Medical doctors are very much a part of my life. I see my primary care doctor four times a year, a dermatologist twice a year, a cardiologist once a year, and other specialists, as needed. Today, I saw an orthopedic doctor for pain in my left hip and a carpel tunnel-like problem in my left hand; a problem I had surgically fixed in 2010. While I was lying on the cold table for an X-ray of my hip, the festering cyst on my upper back — which I had removed a few months ago, but has returned — burst, leaving a wet, bloody, puss stain on my tee shirt. “Wonderful, right?” I have an appointment with a dermatologist tomorrow to figure out what, exactly, to do about the cyst. (I have an ongoing problem with cysts here and there on my body. I have spent thousands of dollars getting them drained and incised. More often than not, the cysts make repeat appearances.)
The orthopedic doctor walked into the room, and after we exchanged pleasantries, I told him why I was there today. The doctor, whom I have seen before, had no recollection of my medical history, including the fact that I have widespread osteoarthritis, and was diagnosed two years ago with:
- Disc herniation (T7,T8)
- Disc herniation (T6,T7)
- Central spinal canal stenosis (T9/T10, T10/T11)
- Foraminal stenosis (T5,T6)
- Disc degeneration/spondylosis (T1/T2 through T10/T11)
- Facet Arthropathy throughout the spine, particularly at T2/T3, T3/T4, T5/T6, and T7/T8 through the T12/L1 levels.
- Hypertrophic arthropathy at T9/T10
The orthopedic doctor was unsure what the problem was with my hand. Scar tissue from my previous surgery? A new problem? He ordered a new EMG — a nerve conduction test. As far as my hip was concerned, he decided my pain was caused by the aforementioned back problems. Solution? Live with it.
And then came the lecture . . . “have you thought about losing weight?” I told him I had lost one hundred pounds over the past three years . He asked, “How?” I replied, “Gastroparesis.” I added, “Nausea, lack of appetite, and vomiting, will do that to you.” I quickly determined that he knew little to nothing about gastroparesis. This, of course, is not surprising since bones and joints are his specialty. His cluelessness didn’t stop him from suggesting I see a different gastroenterologist to get a “second opinion.” Second opinion, for what?
Gastroparesis is an incurable stomach disease. The treatments are limited: medication to manage symptoms, feeding tubes, and experimental procedures. I hate when doctors think they always need to be the expert in the room. I have no doubt that I know a hell of a lot more about gastroparesis than my orthopedic doctor did. I have read the relevant literature, and know gastroparesis is a miserable disease; that no miracle is forthcoming. I take medication, vomit, forego eating, and I had an experimental procedure done under anesthesia last year (to no effect).
Ignoring everything I said, my orthopedic doctor suggested I contact the practice’s weight loss clinic for a consult. He said, “You know, if you lose more weight, it will lessen the pain in your back.” By this point, I wanted to scream. “Are you not listening to me? “Or do all you see is the fat guy?”
Had my orthopedic doctor asked, he would have learned that I started having back problems at age twenty. I was first diagnosed with narrow disc space in my lower back when I weighed 225 pounds and still played competitive sports. My spine is literally falling apart. Losing weight won’t fix structural problems. I have had back problems at various weight points throughout my life. Lose, gain, it matters not, the pain remains. I am a living study that shows that the idea that losing weight will fix whatever ails you is untrue. As I mentioned, I have lost one hundred pounds. The only thing losing twenty-five percent of my body mass did was improve my glucose levels and provide me a new wardrobe. That’s it. My debility and pain remain the same. But, hey, I love my new Charles Tyrwhitt shirts.
I am comfortable in my own skin. Lecturing me about my weight is not helpful, nor will losing weight magically cure my fibromyalgia, osteoarthritis, or gastroparesis. While there certainly could be benefits from losing more weight, I doubt dropping another twenty-five to forty pounds will lessen my pain.
What I most wanted my doctor to do today is see “me;” to listen to me; to consider the totality of my health. Since that was beyond his “expertise,” he is no longer my doctor. In fact, I am done with doctoring. When I leave their offices worse off than when I came in, I wonder “why bother?”
Bruce Gerencser, 66, lives in rural Northwest Ohio with his wife of 45 years. He and his wife have six grown children and thirteen grandchildren. Bruce pastored Evangelical churches for twenty-five years in Ohio, Texas, and Michigan. Bruce left the ministry in 2005, and in 2008 he left Christianity. Bruce is now a humanist and an atheist.
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I once read a book where a doctor said part of the problem in modern medicine is too much specialization. Specialists have 2 problems:
1. They have no clue about body issues outside their specialty.
2. They still have strong opinions on issues outside their specialty.
I suffered for decades because my health care providers (both medical and psychological) thought it was more important to keep me off the welfare rolls than to help me. Yeah, doctors have personal agendas, and they push them on their patients. I am lucky now to have providers who listen to me. And, I am even more fortunate to have found the psychologist who tested me, and found out many of my problems started in the womb, and I would have been disabled even without the dysfunctional home. He is pushing for me to get SSA, and I am grateful.
A therapist once told me “You don’t want to be a burden to society, do you?” Nice thing to say to someone suicidal. I get it, Bruce. You say you vomit frequently, often feel too sick to eat, but a diet will help? That’s specialist logic. He has no training in gut problems, but he feels qualified to give advice on them. And, he doesn’t trust the diagnosis of doctors who are experts in their field. I don’t blame you for getting mad.
I’m sorry to hear this. I am currently boycotting my nurse practitioner even if it means I have to go without a medicine that I should take. She refused to give my very chronically sick son a medical exemption from jury duty. Turns out, all he had to do was get in contact with our rheumatologist. And then he had to pay a couple hundred out of pocket for that nonsense.
I do not have quite the range of problems Bruce has. I do sometimes suffer quite a bit from pain. So I take the pain meds prescribed from my doctor, except the Tramadol. I don’t like it. I do have several herbal pain relievers/relaxants I also take. I wish I could be honest and tell the doctor or NP, but the one time I tried I was accused of being an addict. That is the other reason I’m boycotting my NP.
Anyway, it seems like getting a good doctor in any specialty is hard. And whenever one of those doctors comes within my orbit, they only hang around for 2 or 3 years, and then go somewhere else they can be paid better.
Well ! This particular column sure resonates with me tonight ! I’ve come to the conclusion that most American doctors are crap. I even have injuries from bad doctoring. And I agree, these conservative, judgemental doctors do more harm than good. One doctor at the ER years ago,when I went with my friend to get him help, admitted to us that doctors can be fined for referrals to specialists, for one thing. Those HMO’ S– I just hate em’. They can be so stubborn in their biases and denials, costing patients precious time, sometimes one’s life ! It was vindicating to look up the truth about how American doctors are the worst quality and most expensive of Western countries. Didn’t make me feel any better, but at least I know I’m not imagining things. Many clinics are quacker factories. My heart goes out to you,Bruce and everyone else sharing the medical nightmares that are standard American medical practice. I’m trying to find out about STEM and laser for these things with joints and arthritis. Among other things. One thing too, is concierge medicine, I want to look into that. Leptin resistance, grehlin imbalance can keep one fat. It’s a genetic problem. And cysts ! Those damn things are also inherited. My grandmother had huge ones, fatty cysts everywhere. I only got a few, and I can’t get doctors to cut them out. They do come back if not removed. I’m going to remove some myself. When I do it, I’ll tell you how it went. There IS mole and skin tag remover one can get, Dr. Scholl’s, I think. And I’ll buy that also.
Bruce, I hear you, and I don’t have nearly the experience with doctors that you have! I am an obstacle racing and endurance running “chick” who has been pretty interested in health and fitness for a couple of decades. I know my body, and it’s going through some perfectly normal perimenopause issues that don’t feel perfectly normal based on my experience to date, but text-book-wise it’s standard stuff. Some weight gain (even though I haven’t changed dietary or exercise habits), some feelings of loss of muscle mass, slowing down, longer recovery times, not responding to training the same way, wanting to eat all the time, low motivation but fighting that, frustration……it’s normal stuff for thos change in life. So a couple of months ago, I go for my yearly physical. My doctor is a young woman, she knows my athletic history, I have good health markers. When I went in, I told the nurse I can’t deal with hearing about weight right now, and she was like, “I got you, turn around on the scale, and I won’t tell you.” Relief – I wasn’t in a place to know that number. Unfortunately, the nurse and I didn’t communicate that to the doctor, so she starts in on “you’ve gained 10 lbs in 2 years, your BMI is getting close to the overweight category” blah blah blah. I ripped into her. I said, “You know I am an athlete, right? I cannot possibly work out more. I could put you on my back right now and squat you, my diet is healthful. BMI is based on data from 19th century European soldiers, it isn’t even applicable to American women in their 50s who are going through perimenopause. What specifically do you suggest I do?” She had nothing. Nothing at all. I hope my little tirade taught her something, but I doubt it. Oh, and I asked her if she felt confident offering treatment for perimenopause or should I ask my gynecologist, and she said to ask my gynecologist. So there we go.
Doctors need to STOP looking at patients and judging them by their body fat. Body fat literally doesn’t tell you much useful information about a patient. There are a lot of perfectly healthy people who have some body fat, and there are a lot of unhealthy people who carry little body fat. Would I like to look like a ripped goddess? Absolutely. But that wouldn’t improve my health markers and may in fact harm them if I am undercutting for my activity level.
I don’t have nearly the issues that a lot of patients have. Looking at me without comparative data, my doctor would not have commented on weight because I don’t look “big” whatever that is. The medical training has not done well by training medical professionals to deal with patients that don’t look like a certain ideal which may not be a healthy ideal for everyone.
Bruce: “What I most wanted my doctor to do today is see “me;” to listen to me; to consider the totality of my health. Since that was beyond his “expertise,” he is no longer my doctor. In fact, I am done with doctoring. When I leave their offices worse off than when I came in, I wonder “why bother?””
Zoe: I so relate to what you share re: health issues. For me, it’s the opposite. I’m still judged for my weight but I’m thin, so you couldn’t possibly be in pain, blah blah blah.
I have heart issues but being a woman, not such a big deal. I asked my doctor about using cannabis oil for pain. He was resistant to it unless I started with Zoloft. I looked at him and said, I have tried 5 antidepressants over the years and the cure was worse than the pain. I’m not doing Zoloft.
I learned from a Cardiologist that my losing consciousness was called Vasal-vagal syncope (fainting.) I have since learned that though yet undiagnosed I likely have POTS. Postural Orthostatic Tachycardia Syndrome. What’s funny (not) is the Cardiologist said “well you have tachycardia but it’s not that bad.” sigh Reminds me of the Gynecologist I saw back in the day for my bladder issues. Told me I have a social problem. Apparently peeing your pants in your 30’s is not big deal.
I have a history of passing out or nearly passing out, and so many of the symptoms of Dysautonomia (umbrella terms for autonomic system failure.) But I’ve got a doctor who told my cardio issues were over his head and a Cardiologist who didn’t think I needed any follow up for my “mild” heart failure.
Intestinal issues. Life-long. In my 20’s I’m told I have the bowels of an 80 year old. In my 30’s I’m told I have “shit backed up all the way to China.” Answer? Eat more and don’t forget your fiber. In my late 30’s I’m told there’s nothing wrong with me, then I’m told it might be Crohn’s disease. Then I’m told it’s not Crohn’s disease. Then another specialist suggests we remove part of my bowel. I asked him if his wife presented with a case like mine would he be eager to remove her bowel. I stunned him with my question. He looked down at the floor and said, “No.” So I said, okay, let’s not take out my bowel unless we have too. In my late 40’s I learn that I did have Crohn’s disease. What a bunch of shit eh? I later find out that Fibro, Crohn’s, osteo-arthritis, neck and spine stuff, migraines, rashes and a boat load of other stuff fall under the umbrella term Dysautonomia.
There’s so much more.
My doctor thinks I don’t like him. I wonder why?
All this to say, I hear you.
i haven’t seen my “primary care physician” in over 10 years. the last time i saw him, i caught a glance of the (computerised) medical chart that he was reading from, and i was shocked to discover that i had a heart stent placement a few years ago… except that i have NEVER received a heart stent. i mentioned this to him, and he said “oh, yeah… we’ll clear that up.” i also noticed that, despite the fact that he had been my “primary care physician” for 10 years, there was no mention at all of the brain injury i had, shortly after the first time i saw him. i mentioned this glaring error to him, and his response was “oh, yeah… we’ll clear that up.” i figured that, if he had so little care for me, and my ailments (or NOT ailments), then it was time for me to see another doctor… but (naturally) i was unable to find one, because i am on a limited income and only have medicare (due to my brain injury), and none of the doctors i called accepted patients whose only insurance was medicare… i still haven’t been able to figure that one out. 😒
Bruce, print this post and send it to the doctor. If you mark the envelope ‘contents personal’ the chances of him actually getting it are better from what I understand.
I asked a doctor a few years back, “If I lose 100 lbs, will you still be obtuse?” I have nothing but bone in my knees. No cartilage anywhere, thanks to a failed surgery and then a complete refusal to listen to me.
May that doctor live in personally interesting times. (Yes, that’s a curse.)
I endured peripheral neuropathy for years and take massive amounts of gabapentin, which only sort-of helped. Prescribed by a neurologist. Then, one day when I was seeing my podiatrist about something unrelated, he asked, “Which toes are affected by the neuropathy?” When I told him, he said, “That isn’t neuropathy, that’s your L5 nerve in your back. Go see a physiatrist.” I did, and now I get regular back injections to deal with back inflammation caused by a malformed back that’s pressing on both L5 nerves. That, plus the gabapentin, now work together and I’m pain-free for months after injections.
Neither my primary care doc nor my neurologist figured that out. Apparently medicine is magic, and each specialist only knows a limited set of magic spells.
I realize when you hear body mass being brought up again and again it is annoying, but it isn’t judgmental. Obesity is the cause and contributor of many medical ailments. Your doctor was clueless, but that’s why he was having a dialogue (but hopefully he took notes!). OBSTACLECHICK mentions BMI, while it is a rather antiquated method, better used for statistics than for personal health, it is more of a quick and dirty heuristic. A better method is waist-to-hip ratio (WHR), though since they are going to take your weight and height anyway I can see why many physicians would opt for BMI.
That said, I’m not satisfied that they put the onus on the person. The first time I was told I was overweight by a physician I said, ok what are you going to prescribe? No YOU must eat less and exercise more. I also tried a program where nurses would remind you to exercise. Pretty weak sauce if you ask me.
He wasn’t having a dialog. At best he sounded like a pitchman for the weight loss clinic. My weight had nothing to do with why I was there. Further, telling someone who has already lost 100 pounds; who daily deals with nausea, vomiting, and loss of appetite to lose weight is not helpful. Especially when you consider that my primary care doctor wants me to eat more, not less. No, he was out of his lane with his weight loss spiel and second opinion suggestion.
I’ve done a lot of reading about weight/weight loss/dieting/etc. I’ve concluded that many doctors lack proper training on these issues. Some of them allow personal biases to color their interaction with people deemed “overweight.”
You bring up a good point about the lack of information sharing between doctors. Doctor was out of his lane and he got caught.
Bruce, I wish you didn’t have to experience the cluelessness you describe. As if your pain weren’t difficult enough!
Missi—I have heard that argument about over-specialization. It makes sense to me. Sometimes I wonder whether the health care system was deliberately set up that way. I am not a medical economist , but my somewhat-educated guess is that such a system maximizes profits for the shareholders of pharmaceutical and insurance companies and the conglomerates that own hospitals .
I am fortunate in not having (yet) the range of health problems some have described. I have, however, experienced some bad doctors. As an example, I nearly lost my hearing in my left ear when a doctor didn’t listen (You can’t make this up!) to my complaints of pain and dizziness. And I can’t help but to think that my late mother’s problems were exacerbated by providers who didn’t listen to her and had no idea of what her other providers were doing for/to her.
MJ, it’s usually about money, but it’s also about status. In the book, (the doctor was in his 60’s when he published it) said that when he was a young man in med school, no one wanted to be a plain MD. Students considered it a low paying, low status position where they didn’t get to see the “exciting” cases. When he chose to be an MD because he wanted to help people, they thought he was weird. He said specialists don’t have the patience to deal with incurable ailments, or plain old age issues.
The book is A Family Guide to Natural Medicine, published by the Reader’s Digest Association. The doctor is Dr. Andrew Weil. I don’t agree with everything in it, but it’s interesting reading, and some of it has helped me.
Ironically, our mutual friend could, if he were so inclined, sympathize with your plight, and then some. He still has access to a national healthcare system, which is wonderful if you have time to wait. It is my understanding that he is still waiting to receive proper treatment for an orthopedic issue he had 25 years ago. One of his relatives, if the information I have can be believed, had to actually have a heart attack in order to get priority for cardiac testing. (There is some doubt about whether the information can be believed; one of our conversations included him responding to my question about a family history of coronary artery disease by saying … paraphrased … “[relative] had a heart attack, I’m not sure where you get coronary artery disease out of that.” But I digress.)
I didn’t come here to talk about that. I have no fewer than five long-term diagnoses. Two of them aggregate to cause me a fair amount of pain. The problem comes when I am asked to rate my pain. I have been in pain from one orthopedic issue or another for pretty much my entire life. The result is, I have a high tolerance for pain. The main character in John Green’s “The Fault In Our Stars” talks about rating the worst pain she ever had as a 9/10 – not because she didn’t feel it was the worst pain ever, but because she was “saving her 10” – waiting until she needed to convey that she was in so much pain that she could not hold out one more moment.
My usual answer to the pain question is a 3 or a 4. I often qualify that with “my 3 is most people’s 6.” My 6 is “I had my knee replaced four hours ago.” And that’s partly because I want to give an apples-to-apples comparison for my pain (“6 is twice as bad as 3”)… but also, I have found that if I go higher than 6, it had better be because I just had surgery. Under pretty much any other circumstances, giving a number over 6 will get you labeled a drug-seeker.
By contrast, my childhood orthopedic specialist once examined me when I was having sciatica. After trying to assess my pain and not getting a comprehensive answer, he said, “There are three treatment options. I can do ultrasound over the affected area, I can give you a corticosteroid injection and see if that helps, or I can do surgery to alleviate the issue.” With barely a moment’s hesitation, I opted for surgery. After it was over (turned out a bone spur was pinching the sciatic nerve) he spoke to my parents, recalled that conversation, and said “when he said surgery, that told me how much pain he was actually in.”
I try and leave as much as possible in the hands of my PCP, as she essentially understands the same thing about me. Specialists, not so much.
This misplaced emphasis on weight is probably causing a lot more morbidity and mortality than the people who carry too much weight. I’m a nurse, I never address diet/weight loss with my patients unless they asked me. I joined a gym once, I was loosing weight and gaining muscle, then the pandemic. My employer was the gym owner and they closed the gym permanently. Imagine that! A hospital system in which hundreds of doctors are telling thousands of patients to loose weight, and they closed the gym that had exercise equipment and trained professionals wandering the place helping people use equipment safely.
That told my cynical brain all it needs to know.
Bruce go ahead and call out these fools. You deserve better care than that.