“Because I want to help people.”
When you’re going through medical school interviews, you can expect to answer many variations on the theme of “Why do you want to be a doctor?” (I know I’ve written about this before, but whatever I said and whenever I said it are lost in the misty ethers of the Internet.) And there are all manner of things one could say that would make an acceptable answer. An affinity for life sciences, for example. (“Money,” though perhaps admirably honest, is nonetheless a response best avoided.) However you mix it up, though, you’re going to need to work “I want to help people” in there pretty quick.
And it had better be true. If you don’t derive a good measure of professional satisfaction from knowing you’ve been of service to people who needed you, the money won’t be worth it and the frustrations and annoyances of medical practice will weigh you down. Leaving an encounter with the certainty that you did right by your patient must be a meaningful reward, and one that motivates you to get up in the morning the next day.
We like to help. We’re trained to fix things. We like it when people get better. (A patient population comprising mostly healthy people was one of the signal reasons I chose pediatrics.) We do not like to be confronted with our own collective inefficaciousness. (See also: death and dying.)
One of the things modern medicine is not particularly efficacious at fixing is obesity. Losing weight sustainably is incredibly difficult, and (short of bariatric surgery) medical interventions don’t have a great track record of being all that helpful. Overweight and obese patients are a population we haven’t been able to fix.
So it doesn’t surprise me much to learn (thanks for the tip, Rose!) that we’re not as nice about it as we should be.
Are doctors nicer to patients who aren’t fat?
A provocative new study suggests that they are — that thin patients are treated with more warmth and empathy than those who are overweight or obese.
For the study, published in the medical journal Obesity, researchers at Johns Hopkins obtained permission to record discussions between 39 primary care doctors and more than 200 patients who had high blood pressure.
…when researchers analyzed transcripts of the visits, there was one striking difference. Doctors seemed just a bit nicer to their normal-weight patients, showing more empathy and warmth in their conversations. Although the study was relatively small, the findings are statistically significant.
…expressions of concern and empathy are not remarkable on their own, what was surprising was how absent they were in conversations with overweight and obese patients.
It seems we’re simply not as kind to these patients. I wish I could say I was surprised by that, but I’m not. We are no less human than anyone else, much as we’d like to believe otherwise.
In dealing with patients who are overweight, Dr. Katz added, doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.
“When we can’t fix what is broken we tend to behave badly,” he said.
I should pause here and note that I haven’t read anything but the abstract, linked in the Times excerpt above. If I were a truly industrious medical blogger I’d use the hospital databases to find the full text and learn more about the measures and analyses. Because my own biases incline me to believe these results are an accurate reflection of a real effect, I’m willing to grant it more credence than I might a study about which I had a greater degree of skepticism. YMMV. (Hope that meets your standards, Nob.)
Anyhow, I can see how all manner of factors might contribute to this disheartening effect. As much as we ought to know better, physicians are probably still plagued by the notion that obesity is a failure of willpower on the patient’s part. Add in the frustration of having a clinical problem that resists solving, and it’s no surprise at all to learn that we fail to treat our overweight patients with the same simple courtesies as our other patients.
For my own part, I hope I don’t really fall into that “we.” I’d certainly like to think not. The article goes on to mention patient complaints that their obesity seems to become the topic of conversation with their doctor even during visits for totally unrelated issues, and I’m reasonably confident that’s not something I do. But how to introduce the subject of a patient’s weight and the impact it might be having on health is an extremely fraught question. I try to allow enough time for the patient or parent to mention it as a concern first. Keeping in mind risk of eating or mood disorders as a result of weight, I make a point of saying that any discussion is about health, not appearance. And I try to keep recommendations realistic, attainable and limited.
But given how deeply the bias against obesity runs in our society (which can cut both ways in the physician-patient relationship), perhaps I kid myself to think I’m not affected by it. Perhaps I am no different from the physicians who participated in this study. It would dismay me to have it somehow demonstrated. In any case, my overweight patients are already forced to live in a world that stigmatizes them. They are more vulnerable and more needing of my attentive courtesy than other patients, not less. And I am grateful to the authors of this study for the reminder.