The Right to Question

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?

Doctor:  No.

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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Published in: on August 26, 2012 at 9:40 am  Comments (39)  

39 CommentsLeave a comment

  1. Hilarious… lose weight and the blood will stop gushing so much. I laughed out loud at work and people are wondering what the heck is so funny.

  2. Just curious…did you e-mail your doctor the studies? Did he indicate an interest in them?

    • I made an error here..should say “did s/he…,” not “he.” The default doctor in my mind’s eye is an old man wearing a white coat with a mirror/reflector thingy strapped to his head

  3. I went to several doctors until find good fat friendly ones. They exists, but they are rare.

  4. I didn’t think this attitude existed anymore! I first learned to question doctors at 16, when one gave me a prescription and tried to send me on my way without telling me what my condition was. Even then his explanation was so simplified that it was essentially incorrect.

    Medical professionals may be experts at bodies in general, but I’m the only expert of my own body. Since all bodies are different, its critical that we work TOGETHER to work out what’s best for it.

  5. I am not sure, but I am teetering on the brink of deciding that NOT asking your doctor questions is actually the root of all evil (instead of its being the love of money, y’know).

    How ’bout this, though: One time I was talking to my mother about her doctor’s opinion about her having a hysterectomy and questioning her about the decision process. You know what she said to me? She said: “You’re wrong, and you know how I know you’re wrong? I know you’re wrong because you’re fat.” Oh boy, not only does she buy her doctor’s thinking hook, line, and sinker, but she s&*#s it out on me. (This little episode propelled me into therapy.)

    Anyway, personally, I find the way that doctors do not listen to me about my own body to be reprehensible. I actually have the best luck with emergency room or doc-in-box doctors because they cannot even pretend to have a long-term relationship with me and so they have no choice but to actually ask me questions rather than make a bunch of assumptions. But overall, I avoid them — an ounce of prevention is worth more than its weight in gold. (But, dammit, you have to go when you have a “severed arm”!)

  6. Grrr Arrrgh!

    The whole ‘never question doctors’ thing really honks me off. It assumes that doctors are not people with education in a particular field, but some sort of perfect beings incapable of mistakes, confusion, bad judgment, or just plain arrogance.

    When Mr. Twistie was sixteen, he fell and hurt his arm badly. The doctor examined him, took and x-ray, and pronounced him just fine. Mr. Twistie’s father felt that was good enough for him and started to take his son home to get over himself.

    Mr. Twistie, on the other hand (the one that was still working fine), refused to leave until the doctor would explain how that black line he could see just fine on the x-ray didn’t mean his arm was broken.

    Yup, turns out the sixteen year old kid with no medical training was better at reading an x-ray than the doctor who had been trained to read it. But Mr. Twistie had to raise a royal ruckus and get another doctor into the room from all the shouting before he could get his broken arm set.

    Doctors are human beings. They get tired. They get flustered. They get bad information. Some of them got substandard training in one area or another. And yes, they are prey to every human failing from laziness to cruelty.

    I’m not sure whether it was laziness, cruelty, arrogance, or pure sexism unmixed with any of these other failings, and I don’t care… but I’m certainly glad that when the doctor told a friend of my family that the problem with her daughter was that the girl was twelve and she, herself, was hysterical, said friend of the family took her daughter off to the emergency room for a second opinion.

    That second opinion meant that a twelve year old girl didn’t die of a burst appendix.

    I think that puts paid to the idea of never question a doctor.

  7. I took my mom to the lung doctor last week. She didn’t want to be weighed but the nurse said she had to be. I assured the nurse that no, she didn’t have to do anything she didn’t want to do. I ended up embarrassing my 86 year old mother who mumbled that it didn’t matter and got on the scale. She had lost 16 pounds in six months and she and the nurse were cheering about this. The doctor gained even more of my respect when he wasn’t happy about this weight loss. We figured out that six months earlier she had a serious problem with fluid retention (she has many health issues) and that had been resolved, putting her back to her normal weight. Her doctors all have enough sense to not recommend weight loss to an elderly woman, but I wish someone would train the staff.

  8. See, there’s this thing called “Informed Consent.” By definition, I’m not informed if I don’t ask questions about things that I find confusing or potentially counterproductive.

    Between having my hypothyroid ignored by an endocrinologist, occasionally getting the wrong blood pressure cuff, and having doctors repeatedly start writing prescriptions for the *one* med that I have a known adverse reaction to, I have plenty of personal evidence that doctors aren’t always right. Enough to convince me, and it’s not even as extreme as blowing off or missing a broken arm or a burst appendix.

    Also, I am entitled to prioritize my own health in whatever way I choose, which may be different than how a doctor would prioritize it for me. My ob-gyn, for example, recommended that I go completely off my SSRI before even trying to get pregnant. Her recommendation is to minimize any potential for birth defects, regardless of the effects on my mental health. Having read a little on the actual risks and talked to my psychiatrist, however, I decided it was a better idea to reduce the dosage as much as I was comfortable with, then go off it completely during the second trimester. Having spent the past eight months not pregnant (and growing ever more frustrated at that), I’m really happy that I’m not *also* having panic attacks. My body, my call.

  9. People who refuse to use their critical thinking skills depress me. Or maybe they don’t have any so it’s better that they not use them. But I DO have them, so I use them. And anyway, I had one doctor recommend a medication that she said worked well for most of her patients and didn’t cause blood clots. I switched doctors (ironically because the first doctor wouldn’t TALK to me, explain her recommendations to me, discuss alternatives and answer questions, she just spit out orders for me to follow), and my second doctor told me the same medication didn’t work very well and could cause blood clots.

  10. Fascinating. I’m wondering if the person who left this most recent comment has ever sat before their TV and questioned a call by a referee, the play of a football player, the recommendation of a technician for their AC or heating, or a myriad of other professionals. The point I’m getting at is that we question “experts” every day about things. Be it because we’re confused, testing their knowledge base, or because we can be a bit dickish, we all question. It’s human nature. So why is it that doctors should be exempt?

  11. One field where they do this a lot is Obstetrics. So many of their “routine” procedures are not evidence based and do more harm than good. I’ve had fairly good doctors in this regard, ones that encourage lower rates of intervention, but even so there were things they did I knew would (and did) cause problems, without my consent. I even said, “Don’t do that. Stop!” and they did it anyway, and one time even tried to cover it up when I had problems. (I’m not getting specific because I don’t want to gross anyone out.) And just like when doctors encourage weight loss, they blame the mother for any problems.

    • Agreed. I had issues during all three of my pregnancies. I was expected to shut up and do whatever was asked of me. The doctor was right, anything I might say was automatically wrong. My wishes were ignored. At one point during the birth of my second child, I was asking questions and was ignored. They treated me like I was not a person, just a problem to deal with.

      At one point the clinic where we lived started doing early transvaginal ultrasounds as routine. A friend, pregnant with her second child refused to have it done. They told her she couldn’t refuse. She laughed at them. The doctor told her that she was putting her baby in danger and if she refused this procedure they could refuse to help her in the future if things went wrong. My friend said she’d not been required to have one with her first child. She was not high risk and she wanted to see the evidence that this was necessary. She wanted the doctor explain. She couldn’t. My friend had to go to the quality control office (this was a base clinic) to get help to because she was being threatened for refusing an unnecessary procedure.

      This is why I’m training to be a doula.

      • Yeah, I think anyone who gets pregnant and tries to take the “non-traditional” birth route gets used to questioning docs (and nurses) real fast. I wanted to have a vaginal birth after c-section and even though the risk of uterine rupture is no greater than without a c-section, I couldn’t find any doctors who would support me. Doctors not only are human and have their own fears and biases, they also cave in to pressure because they’re afraid of this litigious society. Which is fine, they have every right to cover their own asses. Just don’t pass off your CYA for “protecting” me and my baby.

    • Are obstetricians doing this then? I’m going to see one soon about a leg problem- one that the doctor said presents just like slipped cartalige but normally occurrs in “heavier people” but he was a good doctor so he wanted the leg doctors to look anyway, but do you think size prejudice is likely to work in the other way for me?

      Like if something like this happened:

      Doctor: You’re thin, so it can’t be that.

      I have been carrying a heavy book bag around at school. I’m 12, I weigh about 70 pounds, people have guessed by bag at 20-30. The teachers let me keep the books in class now. I don’t know why they didn’t before.

  12. Hrm. I have a tricky manifestation of an already misunderstood condition. If I didn’t question doctors, I would — full stop — be dead right now.

  13. I <3 this post. If I didn't questions doctors, I would not have gotten the diagnosis of thyroid cancer or mixed connective tissue disease. I would never have been able to carry my twins or give birth to them naturally. I question my doctors to have a healthier me. :-)

  14. Let’s not forget that the doctor who graduates at the bottom of his class get’s the moniker “Doctor.”

    Mine seems to be pretty good and doesn’t get hung up on my weight. Or at least hadn’t seemed to in the past. But I did have to ask if I could go ahead and get my back MRI’d while I was already at the place to get the ankle–turns out the back is worse than the ankle! I KNEW it was more than sciatica. Degenerative discs.

    My blood work and blood pressure are good, I have some pain meds that assist in sleeping, and have consults for Physical Therapy (both back and ankle). But supposedly the only “proven” way to decrease the pressure on the disc is weight loss.

    This is the first and only time he has brought up that phrase. He did not prescribe a diet, but he did suggest that he felt I would naturally lose a few pounds with added activity due to effective physical therapy. He did not say that weight loss would completely fix the pain, it might decrease the pain. So I don’t think he’s prescribing weight loss or anything… it was just a little bit of a shocker to me. He’s never mentioned weight with me prior to this.

    • My husband has 3 ruptured discs and resulting arthritis in the facet joints. His back doctor said losing weight would NOT help. He said that strengthening core muscles to better support the area might help and that walking every day would help stop loss of function from progressing.(if you don’t use it you lose it). In terms of pain, he finally had a couple of sensory nerves severed and that has been really helpful.

  15. This is a sore subject with me. I went nearly a decade being bounced around from one doctor to another (we’re military) in regard to my thyroid. They all agreed I had nodules but said there was nothing else wrong and that my symptoms were not thyroid related. I was diagnosed with fibromyalgia, at one point told I might have MS, tested for Lupus, told by one doctor it MIGHT be cancer but that is ok because thyroid cancer is the good kind. WTF?! Told by another doctor it might be cancer but why go poking around for it. Then told that statistically speaking I was too young for thyroid problems, told i was depressed and given a prescription for anti-depressants. It was a full 9 years before a doctor realized I had Hashimoto’s disease and a nodule so large it was pressing my airway. They removed half my thyroid and discovered that large nodule was a tumor. Even after all of that, I struggled another two years to find a doctor that would take my symptoms seriously. So yeah, doctors are not infallible.

    • I too have had issues with military doctors… had my ankle been MRI’d way back when I initially hurt it I’d probably still have all my cartiledge in my ankle and far less scar tissue….

      Glad you finally got the treatment you needed!

    • The same thing happened to me. I was misdiagnosed with Graves when I really had Hashimotos. I was told I had nodules but everything was fine. I got pregnant with twins and someone finally started monitoring my thyroid closely and said it was probably cancer. Then I went into the hospital because I wasn’t able to breath or talk very well. My thyroid was so large it was pressing on my air way and my vocal cords. I still have damage to my vocal cords. I have also been told that they THINK the cancer might have gone to my parathyroid because I keep having problems with my calcium even two years after my total thyroidectomy but they just gave me calcium to take at home and brushed me off. Sounds like we have had the same ride. *hugs*

    • Grrr… I have had thyroid cancer. Although I’ll take the survival rate and no chemo gladly over what I might have encountered with another type, there is NO good cancer. I suggest the next time you encounter that phrase, you kick the person solidly in the knee and tell them it’s the GOOD kick in the knee because you only kicked it hard enough to bruise, not break.

    • My mom had a really awful TSH when she was younger, and her… genetic “father” didn’t think it was a problem. My grandmother? TSH around 100. The doctors didn’t know how she was awake.

  16. Amazing as always, thank you Reagan.

    Even if thinness would grant me immortality, I wouldn’t want it– what a prize, an eternity being accepted into the inner circle of people who made my life miserable with their derision and abuse! A WINNER IS ME.

  17. Always question the doctor. They don’t know everything.

    Some don’t hardly know anything! Two years ago, after having hernia surgery, I developed a blood clot in my left leg-known as a deep vein thrombosis. This is a dangerous condition that can kill you. After my visit to the hospital emergency, I was told to follow up the next day with my regular physician. Sheesh! When he came in to examine me, he hadn’t even looked at my chart, let alone know what was wrong. He picked up the wrong leg to look at it.

    I changed doctors after that. I’ve got a good one now, but I still question him, and he encourages that.

  18. I have had SO many wrong assumptions and misdiagnoses from doctors that I question EVERYTHING. One frequent assumption is that my cholesterol MUST be high (as of last week it measured 172). There is annual testing at my job, and this year I improved in every way — blood sugar, cholesterol, blood pressure — and I am also about 10 lbs. heavier than last year. I’ve been misdiagnosed as having diverticulitis when I really had a kidney stone, and as having asthma when I really had an enlarged heart, and as having a weak enlarged heart when I really had a muscular, athletic one.

  19. Unfortunately dealing with physicians is a catch 22 situation. I favor asking questions but they are rushed and also suffer from grandiosity so at some point will see a question as some kind of challenge to their abilities. Many of them have poor knowledge and diagnostic capabilities, so getting good care and respectful treatment is far from a certainty. I myself am very conservative and stay away from doctors at all costs until it is necessary. Iatrogenic medicine is the greatest cause of death in the United States and it is underestimated. In particular stay out of hospitals whenever you can, so many hospital patients contract severe infections often because of lax policy.

  20. Amen to that! I have the same thing. A myriad of specialists all trying to figure out what’s what and very little information due to the rarity of the condition.

    Without me asking questions, schlepping notes and paperwork between drs and keeping an accurate diary of my experiences (including treatment by the aforementioned drs) I would not have been able to spot life threatening issues as they came up.

    I am extremely lucky that with rare exception, I have great drs. Of course I am lucky enough to live in a large city and have medical insurance.

  21. Obviously doctors are so unquestionable with their answers to people’s issues that my GP has yet to realize that all the alarm bells of my symptoms: extremely fast weight loss, low blood pressure that only squeaks into the normal range, constipation, constant heart palpitations, my infrequent food consumption, stomach aches, constant colds and flu from my poor immune system (all information given by my panicking parents) as something entirely normal. My GP said that I only have an irregular heart beat and prescribed me laxatives for my constipations. Oh, those laxatives have been very helpful. In making what’s wrong with me worse. ‘Cause some doctors don’t care, they don’t ask the right questions, they don’t probe farther by taking bloodwork and they just want to get it over and done with. Sometimes they just make it easier for you to get even sicker and the secretive nature of some illnesses make that work into a downright horrible mess. Funny, ’cause I haven’t hidden my symptoms, I just never outright said out loud what my opinion of what’s wrong with me. I just accepted his diagnosis. Definitely worked out in my favor, hasn’t it?

    • Ooh! And I nearly forgot to mention that one other symptom my illness has been demonstrating for the past couple has been my chilblains, which my GP incorrectly assumed to be Raynaud’s disease. But that a pharmacist I know has been able to identify better and suggested an ointment that helped tone down the swelling of my hands that have come from the sensitivity of my body to the cold, coupled with poor circulation. I’ve been to other doctors other than my current GP and they all hilariously thought my chiblains were bug bites. I’ve been with this doctor for years because he was the only one to give me something on the verge of a diagnosis for what was wrong with my hands and feet. But nobody has still been able to determine what’s causing all those symptoms altogether. Not one health professional. If I wasn’t on the Internet, I wouldn’t have secretly known. But considering the stigma from the public that could arise from this illness, I’m not going to outright suggest what it is any time soon to my GP.

      • I had a serious allergic reaction to sulfa drugs diagnosed as “flea bites” by three different doctors at the same clinic. I was on medication for a urinary tract infection and was sure the rash around my ankles, accompanied by my feeling achey and sick, was due to a bad reaction to the drug. When I went listened to the docs and went home only to spike a significant fever, I insisted on going off the medication. Sure enough, I was right–the symptoms went away as soon as the drugs were out of my system. Just because they had never seen a sulfa reaction manifest as welts around the ankles, they were absolutely certain it wasn’t an allergic reaction. Later, the physician assistant at the clinic told me that I could have died of renal failure if I had followed their advice and kept taking the drug.

        This is only one example of dozens of mistakes doctors have made in my 58 years on this earth. Like one of the writers above said, doctors are human. We shouldn’t expect them to be perfect and they shouldn’t believe they’re perfect. I try to do as much research as I can so I can be my own advocate.

  22. I’ve been to over 12 doctors in the last two years, trying to find help for my autoimmune disease. Recently, I had the most horrific experience with a hospital:

    http://www.facebook.com/notes/tracey-cramer/this-is-how-i-almost-died/408721599192685

    http://www.facebook.com/notes/tracey-cramer/this-is-how-i-almost-died-the-complete-story/409315862466592

    • Tracy, those links did not go through.

  23. I’m a cancer survivor. I was diagnosed at 19. I had no ideas what questions to ask or what things to demand. After my thyroid was removed I was sent home. For one month I went without any thyroid hormones in my body. Then spent 10 years trying to get someone to listen to me. No one told me about medication or food interactions, symptoms of high or low dosage, or any other complications that may arise I had to learn them for myself.

    Doctors are educated, yes, but they don’t know everything. They are human, not infallible. As I tell my physicians regularly, “It’s my body. I live here. I’ll tell you what is or isn’t working.” Don’t be afraid of doctors! They provide a service like a plumber or electrician and you wouldn’t hesitate to fire one of them if they did a poor job.

    I always tell people to interview their doctor, see if their philosophy fits yours. Ask for recommendations from others. Again, they are just people providing a service!

  24. You get that comment a lot? Why?!?!

    People who actually work in health care know that there are campaigns imploring people to speak up MORE. Virtually everyone has the patients bill of rights posted, and it has a list of responsibilities (including asking questions if you don’t understand why you are getting a treatment). ARG. These suggestions are there specifically because of the problems that can arise from an uninformed and obedient patient population.

  25. Bottom line: Something I was told by two VERY good docs I was truly lucky to know: You know your body better than anyone else can ever hope to. If you get a doc who tells you he knows your body better than you do, FIRE HIM & GET ANOTHER ONE, whatever it may take.
    Remember, a doctor is YOUR employee; he or she is working for you, not the other way round. Their job is to fix what’s broken & follow up on whatever YOU tell them isn’t quite right.

    • I was told something in a similar vein — your doctor has a lot of bodies to care for, and limited time with yours. You have only one body, and you spend all your time in it. I’ve learned that if my doctor does not consider it a partnership, to flee, do not pass GO, do not collect $200.

  26. Many doctors and nurses have found me to be a difficult subject. I won’t just shut up and do what I’m told. I ask questions and have even been known to tell them that I don’t have to do anything, and that if I disagree with their diagnosis or proposed treatment, I’m free to walk out the clinic door!

    I keep telling people: who’s in charge here? Who is the customer? NOT the doctor! You (or your insurance company) are paying the doctor for a service, therefore you are entitled to take your money to a different service provider if you are not happy with the one you are currently using!


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