But there’s no inherent reason it has to be that way. Especially these days with easy access to medical information, patients have little excuse to allow this interaction to continue. In a sense, you can’t blame the docs for taking control when we cede it-they’re taught to fix problems. So both med schools and patients have to recreate the interaction so it’s more egalitarian. It’s going to take time, but if we, the patients, demand it, change will come.

Nothing in the traditional model, of course, requires docs to be insulting, cruel, or insensitive. I know some med schools have been trying to teach students to be more aware of the experience of the patient, holding classes in which the students practice on pretend patients and taking turns acting as patients themselves. Hospitals are also teaching ethics classes, which can only be a good thing.

Various studies have found, in Australia with our system of socialised medicine, that there is a class element (lower income households are less likely to visit a dr than higher income households), and a gendered element (the research uses the binary gender nomenclature, men are less likely to see a dr than women).

I just don’t know. Perhaps we expect too much of doctors. I know my suggestion above is pretty pie-in-the-sky (and sounded mean and derogatory towards doctors, I’m sorry about that, just frustrated and angry when I think about this issue) but I really believe it’s the right way to go. Doctors simply can’t “treat” this problem alone and I think that’s part of the problem. They can set a broken arm, heal an infection with antibiotics, remove a tumor, but this issue is much more complex and resistant to treatment. I think I might find it frustrating, too, if I were a doctor!

Any thoughts? I have a gut feeling that she’s wrong, but I have no evidence on either side.

I went to the doctor last year as I had a lingering virus (I was over-worked) and one of the questions my doctor asked me was if I had recently lost weight without changing my lifestyle (I can’t remember her exact wording), she was satisfied with my answer and didn’t weigh me. Seeing as cancer and depression (both of which run in my family) have unexplained weight loss as a symptom, I don’t think ignoring weight completely is right. However, I have nothing more to say on the limits of weight as the sole marker of health better than this: http://danceswithfat.wordpress.com/2009/12/15/so-my-doctor-tried-to-kill-me/

I have only ever been weighed when registering with a new surgery, although I wonder if local health priorities affect the doctor or nurse’s reaction. At 25 and just overweight on the BMI scale, a nurse criticised my weight, but not the amount I drank. At the time I was living in a borough where a large percentage of the population is judged to be overweight. 5 years later, I live in a borough with fewer ‘overweight’ people, I drink much less than I did at 25 and am currently just obese. When I registered with a new GP practise, the nurse didn’t say anything about my weight but did suggest I was drinking too much.

I am so often treated so poorly at doctor’s offices that I have come to the conclusion that there is something about medical school and the way doctors are taught about weight and obesity that is dysfunctional. In no other aspect of my life am I ever treated so poorly.* So in my mind, the core issue here is that doctors seem to somehow develop a malignant prejudice in our medical schools and we need to remedy this. Immediately. Stat! It is negatively affecting the health of their own patients!

So @MischiefManager, I think the reason why your seemingly reasonable point that a doctor is remiss in not discussing these things is getting push back is that I have rarely seen a doctor who is able to do this in a non-hateful way! The prejudice is just that strong. My proposal:

1) The medical community must recognize this as a problem and medical colleges must begin required courses on how to deal with your own anti-fat (and other!) prejudices.

2) Because so many doctors have shown that they do not know how to handle discussing weight with fat patients, they must be trained to delegate any talk of diet and weight to trained professionals. My thought here is Nutritionists, who often seem to have a pretty good handle on the social and emotional part of weight and obesity. I have noticed that some clinics have already started to do this. It puts the “problem” in the hands of a professional specifically trained for this. Win-win! If the patient is at the point of truly dangerous obesity, the Nutritionist (or designated health professional) would ideally act as the fat patient’s advocate in their dealings with the doctor. (Regarding the point about doctors being concerned about being remiss/being sued: They didn’t “do nothing” if this proposal is followed. They FOLLOWED protocol!)

While I personally don’t mind being weighed at the doctor’s office, I actually think that at this point in our culture NOT WEIGHING does far more good on the whole than weighing. Weighing every time waves a big red flag about an already explosive topic and I suspect it somehow reinforces doctor’s existing prejudices, though I don’t know how, exactly.

* An interesting side note is that dentists are often quite kind to me. I’m one of the few people you might meet that does not hate going to the dentist!

2. You had an endocrinologist whose scale was located in the hallway behind the receptionists’ desk? Interesting – so did I.