Raise Up, Baby, Get Your Big Leg Offa Mine*

Sphinx #2, From The Full Body Project by Leonard Nimoy

An important piece appeared in the NYT Science Times yesterday discussing weight and bullying. I wanted to share it here because of some significant, if nuanced, facts that arose toward the end of the article. Specific to healthcare and the way in which patients are treated in the medical setting, it seems advantageous to both parties, understanding how body size does not necessarily reflect any measurable health outcomes nor tractable patient behavior.  I have reflected here before on the use of BMI as an outdated standardized measurement of health and lifestyle and have lamented that it seems particularly problematic when assigned as a health marker in my field of obstetrics.  Here is the bit from the NYT article that is taken from a 2014 CDC report:

"A study of more than 400 doctors found that one in three listed obesity as a condition they responded negatively to, ranking it just behind drug addiction, mental illness and alcoholism."  What's more, "while some healthcare experts acknowledge that individual genetic and metabolic differences mean that some people are more prone to gain weight than others, the most widely disseminated public health message is that anyone can achieve a desirable weight by eating less and exercising regularly."

Drug addiction, mental illness, alcoholism, obesity: I think we can agree that these are all very sensitive issues among healthcare providers. I would include pain and poverty in the list of things that can send doctors and nurses into a tailspin. (Is the patient rating her pain an "8" while she talks on the telephone or eats a hamburger and does that make you angry?  Do you sound off to your colleagues when a patient takes an ambulance to the hospital for nothing other than early labor, or a twisted ankle, perhaps because she has no transportation and lives in a dangerous part of town? Then you have experienced the problem, maybe without even knowing it.)

My suspicion is that these issues reflect one simple, unifying vexation of the healthcare provider. That, quite simply, is control.  Whether grounded in a belief that the patient has no self control, no pain control, no control of the everyday necessities of living, or of the provider's desire or need to exert control, it seems that patient experience (which some may label "behaviors") and differential existence (as in, different from our own) are something that we need to learn to incorporate in a more inclusive and open way.

Perhaps an interesting reflection point for us all the next time we have a patient who is just simply rubbing us the wrong way: "Is it the patient... or is it me?"

   *From Big Leg Blues, by the amazing and inimitable Mississippi John Hurt