Doctors, Power, and Honesty

So, I have to make an appointment with a new endocrinologist, which I’m dreading the heck out of. (My previous endo finished her fellowship program and isn’t going to be at Hopkins anymore.)

With the previous endocrinologist, I pretty passively sat through a lot of weight lecturing because I really need someone to actually treat my thyroid issues. The previous one hadn’t, and I knew that if I got written off as the “non-compliant fat chick” there, I was pretty thoroughly screwed.

Since my current endo was extremely knowledgeable, polite, and helpful, I figured sitting through a yearly weight lecture and giving lip service to the idea of losing weight was a fair price to pay.

And, let’s be honest, I was freaking terrified. The power doctors have over you when you’re sick is a scary thing. I remember thinking, before I went to Hopkins, that if they blew me off like the last endocrinologist did, that my best option was probably to crash diet to lose 50 or 100 pounds, in the hopes that if I got down to a socially acceptable weight and was still showing hypo symptoms, someone would actually listen to me.

So, now that I need to make an appointment with the new fellow, I’m trying to figure out whether I’m brave enough to actually say I’m trying to approach my health from an HAES perspective, or if I’m going to just smile, nod, and get out with a prescription for the synthroid that keeps me functioning.

I may take a middle approach where I ask about research and studies without flat-out saying that I don’t plant to attempt weight loss under any circumstances. Because if you can show me a study where even half the participants lost a significant amount of weight, kept it off for five years, and didn’t experience worse health outcomes than the control group, I might be convinced to try *that* diet. To my knowledge, no such studies exist. But if I approach it from an angle of asking questions and being interested in evidence, I may be at least a little less likely to be blown off.

I’m also planning on going into the appointment dressed nicely and groomed as thoroughly as I would be for a job interview, make-up and all. It kind of is a job interview, where I’m applying for the position of “vaguely intelligent grown-up who’s allowed to make her own medical decisions.” And fat people, being supposedly stupid, lazy, and low-class, are generally disqualified from that position. So I’m going to shamelessly work on the markers that I can manipulate to be seen as a person worth helping.

I also have another medical thing going on. Polycystic ovarian syndrome, which seems to be preventing me from getting pregnant, despite a whole bunch of trying. (I kind of wish I’d known I had a condition that’s linked to infertility before I spent hundreds of dollars on BC pills that made me feel like shit, when we probably could’ve just used condoms and been more than fine.)

It’s been six months, which is the point at which you’re supposed to go to the doctor if you’re over 30. I’m thinking the first step will be to go back on metformin. I should also find out what other options are available if that doesn’t do it. I’m not keen on the idea of fertility drugs, since i really don’t want multiples. I also have my doubts that anyone would do IVF on someone with my BMI.

The one nice thing about the fertility stuff is that I don’t *need* to have a baby, not in the same way I *need* to have my hypothyroid managed. I want to have a baby, I will be very sad if I can’t have one, but my life will still be good. My awesome husband will still love me, I will still have a fantastic group of friends and a house full of furry critters. It would suck, but ultimately it would be okay.

That knowledge is a good thing, because it means that if any doctor I deal with in my quest to get knocked up is rude, or bullying, or manipulative, I’m completely free to walk away, in a way that I’m really not with my endocrinologist. I mean, I can walk away, obviously, but it’s not a risk I want to take unless I really have no choice.

It does make me wish doctors had a little more respect for their patients, particularly fat patients, and that they were a little more aware of the power they have over them.