Can I Question My Healthcare Provider?

Ask QuestionsOne comment I often get when I teach workshops or write blogs about participating in the discussion about our health, is that people aren’t sure if they are allowed to question their doctor/healthcare provider.  I’ve had people suggest that if I don’t have a medical degree I don’t have the right to question a doctor. Except this is my body we’re talking about – my health.  The issue shouldn’t be that I’m asking questions, it should be that my doctors don’t have answers.

I don’t think that body size constitutes a health diagnosis but if doctors are going to treat it that way, then we at least have every right to expect that they practice ethical medicine which includes evidence-based interventions and informed consent. Doctors who recommend weight loss as a path to health are suggesting that over 60% of the population undertake intentional weight loss as a medical treatment.  So you’d think that if someone asked questions like “is there a single study that shows that this is likely to be effective” they’d have the answer 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 and time spent with patient tighter, and that they don’t have as much time as they would like with their patients, I know that not all doctors are sizeists, and I mean them no disrespect; but that does not mean that they are above answering my questions,  or that I give up my right to evidence-based medicine or 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.  One balancing factor here is the concept of informed consent – doctors have to give the patient true information about how likely the treatment is to work, what the side effects may be etc. so that the patient can make an informed choice.

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 a doctor cannot ethically tell a cancer patient that everyone who tries hard enough with this treatment cures their cancer.  But that’s exactly what they do with weight loss.  Studies show that nearly everyone who attempts weight loss gains the weight back. That seems pretty obvious, 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 (knowing that health is not an obligation, barometer of worthiness, completely within our control, or guaranteed in any circumstance.) (The research is here)

Here is a highly dramatized version of how this might play out:

Doctor:  What seems to be the problem?

Me:  I’ve severed my arm.

Doctor: What are you doing about your weight?

Me:  Arterial blood is spurting out of my am, could we keep our eye on the ball?

Doctor:  Have you considered bariatric surgery?

Me:  Not interested in having my stomach amputated thanks. Do you really think weight loss will cure my severed arm.

Doctor:  Weight loss will solve all your problems.

Me: Can you show me evidence of a weight loss intervention where the majority of people lost the amount of weight that you want me to lose, maintained the weight loss, and became healthier long term?

Doctor:  No.

Me:  Do thin people ever get severed arms?

Doctor:  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: Treats my severed arm and sends me on my fat merry way.  I have a re-attached arm and a renewed sense of empowerment.

We are each allowed to interact with our doctor in any way that we choose for any reason that we choose (sometimes we might choose to do activism, sometimes we might just want to get the diagnostics or medicine without any extra stress. Both are completely valid choices as is whatever else you choose.)  You are allowed to believe whatever your doctor says and you also have the right to ask questions, especially when it’s your health on the line.

Looking for more skills to advocate for yourself in the doctor’s office and beyond? Check out the Fat Activism Conference.  Three days, 40 speakers, 30 workshops, teleconference style so that you can listen on the phone or computer from wherever you are, recorded so you can listen live or on your own time, only $39 with a pay-what-you-can option to make it accessible to as many people as possible.  Check it out!

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Published in: on July 22, 2014 at 11:39 am  Comments (25)  

25 CommentsLeave a comment

  1. Thanks for today, you have got me laughing. In my case it was usually strep throat not a severed arm but same scenario. There are ripples of change, though. Thanks for throwing stones in the pond!

  2. I’ve only just stopped laughing over the “severed arm” example!! Wonderful!

  3. It’s just a flesh wound!

    • What are you going to do? Bleed on me?

  4. When I first saw a neurologist for my migraines, he did mention my weight as a contributing factor. I very matter-of-factly told him that I have been getting these headaches when I weighed 40 pounds less, so obviously my weight had nothing to do with it. He agreed and moved on to other possible contributing factors.

  5. A great article, as always, but there was a minor grammatical error: “That seems pretty obviously, yet doctors tell us that everyone who tries hard enough can lose weight and that weight loss is the key to health.” I’m sorry to be so damned obsessive about such trivialities, but you write so beautifully that minor things like stand out to weirdos like me. As always, feel free to zap my nitpicking into oblivion once it’s been addressed.

    • Oh my! Grammar Nazi’s are everywhere :)

  6. Always remember that fifty percent of all doctors graduated in the bottom half of their classes. Yes, that’s a bit tongue in cheek, but it’s true that having a degree does not prove competence by itself. Several of the stupidest, least rational people I’ve ever known had advanced degrees in Really Brainy Majors.

    Also, many insurance companies require doctors who take their dimes to parrot their company line with regard to a variety of health issues. For years, every time my husband went to his Kaiser doctor, he was told to quit smoking… despite the fact that he’s never smoked tobacco in his life and hadn’t smoked anything else in at least a decade when they started pestering him about it. Now every time he sees a doctor (still Kaiser) he gets the weight lecture.

    My husband has also had a long string of doctors who desperately needed questioning. When he broke his arm in his teens, the doctor kept insisting it wasn’t broken. His father kept telling him that the doctor knew everything so questioning him was wrong and bad. Finally my husband raised such a ruckus that a higher ranking doctor (What can I say? We’re talking Navy doctors, here) came in to find out what was going on. He started off trying to tell my husband that of course the doctor knew what he was doing… until he looked at the x-ray with the big black line across the bone that was visible to a sixteen year old boy, but not his trained doctor.

    Considering that my husband is a musician who plays: guitar, piano, bass, drums, and a dozen or so other instruments that require both arms to work reasonably well, I’m glad he didn’t shut up until someone agreed that his arm needed to be set and put in a cast.

    And less than a year ago, he nearly died when his Kaiser doctor kept insisting his rattling lungs and inability to sleep at night were simply a question of heartburn from eating too much too quickly… until he wound up in the ER with pneumonia and severe edema… you know, having to do with the same congestive heart failure that was already part of his medical history when this doctor first met him.

    If you disagree with the doctor, or you don’t understand why a particular treatment is or isn’t being given to you, PLEASE speak up. Your very life might depend on it. I came too close to being widowed because a doctor was flat out wrong and refusing to listen.

    • You are so right! My husband almost lost an eye after a resident said, oh that’s going to have to come out, after he was hit by a car on his bike. Fortunately he was conscious and able to fight, since he was seeing out of the eye.

  7. I think part of the problem is that doctors appear to have this God-complex thing going on. I’ve had it recently with my poor husband – he was hospitalised with a psychiatric condition and during one meeting I was so incensed with the two psychiatrists in the room that I was on the verge of walking out. Simple politeness and courtesy cost nothing and when a patient (or in this case the patient’s wife, since said patient was closely resembling a zombie at the time) is asking questions and seeking clarification, a decent physician should be capable of answering them.

    needless to say I wasn’t invited back to a second meeting – apparently the psychiatrists in question didn’t like my need for understanding their decisions. Screw them – ever since I was prescribed weight loss for an ear infection, I’ve learned questioning the medical establishment is a MUST, not a want! :)

    But in most cases, doctors of any description are shocked and appalled when I ask how they’ve reached their conclusions and what evidence they have to support it……please – I can read scientific papers as well if not better than they can and unless they can support their theories with evidence, I ain’t buying it!!

    • Hope your husband is feeling better. During my husband’s most recent psych hospitalization the ARNP managing his meds made several questionable calls and directly contradicted the requests of his psychiatrists. (Psychiatrist not on staff but has been managing his very difficult regimen for years.)

      The day I met her I mentioned that my husband faithfully takes his meds, but it might be possible they had not all stayed down due to his lap band.

      She seized this as an opportunity to tell me how “smart” he was to have lap band and why wasn’t I “smart’ like him. Given that she literally had his life in her hands I had to resist the urge to be sarcastic, so I just smiled and said something about lack of insurance. She then said if I were really “smart” I’d find a way. I nearly bit thru my tongue…

      Anyway, docs are definitely not gods although some think they are. If they can’t stand to answer a few reasonable questions, in my family they get replaced.

      • And ideally I would have replaced him but thank God, we were back under the care of his usual psychiatrist within a week after that memorable meeting – and I didn’t get done for murder :) His usual psychiatrist was a bit taken aback at the level of questioning I subject him to at the beginning but he’s gotten used to it now.

        They are definitely not gods – but some of them really do think they are – how they get as far as they do in a caring profession without being questioned, I don’t know!!

  8. Fantastic article and it really does make the point that we have the right to expect answers that make sense, that are evidence based and that are not hooked on our size for no reason! Thank you for another amazing article.

  9. I feel so fortunate that I’ve had doctors that were happy to answer all my questions.

  10. Speaking as a future doctor (and someone who spent a lot of time watching doctor-patient interactions as my job before med school), I think that *good* doctors WANT to be questioned. When I talk with patients about the plan for their evaluation/treatment, it actually makes me nervous and uncomfortable if they say “yes” or “okay” without asking any questions or voicing any kind of opinion at all (I always try to offer them multiple opportunities to do so). It makes me wonder whether they really heard/understood me, and gives me no confidence that they agree with the plan or will follow it. I’d much rather they ask whatever clarifying questions they need to ask, let me know what they’re concerned about, etc.

    • I wish you were my doctor then! My parents represent the quintessential doctor-worshipper: they never question, never ask things, never consider there may be another “angle” that the doc’s working. I left him 2 yrs ago (we were all served by the same guy, which I think is a mistake, you should have some other source of information than just one guy), and am going to try another clinic.

  11. I just need you to come to Montana and say all this for me. Normally I would be fine to do it myself but they’re sending me to fatphobe central (our local GI who told me to lose weight when I saw him because I couldn’t keep food in for months) to talk about my damaged liver, that they keep saying is from me being fat and that I am saying is from taking 5 different poisons at once to treat my crazy autoimmune diseases that all cause liver damage. I am afraid I won’t have the energy to fight, or that fighting will drain me completely… so I’m sorry, but you’ll need to fly out here ASAP. =P

    • Rose, So sorry for what you have to deal with right now. Getting the care you need should not be a battle of bias and bigotry, which seems to be the norm for fat people. I know you did not ask for advice, but I would like to share what I do.

      If needed, I write a letter and email/fax it over to my doctor and when I get there I bring a copy and ask the doctor if they’ve read it. This way I can take my time to articulate my concerns and advocate for myself in a way that being with a doctor face-to-face sometimes prohibits. Also, since I have a copy of the note with me, I can refer to it—like having speaker notes to assist in advocating for myself for the quality care that I need and deserve–the same as any thin patient.

      • Yeah, I brought papers for him when I’ve seen him before. He insists on pestering me about my weight nonetheless and said the studies (hundreds of them) are all biased and that’s not what the study says, etc. My tactic this time was going to be after affirming that I didn’t want weight loss solutions still (though happy to manage dietary intakes) was to suggest we could just leave this alone and my pancreas could give out and then I would lose all the weight he wanted me to through malnutrition if I didn’t die first. I think though, that I will make some notes and refer to them if need be, or just hand over the right card for the attack and not worry about speaking. This will be supreme among them: Can you show me evidence of a weight loss intervention where the majority of people lost the amount of weight that you want me to lose, maintained the weight loss, and became healthier long term?
        And he’ll lie and say he can, or that fat people are all undisciplined then I’ll ask if he thinks I’m not fat, and then oh, well if we’re all undisciplined how will this work for me?
        Blah, it is just gonna suck.

        • I wish I could go in with you to that doctor! I have a healthy disrespect for doctors who don’t like to listen and don’t mind telling them so while advocating for myself or others. I’ve done it for friends. Once a doctor told my friend who brought me to advocate for her that she could leave the “that rabid little attack dog” she’d brought to the appointment home the next time! He might not have liked me, but at least he started taking my friend a bit more seriously instead of prescribing weight loss for something that had zilch to do with the fact that my friend happened to be what the doctor considered OMGDEATHFATZ!AIEEE!

  12. I will give every doctor the unconditional respect they and others assume their medical degrees afford them when every doctor gives every patient unconditional respect. Instead, far too many doctors disrespect and dismiss far too many patients, They diagnose patients as Fat. As Female. As Young. As Old. As Brown-Skinned. As Mentally or Physically Disabled.

    I spent 7 years suffering in pain and now have permanent damage because I was dismissed as Young when I went to a doctor for an orthopedic problem at age 17. 7 years later I found doctors who listened and found out that the problem I’d had could so very easily have been corrected with physical therapy and bracing. By the time I had competent doctors the damage was done and was no longer 100% correctable and I’d spent years in agony.

    I used to think what happened to me was the exception, It’s not. It’s the rule. I’ve worked in various allied health professions all my adult life. I’ve seen the same thing happen over and over and over. And heard about it happening far more often than I’ve seen.Too many doctors chalk up whatever health problem the patient presents with as being primarily due to a patient’s body size, age, gender, race, or because of a mental or physical “disability”. Yup, even for health concerns that have ZERO to do with size, age, gender, race, etc. Don’t even get me started on what far too many doctors favorite tactic is when they can’t figure out what’s wrong, are too lazy or incompetent to try any longer. When that happens they decide “It’s ALL In The Patient’s Head” and dismiss the patient as Crazy and thus worthy of scorn and disrespect and no further treatment for the physical problem.

    When every doctor respects and listens every time to every patient I will respect them solely because they have Doctor at the start of their name and M.D.. after. Until then though I will continue to work on the assumption that all doctors deserve to be questioned. and challenged. Sadly, I’ve learned the hard way that far too many doctors need to be considered guilty til they prove themselves innocent.

    • One prime example of the “It’s ALL In The Patient’s Head” syndrome happened to me after a bad (really bad!) break-up where I had (TMI alert here) a period, with daily bleeding, for SEVEN MONTHS. He told me after a few scans that I was imagining it, there was nothing wrong with me and to ‘get over it’. When I refused to back down, he inserted a mirena coil ‘since it was mostly harmless and will at least have a placebo effect’.

      Yes apparently I imagined bleeding for seven months. Since at the time I was in the lower end of the ‘overweight’ section on BMI due to not eating for two months, he couldn’t blame it on weight, so he blamed it on an overactive imagination. Lovely.

      That pretty much wiped out any left-over conditioning I had that doctors were always right…….

      • My worst example of it’s all in the patient’s head syndrome is a girl I went to school with. She started having severe pains in her abdomen, along with a high fever and vomiting. Her mother took her to the pediatrician who promptly diagnosed her as a twelve-year-old GIRL with an hysterical MOTHER. A second appointment went the same way. The third time, the mother took her daughter to the ER… where it was discovered my friend’s appendix had burst several days earlier and her gut was riddled with infection. She nearly died. She lost an ovary. But at least she did live.

        That episode was the one and only time I ever heard my father suggest someone should sue anybody for anything.

        On the upside, a few years ago when Mr. Twistie suddenly had a localized pain in the lower right quadrant of his abdomen, lost his appetite (as close as he usually gets to actual heaving), and was running a fever, I knew precisely what was wrong with him. It took me more than twelve hours to hound him into going to the hospital, but they got his appendix before it burst.

        • I’ve been diagnosed as Female and gotten the “it’s all in your head” loads of times. I pretty much stopped going to a doctor for several years after I was told “women like to make up things to get attention, so go home and don’t come back”. When I was 18 it started, and it was these pimples in my armpits. Took 3 doctors before someone said there was anything wrong (#1 said “in your head”, #2 said “it’s normal”, #3 said “you need a surgeon”, surgeon said “in your head”).

          I’ve tied the pimples together with the boils and crotch pimples together as gluten sensitivity and the heavy dieting/anorexia that I had been doing for decades. Now that I’ve eliminated gluten and eat more, problems have gone away.

      • Snorting in disgust here! Did that doctor lose or lack every single one of his senses except Taste? You’d think he could have seen, smelt, and felt that you were bleeding! And it’s obvious he had trouble hearing, because he was near incapable of listening.


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