After four years without a primary healthcare provider, I finally got a new doctor. This is my story.
Going to the doctor can be very intimidating for fat people. We never know if healthcare providers will treat us with respect, hear our concerns, and see past the size of our bodies. Will they diagnose us as fat? Make assumptions about our health behaviours? Dismiss what we tell them about our health? Our lifestyles? Our experiences in our fat bodies?
Doctors (& other healthcare providers) are more likely than the general public to hold anti-fat attitudes. Doctors believe fat patients care less about health issues, are less likely to be compliant. Some doctors are explicit in their unwillingness to treat fat patients. Even when doctors are happy to provide care to fat patients, they may not have the proper education, training, and resources, to do so. Doctors aren’t taught how to palpate a super fat abdomen; most exam rooms don’t have the extra-large blood pressure cuff; hospital gowns provide little coverage (or comfort) for super fat bodies; waiting rooms are full of chairs with arms. For all of these reasons, many fat people avoid healthcare settings whenever possible. They skip screenings, minimize illness and pain, and feel trapped between their desire for medical care and proactive interventions and their desire to protect themselves against hostile environments & toxic situations.
My last doctor was great – he didn’t know about HAES when we met, but he was happy to be educated (note that that responsibility fell to me as a patient, as it usually does for marginalized people). He didn’t diagnose me as fat. He was happy to skip the scale & shelve his bias. I found him by asking around – I consulted the local women’s health collective and similar groups that support groups with deviant bodies – women, members of the LGBTIAQ community, indigenous peoples, etc. No one could point me to a fat friendly, much less fat positive, doctor – but he was recommended as someone who was kind, open minded, and committed to decolonising medicine and healthcare. Before my first appointment, I sent him a letter. I introduced myself, shared my concerns, and asked if he was comfortable treating – and touching – super fat bodies (that’s a Q I now ask anytime I’m booking at a new spa, massage place, sports instructions place, etc). But when he left his practice (& New Zealand), I couldn’t be bothered to go through the search again. And the few times it occurred to me that I’d like to have a doctor, I was either too busy to search or too fragile to embark on the quest.
Because it takes a lot of strength to find, assess, and then meet, a new doctor when you have special needs. Having to explain, during the search, why you’re looking for a fat friendly doctor. Exhausting. Having to assess whether the person/practice you are considering is bias free (or at least less biased) and a safe place to receive care. Exhausting. Preparing to have that first conversation (w/o crying!), and then having it (w/o crying!), with your new doctor. Exhausting.
But after being without a primary care provider for four years, it was time. And just last week, I had my first appointment. I first had an appointment with the manager of the practice, where we reviewed my family history, my health history, my lifestyle, and my needs. I specifically asked about how the practice met the needs of fat patients. The blank, blinking, face I received wasn’t a good start. The manager wasn’t prepared to respond – not surprising. When I unpacked it for her in some concrete ways, she was able to talk about chairs & cuffs & even attitudes. Although she asserted strongly that no one in the practice had anti-fat attitudes (sure, Susan – sure). I left that appointment willing to meet with the primary care provider I requested (based on advice from others), and proud that I had raised my concerns. And glad I had managed to do it without crying.
Before my first appointment with my PCP/GP, I was able to use their online system to request that she ordered blood tests beforehand. Concerns with the metabolic health of a fat patient are understandable; I did these tests yearly with my last doctor. Doing it before my apt would prevent me from having to go back a second time for results. Being able to make my request online was easy, accessible, and allowed me having to ask (& explain why) in person. I always find it easier to have tough conversations through written formats, so this will be great for me moving forward.
At my first appointment, I shared with my new doctor (& the intern that was with her for the day) my concerns about being seen as my BMI – having my body pathologised – missing a diagnosis because of my size and her assumptions. I pointed out to the intern that I appreciated the one (of three) armless chair in the space; explaining that it was more comfortable for me and wouldn’t risk bruising me during the appointment. In fact, through the entire apt, I continually turned to the intern to explain things or highlight why treating a super fat patient may be different than a non-fat one (or even a fat one). He seemed eager for the info (& less uncomfortable as time went by). I left the appointment confident that I had made my needs (& concerns) clear, and that my new doctor had heard me. I’m hopeful we will have a respectful & productive relationship moving forward. I’d love to not have to do this again (find a new one).
Having a doctor you feel comfortable with is important. Having your healthcare needs met in a safe space is important. Being able to exercise agency in healthcare decisions is important. Healthcare is an important part of living a happy & fulfilling life. And fat people deserve that.