The Fat Doctor

Write a script

Before you get into see your healthcare provider, it’s worth writing down why you are there and what you hope to get out of the situation. What are your concerns? What are your expectations? What are you afraid might happen? You can then turn that into a script to take with you to your appointment. Ideally it should include:

1. A summary of why you are there: It could be simple as “I’m here to discuss my test results”, but you’ll be surprised how useful that opening line is.
2. A brief review of any relevant history: a lot of healthcare professionals don’t bother to read your notes or referral letter before they see you. Often, it’s because they are overworked and running late, but that’s not the point. You shouldn’t have to do their job for them but if it makes life easier for you, then it’s probably worth it.
3. What you expect from today’s consultation: this is KEY! Are you looking for a diagnosis and/or treatment? Reassurance? Something in particular? Spell it out clearly and concisely so that there’s no question as to what you are there for.
4. Any concerns you might have: You can say something along the lines of “in the past… and as a result… so I want to avoid that happening again”. This is also the time to explicitly refuse consent to discuss weight or weight loss.

Don’t be afraid to take control of the consultation right from the start

Healthcare professionals are supposed to be patient-led. This means not only do we work for you, but we should also let you lead the consultation. Notice I said, “supposed to”. We often forget this part of our training and revert back to good old fashioned paternalistic healthcare, where we are in charge, and we get to boss you around and tell you what’s what.

If you want to avoid this, then take control from the beginning. Don’t wait for them to start. Just launch right in – maybe even reading from your script. You may put the occasional nose out of joint, but for the most part health professionals will be grateful that you’re doing the heavy lifting of the consultation and they just get to follow along.

Keep it Short and Sweet

We (and by we, I mean Fat people) are used to defending ourselves all the time. We have to defend our right to be heard and treated with respect. We even have to defend our right to exist. As a result, we find ourselves trying to say all the right things to persuade our health professionals to do what we need them to do. This is bullsh*t of course. No patient should have to do this. But what other choice do we have?

The problem is that we often end up saying too much. And then our health professionals latch on to a small portion of what we said rather than actively listening to all of it. And this hardly ever works in our favour because:

• They can end up focusing on the wrong thing and missing out on important clues
• They may feel the need to defend themselves or prove you wrong (classic doctor behaviour) rather than listen to what you’re saying and try to help you
• They can become overwhelmed with information and mentally check out

Do not fill in the gaps

You probably have a few theories about what’s going on in your body. Chances are you’ve done some research. Of course you have! It’s not like you can trust your healthcare provider to do what is in your best interest. You know chances are they are going to blame your symptoms or test results on your weight. Or tell you to lose weight. Or both.

So it’s tempting to bring weight in to the conversation just to get it over and done with. Same thing goes if you have a disability or something else that is often blamed for every single one of your symptoms. So you might find yourself saying something like, “I know I’m fat and I could stand to lose a few pounds but I don’t think that’s the cause of my symptoms”. Or something to that effect.

DON’T DO THAT!!! Don’t even mention your weight. In fact, don’t try and pre-empt any of these discussions. If you want to prevent the weight loss conversation from happening, then do it right at the beginning of the consultation. If you forget or don’t feel comfortable doing that, then the moment it comes up you need to stop it in its tracks. Put your hand up in the air, open palm and say “I’m going to stop you there: I do not consent to talking about my weight or weight loss”.

Bring an advocate

When you bring someone to an appointment, not only do they provide the moral support you need but they also disarm your healthcare professionals. Now there is a witness. Also, it’s essentially two against one. Trust me when I tell you, it changes the dynamic of the consultation. Now if you’re good at your job, an advocate is an ally. You recognise that there are two people in the room who are invested in the health of the patient in front of you, and that’s a good thing.

But if you’re not so good at your job, then that advocate’s has a job to do. And that job is to keep the health professional in line. Their mere presence may be all it takes, but in some cases that advocate may need to speak up or even intervene. So, make sure they understand what weight stigma looks like, when it is likely to come up, and what you’d like them to do about it when it inevitably does.