Health is not an obligation, a barometer of worthiness, a guarantee, or entirely within our control. One of the major variables is access. Access includes a number of things. (I’m going to use HCP to mean Health Care Provider, including whatever health care someone might choose – doctors , nurses, hospitals, acupuncturists, chiropractors, homeopaths etc.)
Ability to get to the HCP
This would include proximity, transportation, ability to get time off work, to go, or ability to visit before or after work, being able to meet the requirements that your insurance has for you to see the appropriate HCP, being able to get an appointment with the HCP you desire to see.
Ability to afford the HCP
Can you get insurance? (Before the affordable care act, I wasn’t able to get insurance because companies were allowed to exclude me because of my size). Can you afford the insurance? If not can you afford the cost of care without it? If yes, does your insurance cover your health issues? Can you afford the co-payment? Can you afford any medicines prescribed? Can you afford follow up care, physical therapy etc. Can you afford to take off work if necessary for the treatment?
Ability to get good care from the HCP
Doctors ability to give good care can be hampered by their own stereotypes, preconceived notions and prejudices. It can also be hampered by what they can afford in their facility. This is where we fat people can have some serious issues. Rebecca Puhl, a researcher at Yale University, does a great deal of around obesity and discrimination. In one of her studies 24% of nurses said that they are “repulsed” by obese persons. Also more than half of the 620 primary care doctors questioned described obese patients as “awkward, unattractive, ugly, and unlikely to comply with treatment.”
I have personally had doctors try to put me on blood pressure medication before taking my blood pressure (it was 117/70), and look at me and mis-diagnose me with Type 2 diabetes without doing any testing. I’ve overheard my doctor tell my nurse that she should use the large blood pressure cuff instead of the extra large because “if we use the right cuff her blood pressure is normal. A too-small cuff will show high blood pressure and maybe that will scare her into losing weight”. I’ve had doctors prescribe weight loss for a broken toe, separated shoulder, and strep throat. I hear stories all the time from people who have been diagnosed as “fat” by their doctors when they have real health issues that could easily be treated.
In order to truly have access to healthcare fat people must first be willing to go to our HCP – if that HCP is a doctor then we have to be able to go in knowing that there is a more than 50% chance that the person we are coming to for health care will think that we are “awkward, unattractive, ugly, and unlikely to comply with treatment”, and an almost 25% chance that the nurse we see will be “repulsed” by us. Even if they are not part of that group, there’s a good chance that no matter what we go in for, we are getting a lecture about our weight, and if we practice Health at Every Size, we are probably going to have our research and choices dismissed as ridiculous by someone who is recommending a solution that almost never works.
If we can get over that, we have to find a doctor who won’t let his/her personal weight bias get in the way of actually treating us for what is medically wrong. Based on my own experience, my fat friends’ experiences and the stories that I’m reading all over the blog-o-sphere that is much easier said than done.
I wonder how many of the incidences of major health problems in obese people are due to the fact that going to the doctor is such a stressful, humiliating, and ultimately useless experience for us that we don’t go until our minor medical problem has become something major? How many people miss out on early diagnosis and early cure of issues because they couldn’t bear to be humiliated and lectured at their annual annual physical, or they don’t get a proper examination because the doctor is convinced that weight loss is some sort of snake oil cure-all. How many people don’t go get follow up x-rays because they just can’t bare to put themselves through the process of being naked in front of someone who is repulsed by them. How many people gave up on doctors because no matter how healthy our habits were, we were called liars if we claimed to be anything other than sedentary over-eaters.
One of the lines in a widely used version of the hippocratic oath is:
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
I cannot find a version of the oath that includes “unless I find that patient ugly, unattractive, and awkward”. So no matter what their personal weight bias may be, doctors appear to have agreed to treat us with warmth, sympathy and understanding. I think it’s time that starts happening.
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