Should doctors provide weight management advice to their obese patients?
An MD’s job: To make you heal good, not feel good
Shooting the messenger
I’m going to get in trouble for this one, I can tell. Oh, well
In the last Daily Dose, I wrote to you about the basic conflict of interest the majority of mainstream MDs seem to have with their patients’ being of good health. As evidence, I cited a CDC report from 2004 revealing that 60% of doctors DO NOT counsel their obese patients to lose weight.
The reason for this, I theorized, was that modern medicine depends, to no small degree, on the sick and dying for its sustenance. After all, there are more doctors per capita now than at any point in our country’s history – and they’ve all got to pay the bills somehow. So when I read the CDC’s report, I could figure only one reason these docs might not be talking to their fat patients about weight control in these Hippocratic Oath-less days:
To stay profitable, they need sick people to treat. And fat people are among the sickest.
But in just the few days since that last Daily Dose, another reason occurs to me, sparked by a story that’s been all over the news for the last week: Perhaps doctors are AFRAID to confront patients with their own rotundity. Now, if you’re over 50 – in other words, if you were born back when doctors were supposed to make you HEAL good, not FEEL good – you’re probably asking: What could they possibly be afraid of?
Being sued, disciplined by some power-mad medical board, or being perceived as insensitive by patients. None of these things help pay the bills too well.
And such is exactly the case for Terry Bennett, a New Hampshire “old school” doc who’s the last independent physician in his county (all the others are hospital-owned), according to a report in the Union Leader News, a local newspaper in the granite state. After some hyper-sensitive overweight woman complained that she’d been repeatedly lectured by the good doctor for her obesity, he’s now being investigated by his state’s Assistant Attorney General.
This, even after the state medical board reviewed the woman’s complaint and found no grounds for any disciplinary or punitive measures! Somehow, the case found its way to the Attorney General’s Administrative Prosecution Office. Initially, the Assistant Attorney General proposed that the “offending” doctor Bennett attend a course of some sort (sensitivity training, no doubt), and acknowledge he made a mistake.
In his blunt rejection of the proposed disciplinary action, Dr. Bennett uttered what must surely be one of the great medical quotes of all time:
“I’ve made many errors in my lifetime. Telling someone the truth is not one of them.”
A great quote, but sadly, wrong in this day and age. Keep reading
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The truth hurts – a doctor’s career
Dr. Bennett’s case is one that has been taken up by both sides as illustrative of their point: Some argue that physicians are obligated first to a patient’s health, feelings be damned; others that the blow to self-esteem a doc’s blunt bedside manner can deliver is a health concern in itself.
But I see the incident as starkly illustrative of another point, something I’ve written about before in many contexts: The increasing trend away from personal accountability and toward a condition of the “blameless individual.” Here’s what I mean: For an obese person to be so offended as to report her doctor to the medical board or Attorney General’s office simply for telling her she needs to lose weight leads me to only one conclusion: She must feel that it’s an UNJUST characterization.
This, in turn, can mean only one of two things: One, that she thinks she ISN’T really fat. This would be a logical by-product of the “offend no one” PC movement, which doesn’t acknowledge flaws and that holds self-esteem above all other things, including health. Or two (and more likely), that it’s not her FAULT she’s fat, and that she’s resentful of a condition that’s been thrust upon her by a culture obsessed with waifs in magazines.
Of course, all thinking of this type fosters a “blameless victim of society” mentality for anyone who’s not born rich, into the right neighborhood, or with a perfect body.
The bottom line is this: Life’s not fair – but doctors should be. And I’m relieved to say that I might’ve been a bit too cynical before in thinking that dollars and cents were the sole reason 60% of MDs don’t mention their patients’ obesity. Some might be holding back because these are sensitive times, and a reputation for sensitivity is a tough thing to try to maintain in them.
But it isn’t their JOB to hold back. It’s their job to heal and preserve health, like the Oath says. And to Dr. Bennett and other truth-telling MDs: I salute you, and keep fighting the good fight – against both fat and the “sensitivity police.”
Healing good AND feeling good,
William Campbell Douglass II, MD
