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Ana

Last year at my annual gyn checkup (or was that two years ago now? I'm not really strict about the annual part) I hit my highest weight ever on the doctor's scale. Let's just say it was above a sort of milestone that I didn't know I was above, and it made me panic enough to actually tell the doctor I wanted to lose some. She said, "Increase your intake of water, vegetables and fiber, and get 30 minutes of exercise every day."

That was a pretty good response. I liked that she didn't give me a list of don'ts and forbidden foods. Just some small behaviors to change. I haven't completely changed them all but I have improved a bit and lost about 7 pounds since then without a big ol' effort.

Melissa

I agree with that kind of response, Ana. Just the kind facts, ma'am. As long as a moral/social/etc. view doesn't color the advice, then you should feel free to tell your patients your best health advice. Since you are obviously thinking about this, I'm sure you will do just fine. Yay for another good doctor!!

Mary Siever

I agree, the facts, no judgement and a lot of understanding and compassion.

It isn't just weight issues that doctors can be so insensitive about, when I miscarried my first child, I had gone for an ultrasound. The radiologist took one look at the ultrasound and said "How far along do you think you are?" and then when I told him 10 weeks, he said " This isn't a viable pregnancy" and proceeded to tell me to wait for a phone call from my primary care physiciam and left the room. NOW, I would lambast him for his ignorant and completely inappropriate attitude (I had just recieved a shock. I had no idea my baby was dead), then, I was the typical "doctor can't do wrong" well, ok, not that bad....but I wasn't confrontational. I later commented on a comment card specifically about his nasty attitude. People like that shouldn't be allowed around anyone.

M

I'd say one of the most important things is if you do need to tell someone to lose weight that you don't bring anything into it other than health. (I think I remember someone saying in a comment that their doctor suggested that losing weight would help them get a boyfriend?)
As Melissa said above, really just you thinking about this is a good sign, and that you'll treat people the way you want to be treated.

In one of my experiences, my doctor had found that my acid reflux got worse and he automatically blamed it on my having gained weight. (Yes, I had gained a lot, but most people around me realized that there had to be something wrong if I gained so much so quickly.) He followed up with "that's another reason to lose weight." I wasn't quite clear on what precisely were supposed to be the other reasons, being that the word "another" implied a list. I asked him if the acid reflux could be at least partially caused by anxiety, and he told me that "everyone has some anxiety." He said that knowing that I'd just been put on a fairly strong prescription anti-axiety medication. Incidently, this was also around the time that pain killers causing stomach problems was being highly publicized.
I'd say the problems there were:
1. He brushed off my question giving no consideration to my medical history
2. He didn't ask any questions about my lifestyle (pain medications, acidic foods) that could be causing the acid reflux
3. He didn't propose other solutions besides losing weight
4. He didn't have any suggestions for healthy weightloss

I guess the main points are respect (as you know), if you need to recommend weightloss help the person with reasonable suggestions and even referals to nutrionists who can help them in healthy ways, and consider all possible causes of a problem before jumping to the "if you lose those 5 lbs everything will be cured" conclusion.

Sorry about being so long-winded!

Sham

I am going through the "you need to lose weight" anxiety issues with my ob-gyn. He is a great guy and pretty tactful about it all. He has compiled a little pamplet to hand out that has some recommended ways of losing weight all very healthy and managable and he is also compiling good healthy recipes that mimic favorite often not so healthy recipes. Bottom line, he is being very helpful, pointing me in some directions and doing it in a concerned friend sort of way. Less stress than a Dr who says lose weight and leaves it at that. I say as long as you give good solid info and facts in a caring and friendly way your patients are going to respond just right. Offer suggestions and be responsive to their comments and I think you will do great!

Anna

I remember one visit to my old family doctor when I was complaining of migraines. I had done all the right things before my appointment... You know, keeping the migraine chart of when they happened, my diet, my environment, all that jazz and he completely blew me off. Instead of looking at my three month's worth of migraine charting or listening to the helpful comments I was giving (ie 'I seem to get them most frequently under flourescent lighting') he just said 'Maybe it's the changing of the seasons. Wait a few months and see if they get better.'

What the hell? Three months wasn't long enough for a complete season changeover to have occured already? Never mind his utter lack of concern when I told him that I had collapsed at school because of the pain.

I'm sooo glad I have a new doctor. She had better work until the day she dies, because I will cry like a schoolgirl if she ever retires.

My heart goes out to you, Mary. Having a miscarriage sucks, I know.

leap-b4-ulook

You know, I've known for awhile that many of the overweight people I've met in support groups, etc, have child abuse issues they're dealing with, but I recently learned that when we experience trauma, our nervous systems (fight, flight, or freeze) kick in and actually shut down our other not-essential-for-survival systems, such as digestion. No wonder so many sexual abuse survivors have eating disorders. Why don't doctors acknowledge this?

G.D.

I think the fact that you don't look like Gwyneth Paltrow helps the cred part(having been advised by her look-alike N.P. to "...do whatever you have to do to lose the weight.." which I thought was pretty crappy advice at best and potentially dangerous at worst).
I'm definitely rooting for you.

Susannah

I like my doctor. I had to visit him for a checkup a few months ago, because I hadn't been in years.
After complaining about my acid reflux and excercise-enduced asthsma he went to through a ton of options until finally getting to, "Well, you have a little bit of a weight issue we could work on." I couldve kissed him. 'A little bit of a weight issue' rather than 'drop the extra 110 pounds [of which I've now dropped 38] and everything will be fine.'

Stacie

Ugh, my doctor's response to "I want to lose a little weight" is "Cut out the carbs and exercise." I'm like..riiight. I'm going to cut out carbs for the rest of my life? I don't think so. This same doctor also told my mom to get down to 120 lbs. HA! My mom and I are the same height and the only time I've weighed 120 was when I was starving myself, and the same goes for my mom.

Mary Siever

Anna,

Thank you. It was several years ago, and I have not miscarried since, but I do miss my baby sometimes.

It did make me more aware of many things and particularly how important it is for people dealing with those who have suffered loss, to be sensitive and compassionate. I dont' care how many people they have in a day, it doesn't cause any hardship to show some compassion.

One of the main problems I think, is that doctors have very little understanding about weight, nutrition and the psychological aspect. I was told for many years I "had to lose weight". They didn't bother to look into WHY I was unable to lose weight for so long (because I had PCOS and not knowing this I wasn't taking care of it properly) and so a person is left to flounder along not knowing what to do or how to do it. And having negativity thrown at you doesn't certainly solve it. I remember once being told by a doctor to lose weight no matter what it took, and starting to laugh. He asked me why I thought it was funny, and I told him that the fact he didn't care what it took was "ironic", and it was. Seeing so many people out there with severe eating disorders, it DOES matter how a person loses weight.

And when I DID lose weight, it certainly wasn't because of the doctor or any other professional who didn't have any of the knowledge to help me anyway. I did it because I wanted to and I found the tools and the determination because I needed to, not because I didn't fit some sort of norm.

leap-b4-ulook

Mary,
I'm sorry to hear about your baby, too. To lose a baby is the hardest thing. We lost our first at 22 weeks gestation back in 1993. I have two healthy kids now, but I do sometimes wonder what it would have been like to have been able to keep all three of my kids. (((hugs to you)))

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