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.

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12 thoughts on “Doctors, Power, and Honesty

  1. Carol Gwenn says:

    Oh dear, no!

    YOU are not the interviewee (vis a vis the new doc); HE is. You are HIRING him/her to work for you, not the other way around. Allow this person to express his opinion regarding your weight. Then, tell him politely but firmly, “You have expressed your opinion. Now, let’s get down to business.” If h e doesn’t take the hint, THEN be more forceful, but NEVER FORGET, the doctor is working for YOU.

    That was the best advice ever given to me by two really top-notch docs, along with the information imparted to them during their training: “We’re just repairmen – don’t let us get too big for our britches!”

    • KellyK says:

      Thank you! I know that’s how it’s supposed to work. And I do try very hard to view doctors less as authority figures and more as people I’m hiring, and if they provide crappy service, I’m free to ignore their recommendations and take my business elsewhere.

      My problem is, I’m running out of elsewheres. My family doctor didn’t want to treat my hypothyroid, because my TSH was low despite me being really symptomatic. My first endo, well, they were just horrible. I live in a quasi-rural area, so there aren’t tons of options. Currently, I drive two hours to go to Johns Hopkins, because other than the fattie lectures, they provide awesome care.

  2. Emolee says:

    I am going throught the exact same thing. I have hypothyroid, PCOS, and am really fat. I can’t go back to my endocrinologist because she demands I lose weight when I return. I am looking for a new doctor in NYC. Best wishes to you. I think your plan is a good one- asking about the research and dressing profesionally. Don’t let them bully you. I am pretty assertive and confident, but when the doc starts weight bullying, I tend to sit there speechless and dissociate.

    • KellyK says:

      Same to you. It can be really discouraging. I hope you find a good doctor.

      It always boggles me, having PCOS and hypothyroid, when I’m told to lose weight. So, I have two metabolic conditions, and you want me to do something that 95% of people, most of whom don’t have those conditions, can’t manage? Ri-ight. And for my next trick, I’ll climb a mountain with both hands tied behind my back.

  3. Nicole says:

    Good luck! And can I recommend Hanne Blank’s doctor letter? (http://cat-and-dragon.com/stef/fat/hanne.html) I used a version of it with my current OB/GYN, and it worked really well. I sent it ahead of time AND brought copies with me. It’s got a great combination of humor and firmness, which I think helps.

    • KellyK says:

      I really like that letter. I may craft one based on it, for both the new endo and whoever I end up seeing for reproductive stuff.

  4. Don’t be afraid to try some other doctor options if this new endo doesn’t work out. Family docs can test and treat this stuff, and so can nurse-midwives, physician-assistants, and nurse-practitioners.

    So can naturopaths. Some naturopaths are fat-phobic, yeah, but many are very open and respectful of the idea of you choosing what you are there to be treated for….AND they are much more open to the idea of subclinical hypothyroidism needing treatment. Anyhow, just wanted to point out that it doesn’t have to be an endo to get reasonable thyroid treatment. For my thyroid issues, I’ve had better luck with non-endo practitioners, frankly. The endo I saw told me I was looking for an excuse for being fat.

    I’m sorry that you are dealing with PCOS. Metformin and exercise and being careful about carbs is probably the best way to deal with it for most people, but be open to the possibilities….your needs might be different. Experiment.

    I’d also add that many women with PCOS find acupuncture and herbs like chastetreeberry (vitex) helpful. If you are open to alternatives, those are other options to consider too.

    But the basic message of your post is right on the money. The power that docs have over you is scary, especially if they label you “non-compliant” if you don’t bow down to the weight loss paradigm.

    • KellyK says:

      The endo I saw told me I was looking for an excuse for being fat. Wow, do we have the same former endocrinologist? I got the same thing.

      I’m actually getting really good treatment from the endos at Hopkins, so I’m hoping I don’t have to look elsewhere. I do get acupuncture on occasion for sciatica, so I’d definitely be open to considering that as an option.

      My big fear is of being between doctors and having my synthroid prescription run out. It’s made a world of difference; I’d really like to not go without it. It’s possible my family doc would renew it, but I went to them initially and they didn’t think my levels warranted treatment. (Actually, the PA I actually see was all set to prescribe, and the doctor overruled her. He’s set to retire, so I may have better luck there if it comes to that.)

  5. kprofou says:

    I have subclinical hypothyroidism; my TSH was this side of the old normal values that a lot of labs still use. I went to my GP and told him that I was going to see every doctor in Texas until one prescribed me thyroid replacement if I had to and he did. If only I’d known it was going to be that easy. What put me over the edge with him is that it was a very, very hot day and the a/c was not working very well in that office and I was still freezing, goosebumps and everything, and he was sweating. Also, while this probably doesn’t apply to you, I tested negative for Hashimoto’s while on Enbrel, but positive for a brief time when I stopped taking them to see if I could live without Enbrel. I asked my doc to test me, you know, just in case, and he did. Once I started taking thyroid replacement, my period started up again on a completely normal schedule.

    I have been diagnosed with PCOS about 10 years prior, but with no tests, the endo diagnosed me just by looking at me. I’m going to get tested again armed with what I know now from Well Rounded Mama and other sources, but at the time the only treatment the endo offered was metformin, but only if I went on birth control pills, which I wouldn’t do because when I was on birth control pills I gained 100 lbs in 8 months. I’ve had much better luck with treatment from my GP than an endo or ob/gyn, but that’s still like getting water from a rock, possible, but not easy.

    Let us know what happens, best of luck.

    • KellyK says:

      Yeah, when your body pretty much refuses to generate heat, that’s kind of a giveaway. I had something similar. We fired up our woodstove for the first time, and got the temperature in the living room up over 80. Everyone else was sweaty and miserable, while I was going “Ah..I’m finally warm!”

      What is Enbrel?

      I’m glad your GP finally listened.

      • kprofou says:

        Enbrel is an immunosuppressant used to treat a variety of autoimmune diseases, I use it for psoriasis and psoriatic arthritis.

        The crazy thing about my GP is that I told him my waking temperature was in the high 94 to low 95 range and he told me that didn’t matter. That’s some good doctoring.

  6. […] So, I had my appointment with my new endo today, which I was more than a little worried about. […]

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