Where is the “Care” in Healthcare?

This week, a news story has been circulating about a patient who was turned away from a physician because she weighed more than 200 pounds. Read the article here, and then come back. I’ll wait!

Some of the comments I’ve heard supporting the doctor go along the lines of:

• “Good – most obese people don’t admit there is an issue with their weight, so they need to be made aware that their weight is an issue.”
• “Why does a doctor have to take a time bomb on as a patient?”
• “The risk of lawsuits from people who are serviced in a place that doesn’t have equipment to handle size is a good enough reason for doctors to be able to turn away these patients.”

Here’s an op/ed piece from HAES advocate Marianne Kirby on xoJane. It’s worth a read before moving on, so check it out.

Going to the doctor is already fraught for many fat people. And a lot of fat people just don’t go. As a group, we’re more prone to avoid medical treatment for fear of shaming. People yammer on about how we should lose weight for our health but then create an atmosphere where we really actually are afraid to participate in health care. Because that’s logic, right?

As a super morbidly obese person on a genuine, ass-whooping mission to get healthy, I have so much frustration when it comes to the healthcare system. I repeatedly state how fortunate I feel to have health insurance with co-pays that I can afford. Along with that though, I haven’t found a set of medical professionals that I feel truly can help me with any medical issues I might have that has led to this size. Yes, food in my mouth and lack of exercise got me here. But I know there are also underlying issues that need to be examined to help deal with the metabolic damage I’ve done with 20 years of dieting extremes.

I have a good relationship with my general practitioner as I’ve seen him since I was a teen. The problem though is that everything is spot-treatment: ailment X, take medication Y. With big pharmaceutical company influence and heavy patient loads, many doctors utilize the Band-Aid approach and throw some pills at people to take care of their problems without regard to their medical past or other underlying issues that may exist. My primary doctor is no different. I’m glad to have a space that I’m comfortable in going to, knowing I won’t be turned away from my weight, and seeing the same nurses I’ve seen for years. That intimidation factor is gone, which is something that I know many people have to deal with.

In the past year, however, I’ve gone to multiple medical professionals to try to deal with my entire weight problem. Some have taken insurance, and others haven’t. I’ve been fortunate to have enough income to be able to see a doctor with an integrative approach who doesn’t take insurance. It’s difficult to pay for health insurance and then fork over money to somewhere that doesn’t take it. But for the care and treatment I want, that’s the choice I’ve made.

Medical professionals I’ve seen the past year:

• General Practitioner/Family Doctor: for the average cold or allergies. Accepts my insurance
• Psychologist: therapy. Not covered by insurance
• Psychiatric Nurse Practitioner: medications for my anxiety and depression, in conjunction with Psychologist, but with a copay (here, we’ll cover your meds but not the therapy needed so you can treat the problem properly)
• Dentist: basic cleanings. Accepts my insurance, but I pay extra for treatment of hereditary periodontal issues
• Nutritionist: Not covered by insurance
• Orthopedic Surgeon: Treatment of half-marathon injury. Had to meet my deductible before treatment.
• Physical Therapist: Covered by insurance, but 4 months of sessions add up, insurance or not
• Podiatrist: Feet issues prior to orthopedic surgeon.
• Pulmonary specialist: Exam to find my basal metabolic rate at recommendation of nutritionist. Not covered.
• Integrative Physician: The person I see the most, and not covered by insurance. This is ongoing exams of food allergies, blood work for metabolic issues, vitamin deficiencies, adrenal fatigue, hormone dysfunction, etc.

In our healthcare system there is very little collaboration between medical professionals to be able to provide comprehensive, collaborative care for patients. We see 5 different specialists and none communicate with each other. And to see medical pros that DO collaborate, you’re in my situation where they don’t take insurance. To tackle a health epidemic, you need a system that will support a long-term approach to education, prevention, and treatment. Perhaps many obese people are in denial or don’t want to do the work, but for those who want to make a change, give them easy access to the resources they need to treat the whole patient.

I’ve joked before about how I have insurance yet can’t get covered for gastric bypass because of the insurance direct exclusion (I don’t want it now, but explored it a few times). I tried with 3 different insurance companies I had.  Yet most Medicaid recipients are eligible for the surgery assuming they meet the candidate criteria. Yet many of our insurance covering physicians try to send us to the nearest surgical weight loss center for treatment of our fatness. And if we don’t want to take that option, we’re crazy.

Anyway, I’m getting off track. The point is, those of us who are seeking treatment or help for our obesity have so many problems to worry about in being good advocates about our health, and to add in discrimination or possibility of being turned away is enough to scare even some of the most motivated of fitness-seekers. I forsee people being discouraged before even trying, and it will turn into one of those situations that people think they need to lose weight or get fit BEFORE getting help (like “I need to lose weight before I go to the gym).

We have to be strong advocates for our health, and be resilient if we encounter people who aren’t interested in helping address your questions. Be vigilant and seek others help. Eventually, you will find help, and it will be worth it. Don’t wait.