Good doc, bad doc

I wish my doctor had done this. Except that then this blog might not have happened, because what got me angry and ranty enough to want to blog was the way my (former) GP dealt with my weight. Except that I'm a big procrastinator and I was emabarrassed and stuff and never did write that post, although I started blogging anyway. Here's what I would have written, now that Dr. Charles' post has reminded me.
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My annual physical exam last year was something I had actually really been looking forward to. Not that I have some kind of weird speculum fetish or something. Just that I'd been making some really positive changes in my life and I was expecting that those changes would show up in discernably improved health and some empirical validation would be nice.

You see, all my life people (including my pediatrician at age 4, one of my earliest memories) have been telling me I'm fat. This is really stupid, because I was never more than a little overweight. In my first year of university, though, I started moving from really not fat at all, to slightly fat. When I hit 150lb, I panicked, and went to Weight Watchers, and stuck to their regimen assiduously, and got down to 120 lb (WW said my goal should have been 110). I also shot my metabolism to hell, and developed a habit of bingeing under stress, driving around town in the middle of the night to different drive throughs and having three or four super-sized combos from different McD's and throwing out the wrappers in garbages far from home so there'd be no evidence, then feeling so awful about myself that I wouldn't eat the next day, causing... more stress. I suspect that the disordered eating was the result of the group dynamic at WW, where there was a lot of good food vs bad food rhetoric going on, a sort of confessional atmosphere that seemed to rely a whole lot on food guilt and feelings of shame if the number on the scale wasn't moving inexorably downward. Plus of course not eating nearly enough to be well can wreak havoc on any body.

Not surprisingly, I didn't stay at 120lb for long. In fact, a year later, I weighed 180. A year after that, I weighed 210. I discovered that as long as I ate as much as I wanted, whenever I wanted, I could avoid the binge cycle, and for several years, as long as I was able to exercise, my weight was stable. And then there was the knee surgery and the time I couldn't exercise, and by the end of 2004 I weighed 230lb and felt really unwell. I started to get scared about what I was doing to my body and that I was going to die by the time I was 40.

So I set out to lose that weight. I made a lot of positive changes: I started exercising again - slowly at first, but then more and more, and I discovered it made me feel fantastic. At first I restricted my calories too much, but when that was unpleasant I started focussing instead on getting all my servings of fruit and veggies and lean dairy, and eating vegetarian as much as possible. Is there a word better than fantastic for how good I was feeling by the time it got to be time for my physical? I'd lost 20lb, but by then that was secondary to just plain feeling good. Also worth noting, in reference to Dr. Charles purgatorial experience, is that I was eating about 2300 calories a day, not 1600, and the pounds were melting away.

The doc was relatively new to me, since my usual doc had suddenly moved to Vancouver and left me in the lurch. I'd only seen Dr. X a few times previously, for help with my knees when I'd pushed them too hard by doing too much new exercise too fast, but I had really liked and respected him during those visits. Which is why what happened was such a shock to me.

We got off on the wrong foot right away, when he took my pulse and blood pressure (fast and high, respectively), and commented, “You obviously haven’t been getting any exercise.” I know better than to expect him to remember everything about me, because I know he has a lot of patients, but the last thing in my chart before the physical would have been that I came to see him because I was having pain and swelling in my knees that was interfering with my exercise regimen. He was holding my chart while he said it. So I’m curious why he just went straight into berating me for being out of shape. Would he have said that if I were thinner, or would he have assumed I was feeling anxious and tried to say something to put me at ease? Do people whose BMI is greater than 30 suddenly not have sympathetic nervous systems? What about feelings?

Then I told him that I had in fact been exercising, alternating swimming and weights. If he hadn’t interrupted me, I would have told him that in a good week I’ll go six times, but four or five times is pretty usual, that my swimming speed and endurance has increased dramatically, and that I still do cardio on resistance training days. But he did interrupt me, and rather than saying something positive like, “That’s great that you’re committing to getting fit,” what he said was, “Don’t do weights.” I was so flabbergasted by that, that I didn’t get a chance to ask why on earth should I not be doing weights?

I don’t remember the exact order of what happened next, but somewhere in there he launched into a stern lecture about how dangerous it is to be overweight and all the bad things that will happen to me if I don’t lose weight and so forth. I was trying to tell him(and if he'd referred to my chart he would have already known) that I don’t need to be scared or shamed into losing weight. Not only am I already scared out of my wits, I’m scared enough that I’m doing something about it, and I’ve had a modest amount of success at it. But I couldn’t get a word in edgewise and there he was going on and on like I have no idea that being 5’3” and over 200lb is bad for me, and I’m just obliviously sitting my fat ass on the couch eating deep-fried cake. I would have liked to have talked to him about the plateau I was stuck on, and the emotional ups and downs I’d been having where some of my disordered eating seems to be slipping back in, and that as far as I can tell it’s only because of the exercise that I haven’t gained everything back plus extra. I would have appreciated some encouragement, and some constructive advice for getting out of the rut. I got neither.

Then he asked me if I’m married, and whether I’m sexually active. Now, that’s a perfectly reasonable question to ask a patient, because marital status is a major determinant of social supports, and of course you need to know if I need my prescription for birth control refilled. But my level of trust at this point in the visit was so low, that my first thought was, “Oh no, he’s some kind of religious nut who’s going to refuse to provide me with contraception,” and my second thought was, “What, fat chicks can’t get laid unless they roped someone in back when they were skinny?” He also neglected to ask whether I was in a mutually monogamous relationship and whether I thought it would be a good idea to be tested for STDs.

Then he launched into a lecture about the risks of being on the pill for obese women who are getting close to 30 – which I tried to tell him I knew, but he just went on and on anyway, again as if I am oblivious and/or ignorant of the risks of my weight. I had really been hoping we could have a constructive discussion about birth control, because the risks of being on the pill really do concern me and if I have other options (besides abstinence or having a baby every year until menopause) I would be interested in pursuing them. But the way he was going on, I was afraid he wasn't going to give me any contraception at all, so I just asked him to refill my existing prescription because I didn’t feel up to fighting.

At some point we talked about diet, and I got a mini-lecture about not eating fried foods. I was able to interject there that I was in fact making a serious effort to eat a healthy and balanced diet, but I was feeling so frazzled and picked-on by this point that when he asked what I meant by eating healthier, my brain went absolutely blank.

When I couldn’t tell him specifically what I was doing with my diet, he told me to go to Weight Watchers. He refused to listen to me when I told you what an awful time I had with them. And then when he finally let me get a word in edgewise, he dismissed my concerns. "Well I've never heard of that." Like since he's never heard of it, my experience can't possibly have happened.

Here I’ve taken reasonable and effective action on my own to get healthier, and here he is insisting that I participate in a program that’s required by law to say “*results not typical” in all its advertising, and that I already had an awful experience with. I thought he was supposed to be on my team helping me get healthy.

So after my appointment I went and sat in my car and cried for a while, then I went to the pool and swam a bunch of laps and I was still angry, so I got out of the pool and rode the stationary bike and pumped some iron and I was still angry after that, so I went and wrote a strongly-worded letter, and left it with his secretary, asking if we could discuss it when the results of my bloodwork came back.

After telling me that all my bloodwork was in the ideal range, he told me he didn't want to be my doctor any more. That he remembered being in a rush, but didn't remember any of the appointment that way and clearly I need a better doctor than him. Which, evidently, I do, because I don't need a doctor who sees my size and then saves time by kicking in a stupid-fat-person heuristic.

So the question now is, how do I find a new doctor, when that letter will be with my chart if they get my old records. And then maybe that doctor won't like me either.