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  #1  
Old 12-01-2005, 10:09 AM
Brynda Brynda is offline
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Doctors talking to patients about weight: how not to get sued

I am scheduled to give a Continuing Medical Education presentation on the topic of how doctors can approach their patients who are overweight about their weight. What advice should I give them? Have you been told well? Badly? What made it good for you or bad?
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  #2  
Old 12-01-2005, 10:37 AM
bouv bouv is offline
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Ummm...what's wrong with saying "you're overweight."? It's not insulting or derogatory, like "fat" or "heavy-set" mgiht be. It's just what it says...over their ideal weight for their age, height, and gender.

If that's no good, then the doctor can say, "you're health might improve if you lost some weight."

And if I might add, that anyone who sues a doctor for calling them fat (i remember we had a thread on this a while back (or two or three threads) is a douchebag. I mean...you pay this guy to tell you what's wrong with you, but you don't like his answer, so you sue him? What's next, sueing him because he told you you had a heart attack?
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  #3  
Old 12-01-2005, 10:38 AM
astro astro is offline
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Quote:
Originally Posted by Brynda
I am scheduled to give a Continuing Medical Education presentation on the topic of how doctors can approach their patients who are overweight about their weight. What advice should I give them? Have you been told well? Badly? What made it good for you or bad?

Well...don't do this
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  #4  
Old 12-01-2005, 10:44 AM
pbbth pbbth is offline
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"anyone who sues a doctor for calling them fat (i remember we had a thread on this a while back (or two or three threads) is a douchebag. I mean...you pay this guy to tell you what's wrong with you, but you don't like his answer, so you sue him? What's next, sueing him because he told you you had a heart attack?"

Seriously...how about suing you for telling me I'm female or something? Just be tactful about it and I would think that it shouldn't be a problem. I might be offended if a doctor put me on the scale and said, "Whoo, are you fat! Seriously, look how fat you are!" But anything along the lines of, "You could probably stand to lose some weight" or "You are overweight, and it will start effecting your health if you don't do something about it" are not meant to be insulting and are a proper medical diagnosis.
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Old 12-01-2005, 12:17 PM
MLS MLS is offline
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Of course, a good and understanding doctor would also not just say "You should do something about it," but offer some suggestions or sources of help as to how "we" can address the problem. I think tact is the issue here.
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  #6  
Old 12-01-2005, 12:25 PM
kunilou kunilou is offline
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Having spent 11 hours in the emergency room Monday after suffering chest pains, I had a heart to heart (so to speak) conversation with my doctor about just this topic.

He said

"You need to follow a consistent program of exercise and maintain a consistent diet. If you can be [/I]consistent[I] in both of those for the next six weeks, I'm sure those scores will be back in the normal range when we repeat the tests."

I understand "consistent" to be "put down the brownies, get off your fat ass and do something before I have to perform angioplasty."
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  #7  
Old 12-01-2005, 12:39 PM
Dewey Finn Dewey Finn is offline
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The doctor could post the BMI index chart on the wall, indicate where the patient's ideal weight range lies and show them where their current weight is.
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  #8  
Old 12-01-2005, 12:41 PM
davenportavenger davenportavenger is offline
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I think the goal should be to treat it strictly as a medical problem, and not a problem with them. For instance, doctors should say things like "you're such-and-such over the ideal weight for a person of your height/build" and "these are the medical problems you may face if you are at this weight, here are some symptoms of these problems you're experiencing now." Bring up facts, bring up statistics. Don't ask them any questions about how it affects their psychological health or self-esteem. Don't make any judgements about them as a person. The doctor in that linked Pit thread was way out of line. Obesity is enough of a physical problem that you don't need to bring someone's mental state or social stigma into it. People do not need life advice from their GP. If someone is offended by real-world statistics, then that is their own fault.

Anyone else thinking of last week's Family Guy episode? "I have something to tell you, it's not easy to say, okay here goes... I'm fat."
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Old 12-01-2005, 12:51 PM
VunderBob VunderBob is offline
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I'm still waiting for some douchebag doctor who doesn't know my medical history to unload on me about my weight. I thought it might happen last night when I went to the ER for a sports injury, but the ER was at the hospital where I had my gastric bypass, so it would have been readily apparent in my records.

My point? I've lost 85 lbs since June, and by all accounts, I'm doing nearly everything right, but there's going to be the egotistical jerk somewhere who will want to berate me for still being fat.
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  #10  
Old 12-01-2005, 01:04 PM
Corii Corii is offline
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Originally Posted by VunderBob

My point? I've lost 85 lbs since June, and by all accounts, I'm doing nearly everything right, but there's going to be the egotistical jerk somewhere who will want to berate me for still being fat.
To be blunt, so what? Are you losing weight for them, or for you?
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  #11  
Old 12-01-2005, 01:05 PM
Corii Corii is offline
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And I should add, congrats on the weight loss, I'm glad it's working well for you.
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  #12  
Old 12-01-2005, 01:09 PM
Ensign Edison Ensign Edison is offline
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Don't say "You're so fat you're going to end up alone or with a black guy" like the doctor who got sued did.

Be sure the patient is actually obese. I had a doctor who was on me about my weight when I was 5'5" and 130 pounds.

I would imagine that starting out with a question - "How do you feel about your weight?" or "Are you aware of your potential to develop X health problems?" - might be good. It is not news to most fat people that they are fat, so taking the approach that they must not have noticed and should be told is bound to be irritating.
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Old 12-01-2005, 01:30 PM
VunderBob VunderBob is offline
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Quote:
Originally Posted by Corii
To be blunt, so what? Are you losing weight for them, or for you?
I'm definitely doing it for me. I'm used to dealing with the snide remarks aimed at fat people, and I anticipating someone opening their mouth not realizing that I'm a work in progress.
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  #14  
Old 12-01-2005, 02:48 PM
Tevildo Tevildo is offline
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One thing I would say to doctors; "Don't mention my weight if it has nothing to do with my medical condition." I hate it when doctors spend most of the consultation disapproving of my lifestyle (which I accept isn't perfect), rather than just writing the goddamn prescription.
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  #15  
Old 12-01-2005, 03:24 PM
StGermain StGermain is offline
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Brynda - I wouldn't go into legalities unless you know exactly what the law will allow. That's shouldn't be part of your topic. As far as giving the information to patients, I'd advise doctors to keep it medical, not personal. And if the patient's weight isn't impacting their health at the time, don't harp on it. Maybe a comment about potential problems in the future, but if they've come to you for a sinus infection, it really isn't relevant, is it? And if it is relevant to the problem, state it clearly and unequivically, and tell the patient that you can help them if they will accept help. For example - "Mr. Smith, you're currently about 80 lbs over your ideal weight. That's part of the cause of the pain in your knees. We need to develop a diet and exercise plan that will allow you to loose weight without causing more pain and damage to your knees." But stay away from offering legal advise - that's for lawyers.

StG

StG
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  #16  
Old 12-01-2005, 03:52 PM
Brynda Brynda is offline
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Thanks for the advice so far. My plan is to come up with lists of things for doctors to think about and things to say. For example, I like "don't mention it unless it is germane to the condition" and "don't blame the person" advice. One thing I had thought of was to advise them to acknowledge that losing weight is difficult and that the person may have tried before.

There will be a doctor speaking with me who will offer them some medical suggestions as to how to lose weight; my job is just to give them some ideas about how to approach it so patients won't be offended and will listen. My guess is that some doctors don't mention weight because they don't know how, so my part is to put them at ease.

St. G, I don't intend to give legal advice. That was just a (weak) joke about the case mentioned above.
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  #17  
Old 12-01-2005, 03:58 PM
Harriet the Spry Harriet the Spry is offline
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Correct me if I'm missing something here, but what legal issues? The linked story is about complaints to a medical board, which are not the same thing as lawsuits, correct? Does anyone have any links to stories about doctors actually losing lawsuits due to advising patients on their weight?

Because the saying "anyone can sue for anything" didn't come from nowhere. But perhaps obviously not every lawsuit is decided in favor of the complainant. Lots of lawsuits are dismissed. Agreed, though, they are still to be avoided because they are expensive to deal with in terms of time and money.

However, the Dr. Bennett in the linked story surely should have expected complaints. One complaint alleged he told the woman to "get a pistol to end her life." For crying out loud! Can any of us in any field tell customers that without someone complaining to the relevant authority?

So I kind of agree with StG, in that you shouldn't go into legal issues if you don't understand them. But I would also add, don't assume there are more legal issues than there are.

davenportavenger's suggestions seemed totally on target.
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  #18  
Old 12-01-2005, 04:21 PM
Busy Scissors Busy Scissors is offline
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It helps if the doctor is not fat. Its going to be difficult to accept advice on losing weight from a person who is hefty themselves, no matter how sensible the instruction. Reason I mention it is that my doctor is fat, and I think she might find it tough dispensing medical advice in this area.
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  #19  
Old 12-01-2005, 04:26 PM
Dangerosa Dangerosa is offline
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One thing that hasn't been mentioned is to discuss anything NEW. Someone who has struggled with weight their whole life doesn't want to be told about the same diet that didn't work the last nine times, but may want to hear "gastric bypass has had a success rate of XX%" if they are a good candidate. Also offer referrals to nutritionists, if applicable.

All patients, regardless of size, should be shown their height/mass/bmi etc on charts during checkups. Even the skinny ones. Its one of the ways I know I need to lose five pounds - when I creep up to the top of my range. Five pounds is easier to lose than twenty five. If you make showing the chart and the relative position of the patient on the chart just part of your standard practice, it will come naturally regardless of size.
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Old 12-01-2005, 05:24 PM
StGermain StGermain is offline
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Brynda - Sorry for misunderstanding the legal comment. I can be distressingly literal at times.

StG
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  #21  
Old 12-01-2005, 06:08 PM
Dr_Paprika Dr_Paprika is offline
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Hard to get sued successfully for telliing the truth. Juries understand a BMI of 45 is bigger than average.
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  #22  
Old 12-01-2005, 06:46 PM
Brynda Brynda is offline
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Hard to get sued successfully for telliing the truth. Juries understand a BMI of 45 is bigger than average
I am so sorry I put the joke in about not being sued, because clearly that confused some people. As I said above, this is NOT about being sued. That was a joke, a reference to the court case mentioned above. I will NOT mention suits or anything remotely like that in my presentation.

OK, back to the question. I am a psychologist giving a presentation to doctors about how to effectively talk to patients who are overweight about their weight. I am looking for advice that I can pass on to the doctors, like "do try to empathize that they may have tried to lose weight before."

I am also looking for stories of how this was handled badly--sort of "don't do it this way."
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  #23  
Old 12-01-2005, 08:27 PM
Metacom Metacom is offline
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Quote:
Originally Posted by Brynda
I am looking for advice that I can pass on to the doctors, like "do try to empathize that they may have tried to lose weight before."
My one experience was when I was a junior high and my doctor gave my mom some pamphlets on dieting. THat was a non-confrontational, though inneffective, way to approach the situation (I was obese then; my BMI is healthy now).

My advice to the doctors would be to not explicitly mention the patient's weight. They know they're fat. Perhaps instead they could simply focus on the medical issues that result from it ("You have increased risk of X, so I'd like to test for it/we need to check that more frequently/whatever") and be prepared to non-confrontationally offer any resources they have available (e.g., "I know an excellent dietition, let me know if you'd like a referal").

IANA mental health professional (heh ) but, thinking back to when I was overweight and very sensitive about it, I think that approach would have worked best with me.
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  #24  
Old 12-01-2005, 08:30 PM
amarinth amarinth is offline
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Quote:
Originally Posted by Dr_Paprika
Hard to get sued successfully for telliing the truth. Juries understand a BMI of 45 is bigger than average.
But even being sued unsuccessfully is hard on the pocketbook.

Have a list of people to whom the doctor can refer the patient. People like nutritionists, physical therapists, psychologists and psychiatrists who work with disordered eating, whatever. For other medical problems, patients get names and locations (e.g., "See Dr. Smith, she's a cardiologist, she's at Memorial Hospital. She's specializes in this exact problem.") - for this, it often becomes, "see a nutritionist," with no info on where the patient might find one or who is a good one to find.
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  #25  
Old 12-01-2005, 09:03 PM
Dr_Paprika Dr_Paprika is offline
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Even if I called a patient "fat" (which I would not), I would not lose sleep about the patient suing me.

We weren't explicitly told during medical school how to address this problem. Most people who are overweight realize they are heavy and are sensitive about it. Doctors often do need to know the patients weight. Just asking for the height and weight of the patient can allow you to calculate a BMI and lead into a discussion about diet and exercise without mentioning words like "fat". I wouldn't be shy about asking patients their weight -- but I suppose you could just ask them to step on a scale and sidestep even this.

I wouldn't make it personal or judgmental. I suppose you could say something along the lines of "Many of my patients are interested in becoming healthier. Would you be interested in some advice on diet and exercise?", or "I'm afraid you are currently at increased risk for heart disease, diabetes and joint pain. I can give you some advice on diet and exercise to reduce these risks." If they say no, you could offer to refer them to a nutritionist or physiotherapist. Again, just saying this without mentioning weight or fat specifically is enough... patients get the idea. You are not doing a patient a favour by ignoring the topic, but I've heard plenty of patients complain about "other doctors" who told them they had to lose weight.
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  #26  
Old 12-01-2005, 09:19 PM
Harriet the Spry Harriet the Spry is offline
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I don't think I have ever seen an MD without having to get on a scale first. If they don't already have my height on the chart, they measure that, too.

I think it would be reasonable to have charts made up where they have the BMI ranges and tell you the number every time, just like they tell you your blood pressure. I can never remember what the blood pressure numbers mean, so I always just nod and smile (my blood pressure has always been on the low side). But to state "your BMI is up from 26 last year to 28, which is now considered obese" or whatever, that could work well for me.

Also, I think my doctor's health history form usually asks how much I exercise. So if weight is out of the normal range, the doctor could reconfirm the exercise piece, and make an appropriate recommendation: "you're exercising 5 times a week, which is good, but since you're still gaining weight, let's talk about diet" or "you indicate you exercise once a month, let's talk about ways you can be more active."

I'd also say mention weight if it is germane to what the patient is being seen for today, or if it is the patient's annual physical. That's kind of a "state of the nation" address, so if there's an issue it should be covered, whether it's weight or smoking, etc. If the patient is in for something unrelated, like poison ivy, the discussion about weight is probably best at another time.
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  #27  
Old 12-01-2005, 09:40 PM
Ferret Herder Ferret Herder is offline
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Just an anecdote about how this worked for my husband. (I'll note that he is an intelligent man, and has fought weight issues for much of his life.) After experiencing various health issues, I finally convinced him to visit a general practitioner, in April of this year. The doctor did an exam, diagnosed him with high blood pressure, had him do a blood test, and also diagnosed high cholesterol after those results were in. He noted how my husband's tiredness, blood pressure, and cholesterol could all well be affected by his diet and weight, and quite possibly cured by dietary changes. He did not say it like 'you are fat, you're ruining your health' but posed it as a rather necessary change to help his health and possibly even fix his problems without having to take medication. He gave my husband a copy of the American Heart Association's low-fat, low-cholesterol dietary plan, plus a prescription for a mild ACE inhibitor to get his BP down right away.

My husband said that for him, at least, the motivation to lose weight clicked when he talked to the doctor; he always knew that he had to but hearing it like that really hit home for him. I also worked hard to try to fit the diet to his eating preferences, and we both worked together to find acceptable snacks and food for meals. Since April he's lost around 35-40 lbs. He still needs to lose a bit more, but he says he feels much better, and he looks good. I'm very proud of him.
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  #28  
Old 12-02-2005, 12:44 PM
psychobunny psychobunny is offline
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Don't treat the patient as if he doesn't know he is overweight. Trust me, overweight people know that they are overweight and it is ruining their health, just as smokers know that cigarettes are dangerous. Don't patronize.

Personally, I say "You know I need to say something about your weight. I wouldn't be a good doctor if I didn't tell you that your bllod pressure (diabetes, sleep apnea, whatever) would be better if your weight was lower. I know it's hard. Trust me, if it was easy I'd be thinner". Then I ask what they've tried and what has worked. Telling patients to lose weight without a plan or siggestions is useless.

Also, make sure that the doctors know what is available in the area and are up on the latest diet fads and herbal supplements. They should be able to recognize commonly used herbals in weight loss medications (such as cascara, which has a laxative effect, and kavakava, which has a diuretic effect) and be able to explain why these may or may not be useful and how they interact with the patient's other medications. The doctor should be familiar with programs such as Weight Watchers and Jenny Craig and be able to explain the difference to patients (ie, some people benefit more from programs with prepared foods).

In short, treat the patient as an informed and intelligent person, and have options available for treatment.

Also, for the record IAAFD.
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  #29  
Old 12-02-2005, 01:29 PM
Waenara Waenara is offline
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One thing I would recommend is that if the physician isn't already familiar with the patient they shouldn't assume that the patient's current weight is the full story.

I saw a new doctor recently (gynecologist), and after asking my weight she started into a spiel about how my weight was unhealthy. I weighed 240lbs and 5'5" (26yo female) - definitely need to lose weight. However, six months ago I was 270lbs, and I'm still losing weight (currently 230lbs).

So basically, don't just assume that the patient is overweight and that's that. Ask about recent weight changes (losses or gains), to get the bigger picture. Knowing about a trend of continuing weight gain, or a pattern of yo-yo dieting, or successful weight loss is more important than simply knowing that at this moment in time they're XXX lbs overweight.
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  #30  
Old 12-02-2005, 03:28 PM
susan_foster susan_foster is offline
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Quote:
Originally Posted by Dangerosa
All patients, regardless of size, should be shown their height/mass/bmi etc on charts during checkups. Even the skinny ones. Its one of the ways I know I need to lose five pounds - when I creep up to the top of my range. Five pounds is easier to lose than twenty five. If you make showing the chart and the relative position of the patient on the chart just part of your standard practice, it will come naturally regardless of size.
I think this is a good suggestion. Especially if there were warnings on the chart for those who were underweight AND those who overweight.

Susan
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  #31  
Old 12-02-2005, 06:39 PM
DoctorJ DoctorJ is offline
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It helps if the doctor is not fat. Its going to be difficult to accept advice on losing weight from a person who is hefty themselves, no matter how sensible the instruction. Reason I mention it is that my doctor is fat, and I think she might find it tough dispensing medical advice in this area.
Fat doctor here...the fact that I'm overweight seems to help people understand that I really don't have a magic bullet for weight loss. In my area, everybody believes that there is a pill for every problem, and that if I'm not giving it to them, it's because I don't want to. (This is especially true of weight loss since a few less-than-scrupulous docs around here are using some potentially unsafe and ultimately ineffective diet pills.) One look at me and they know I have no such pill.

Personally, I think I'd have a harder time taking diet advice from the nutritionists at my old hospital, none of whom weighed more than about 90 pounds. I'm sure they ate better than most people, but they were without exception just tiny little people to begin with.

I can usually find a segue into the subject, and I don't talk about it any more than the patient wants me to; after all, I can talk until I'm blue and it won't help if the patient isn't that interested. The important thing is to be specific. Don't just say "eat less"; try to find something specific that the patient can cut out, or encourage them to learn how to count calories and keep a food diary. Don't just say "exercise more"; come up with a plan that the patient can do and stick to.
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  #32  
Old 12-02-2005, 10:53 PM
danceswithcats danceswithcats is offline
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Originally Posted by MLS
Of course, a good and understanding doctor would also not just say "You should do something about it," but offer some suggestions or sources of help as to how "we" can address the problem. I think tact is the issue here.
Do you really believe that? Unless the doctor bought food and helped you shovel it into your pie hole, it's not a "we" problem, it's a "you" problem. Get off this touchy-feely-nobody-is-to-blame nonsense. Taking responsibility for what's wrong with your life is the first step to fixing it, whether it's booze, drugs, overeating, smoking, or anything else.

Blaming the candor of a doc is an attempt to gain victim status and avoid dealing with the root issue, IMO.
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  #33  
Old 12-02-2005, 11:07 PM
MLS MLS is offline
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I'm not blaming anyone. Just suggesting a way to be tactful. That kind of phrasing could indicate that while the doctor can't cure the problem as he might cure a sinus infection, he is willing to work with you to find a means of addressing the issue.

Why the hostility, anyway?
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  #34  
Old 12-03-2005, 04:33 AM
petalpusher petalpusher is offline
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My hubby and I scheduled back to back physicals with our doctor (a small, lightweight guy). I'm about 20-30 pounds over my ideal weight, but was exercising regularly and am healthy. This doctor went on and on during my physical that I should drop this weight (duh) and go on Atkins. When I balked at Atkins he suggested Suzanne Somers plan. All the while, I listened dutifully, just knowing my 300lb plus hubby waited in the next room. I was glad this doctor was so concerned with weight and was sure he would berate my husband for his sloth and gluttony. Guess what? Not one friggin' word was said to him regarding his weight. Way to go Doc.

As for suggestions, I'd recommend they have hand outs or a website to direct their patients that are serious about losing the weight. Doctors should also stress that it's a lifetime commitment to changing eating habits and moving joyfully more often. Too many doctors are quick to prescribe meds that cause long term damage (fen-phen anyone?) or bowel leakage. It sounds wonderful that a pill could release us from the evils of weight gain, but at what cost? They should also remember that people overeat for many different reasons. It's not all about the willpower or lack thereof.
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  #35  
Old 12-03-2005, 04:51 AM
don't ask don't ask is offline
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I was at the doctor's a few weeks back to get results for liver tests. He was checking everything out and said to me, "Let's see what's happened to your weight since last time I weighed you." We went to the clinic room and he weighed me. He pointed out that I had gained weight since last time. He jerked his thumb toward his room and said, "Come on, let's head back Slim."

Absolutely broke me up.

Mind you he told me once that he had told a female patient, "Not everything can be fixed with medication, what you need is a good fuck 3 times a week." When she remonstrated with him that he was being unprofessional he told her, "Being unprofessional would be offering to fill the prescription."
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  #36  
Old 12-03-2005, 08:43 AM
xbuckeye xbuckeye is offline
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I guess I have to respectfully disagree with everyone when they say don't raise the issue if it is unrelated to the visit. Many of us only go to the doctor when we have a complaint. I haven't had a real physical since the early 90's. My weight has changed alot since then. I'm not saying that a doctor should ignore the complaint and say "your fat" but they should mention the problems associated and suggest that the patient come back for another appointment with their PCP or see a specialist, etc. and point out that whatever their problem, it may be exacerbated by weight (if it may actually be exacerbated by weight, ie, not a hangnail)

What they shouldn't do is ignore a weight problem. I was told around the time of my last physical that it was OK for me to weight more that 90% of people my age (before BMI was invented) because I always had. Hunh? Fat is OK if you are used to it? WTF?! Fast forward a few years, and make me a healthy weight and then I get a Dr telling me that I might be worrying about my weight too much and that isn't healthy. My BMI is 21...I'm not exactly starving to death.

I used to have the 'pleasure' of accompanying my grandfather to the doctor's office. He complained about having to take his blood pressure medication and his cholesterol medication and that he was tired and had trouble moving around and etc., etc., etc. Did his doctor suggest that he change his diet or excercise? Nope! Write another Rx and send him out the door! He did send over-photocopied pamphlets home, but my grandfather doesn't see well enough to read and doesn't understand all the do's and don'ts when they are written in medicalese. So, he gets mad and ignores all dietary advise and then wonders why he's developed Type II Diabetes. My mom is the same way, her doctor just writes her another Rx when she probably weighs 300# for a BMI of well over 40. There are lots of people out there who need it spelled out: eat this for breakfast at 7, this for a snack around 10, this for lunch, this when you get home from work, this for dinner and that's it. Then go for a walk for 30 minutes 4x per week. Make it sound easy and a person might follow it, make it sound hard and all of the sudden it is impossible to lose weight and they give up within 24 hours.
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