that helps me out.

So a question I get a lot, especially after my recent post about self-advocacy at the doctor’s office, is what about people who don’t have this as an option. It can happen for lots of reasons – from a lack of choice of doctors, to not being a physical mental space where someone can self-advocate (and, again, there’s nothing wrong with that since we should have to prepare for a doctor’s appointment like we’re on the frickin’ debate team.)

First of all (yes, I’m going to say this again) remember that you shouldn’t be in this position in the first place – doctors should not try to prescribe dieting at all since the most common outcome is weight regain, with a majority of people gaining more than they lost – so weight loss does not meet the criteria for ethical, evidence-based medicine. Basically, your doctor is committing malpractice and you’re having to overlook it because of your circumstances, and that sucks, and it’s not your fault.

I want to dismantle medical fatphobia, but I also want the people who are being harmed and killed by medical fatphobia to get help now.  Knowing that, each person needs to decide their own personal boundaries, including taking into account that there may be downsides to misleading your healthcare professional  – it’s sad that sometimes we have to take those risks just to get a chance at decent healthcare, but that’s what happens when we have healthcare in a fatphobic world.

The most common situation that I hear about happens when a doctor is trying to prescribe weight loss for a health issue for which a thin person would get an evidence-based intervention (which is basically every health issue that exists.) Consider asking a question like “Out of curiosity, what is the treatment for thin people who get this health issue?” or “If I lose the weight and still have the health issue, what would my options be at that point?”

Once you’ve established that there is an actual treatment protocol besides attempting to manipulate your size (and there always is,) then you can request a simultaneous treatment, for example “That makes sense. Since dieting can be so unpredictable – especially for people like me with a life long history of yo-yo dieting, and can take a long time regardless, I would like to start the treatment that you just mentioned, and I’ll try weight loss as well, that way we’re doing everything we can for my health.” Then you can do the actual treatment and skip the weight loss. When you come back ask the doctor to focus on the actual health issue and say you’ll keep trying with weight loss.

When the doctor is asking you to consider amputating part of your stomach the stakes get a lot higher.  I once had a doctor tell me that he would withhold treatment unless I went to a stomach amputation recruitment rally (though I’m pretty sure they called it something else.) I refused and argued, but I could just as easily have said “sure, I’ll go.” It’s not like he could have un-set my broken toe if I never went (and unless I was actively protesting it there’s not way I would.)

Sadly in some cases doctors are insisting on stomach amputation (also known as “weight loss surgery”) as a requirement before a fat person can get other medical treatment.  This could not be more fucked up.  First of all, I can’t believe how many people I’ve heard from whose doctor said they couldn’t do a routine surgery because it they claim surgery is too dangerous at their size, and then recommend… you guessed it, stomach amputation surgery.

While people are allowed to choose to have their stomach (or any other body part as far as I’m concerned) amputated, I want to make it very clear that if you are going to choose WLS, then the thing you are trying to fix had better be worth dying for, because dying is a distinct possibility. It’s also a possibility that you’ll be one of the many, many people who has such horrible lifelong side effects that they would do anything to take back the surgery.  To me, a doctor requiring that I amputate my stomach before they’ll treat an actual health issue is time to pull out all the stops  – look for a doctor out of network (or the state, or the country) and try to find a way to fund it, file a medical ethics complaint, do whatever I can do because that is a line that I will not cross.

I’m for healthcare without bigotry and from a Health at Every Size paradigm. Until that’s a reality, I’m for people doing whatever they have to do to get the care they need within their own personal boundaries.

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