Okay, not verbatim that, but just about. Here’s what I’m referring to:
A situation regarding the gratuitous ‘obesity’ commentary made by a doctor in New Hampshire has been causing quite a stir in both the media and in the blogosphere this week. I’ve been following the debate and commentary made about the situation and have been horrified at the sanctimonious bullshit people are spewing about the right of doctors to include inflammatory social commentary as part of their medical lecturing on the health risks of being overweight.
So here’s a bit of a rundown on what happened. Dr. Terry Bennett of Manchester, New Hampshire is being investigated for commentary he made to a patient that led to her filing a complaint against him with the New Hampshire Board of Medicine. According to MSNBC, Bennett is unapologetic and explains his actions as thus:
Dr. Terry Bennett, who practices in Rochester, said he has “an obesity lecture for women” that is a stark litany designed to get the attention of obese female patients.
He said he tells obese women they most likely will outlive an obese spouse and will have a difficult time establishing a new relationship because studies show most males are completely negative to obese women.
People have seemed to have a hard time grasping that not only is this charming doctor sizest, but he’s sexist to boot, and has a really poor concept of professional behavior.
A settlement was offered to Dr. Bennett by the New Hampshire Medical Board, but apparently Dr. Bennett feels that his actions were just fine and is in no need of changing his approach:
A settlement agreement was proposed that would have had Bennett attend a medical education course and acknowledge he made a mistake. He rejected the proposal.
“I’ve made many errors in my lifetime. Telling someone the truth is not one of them,” Bennett said.
The abrasive cacophony on web discussions is that being a doctor is a thankless job and the good doctor was being brave and kind for pointing out to the woman that she’s fat and that if her husband dies before her, she won’t be attractive to other men. I’m just boggling.
BSTu, what I meant was, if the doctor perceives that the patient needs help understanding metabolism, nutrition, exercise, etc., there are people who are trained to understand and keep up to date with these things. Just like a doctor wouldn’t hand you a list of exercises for your bum knee, but would most likely send you to a physical therapist for some professional support — I realize that you think that weight loss is never medically necessary (or at least that’s what I perceive from your posts), but even for many doctors who do think that it would be at least medically prudent, they don’t treat excess weight like the medical condition that they profess it to be. Somewhere in there is the juxtaposition between mediocre understanding of weight management and weight related medical issues, and social conditioning and prejudice: Yeah, it’s a medical issue, but since it’s all your fault it’s your job to figure out what to do with it. Geez, even smokers get the benefit of medical solutions to what is clearly a self-induced problem. A person who presents with lung cancer is still offered a medical, not a moral solution.
Now back to the topic at hand, the doctor was almost certainly a jerk, and probably unprofessional, but he may have also had a point about people who want to be tested and medicated and treated
And so it’s OK to be an unprofessional jerk to those people?
Barbara wrote (talking to BStu):
This misses the point. What is the use of considering whether weight loss is necessary, when it isn’t even achievable in a healthy way, for the vast majority of fat people.
That’s what the problem is with doctors prescribing weight loss so much. Well, one of the problems.
HT, this is just a blog, but my short view on this is that, usually, weight loss is the wrong goal. However, that is not just the fault of doctors, though they could lead the way out of the morass — it is often the fault of the patients, who aren’t interested in the other achievable goals that might or might not be accompanied by weight loss if carried through. To a very real degree, many people would rather take a pill or an injection, with whatever risks (both residual and added) accompany that step than to change their behavior. This is not to assign blame but to state a fact — for many people weight loss is the only carrot that resigns them to the “stick” of, say, eating a lot less fast or junk food. Sure, thin people shouldn’t eat fast or “junk” food either (not a steady diet of it anyway), and the fact that THEY perceive no problem with eating it — well, basically, all groups are more interested in issues of appearance than health. (Junk and fast food in my book can be defined as a combination of being light on nutrition and dense in calories.)
I don’t think that weight loss is “impossible” for lots of people (I have no idea what percentage that would be) but it is rarely “achievable” because the hurdles are just insuperably high even when there is a will to change behavior — and this is made evident by the fact that those groups who are most likely to be overweight (low income) face the highest barriers to both good nutrition and the availability of exercise. They also face high levels of stress and inadequate access to medical care, which probably makes not only weight loss but other health related goals very difficult to attain.
Losing weight creating problems for some may be a result of dieting vs. diet. Restricting food groups and stressing to loose large amounts of weight and bumping back up again causes worse problems. When I was younger I could not gain weight. (assisted by coke and crank…) at 30 though I really put it on and fast, I started having issues with gall bladder etc. I took my recovery and directed it towards what I ate and I slowly lost a good bit and am now happy with a little in the middle, as I do not have the blood sugar issues I did when I was very lean. My vitals are all low at this time. I did not go on a diet; I lowered the amounts of foods that were contributing the most, and increased the variety in whole foods.
What I found helpful is a Neurologist friend, (refers to herself as “a big girl”) we were talking about no fat dieting and things she was seeing in her practice and trends in the lit. She pointed out the brain and CNS is largely lipids and many processes require a variety of fatty acids to function. So, I included reduced amounts but high quality fats in my diet. (Cold pressed oils, nuts, fish oils etc.) Life goes on, I get deeply involved with mental health in addicts, and research showing that Omega 3 fatty acids reduce or alleviate depression in certain populations. I get hooked up with some Drs. Doing the research and we start on a few of my guys with severe depression. (It is no secret that depression and bi-polar disorder people have been self medicated with dope for years creating many addicts.) It does little good to get clean and then still suffer from depression. What we are seeing is by increasing a single group of fats, that significant improvement can be achieved in very short periods of time in both affect and from diagnostics. (Then I go and get transferred…another story) this is all so ground level, but it makes sense to a certain degree. What will we find if we continue to fund research on mood disorders as they relate to diet? Perhaps some obese folks are craving a micronutrient that is oil based? Perhaps they need more of specific foods not less to produce the needed affect? There are far more reasonable questions to be asked than to simply relegate ones appearance (based on pop culture) to the determining factor about health and diet. When we get into the judging thing we destroy any hope of objectivity and create this fear and condemnation thing that is cruel and self serving. I hate to oversimplify, but populations become very easy to manipulate when fragmented against each other. The power of advertising and governments (including big buis.) creates all kinds of demand for themselves when folks are scared. When we look with open eyes and hearts, we see there is no fear and condemnation; when that happens, the folks in power will be in trouble for the chaos they create to stay in power. How ridiculous to reduce how we feel about another human being to something as subjective as weight? That is almost as ridiculous as judging someone for their gender… Blessings.
Bean has nailed it. natural’s attitude of superiority over & condescension towards patients is the reason that I have an exhaustive interview of any potential doctor. It is also the reason I tend to avoid them whenever possible.
The best thing we can do is to educate folks that their doctor is most likely as competent in their profession as their auto mechanic or plumber is at theirs. We need to ask a lot of questions, we need to do our own research & we need to have the ability to direct our own professional care if that is our wish.
I’m not fat (yet), but I’ve experienced similar problems of doctors w/ preconceived & unshakeable views about my lifestyle that were false and, therefore, hindered effective treatment.
Bleah. Should be “medical care” in place of “professional care”. Stupid proofreading!
Bean,
Please reread my earlier post. I did not say that all Native Americans are alcoholics. I stated that, as a medical care team member, I should anticipate certain problems. In nursing school, I learned how to do complete assessments on patients. In the real world, this is impossible with the amount of patients assigned to nurses and the time constraints. When I graduated and entered the real world of nursing, I learned to do the “down and dirty” assessments. In these, I anticipate the problem areas of each patient and can hopefully catch the relevant details in order to help the patient recover or stay healthy. In my current field, I know each patient fairly well as I see most three times a week, so this “patient profiling” is not really necessary for me. However, the great majority of nurses work in acute care settings and need to employ a tactic such as this to help the patients (and stay employed). As I mentioned earlier, you may view this as racially biased or prejudicial. To me, it is practical and in the best interests of the patient.
Jake,
I do not feel I have superiority over my patients. Not all of my patients (in chronic renal failure) are in need of my nursing advice in terms of education or referrals. Many are full team players who come in and tell me what they want and need. These patients sometimes teach me about their conditions. For these patients, all I offer is dialysis administration. These are my dream patients who view themselves as part of the team of health care. I wish all patients felt this way.
Education of CRF and the disease processes involved are for patients who are consistently noncompliant. These patients have problems that need to be addressed. One patient, whom I have routinely counselled on fluid restrictions for two months has just been discharged from the hospital for pneumonia and fluid overload. Another has just now gotten onto the transplant list because he just now started to listen to me about being compliant with his treatment prescription time and his blood pressure medications. You may think that I am being arrogant about what I know about these patient’s conditions. But I contend humbly that, in these cases, my knowledge is a benefit to these people. I will continue to do what I do because it helps the patients. Maybe the first patient will not be back in the hospital any time soon, and the second may get a transplant.
One of my ONLY concerns is good outcomes for my patients. My second concern is maintaining their dignity and self -respect. I have seen nurses in this field who just come in and are task-oriented. They perform dialysis and go home. They do not take the time to help these patients help themselves. I teach many patients on something every day. It may be better blood sugar control, how to keep their shunts in good condition, signs and symptoms of infection and electrolyte imbalances, or consequences of nocompliance. For my dream patients, I still offer my expertise about laboratory values and their meanings or answer questions they have that they forgot to ask their doctors the last time they saw them.
I hate to say it, RN does mean that I may know more about some aspect of health care than some patients whom I see. You read condescension, but almost all of my patients see that I care about them. These patients are at risk for pneumonia, cardiomyopathy, anemia, osteoporosis, hyperparathyroidism, myocardial infarction, and death. And this list is only due to CRF itself. Almost every one of these people have comorbidities that put them into CRF in the first place, such as diabetes and HTN. Nutritional parameters for dialysis patients are also VERY different than normal people, and these may need to be addressed.
This is life and death for these people. Believe me – if every single one of my patients suddenly knew all about their conditions, ate correctly, limited their fluids, took all their medication as prescribed, and became compliant with treatments, my job would become a lot easier. It is all about preventing and minimizing complications. If you don’t like my philosophy, that is your loss.
bean, it is just possible that there is a big divide among natural’s patient population — that is, a big educational divide. Anyone who has worked or volunteered in a public hospital or other facility that serves a high proportion of indigent patients sees that you cannot approach every patient the same way and that education plays a very big role in patient understanding and compliance. What would indisputably seem like condescension to you and me probably seems like nurturing and compassionate care to others. I read natural as trying to react based on what the patient brings to the table in the way of their own understanding and willingness and available resources to learn more. It is infuriating to meet a doctor or nurse who will not credit your own abilities, but it would also be less than good care to assume abilities and understanding that don’t exist. For instance, many doctors use medical vocabulary when plain English — even obscene English — is the only thing that the patient might understand. That is also a form of condescension, though it is very different from the type of condescension that you are referring to, and it is not easy for professionals to find just the right touch with each and every patient if they serve a diverse population.
Sometimes when I read these threads I feel like posters don’t quite get that all of these diseases and conditions like diabetes and ESRD (or CRF) fall disproportionately on people who don’t read this or any other blog and likely have very little access to the reams of information out there on their disease, not to mention a decent grocery store. I have a feeling that it is this population that natural is tending to, disproportionately, and it seems a little unfair to assign her such negative baggage.
I just don’t get the parallel between telling your patient, “Keep your shunts clean if you want to avoid infection” and “Lose weight or men won’t want to fuck you.” The former is not a value judgement. The latter is.
Is natural claiming a “natural” link between kidney disease and a few extra pounds ? I’ll probably be sorry I asked…
Here is a link to an article on kidney disease that recently appeared in the Washington Post. Washington D.C. has one of the highest rates of kidney disease in the country.
http://www.washingtonpost.com/wp-dyn/content/article/2005/08/22/AR2005082201155.html
From the WP article:
At no point do they mention that kidney disease can also be hereditary. As someone who aquired it that way, I find it astoundingly sloppy reporting, to say the least.
Alsis,
My experience is in CRF. I write about it because there are items that I discuss with my patients that are clinical but could be construed as value judgments. Once I told a patient going in for a possible transplant that, if he were to continue doing drugs, he would ruin the chance given to him. If he did more drugs, he would be back in the clinic. “You shouldn’t do drugs” – is this a value judgment? Sure it is. But it is clinically oriented, and I was not judging him for doing drugs. I was warning him of the possible consequences for his unhealthy behavior. I was clinical in my approach. Believe me – he did not take it as a value judgment.
I care about my patients. Judging patients for bad behavior is counter-productive for me, and there is no clear line with respect to a patient’s accountibility for his or her illness. Most in my clinic are here for diabetes and HTN. Is it their fault for having diabetes? Is it their fault for not keeping their blood sugar in control? Is it their fault for being too poor to afford the blood pressure medications? Is it their fault for not eating better? I can’t and won’t answer those questions.
My job as a nurse is not to judge. It doesn’t matter to me one way or the other how or why people have these illnesses. My jobs are to understand the disease processes and to work with the patients to prevent and control them. Values make not factor into the way I do my job.
The main problem I have had in these posts is not because people are upset about what the doctor said. If I were the medical board, I would mandate the doctor take a class on bedside manners as well as do a literature review about obesity (in regards to psychology and mortality). His comments were unfounded and wrong. However, I have a problem with posters not allowing the doctor to connect body functions with illnesses and being overly defensive about it. Obesity in the medical community is described as a disease with connections to other adverse health conditions. I don’t think it out of line for a doctor to have the opinion that the underlying cause for the patient’s complaint(s) may, in fact, be caused by obesity. The good doctors do complete physicals and tests to rule in or out possible causes. But if the doctor’s medical expertise points to obesity, that should be allowed.
The health care process is a team sport. The client is paying the doctor for an opinion and medical skills. If the client does not like the diagnosis or opinion, it is ok to fire the doctor and find someone else. But the client should also check modesty and defensiveness at the door.
Most doctors do not mean to judge behavior. However, some doctors may get frustrated by patients coming in over and over who complain about correctable problems and do not listen to their advice. This doctor was over the top, but to me it seems like he has given up the normal warnings because they didn’t work.
I could be wrong. But I encounter frustration like that every day. I tell some patients that they are killing themselves by their actions. These are not fat people or people who just have CRF. These are people in ESRD (end-stage renal disease) who routinely get their catheter dressings wet, drink themselves into the hospital, and eat 5 tomatoes in one sitting (causing increased serum potassium). I am not passing judgment in the societal sense – “what you doing is wrong and immoral”. However, I am judging the patient on how much the patient wants to be relieved by his or her symptoms.
People on this board continue to write about their experience with being fat and compare it to this obese client. I am merely trying to explain the reason why the medical community makes a stark dilineation between fatness and obesity, the latter being related to other disease processes. I find fault with posters who deny the medical community’s ability to assert that obesity MAY in fact be either a cause or a mitigating factor.
Research is important, but the doctors are in the trenches every day. It is harder to ignore the fact that many hospital patients are obese (meaning they may be sicker) or that the obese patients have a preponderance of certain other illnesses when they see it first hand. Obesity, in some cases, is easier to correct than curing the patient’s insulin resistance, HTN, or
replacing all the joints.
I am not saying that curing obesity will cure all other ailments in our patient populations. But one should not remove a weight loss strategy from the medical arsenal.
natural,
I appreciate that you do not intend to come across with an attitude of superiority or condescension. I fully believe you when you say that. Yet, I am not the only one who gets that impression. I don’t mean to be insulting in this comment when I say that, perhaps, you might examine your communication style to see if there is any validity in what I and others are getting from you.
It is truly a good thing that you don’t judge your patients. I wish that there were more medical professionals who did the same.
I want to note that it is not necessarily a bad thing to have a preconceived notion of a patients lifestyle. But it is bad if that view is unshakeable – which seems to often be the case when dealing with fat or obese patients.
natural, even if there are doctors who sincerely believe that weight loss would be a good or essential step to improving a person’s medical condition, that belief is more than counterbalanced by how frankly amateurish most doctors’ efforts are to assist the average patient in such an endeavor, I mean, especially compared to the efforts that doctors make when they are advocating this or that test or drug. The alleged seriousness of the problem is hardly matched by the seriousness of the effort made to address it. It is no wonder that patients are underwhelmed by doctors who advocate that they lose weight.
Jake –
I am only speaking of patients who need guidance in their health care. My patients who cannot seem to make the connection between their drinking fluids and their shortness of breath are my focus of my teaching. These people NEED someone who can explain the physiological processes of those with ESRD (or diabetes and HTN for that matter). If they don’t get it, I just need to teach them in a different way. The point is that they must somehow understand at some point in time. I cannot be with them 24 hours a day. For these patients, I do know more about these processes. That is why I went to school. I am sorry that you and others do not seem to understand that this is literally life and death for these people. I am paid to keep these patients safe and to try to prevent further morbidity.
I am not calling anyone stupid. On the contrary. Many illnesses are complex in their etiology, symptoms, and physiological effects. I learn about a new apsect of ESRD almost every day at work. Many of my patients are very smart in their respective fields. I often ask their advice during treatments. You should accept that a medical professional is not any different than any other professional. Not infallible, not ominscient, but certainly specialized in terms of knowledge. I would not accuse my mechanic of a feeling of superiority if he had to tell me that I was not changing my oil enough. Just because it is a human body does not make it any different.
Like I said in my earlier posts, patients who are active team members are not victims of my wrath, as you and others like to see it. For these people, I only assess and administer treatments. I do not emphasize it as much because this thread is about a woman who routinely came to her doctor with ailments who was subjected to an assinine lecture. She refused to be assessed (weighed). Obviously she is a patient in need of teaching that she should try to be more of an active recipient of health care.
You and others seem to be active participants in your health care. However, you are not in the majority. I am fortunate that you exist. I may be fortunate enough not to ever see you in my clinic. However, many clients who come in for multiple complaints (including some of my patients) are more passive. They have a problem, and they expect the health care provider to make it better. Take a pill, and you will feel better. For some of my patients, they expect to get a transplant without being compliant. They want to not have to alter their behavior now, not understanding that they will have a detailed regimen of pills and doctor appointments after the transplant. This is the world I work in. This is what I am referring to.
What you and others do not seem to realize is that two of a nurse’s main jobs are to assess and to teach. This is what I do every day. Of course, each patient may need varying levels of both of those things. Some patients need no teaching. Experience helps me to teach what I need to without brow-beating people. If you think that I do that, you are mistaken.
Barbara,
I am in total agreement. I often wonder why doctors do not have more pharmacology or nutrition during medical school. That is one (of the many reasons) why Merck (the maker of Vioxx) is in so much trouble. The drug reps come and advertise all the benefits but do not mention any drawbacks or limitations in effects. The doctors could have avoided most of this by simply reading the inserts (or PDRs) before prescribing these to their patients.
I think that nutrition, body mechanics, and exercise physiology are core components of preventive medicine. It is a shame that many doctors are more focused on treating disease instead. Please do not fault those who are really trying, even though they are incompetent. Hopefully they will get better. Most of us in this field are constantly trying to improve our skills and information. It is in the patient’s best intersets that we do so.
The best doctors go out of their way to learn more about these things. Others just give good referrals so the patient does not end up flailing in the wind. That is one reason why I love my job – my close contact with the patients allows me to address some of their concerns when the doctor does not have time. If I can’t help them personally, I usually find someone who can.
Some doctors make recommendations but offer patients no concrete, detailed plan for achieving the goal. Any person who feels that this is the case should demand that they do so or fire them. Again, it is a team sport. If you don’t understand something, speak up . If the doctor doesn’t help you, change teams.
Did I say something? No, no, I didn’t think so.
natural’s response is a perfect example of the attitude that I have seen in the medical profession. She didn’t actually address what I had written, she took my labeling of her mode of communication (“superior & condescending”) to mean that I said that she was calling people “stupid” and that I saw her writing as full of “wrath.” None of those assumptions are true, she just heard what she wanted to hear. natural just wrote past my comment and went on with why she is right. There is no possibility that there is something in her method of communication that is causing the impression of superiority and condescension that I see, no possibility of self-examination. I just see her as angry and calling people stupid and, so, can be dismissed.
This, natural, is my point about your style of communication and my point about the attitude of most medical professionals with whom I have interacted.
If the doctor doesn’t help you, change teams.
What is your attitude if someone comes to see you and, looking at their chart, you find that they have seen 8 different doctors in the last 2 years? Most doctors are immediately certain that this is a “problem patient.” I don’t disagree with your advice, but you don’t mention the probable repercussions of “changing teams” until you find someone who can work with you.
Jake –
I don’t know how you are reading into my comments that I feel that I am better than my patients or that my opinions of them are unchangeable. What part of “a team sport” are you getting that? I am getting tired of having to explain why it is my experience that I cannot treat all patients the same because they are not the same. This thread is about a patient who refused to be weighed. If nothing else, she was noncompliant in that she did not allow the doctor to assess her completely. Being weighed is not only for a number but to see if a change exists from the last visit. My comments were directed towards other noncompliant patients and explaining the health care provider’s POV on health, obesity, and compliance. Nothing more.
Just because you are knowledgeable about your body and try to learn all you can does not mean that everyone else does (or wants to do) the same. My job to reduce morbidity is the same no matter what the patient brings to the table, so if the patients brings less, I have to work more. When they are my patients, I feel that I have a responsibility for their safety. The nursing board in my state agrees.
You write that it is best that the patient learn more. This is definitely true. But it can be common for patients with chronic diseases to not think that this is necessary. It is common that some patients want to exert control over their illness and refuse to alter their behavor. Others have given up thinking about their condition and would rather just have the provider tell them what they need to do from day to day. Luckily, a lot patients learn to take an active part in their condition after their fourth trip to the emergency room for pneumonia. Alas, it is not always the case, and some people will never want to become as active participants on the team as you and I would want them to. Just because you are not one of these patients does not make them not exist.
You write that my interpretation of your comments to me about my thinking my patients are stupid is wrong, yet you write in the same paragraph the very same idea. Now tell me that I was wrong to take your comments that way. I have not been angry, but I am starting to feel that way because you refuse to see it from a health care provider’s point of view. This is the whole reason for my comments on this thread. Sometimes I have to worry more about the patient dying while on dialysis because his or heart is so weak and this person put on 20 pounds of fluid since last treatment. Tell the spouse that although I didn’t try hard enough to convince the patient to stop drinking so much, the heart attack and death was justified because I didn’t portray the feeling of my superiority.
You may despise my “feeling of superiority” to a select few (and only these, I might add), but I can assure you that my heavy-handedness can help. You do not allow me to explain that I know these patients and am only trying this tactic when nothing else works. If the patient is changing his or her behavior only because he or she doesn’t want to hear my lecture again, that is really ok with me. The goal is to reduce morbidity. All my patients know that I care about them, and there is a reson why I am lecturing them for the upteenth time. And don’t think that the health care provider is the only one using this technique so you can label me as having a God complex. Noncompliant patients’ spouses also lecture and scold. So now their spouses are angry and think their husband or wife is stupid? The fact is that I treat patients like people. There are different types of people in this world, and it is wrong to assume otherwise. Some people do not need guidance, but some do.
For the record, I (as a patient) have had a problem with doctors. When I hurt my knee several years ago, 3 doctors told me there was nothing wrong with it. Did I get frustrated? Surely. The third doctor told me that all I had to do was put on a Nike shirt that says “Just do it”, go back to running, and forget about it. To him, it was all in my head. It was an offensive comment but it was also just his assinine medical opinion. As a patient in charge of my own health, I did not get discouraged. I still had pain, and by a year’s time, my leg was starting to stiffen up. I knew that those doctors were wrong. I sought a fourth opinion. This last doctor did not think that I was a problem patient. He examined me and then repaired my torn meniscus.
Your experience tells you that doctors see these type of patients as problematic and refuse to look at the complaints with fresh eyes. My experience (both as a patient and as a nurse that deals with several types of doctors) tells me otherwise. Doctors are people too, and they can deal with this issue differently. Some do dismiss complaints, but not all do that. You may be projecting your bad experience onto the whole medical community. You want doctors and nurses to see you as a unique person and not as simply a problem patient, but you refuse to see doctors and nurses as people too. Many doctors and nurses are quite competent, have the urge to discover a cause for your ailment, and do not pigeonhole patients (even if you think that we do). Please take the time to see that.
natural writes:
I don’t know how you are reading into my comments that I feel that I am better than my patients or that my opinions of them are unchangeable.
What I read from your comments is an attitude of superiority over all of us on this thread who are not medical professionals. I have no idea whether or not you feel that you are better than your patients, I can only speak to what you have written here. I have never said that your opinions of your patients are unchangeable. What I have said is that many doctors have a preconceived notion of what is wrong with a patient based on first appearance and are unable to change that initial opinion.
I still feel that you have not really listened to what I am trying to say. So I will try to put it into a couple of simple sentences.
Your writing on this thread leaves me (and, it appears, several others) with the impression that you have an attitude of superiorty. “I know what is best and you non-medical professionals have nothing of value to add,” might be a summary of this attitude.
Your writing on this thread has seemed to me (and, it appears, to others) to be condescending.
The condescension and the attitude of superiority seems, in my experience, to be typical of the medical profession.
Your responses to my comments seem to have ignored, for the most part, what I have actually written and, instead, been about how your assessment is correct. This is also, in my experience, typical of the medical profession.
natural writes:
I am getting tired of having to explain why it is my experience that I cannot treat all patients the same because they are not the same.
I never once asked you to treat all patients the same. I did, however, say that I felt you were being condescending in your comments. “Condescending in your comments,” is in no way related to how you treat your patients. Rather, it is how you are addressing us in this thread. I find the condescension to be typical, again in my experience, of the medical profession.
natural writes:
You write that my interpretation of your comments to me about my thinking my patients are stupid is wrong, yet you write in the same paragraph the very same idea.
What? Perhaps you should read that paragraph again. You have misread it. The last sentence was meant to reflect your point of view – what you thought I meant/had written – that is why the end of the sentence reads, “and, so, can be dismissed.”
This is typical of your responses to me – you read what you want to read, not what has been written.
natural writes:
All my patients know that I care about them, and there is a reson why I am lecturing them for the upteenth time.
This is a great example of your attitude of superiority. You know this to be true. It is an unquestionable fact in your opinion. You never, in your writing in this thread, leave open the possibility that you are not 100% correct. How do you know that 8% of your patients don’t know that you care about them but are afraid to say something about your interminable (“upteenth time”) lecturing? The fact is that you don’t. Perhaps you could have written, “I believe that my patients know…” That would have made the same point without trying to establish it as undeniable.
This is what I am trying to tell you. I don’t think that you are a bad person, nor do I think you are doing less than your best for your patients. I am trying to make you aware that the way that you communicate may not be being perceived in the way that you intend it to be.
Rather than say to me, “Gee, I’ve never heard that from anybody before. Maybe I will pay more attention to how I say things and how people/patients react,” you spend your time telling me how I don’t know how you treat your patients and how what you do & how you communicate is correct. You don’t see the attitude of superiority or the condescension in that?
What amazes me about this whole exchange is that when I say, “When you do X, I feel Y,” you respond with, “There is nothing wrong with me doing X, the fact that you feel Y has nothing to do with me.” Your inability to acknowledge the possibility of a connection is yet another example of what I am trying, obviously ineffectively, to say to you may be a problem.
I feel that we are talking past each other and I feel that that is mostly on your part. I think that I have been saying the same thing to you consistently, yet you respond as if I am saying something else. I don’t know what I’m doing wrong in trying to get my message across to you, but I’m trying my best to figure that out.
OK, now we have a plethora of evidence that Bennet’s handling of patient care goes beyond the standard physician’s bed-side manner is mis-match to patient needs.
natural, I think that what is happening here is a disconnect between your version of professional communication and the one that your audience expects or desires. As a communicator, then–and a great deal of a nurse’s job is to communicate well– your job is to find a way to reach your audience more effectively, rather than to simply argue that everyone is wrong about your intentions, motivations, and attitudes. You probably make these audience-based accomodations all the time “on the floor” without even thinking about it.
Or, maybe you should think about it–especially if you are lecturing a patient on ANYTHING for the “umpteenth time.” If you fail to reach your audience, then perhaps it’s your communication (content or style, take your pick) that needs to change, rather than the audience’s ability to understand the meaning-behind-the-meaning. In a way, I think that the way you assume that the problem is in the (amateur) hearer rather than the (professional) speaker is indicative of the problem that many of us have with the medical community.
And sometimes you guys are just plain wrong. We know it, and that doesn’t help us to feel secure in granting you a cloak of credibility simply because of your profession.
Sometimes, speaking to your audience instead of at them involves acknowledging your own fallibility–even if you are a trained professional. We acknowledge your training, dear, and your good heart. Now, please, acknowledge that the wisdom of the medical community is very “conventional” in many ways and that looking outside the box that we patients are presented with is one of the few ways that we can experience some control. Peace be with you all, no hard feelings, I hope, and I’m glad to join this thread.
Hey, now. If this doctor offering racist commentary makes one fat person feel awful about themselves, then he’s done his job. Why, this man deserves a medal. Perhaps a nomination can come from the crew above who were so gleeful about excusing his invasive “advise” when it was “merely” sexist. Surely, if sexist fat bashing is allowed, so is racist fat bashing. Its all just because he cares, don’t ya know.
Actually, I am constantly trying to alter my communication style with the patients. It is my job to attempt to reach them. However, some of you don’t realize that some people with chronic conditions have this need to control their situation. They miss treatments because they despise having to come in 3 days a week for the rest of their lives. They do not check their blood sugar regularly because they feel fine (and then they may have to actually inject themselves with insulin if the readings are too high). The list is exhaustive for these patients. It is frustrating to hear their complaints after their fingers or legs were removed when they should have been compliant with their diabetes regimen. I have trouble reaching them. You try it.
I completely agree that those of us in the medical community can be wrong. Lord knows that this doctor in question was. However, I attest that sometimes patients must allow us the possibility that we are right, even if our answers are not what you want to hear. This is what I was reacting to. I hear so many people question the medical profession more than other professions. Maybe I am just more sensitive. But I do not see these people jump on the lawyer for professing more knowledge about the law because these people watch Court TV.
The internet is a valuable resource for knowledge, but not everything in it is correct. Surely a wise patient should check in on it to help ensure his or her health care provider is on the right track (or make suggestion because the said person is completely wrong). If you think the doctor is not fulfilling your needs or right in the diagnosis, please speak up. Most doctors will respond respectfully. The ones that will not treat you with dignity do not deserve you as a client. But do not be so quick to jump on the doctor because he or she doesn’t really know anything or is certainly wrong.
I feel that this society is very complex in its structure, encorporating many niches of knowledge. The mechanic knows a heck of a lot more than the average person about a car’s transmission. An engineer knows more about Fluid dynamics. And a doctor knows more about the human body. I realize that, since everyone has a body, he or she has some basic understanding. But please allow the doctor to state that, from school and experience, obesity may be related somehow to the complaint you are coming in with.
Jake –
If I had said that “all my patients love me” or that “100% of my patients know…”, I could be totally on board with your objection to my comment. However, I made a generalization. A generalization does not imply “every” with regards to a parameter. Why did I make a generalization like that? Because I work with these same people for 4 hours, 3 days a week (until recently). I get to know their children’s names, know what they did over the weekend, and their anxieties about their upcoming surgery. How can anyone “know” about what other people think? By actions. Patients call when I am not there, ask for me, and hang up when they find out that I am not working that day. Others find out my new schedule and call me on the days that I am at work. When I told the other shift that I was going to cut back my hours, many expressed a dismay that now who would help them. Not every patient. And I am not the ultimate nurse that everyone flocks to me. It is just that they trust me more than the other nurses to help them. Should I put a qualifier like “I feel that” before that statement? Maybe, but maybe it is not necessary.
An amount of certainty is valuable in any profession. How else can one be expected to do a job that one doesn’t feel confident in one’s abilities? In health care, confidence is very important. If a patient was told that the doctor was kinda sure of a diagnosis but not positive, would that patient see that doctor again? Most assuredly not. If the patient did not object to running a whole host of unnecessary tests because the doctor was clearly grasping for straws, bet that their insurance carriers would drop them faster than you can say “medical incompetence”. There are inherent ramifications for being wrong. State medical and nursing boards have been put in place to address that issue. Courts are filled with cases brought by patients or their survivors. Some of you have deep animosity towards our “cockiness”, and some of it is well-deserved. However, I assert that doctors and nurses are often reared to be that way. Do not exault the confidence when “the doctor knew right away what was wrong with me” but remark how condescending the doctor was under your breath when you think that he or she is wrong.
Thanks to ol cranky for the link. It is a poor excuse for a practitioner to not understand medical literature (and I have never run across a peer-reviewed study of black men’s attraction to fat women). It is a poor excuse of a professional to make the patient feel bad about him/herself. But most importantly, it is a poor excuse of a human being in the 21st century to insert race into an issue when it is inflammatory and unnecessary. My only question is how this man has gotten away with this behavior for so long.
ceres writes:
Good point, Ceres. In my opinion, if a doctor or other medical professional should NOT be giving a patient a medical lecture on anything for the umpteenth time. If he/she does find him/herself about to give a lecture after the point has been made to this patient several times already, then the professional should stop a moment and think “Hang on, I’ve said this before, if I just repeat the same lecture it’s unlikely to have any effect except to make the patient feel nagged. Is there a better way?”.
For example, a doctor might say something like “I remember saying to you a few times before about the importance of …. in order to avoid …. but I see you haven’t been …. this time either. Is there some problem that prevents you from ….. ? …. Is there anything I can help with to help you do …. because I sure hate to see you with these problems. The patients that do manage to do …. only 5% of them have recurrences.”
In other words, there’s a different in approach between
“Bad non-compliant patient! Have a lecture”
and “Is there some way we can improve the situation here”
natural writes:
Your description sounds so innocuous, but there is a big range of patient experience with doctors mentioning obesity, from the innocuous to the very upsetting/harmful.
For example, suppose someone is fat, and comes to see the doctor with a bad knee.
Some doctors may take the “lose 100lbs and call me in the morning” approach, that is, they put the ball firmly back in the patient’s court, and refusing to contemplate any treatment except weight loss.
Some doctors may take an obesity-mentioning approach more like “Well, being heavy can exacerbate a bad knee, but losing weight is extremely difficult and thin people can get bad knees too, so let’s examine your knee and see exactly what the problem is and see what feasible treatment options there are.”
The problem with doctors isn’t really that they describe how obesity is related to medical conditions, it’s that they insist on weight loss as a primary/only form of treatment when it’s not practical for the patient, and they treat the patient with disrespect.
Most doctors probably don’t think they treat their fat patients with disrespect, but I believe that any time they think the patient isn’t telling the truth about their lifestyle, or they assume things like the patient has an eating disorder, or doesn’t care about their health, or doesn’t exercise, or is making excuses, … that comes through in how they treat the patient. Sure, they probably won’t say it out loud explicitly. They probably think they are being kind and professional to the patient. But every time a doctor has a lack of respect for the patient, I believe it will come through and a patient will know it.
I can’t work out which is more infuriating, doctors who insist that weight loss is feasible and practical and any reasonable person ought to be able to do it (hello? haven’t they read any medical literature on the long-term weight loss success rates?), or doctors that acknowledge that long-term weight loss is nearly impossible but still insist that you have to do it anyway.
Here’s what I say about Dr. Bennett and the First Amendment:
http://christopher-king.blogspot.com/2005/10/youre-so-obese-only-black-men-will.html
Let’s get a grip, here folks. Dr. Terry Bennett’s comments, in lilly-white New Hampshire, are not the same as a doctor telling a skinny black woman, “you’re so skinny only white boys will like you,” and if you can’t see that, or comprehend why it’s different in a context like this, you may be cursed with another physical ailment beyond the Good Doctor’s bailiwick: Myopia.
Having dated leggy blondes to short brunettes and women of many body compositions between 4’10” to 6’2″ and in between, I appreciate all sorts of women. But apparently some white professionals in the “Live Free or Die” state don’t appreciate black men appreciating white women in that way because he used it as a scare tactic. Well that’s pretty scary to me, folks, so I’m gonna file a complaint with the Seacoast Branch of the NAACP later today. Peace.
PS: His speech is not entirely protected by the First Amendment, as mine was and is in Jaffrey, New Hampshire. He relinquished a degree of his First Amendment Rights by agreeing to be subject to a regulatory board — and he may even be governed by commercial, rather than general, Free Speech doctrines. I, on the other hand, was exercising a Fundamental right as a free negro (or caucasian) citizen to seek redress for a man who faced three (3) drawn guns, arrest and a body cavity search from undercover police who rousted him and eventually charged him with “loitering,” which he beat. See my 16 Oct. blawg, “Open Complaint to NAACP Legal Defense Fund,” which still has not been answered substantively.
-c
I’m a widow. And I am fat and ugly. Yes fat is ugly. I agree. But I’d like to know why these doctors think we have to have a man in our life? If a man chooses to dislike me because I am fat, oh well his loss! I like my independance. I totally enjoy doing what I want when I want without having to answer to someone else. And if a man is more worried about the cover than the book, then he is very shallow and not worth my time.
Dr. Bennett must have been, at the very least, very frustrated by this patient. Yes, he’s blunt, but to make such a statement he must have been at a point where he couldn’t think of anything else to get through to her. That’s his job. To get through to patients and make them healthy. So what’s the problem here. He’s my doctor and I think he’s great. He tells it like it is. Like “quit smoking or you’re going to die”. I find it very hard to believe he said anything about a black man. He was just trying to get through to her, that her life was in jeopardy. Were any of us in his office when these things were supposedly said? No! Is there a recording of any of this? No! Do we believe everything we hear? No! Just because it’s in print is it the truth? No! Is it the job of the board to punish a doctor for his bedside mannner? No! It’s time this silly case ended and that the board got back to more serious business, such as getting rid of doctors that are “actually doing harm to patients”. Does the board take into consideration that this “terrible” doctor probably doesn’t make any money in his practice because he treats you whether you have insurance or not? Does the board take into consideration that he is available 24/7, whether you have insurance or not? Does the board take into consideration that this doctors office is almost always full? Terry is probably one of the most intelligent people I have ever met. He doesn’t say these things to hear himself talk. He is genuinely concerned about our health and will do just about anything to get through to us even knowing that it will hurt us emotionally. I would rather be a little offended by what he says than to die because he didn’t do whatever was necessary to get through to me. If your that thin skinned, don’t go to him. If you want a good doctor who knows what he’s talking about, go to him. As far as I’m concerned this woman is just looking for an easy buck and to get her eqo stroked. Personally, if I were overweight I’d do everything possible to keep myself out of the limelight and to lose weight. Maybe if she lost some weight she wouldn’t be quite so sensitive. Dr. Bennett has been in practice for 40 years and this is only the second time he’s had a complaint filed against him. That should tell you something about what kind of doctor and person he is. This country has become sue happy and because of that it is becoming increasingly harder for a doctor to pay for malparactice insurance, which is causing the number of people becoming doctors to decrease. Can we afford for this to happen? Definetely not. This insanity must stop and this case is a good place to start.
My neurologist recommended that I lose weight after doing a meylogram and two MRI’s to confirm the ruptured disks in my back. After he performed the surgery and I’d recovered, we had a long conversation about maintaing my back to prevent further injury. One of the things he mentioned (after proper lifting, and exercise) was that I needed to maintain a healthy weight. He stated openly that the guidelines used to guage this were not exact, and that my pre-injury weight of 143 was a good goal for me.
My gp has mentioned to me that carrying extra weight can often aggravate knee injuries and he mentioned a book that advocates a balanced diet with “good fats” rather than bad, portion control, and a moderate exercise routine. That was how I lost the weight originally.
The doctor in the article used poor judgement, but to say that in all cases that obesity is a cause of health problems is just as wrong as the statements I’ve heard that obesity isn’t a mitigating factor in some diseases and health problems.
I’m thankful that my doctors think enough about my health to risk my getting offended in pointing out what I should already know. And both of these men never made mention of my appearance, dating, or social life. They were more concerned with my current eating habits, what exercise I had been doing since completing my PT, and how I was planning on handling my return to work.
If you aren’t happy with your doctor or doctors then change. And you don’t have to tell the new doctor about any previous physicians.
Excuses, excuses, excuses. Its amazing how much can be excused with a little fat hatred, isn’t it?
But that’s right, the doctors who look at the evidence and realize that the conclusions drawn have no factual basis are just as wrong as those who threaten patients with sex with black men. There is little cause to think you are open to these issues, when you equate disagreement with you, Mendy, with the kind of bigoted and hateful remarks of this nutjob.
BStu,
I don’t hate fat people, I don’t hate anyone for any reason unless their actions give me reason to. I’ve stated before that I understand that fat people are rountinely discriminated against. However I cannot understand how weighing 700 pounds and being physically unable to walk is healthy for an individual (Admitted this is my opinion, if you have a study that states I’m wrong then I will admit I’m wrong.)
That being said someone who weights 90-120 pounds can be more physically unhealthy than a person who is overweight. I never admitted anything else.
I’ve not seen any studies that state that the modern conclusions are incorrect. I’d like to see some of those studies. I personally don’t equate your disagreement with me, but with the idea that in *any* circumstances could a persons weight be a mitigating factor in their health. Notice I said a mitigating factor and not a primary cause. And I can’t speak to everyone, but I’ve been told by people a lot larger than me that if I’d lose a few pounds I’d feel better.
I’ve enjoyed reading the thread, but I can’t continue to participate.
I’ve done some research. I must say that the experts are about evenly divided over obesity as a cause and obesity as a mitigating factor. The three studies I’ve read and the four articles suggest that BMI alone isn’t an indication of premature death unless other factors are already present: high blood pressure or a family history of diabetes.
So, I would think that being over weight and “fit” would be better than being “thin” and a couch potato.
I also need to clarify my position on what the doctor in the original post did. His behaviour was unproffessional at best and bigoted at worst. The patient was well within her rights to contact the state regulatory board and complain.
The doctor was wrong, period!
Most of the research I’ve seen in the past hour or so seems to indicate that being overweight in the presence of existing hypertension, pre-disposition of caridiac disease, or tabacco use, the the weight can be a mitigating factor in the expression and results of these disease pathologies.
My biggest complaint is the inconsistant methods we use to judge “normal” versus “non-normal” weights. BMI isn’t reliable as a very fit person will have an abnormally high BMI. And just using weight isn’t a good measure either. In conclusion, I do not feel that being fat by itself is an indicator of bad health. But being big when there is predisposition for high-blood pressure, cardiac diesease, or diabetes — then it isn’t the weight that causes the illness, but acts as a mitigating factor to how the illness presents.
BStu: I’m not striving to be thin, but only to be healthy. If I’m healthy at 170 pounds, so be it. I don’t eqate disagreement with me personally, as being anywhere close to what the doctor in the article said to that woman. Had I been his patient, I would have called him on it and let everyone in his waiting room know he was a bigot.
However, when dealing with this issue along with others it can become personal. I’m not trying to make any conversation personal, beyond the fact that I can only speak to my personal experiences. (Note: my experiences are not everyone’s, nor are they to be considered normative.)
I may have misunderstood you, BStu. Are you saying that in no instance does weight ever play a role in a person’s health?
I’ve long lost my patience for faux-middle grounders who claim to object to both sides of the debate when that’s not what they are doing at all. They are objecting to the entirity of one side and only extreme rhetoric on the other. What they suggest as compramise really only gives the hate mongers everything they want. Just without the explicit hate monger. Kinder, gentler fat prejudice is still fat prejudice. All the faux-middle grounders are doing is fighting for the status quo. They middle ground they claim is squarely on one side of the debate. But still they insist on the appearance of being “above it all” while their stance betrays them. Insisting on one side give up everything they believe in if the other side just tones down the hate a little is not genuinely trying to find a consensus. Constantly adopting the stance of “well, surely you don’t mean that” is not something I can respond to. If you see fat acceptace as the equivilance of vicious and racist fat hatred, then I don’t know how you can expect me to be able to justify myself to you.
I don’t expect you to justify yourself to me. Here’s the deal: The middle ground you say I’m not standing on exists, because I am squarely on it. I asked for cites to the studies that state that being fat is not bad for you. I asked for more information, and all you can do is attack me for not blindly following along behind you.
That’s fine. I don’t hate you for any reason. I do not hate fat people, because I myself am fat as is most of my family. You don’t truly want a consensus, you just want to rant.