Wednesday 18 December 2019

Fat Healthcare

Ragen Chastain has another excellent piece on the way thin people often receive evidence-based care, while fat people with the exact same condition get a prescription for weight loss. Even when the means recommended to obtain weight loss are riskier than the original condition.

A lot of the time, this seems to be less about an objective assessment of risk, and more a way to ascertain who “deserves” treatment and to hold people’s health hostage in order to force them into compliance.

Take knee surgery, for example.  Ragen points out that it’s pretty obvious that nobody’s prioritizing our health…

 when a fat person who actually needs knee surgery is told that they can’t get it because knee surgery is too dangerous, and then they are given the recommendation to have stomach amputation surgery, which is far more dangerous with far worse possible side-effects.

But if it has less to do with the actual risks and complications of the actual surgery, and more to do with viewing fat people as lazy and immoral, and therefore undeserving of care, it makes a lot more sense.  Horrifying, frustrating sense, if you happen to be a fat person who would like to actually get the medical care you need.  If someone’s thin, they’re seen as worthy, but a fat person has to lose weight first, to prove themselves deserving.

There’s also a ridiculous amount of paternalism in medicine, where rather than listening to a patient’s issues, doctors seem to want them to shut up, do as they’re told, and go away as quickly as possible.  This is exacerbated when stereotypes make the doctor see a given patient as “less than” and therefore even less competent to know what they need.  Fat is one example of this, but it also applies to every category of oppression that a doctor can tell by looking at you or infer from your chart. A big part of the terrible maternal mortality rate among black women seems to be from doctors simply dismissing their concerns.

As a white, college-educated woman without any visible disabilities, I probably get brushed off a lot less than a black, visibly disabled fat woman, or than someone whose queerness is more visible than mine because their spouse is the same gender they are.

And yet, it still took 3 different doctors and months of trying to get treatment for hypothyroid. It should have been so very simple.  I was cold and tired all the time, I’d gained a lot of weight despite no change in eating or activity, my TSH was high, and I had a nodule on my thyroid.  It would have been simple if the overseeing doctor hadn’t overruled the PA’s decision to start me on Synthroid.

Nobody ever actually explained to me why this decision was made.  Now, thinking about oppression in healthcare, I have to wonder if the problem isn’t just doctors not listening to patients, but also male doctors blowing off the opinions of female staff, including PAs and nurses, even when those staff interact with the patients more than the doctor does.  It’s hard not to see sexism when the female PA is all set to treat your problem, then the male doctor who you’ve never interacted with swoops in and changes everything without even telling you why.  My mom and my mother-in-law, both nurses, could probably tell enough stories about male doctors being arrogant, sexist, and wrong to fill several volumes.

From there, I went to an endocrinologist who was convinced that my hypothyroid wasn’t causing my symptoms, but had no idea what was, and recommended weight loss.  It was this same endocrinologist who found the nodule and saw nothing at all contradictory about needing to biopsy the nodule and not treating the hypothyroid.  To make matters worse, the biopsy was incredibly painful *and* inconclusive.

At that point, I called it quits with this practice and went to Johns Hopkins.  I had a family member with thyroid issues who was pleased with the care she got there, so I drove two hours to every single appointment.

They put me on Synthroid after the first appointment.  When they went to biopsy the nodule, there was nothing there to biopsy.  After being on Synthroid, it had gone away on its own.

Being on Synthroid was like magic. I could finally get warm.  If my feet brushed my spouse’s leg in bed at night, he didn’t yelp and jump out of bed from the cold.  I didn’t have tons of energy, but I had enough to get through the day without drinking ridiculous amounts of coffee. And my weight stopped skyrocketing upward. All it took was for someone to take me seriously and treat the symptoms I was having, rather than treating weight loss as a panacea or brushing off my concerns without so much as a suggestion of what might help.

via Kelly Thinks Too Much