Real Quick: The chicken and the egg

Even Hatchetface knows she deserves adequate preventative care!

A few sharp-eyed readers have sent me a link to this recent poll of South Florida ob-gyns, which revealed that some offices outright refuse treatment to all women over a certain weight.

Fifteen obstetrics-gynecology practices out of 105 polled by the Sun Sentinel said they have set weight cut-offs for new patients starting at 200 pounds or based on measures of obesity — and turn down women who are heavier.

Some of the doctors said the main reason was their exam tables or other equipment can’t handle people over a certain weight. But at least six said they were trying to avoid obese patients because they have a higher risk of complications.

Hey, something else to add to my comprehensive list of reasons why I refuse to be weighed at the doctor’s office. The equipment argument is one of my favorites, as it’s unlikely you’d find doctors as willing to outright refuse accommodation to anyone other than fat folks. In my own anecdotal research, consisting of me hefting my 300+ pound ass up on many an exam table over the years, I have never yet run into a table that seemed on the verge of collapse under my ponderous girth. This doesn’t mean that weak tables don’t exist, but it does mean that strong ones do, and that they are common in the world.

Several ob-gyn offices said their ultrasound machines do not give good images of internal anatomy in obese women, making it harder to diagnose some medical problems.

Solution: don’t treat them! Brilliant!

I have gone for regular annual pelvic exams every year of my life, starting when I was eighteen, even before I was sexually active. Last year was the first year since that I didn’t have one, because my doctor now believes that given my monogamous long-term partnership and my lack of ever having had an abnormal result, I could do with only being papped every couple years or so. I am fine with that, because in spite of my near-religious adherence to regular meetings with the speculum, I have never been fond of the procedure. For many years I had debilitating anxiety leading up to it, a result of three different doctors who decided the best time to ask me about my presumed plans to lose weight was during a pap smear. At the time I thought it a terrible coincidence, but in retrospect I wonder if they chose that particular moment to mention my obscene size because, hey, they didn’t have to look me in the eye while they did it.

Roughly a year ago I had a trans-vaginal ultrasound. My current doctor, who has never asked me about my fatness while staring at my cervix, recommended it during a time when we were wondering if I might have a fibroid or two. Prior to this procedure I did a whole lot of research and discovered that a TVU is also commonly used in early pregnancy, when the fetus is too wee to image with your standard external ultrasound. So I went and got jabbed in the ladyparts with a wand smaller than your average sex toy, and though it turned out I was fibroid-free, we did get a nice baseline of what my lady innards look like, and I got to see the follicle from whence that month’s egg was primed to burst, which was SUPER COOL.

After the TVU, I asked my doctor point-blank whether my fattery impeded his ability to feel my ovaries or my hypothetical fibroids or whatever, and if that wasn’t an additional reason for his recommending this procedure. He gave a noncommittal shrug and said kind of, but mostly there were details one could get from a TVU that you just can’t reach with a standard pelvic exam, and he thought a baseline reference of my plumbing was a good thing to have, should I have problematic symptoms in the future.

Doctors also are allowed to drop patients, if they believe they lack the medical skills to properly treat them… [B]ut decisions about patients typically are made after assessing the individual’s condition during an exam, not by ruling out an entire group, said Dr. Robert Yelverton, a board member of the Florida Obstetric and Gynecologic Society. He said he would discourage physicians from excluding the obese.

“Do I think it’s a good policy? No,” Yelverton said. “Overweight people need doctors. I don’t know where a patient in that situation would go if every practice had that policy.”

A good doctor will take into account the subjective health and characteristics of each individual patient, and recommend a course of diagnosis and treatment based on these points. While frivolous malpractice suits are an understandable concern, the idea that fat people are a homogenized group sharing all the same illnesses and risks is both inaccurate and damaging. I am not going to go into the hard facts about the dubious science that says obesity in pregnant women always makes them “high risk”, because The Well-Rounded Mama (possibly NSFW) does that already.

This candid practice of denying fat women treatment simply because they are fat has cultural effects that go far beyond individual inconvenience. It contributes to the widespread anxiety that fat women feel about going to the doctor at all. It creates the statistical reality that fat women are less likely to seek routine preventative care and screening, both gynecologically and otherwise.

Some of these doctors felt justified in openly proclaiming that they refuse to treat fat women. This says something about the medical community, that even a minority of doctors think this is acceptable behavior. The implication is that fat women are less deserving of regular care, and must be singled out as untenable health monsters to be shuffled off on “specialists” whose treatment may cost more, or may not be covered via their health insurance at the same rate (if they are lucky enough to have health insurance at all!). Certainly, there will always be some number of fat women for whom this is legitimately true, but the assumption here is that all fat women are automatically a “problem”, an idea which is borne out by numerous studies which have found that doctors see their fat patients as “awkward, unattractive, ugly, and noncompliant.”

Given these attitudes, is it any wonder that there might be a statistical correlation between obesity and health problems? Avoiding the doctor is a major health problem in and of itself, as is failing to receive life-saving screenings for cancers that are treatable and survivable, as is simply believing that we do not deserve respectful and well-informed health care that is invested in treating us as whole people. The popular “Those damn fat people are using up all the healthcare!” guilt-trip allegations reinforce this idea to the extent that avoiding the doctor—that we don’t consume more than “our share”, a worry common enough amongst fat people already—seems normal and appropriate, when it’s wrong and unjust.

So long as these assumptions are in place, how can we ever say for sure which came first: the anti-fat attitude, or the obesity “disease”?

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