An Open Letter to Health Professionals
I got a text from a dear friend last week about her attempt to find a primary care physician in the city where she’s recently relocated. She was shaken and stunned at the way she was treated by a doctor who had never laid eyes on her before that day.
I wish I could say that this surprised me but I’m all too familiar with this type of interaction, having gone through it many times myself with doctors, nurses, dentists, hygienists, naturopaths, chiropractors and others who provide health related services. I have to admit that it pissed me off even more when this happened to a friend than when I put up with it myself. Hence, the following.
Dear Health Professionals:
I shouldn’t have to say this but just to skip through the unproductive fatphobic part of the conversation, FOR THE RECORD: I’m a 45-year-old, size-16 woman with no health issues. No matter how much you’d like me to confirm your biases by having high blood pressure, cholesterol or blood sugar, I still don’t. No, you can’t check it YET AGAIN just to make sure. I eat whatever the hell I want and exercise as much as I feel like, which is, BTW, more than most of the thin people I know. I also trained in hand-to-hand combat with the US Military so I can probably take you in a fight….but I’d rather keep this conversation civil. For now.
The fact is, even if I walked into your office with every health condition in the world and had no intention of following any of your advice, it doesn’t change our relationship.
You are not my parent, guardian, commanding officer or employer. I am not your child, ward, employee or an agency that you have been tasked with regulating. I have hired you to provide expert consulting, education services, and advice UPON REQUEST about my health.
Try not to let your cultural biases overshadow the point of my visit.
If you suggest something, whether it’s a mouthguard I know I won’t wear or the latest version of some ridiculous diet that you read one JAMA article about over lunch, I have the right to choose whether or not to take that advice. I retain that right, just as I would with any other professional that I pay for services. If I choose to reject your advice, I am not “non-compliant” because, as a sentient adult paying for your services, I am under no obligation to take your advice.
I have lived in my body for over forty years, so despite your training, there’s a pretty good chance that I know a bit more about it than you do upon meeting me for five minutes. Try not to let your cultural biases or the latest trends you’ve been reading about overshadow the point of my visit. For example, if I’ve got a migraine or a severed artery, this may not be the best time to offer me unsolicited advice about gastric bypass or some random keto diet.
My intention is for this to be an invitation to do better.
Your first and most important job should be to listen to me and believe me when I tell you what’s going on with my body. Just because I’m a woman, doesn’t mean that my pain is less serious or that you should ignore it. The same is true for people of color or with other marginalized identities. Many of us avoid seeking treatment because we know that we’re likely to encounter bias and maltreatment so if we’re here, you can bet your ass it hurts.
The fact that you have some alphabet soup after your name does not mean that you are all-knowing or give you the right to talk down to me or anyone else. I get that you had to be smart to get through med school or dental school or whatever, but the fact that you chose patient care instead of research means that you have to deal with people. I too have alphabet soup after my name, and some of what I studied on the road to obtaining those degrees was that having an MD and a God-complex does not make someone immune to implicit bias.
This might feel like an attack and, if you are the type of professional I’m talking to, you might have stopped reading already, but I hope not. My intention is for this to be an invitation to do better.
My hope is that that’s what you want too, to do better by ALL of your patients. If you do: start by taking a look at your own biases. Then believe your patients when they tell you that they’re in pain or that something isn’t right. If they have reservations about what you might be recommending, respect that your patients have the right to decide how to care for their bodies and that your role is to consult, not dictate. Stop prescribing various diets (even if you’re not calling them “diets”) to larger people when the evidence shows that long term weight loss through dieting is nearly impossible for most of the population and three out of four women already show signs of disordered eating.
Take doing better a step further. Question the medical establishment and challenge the things that don’t make sense. Look at the evidence of which people tend to have worse “outcomes” when seeking medical treatment and think about how you can advocate for them.
Thinking about how you can be a partner and making health goals a collaboration can be far more productive than handing out judgement and issuing edicts from on high. It starts with recognizing that your patients are, first and foremost, human. And so are you.
P.S. Over the years, I have also worked with many kind, compassionate, talented, respectful and amazing practitioners of all types as a patient, in providing co-care and in research. My current “care team” is spectacular. This letter is not directed to them.