One comment I get pretty often is that I have no right to question my doctor or healthcare professionals. Yesterday some genius commented “Get a medical degree if you want to question a doctor.” Let’s see, how can I put this delicately… Screw you buddy.
This is my body we’re talking about – my health. The issue shouldn’t be that I’m asking questions, it should be that the doctors don’t have answers.
Doctors who recommend weight loss to a “normal BMI” as a path to health are suggesting that, according to some statistics, over 60% of the population undertake intentional weight loss as a medical treatment. So you’d think that if someone asked questions like “upon what evidence are you basing this treatment”, they’d have the answers at the ready. People are allowed to do whatever their doctor says without questioning, but you don’t have to have a medical degree to expect that your doctor can support his or her treatment plan with evidence.
I understand that doctors are under a tremendous amount of pressure, that insurance can make money tighter and that they don’t have as much time as they would like with their patients and I mean them no disrespect; but that does not mean that they are above explaining themselves or that I give up my right to evidence based medicine and informed consent.
In order for medicine to be evidence based, there has to be a reason to believe that it will work, with an understanding of any potential harm it might do. These two things can and do vary greatly with the severity of the illness and the risk of the treatment. The balancing factor here is the concept of informed consent, which states that you have to give the patient true information about how likely the treatment is to work, what the side effects may be etc.. So if a cancer treatment cures people completely 5% of the time but 95% of the time the cancer comes back – often worse than before – then you cannot tell a cancer patient that everyone who tries hard enough with this treatment cures their cancer. Duh. But that’s exactly what they do with weight loss. Studies show that nearly everyone who attempts weight loss gains the weight back. Yet doctors tell us that everyone who tries hard enough can lose weight and that weight loss is the key to health. And that’s despite the fact that there is good evidence that healthy habits, and not body size, are the best predictor of health.
So what do we say to our doctors? Here is a (dramatized) example from my last trip to the doctor:
Doctor: What seems to be the problem?
Me: I’ve severed my arm.
Doctor: I see that you’re fat. If you lost weight the blood would stop gushing so much and the arm would re-attach itself.
Me: So you’re recommending weight loss as a medical treatment.
Doctor: Yes, all thin people are healthy and immortal and everyone who wants to can lose weight.
Me: (In a genuinely curious tone) How do you reconcile that with the findings of Matheson et. al., Wei et. al,, and the Cooper Institute Longitudinal Studies?
Doctor: Gives me crazy eyes.
Me: Are you not familiar with those studies?
Me: I’m sure you mean well, but it sounds like you haven’t done enough research in the area of weight and health for me to be comfortable taking your recommendations where that is concerned. Do thin people ever get severed arms?
Doctor: What…Well. Yes they do.
Me: Ok, let’s treat my severed arm just like you would treat a thin person’s severed arm and then I’ll be happy to send you those studies if you would like.
Doctor: Probably wants to kill me but treats my severed arm and sends me on my fat merry way. I have a re-attached arm and a renewed sense of empowerment.
You are allowed to have whatever interactions with your doctor you want but don’t ever let anybody tell you that you don’t have a right to ask questions, especially when your health is on the line.
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