Let’s Go to the Doctor! Part One: Performance anxiety.

By | March 21, 2010

I’m an “out” blogger, as they say — I blog under my real name, and I have a certain awareness that there are a lot of folks out there in the world who “know” me, or at least know some fairly personal things about me, as a result of reading this blog. Some of these are also folks who, for example, work at the same place I do. I only bring this up because in the course of conceiving this entry, in which I discuss my ladyparts, it occurred to me that when said folks see me in the hall they may be likely to think, “Ladyparts!”

But! The subject of ladyparts-medicine is too often associated with shame, in my opinion, and surviving a doctor’s appointment with sanity intact is too critical to the lives of many fat folks for me to ignore, and so I am putting this out there regardless.

I have a very thorough doctor, whom I generally appreciate and dig mightily. And as a person given to mild episodes of hypochondria, I am a very compliant patient. So when my doctor says “I’m going to recommend you get X” I am not the sort to ignore this suggestion. I tend to go and get X at my next convenience. Most recently, following some minor menstrual eccentricity, he suggested I have an ultrasound — the combination platter of abdominal and transvaginal — given that both fibroids and endometriosis have tended to run in my family. I made the appointment, and was generally calm about it until the day arrived, when, like any rational-thinking adult, I began to hear voices screaming in my head: “OMG TUMORS CANCER IMMINENT DEATH”.

See above regarding mild episodes of hypochondria.

I realized a few hours in advance of my appointment that my anxiety was not exclusively connected to the morbid fear of looking within and discovering something ominous. Certainly that was a factor, but if that were all I had to worry about, I could have managed it. I did a fair amount of pre-ultrasound research as a coping strategy, which usually helps. I’ll break it all down for those of you who haven’t had the pleasure: the two-part ultrasound begins with a bladder full of pee and a traditional on-the-belly survey. Though indeed it may be more accurate to call it an on-the-bladder survey, since a goodly portion of the procedure involves the radiologist-tech person smashing the ultrasound boom mic against your urine-engorged bladder. Pleasant. After that, you will be instructed to toddle off and pee, and then return for round two, in which a different wand gets stuck up in your lady business. The vag-wand at my place du ultrasound was longish, narrow, white, and made of smooth plastic, as if Apple designed it. Most folks seem to recommend taking on the insertion of this bit of equipment oneself, and much of what I’d read indicated that the typical instruction was to “insert it like a tampon”. Not a tampon-user myself, I found this specificity amusing, given that you only “insert it like a tampon” inasmuch as you insert it into your damn vagina, which would be a clearer instruction, but WHATEVER, MEDICAL COMMUNITY. I presume the “tampon” business is an effort at making this seem normal, though I think using code contributes to the weird cultural shame around much of women’s health.

Maybe now you understand why I was feeling a little skeevy about the whole process. Some folks described the ultrasound as harrowing; some said it was preferable to a standard pelvic exam. Let’s spin the wheel and see what she’s won.

But the worry over the weirdness of a new procedure and the possibility of it being wickedly uncomfortable wasn’t all that was on my mind. My ultrasound-anxiety was being compounded by the standard anxiety I feel when I have to meet with a new medical practitioner. Performance anxiety.

There are two things in this world about which I am religious: oil changes for my car, and annual checkups for me. I have always been meticulous about preventative maintenance and I credit this habit for both my good health and my ability to keep an old car running for a very long time. Having such a committed background in regular checkups, I’ve learned the art of making a good first impression on a new doctor or specialist, which is pretty key for me as a fat person looking to get quality care.

My secret to getting a positive response (or at least a less-negative one) from even the most fat-squicked doctor is this: being terrifically cheerful.

Numerous studies going back decades have repeatedly demonstrated that a stunning number of doctors automatically harbor negative assumptions about fat patients, based exclusively on their weight. One more recent example is discussed in an article in the Huffington Post here; another on CNN.com here. What can I do, knowing that I have roughly a 50/50 chance of seeing a doctor who will judge my health and capacity to follow instructions based on my appearance alone, before even looking at my chart? My response, historically, has been to adopt a near-insufferable level of joviality. In cases where the doctor responds positively, I’ve made my interaction with them markedly easier. In cases where the doctor responds negatively (which does happen on rare occasions), I at least get to feel satisfied that I’ve probably annoyed the shit out of them for the duration of our appointment.

This works; being cheerful and upbeat simply works to get a better quality of care in almost every instance. But it’s also enormously taxing, because it is, after all, a performance. Going in for my ultrasound appointment, I was nervous as hell, but I also knew that as soon as I met with the wand-wielder I’d have to push all that worry away and take on a lighthearted, friendly, cheerful persona if I wanted to be certain I’d be treated like a whole person. I’m not really complaining here: I have the good fortune of having excellent health insurance and also living in a city that’s home to many of the best hospitals in the world. But this pressure to perform under what are at best extremely uncomfortable circumstances does add an additional layer of stress, a layer that a thinner woman who felt entirely justified in being nervous when she was actually, you know, nervous, would not have to face. I resent it. I resent having to put this happy-fat-lady caricature on. But it’s the most reliable method I know for securing good customer service when I’m meeting a specialist or any new-to-me medical professional for the first time.

Edited to add: Just in case anyone’s reading this entry after googling “does having a transvaginal ultrasound suck?” I will state that my own personal experience was that it was indeed more comfortable than a standard pelvic exam and pap smear, but it also lasted like five times as long. So, in summation: less straight-up discomfort, but taking a length of time (around fifteen minutes, probably) that rapidly became very annoying.

Coming up, in part two: No, I Will Not Hop Up on the Scale, Thank You.

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