Compassion From Doctors Isn’t A Substitute For Evidence-Based Care

Herma HesseI was reading a conversation online where a fat person was saying that they wanted evidence-based care from their doctors. A man replied that he teaches nurses and that he makes it a point to teach those future nurses to treat “ob*se people” with “compassion and never cruelty.”

This guy is well-meaning, but check again because he is completely missing the point. There’s nothing wrong with compassion, and it’s certainly a step up from how a lot of healthcare professionals treat fat people. But it’s not a substitute for competent, evidence-based healthcare.

Believing that being fat is a health condition that requires treatment is a problem, whether someone has compassion or not. It’s a paternalistic view rooted in weight stigma. It’s how we end up getting bullshit “people first language” instead of (potentially life-saving) evidence-based care. Calling me a “person with fat” doesn’t help me, having a blood pressure cuff that actually fits me and getting a prescription that isn’t “be thinner” does.

We aren’t asking healthcare providers to see us and think “oh, that poor fat person” we’re asking them to see us and think “there’s a larger patient, I will give them the same treatment a smaller patient would get.”

It’s not that compassion is a bad thing, it’s that all too often “compassion” just ends up being a condescending pity for the fatty who they believe smart or willed enough to succeed at diets, rather than realizing that we don’t fail diets, diets fail us. It’s giving us sub-part treatment but, you know, nicely.

The kind of compassion we need from healthcare practitioners is compassion for the issues (which can include health problems) that can come from living in a fatphobic world, compassion for the fact that we may have serious anxiety about visiting a healthcare practitioner because of the horrible experiences we’ve had with fatphobic HCPs. We need compassion in the form of armless chairs and loveseats in the waiting room and medical equipment that is built to accommodate us.

Fat people deserve compassion from HCPs but we deserve more than that. Fat people deserve compassionate ethical, evidence-based healthcare with the goal of supporting our health, not manipulating our body size.

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10 thoughts on “Compassion From Doctors Isn’t A Substitute For Evidence-Based Care

  1. It would also help to be able to get surgeries instead of told don’t come back until you have at least lost this much. No compassion or thought in pain it makes it even harder. Just want fair treatment. I would even give up compassion if I could get treatment

  2. When I go to the doctor…

    I don’t want my personhood affirmed.
    I don’t want my fragile self-esteem protected.
    I don’t want to be made to feel “happy.”
    I don’t want to be reassured that being a fat person “isn’t my fault.”
    I don’t want you to tell me how much you “understand” and “sympathize.”

    I want a DOCTOR. I want the same doctor a thin person with my issues takes for granted they’ll get. I want someone who’s going to talk to me the same way they’d talk to a thin person. I want someone who’s going to give me the same tests they’d give a thin person with my problem. I want someone who’s going to prescribe me the same medicines (adjusted for dosage) they’d give a thin person with my problem. I want someone who’s going to refer me to the same specialists they’d refer a thin person with my problem to. I want someone who doesn’t consider my life a “waste of medical resources,” whose number one priority isn’t turning me into a different patient they want to treat more, but treating the me that’s in front of them right now. I want a doctor. Why is that too much to ask?

    1. “I want a DOCTOR. I want the same doctor a thin person with my issues takes for granted they’ll get. I want someone who’s going to talk to me the same way they’d talk to a thin person. I want someone who’s going to give me the same tests they’d give a thin person with my problem.”

      All of this.
      Fortunately, my PA has been quite good about this. She never brings up my weight, focusing instead on the issues I come to see her about. I’ve been much happier with her than with any doctor I’d gone to previously.

  3. Would it hurt them any to provide BOTH compassion and careful treatment as you have described? Why’s it have to be an either/or?

    1. It doesn’t, as I said in the last paragraph of this post “Fat people deserve compassion from HCPs but we deserve more than that. Fat people deserve compassionate ethical, evidence-based healthcare with the goal of supporting our health, not manipulating our body size.”

      My point is that when they talk about “compassion” they are often discussing a condescending and paternalistic approach to fat patients that is rooted in weight stigma, where the discussion is semantics, rather than coming from a place rooted seeing fat people as people worthy of ethical, evidence-based care in the bodies they have.

      1. Yeah. Sincere compassion is always a plus, but what fat people encounter far too frequently at the doctor’s office is a kind of nasty superciliousness that reminds me of the way Nice Guys treat women: “I must get this subhuman to behave how I want, but I can’t just explain what I want like I’m talking to a person, because *these things* aren’t people, and besides, if I give it the opportunity to tell me no, it might tell me no, like it thinks it has autonomy or something. Instead, I will blow a constant stream of sunshine up its ass in the hopes it will feel obligated to repay my kindness with the desired behavior… and of course, rage like I’ve been subject to some great injustice should it not feel obligated to repay my kindness with the desired behavior.”

  4. I’ve had a nurse (who I was speaking to as a friend, not a caregiver) tell me that being fat is unhealthy. I’m terrible at in-person conflict/discussions, so I didn’t follow-up, but I was disappointed.

  5. I was fortunate once–while I was waiting for a doctor, this twit of an assistant started yapping about “taking responsibility” and I told him that that was just what I am doing by blowing up stupid lies, and he fled with his tail between his legs.
    Lady Rhapthorne–that pseudo-compassion is reminiscent of all those people who told me I was “bright” in between laying trips on me about everything else.

  6. Yeah, I have seen it both ways. I just sit there smiling waiting for the re-baked BS to ooze out of their mouths. Sometimes I see it coming and jump the gun. “No.” before he even opened his mouth. “No, what?” he asked. “No, I am not interested in weight loss surgery.” He was shocked, tried to double down but it just doesn’t matter. I have gotten to the point where I will lie and not care. Chances are I will never see this person again, (teaching clinic, new DR in training every year). Smile nod, get what I came for (have so far), walk away.
    Had an appointment for sleep study, pretty sure I don’t have apnea, the nurse was very fat, and nice, asking if the armed chair was comfortable. The doc was silently judgmental. Just order the study and I’ll go. I thought the whole time.
    Lucky when we can ignore them…

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