The doctor's office is a place where we're often at our most vulnerable. And when doctors are judgmental, be it about our sexual history, our relationship status, our orientation, or our weight, it can be hard to know how to respond. Below, some tips on handling this difficult situation.
Anybody who's been to a doctor recently knows this well, but it's worth reiterating: asking certain questions is part of a doctor's job. Some of these questions may be sensitive, but that doesn't mean they're invasive. I talked to Jaclyn Friedman, author of the brand-new What You Really Really Want: The Smart Girl's Shame-Free Guide to Sex and Safety, who explains, "It's totally appropriate for a doctor to want to know the equipment of people you're sleeping with, and if you're sexually active. That has to do with disease prevention, and whether or not you need birth control." It's also reasonable for them to ask if you feel safe in your current relationship, if you have one. A caveat: these questions make sense at a gynecological visit, yearly physical, or your first intake with a new doctor — barring extraordinary circumstances, they don't make sense if you go in with a sore throat.
I also talked to Stef Maruch of FatFriendlyDocs.com, who says, "it's reasonable for a doctor to tell you that weight might contribute to a problem you have, and to ask if you want to discuss weight loss as a treatment, assuming you haven't already told them you don't want to." It's not necessarily comfortable to talk about your sex life or your weight with someone you barely know, but knowing that these things might come up will help you mentally prepare — and help you recognize what's out of line.
Friedman explains that while "collecting information is fine," doctors shouldn't "editorialize." Lena Chen of The Ch!cktionary puts it another way:
They should make absolutely NO snarky comments on your sex life, whether you have one or not. Emotions your doctor should not be visibly experiencing include: astonishment, disgust, horror, or envy.
Explaining how to protect yourself against STDs or unintended pregnancy is a positive thing. Telling you that you had too many partners in the last month isn't. Similarly, Maruch offers a list of unhelpful medical responses to weight issues:
- Pushing weight loss after you've said you aren't seeking weight loss advice.
- Blaming your problem solely on your weight. There are no health problems that are caused solely by fat, and for problems that fat contributes to, it's virtually guaranteed that there are many fat people of your size and larger who don't have the problem. So weight is never the whole story and a doctor shouldn't say that it is.
- Assuming that all fat people overeat, eat junk food, and/or don't exercise.
- Refusing to believe you when you talk about what you eat and what kinds of exercise you do.
- Expressing disgust. Being unwilling to physically examine you.
- "Medical cursing" — e.g., "If you don't lose weight, you'll be dead by the time you're 40." There are statistics about the outcomes of various health problems, but no doctor knows the exact outcome for a
- Refusing to treat or diagnose you until you lose weight. If they don't have sufficient experience with people of your size to treat or diagnose your conditions, they should refer you to someone who does.
- Bringing up your weight in the middle of an uncomfortable procedure. (I've heard multiple stories about doctors who stick a speculum into a woman's vagina and then start haranguing her about her weight.)
These are some examples, but a bad interaction with a doctor is also something you'll probably know when you see it. Says Jess Zimmerman, XOJane contributor and author of "Dear Doctors, Quit It With the Weight Bullying,"
Being able to tell when someone thinks ill of you is not exactly the triple axel of social interaction; a lot of people can manage it, even if they can't necessarily break down what's making them feel that way. If you feel belittled, if you feel uncomfortable, if you feel ashamed, your doctor is DOING IT WRONG.
Friedman notes that if you're feeling judged, or if someone has made an incorrect assumption about you, it can be hard to respond right away. That's fine, and you shouldn't feel like you have to. But "if you're capable of doing it in the moment," she says, "just making a simple, direct correction is probably the best strategy." She notes that doctors will probably be reluctant to get into a long discussion, simply because today's healthcare realities mean "they're on the clock," and a direct statement may be the most effective response. Zimmerman offers an example:
I think probably the best approach is to say to a doctor "I'd like to focus on health rather than weight." If they start harping on how weight will increase your risk for this and that, you can tell them that studies show that focusing on health rather than weight improves health outcomes more consistently and for longer. You don't need to be able to cite chapter and verse of the literature — just keep coming back to "I'd like to focus on my health, not my weight." You can give examples: having good blood pressure and lipids, nourishing yourself well, having good cardiovascular health, increasing strength, increasing flexibility, sleeping well, reducing stress, managing chronic conditions, whatever is of particular interest to you in terms of maintaining your health. Keeping the focus there basically forces them to either drop it or say "I care about your weight more than any of those other things," which of course tells you what kind of doctor they are.
As Friedman says, it's not always easy to speak up when someone is making you feel uncomfortable — especially if you're wearing a paper gown at the time. She adds, "don't feel like you have to be a hero in that moment." Instead, you could also choose to respond later, when you've had more time to process and figure out what you want to say. Consider "sending a thoughtful email or letter after the fact and inviting conversation or making recommendations for people who might do training if you know those resources." This course of action gives the doctor time to respond when he or she isn't under pressure, and could be more effective than an in-office confrontation. Also, you get to do it with your clothes on.
If you've had bad experiences with doctors in the past, or have reason to believe that you might in the future, there are steps you can take when seeing a new clinician that may help. Mara Nesbitt, also of FatFriendlyDocs, speaks to doctors on the phone beforehand, asking them questions like "Do you think a person can be both fat and healthy?" and "Are you comfortable touching a fat person?" If they say no, she goes elsewhere if possible. Maruch takes another approach:
I write up notes to give to the doctor (history of the problem I'm seeing him or her for, treatments I've tried so far, list of medications) and include at the bottom of the note:
"NOTE: I understand weight loss can help with [CONDITION] but I'm not seeking weight loss advice through this office."
If there are other issues that may affect your medical care — Friedman notes that people in certain kinds of BDSM relationships might want to alert their doctors to the possibility that they might have bruises — you can state these at the outset in a similar way. It doesn't guarantee that you'll be treated sensitively, but it may help.
Given the current sorry state of the healthcare system, we don't always have much choice in who treats us. If you do, however, you may want to consider switching providers if your doctor fails to understand your concerns. Chen says that if your doctor is being judgmental about your sexual history, relationship status, or sexual orientation,
I think you should switch doctors immediately. Sexuality is an integral part of people's lives, and it's not something that you should conceal. It could actually be quite harmful for your health if your doctor is giving you advice based on incomplete information. If you're queer, your doctor needs to be someone you feel like you can be out to.
If you find yourself avoiding going to the doctor because of how they treated you, try to find a new doctor. If you lose confidence in your doctor's ability to diagnose and treat your health conditions, try to find a new doctor. You deserve good medical care.
Many doctors are open to dialogue and may respond well to the kind of "simple, direct correction" Friedman talks about. If they don't, though, they may not be the right fit for you — and a doctor you can't talk to won't help you stay healthy.
Friedman says that when you're looking for a new doctor, the best thing to do is get a referral from someone you know and trust. They'll know you and your concerns and may be able to recommend a doctor will be sensitive to them. You can also go online — Friedman recommends Scarleteen's Find-a-Doc service, which collects reviews of doctors in a variety of specialties. Maruch recommends Kink Aware Professionals and Poly-Friendly Professionals as places to start if you're looking for doctors who are familiar with kink and polyamory. And FatFriendlyDocs maintains its own list of fat-friendly health professionals.
Friedman adds, "if you have really understanding service providers in your area please list them, because then other people will find them." So if you go to someone who's really great, pay it forward by writing a glowing online review or recommending them to a friend. And let them know they did a good job — caring for people is tough, and those who do it right deserve a pat on the back.
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For all Social Minefield columns, go here.
What You Really Really Want: The Smart Girl's Shame-Free Guide To Sex And Safety
The Ch!cktionary [Home]
Dear Doctors, Quit It With The Weight Bullying [XOJane]
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