Thanks for another well-written, intelligent blog that refutes the overly expressed, and overly simplifed faux science that is being thrown at us.

All doctors have been patients at some point in their lives. Some doctors are fat; some doctors have chronic conditions; some have had emergency surgery. I wonder if, when we find a very compassionate doctor, we have found someone who can mentally switch hats–who can remember what it’s like to be the patient in such a scenario. Dr Jane Q HIppocrates may tell 20 patients a week to do X, and she may get frustrated by the 21st time. But if she’s compassionate, Dr JQH will remember that for any given patient, it is the first time she’s recommended X, and that every patient is different, even if some conditions are shared between them.

When I was an editor, I would often get angry at the author whose book I was working on for submitting a manuscript that, uh, needed to be edited. At both the copy editing and substantive editing levels, I would find SO MANY FUCKING PROBLEMS that seemed like sheer sloppiness to me, and after I’d been working for a few hours, I’d have to get up and walk away, because I was so infuriated that this person got a book contract in the first place. (And this was at a small press, so most of these mss had not gone through the filter of agents, and my job as editor was actually to edit.)

That? Was a terrible attitude. I mean, those errors and logical inconsistencies and superfluous chapters and point of view shifts and pacing issues gave me a job to do. I should have been grateful for them. But precisely because my whole job was to look for that stuff, A) I could see it really clearly, and B) I felt like it was the most important thing in the world. Those things aren’t true of any writer (including me), who’s looking at his or her manuscript in a big-picture way and is very close to it. I knew that. But I would still end up yelling at piles of paper (rarely at the authors in person), “WHAT THE FUCK IS WRONG WITH YOU?”

So I wonder if it’s a little like that. Like, doctors are so focused on illnesses, they A) lose sight of the big picture and B) inflate the importance of their own particular knowledge and where it fits in to a whole healthy life?

And that’s without getting into the assumptions they make. (Shade, your story kills me.) This is kind of a dumb analogy, but in keeping with the editorial theme… when I was in college, I once turned in a paper where I used “affect” for “effect” or vice versa. I absolutely knew the difference and prided myself on being a stickler for such things, but as it happened, I made a typo and didn’t catch it when I proofread.

Instead of simply correcting it, the professor wrote, “Look up the difference” in the margin. I felt sick when I read that. Humiliated beyond belief. (Yes, that’s how much of a nerd I am.) The professor just assumed that I was ignorant, not that I’d made a mistake, and I couldn’t stand it. Obviously, I still remember that ten years later, and I don’t remember any other single comment I ever got on a paper, good or bad.

I’m sure there are many college students who don’t know the difference between “affect” and “effect.” (In fact, having tutored in a college writing center, I’m positive of it.) But I wasn’t one of them. And the professor’s choice not to give me the benefit of the doubt really stuck with me — obviously.

So maybe it’s kind of like that. It’s the fact that so many doctors don’t see us as individuals who might have gotten sick for any number of reasons — they see us as part of a group of People who Don’t Know any Better. Which is humiliating and alienating.

I deliberately never took another class with that professor. What do people who can’t afford to switch doctors do?

Shade: Funny that your doctor said to go on a low-carb (=low sugar) diet to control blood sugar, but then claimed that it was the resulting weight loss that would actually help your blood glucose levels. To borrow an analogy from J. Eric Oliver, that’s like saying that yellow teeth cause tobacco addiction.

Professionals at some point seem to get carried away with it all in a grab for power and influence always end up having to backtrack when they begin to feel overwhelmed. I think that a lot of this ‘obesity crisis’ has been triggered by this. If so they could have the decency to have an open discussion about it, so we all know where we stand.
The problem is they appear to be in two minds, it’s hard to let go, in some ways responsibility=equals status. Something has to give.

His assumption that I would automatically lose weight was infuriating. Despite having a doctor/patient relationship that (I thought) was built on mutual respect and trust, his comment revealed that he believed I was fat because I ATE TOO MUCH.

After I described the years of near-starvation diets (including low-carb!) that resulted in WEIGHT GAIN. (And not later–I mean that I never lost a single pound. I just felt like crap and continued to gain weight. And I won’t even tell you what my previous doctors told me.)

After I mysteriously lost 30 pounds when my tumor went into remission.

After I discussed WITH HIM the likelihood that I would never be able to lose the weight!?!

Of course, I didn’t actually tell him how upset I was. Momma raised me to respect authori-tai. And now I’m kicking myself.

I don’t think diabetics should be blamed for being ignorant of heart disease risks. I’m not sure if the author intended for that tone or if it is a side effect of the NYT-style.

What I have experienced is that most clinicians blame bad blood lipids in diabetics on the patient, not on the care. That needs to stop. Demanding every one lose weight is not proper medical care or even sound scientific thinking.

So there’s six different causes off the top of my head for why various people could look fat. Six different reasons for a problem, and it’s not even counting on the combinations and permutations of those reasons alone. Yet the only “treatment” offered for any and all of these is restricting food, increasing exercise, and surgery to ensure food is restricted further. Talk about “one size fits all” with a vengeance. Now, add in a number of diagnostic measurements which have been discredited repeatedly (BMI, pinch test, height/weight charts), several diagnostic measures which are prone to misdiagnosis or misuse (blood pressure, thyroid levels, insulin levels) and a complete lack of consensus as to what constitutes “unhealthy” and what would be “healthy”, and I see something which is most definitely not good medicine. Tell me again why I’m supposed to believe conventional wisdom on this matter… I keep forgetting.