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Ms Crankypants. April 15, 2008

Posted by phledge in black bile, fat, health, medical school, osteopathy, yellow bile.
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If I seem a little less than graceful or generous it’s because my campus in deep in the throes of what is being called “Fit For Life Week.”  The motivation behind this is misguided at best and fat-phobic regardless.  The current president of the American Osteopathic Association, a Dr Peter Ajluni, has taken it upon himself to overcome Teh Obeeeeeesity Crisis!!!!1!eleven! during his tenure which, thankfully, ends in July (the tenure, not the so-called crisis—forsooth, something can’t end if it hasn’t yet begun).  His presidential theme is “DOs:  Fit For Life” because he thinks that it’s absolutely shameful for osteopathic physicians to not look good.  Oh, hell, let him tell the story:

http://blogs.do-online.org/aoapresident.php?itemid=3435&catid=12

http://blogs.do-online.org/aoapresident.php?itemid=3162&catid=12

http://blogs.do-online.org/aoapresident.php?itemid=2965&catid=12

I could freaking go on.  My favorite?

Many resolutions as well as my inaugural address focused on fitness and obesity. I believe it’s important for us as DOs and future DOs to set an example for patients by living a healthy lifestyle that includes exercise and eating heart healthy foods. After all, would you go to a dentist who had bad teeth or a barber/hairdresser who had a bad haircut? Probably not. So my theme this year focuses on us getting in shape.

Yeah, except, raise your hand if you know what’s different about fat as a marker of your health?  That’s right, it’s a fucking RUSE.  (And a funny commenter on that page mentioned that getting a bad haircut is the responsibility of the barber’s barber, not his own doing.)  As a physician am I supposed to be posting my blood pressure, cholesterol count, and 5K times on my front door?  Or should I just let my patients decide that I’m unhealthy because I’m not the size they and the dominant culture think I should be?  OR, Maude forbid, they can come to me because I’m compassionate and competent and because I treat them like humans instead of approaching them as the godhead to which they should all aspire?  What?  How is that, what you say, revolutionary?

Oh, and also?  Make our profession a place such that it is FUCKING POSSIBLE to lead this life you purport is so crucial for good doctors.  Not “hee hee the ACGME put work limits on residents but we don’t have to.”  Not “we support insurance companies so our members have to see forty patients a day to meet overhead plus loans hee hee.”  And sure as hell not “what do you mean you have to spend most of your waking hours explaining what a DO is hee hee?”

My problem (besides the brain damage) is that someone is asking me and my colleagues to be “perfect.”  That just in case it’s not already difficult enough to be a good doctor in this sue-happy, managed care nightmare that is modern medicine, we are expected to be models of health, wealth, knowledge, saintly behavior, and probably good taste in luxury goods.  That in order for me to be an excellent physician I have to be an outstanding role model in all of my representations.  The unfortunate fact is that my weakness (if that’s what you want to call being fat) is visible, like a bad haircut or dental caries, while others’ weaknesses—beating their spouses/children, abusing both legal and illegal substances, engaging in high risk behavior such as speeding, gambling, and unprotected sex, or just generally being a tool—are easily overlooked.  Oh, and that my “weakness” doesn’t hurt ANYONE ELSE while, well, there’s some shit that just won’t fly when it comes to keeping your license (although if Dr Marathon had his way it’d probably be grounds for revocation of licensure to be faaaaaat).  If El Jefe Osteopatico deigned to meet me he would discover that I swear and I am fat, but that I’m one of the top students in our class and, damnit, people like me.  (Disregard the fact that I am blogging during a pathology lecture.)  There’s just so much wrong about it that I feel like Prometheus.

Which brings me to this week.

Thus far we have had two presentations in concert with our FFL Week:  first, a lecture about how to eat healthy on a small budget, by a registered dietitian.  Hey, I’m okay with that, actually!  Someone finally addressing the fact that socioeconomic factors can impact your food choices!  Wow!  Someone has a neuron!  But wait.  The student group endorsing this event put a flyer together that had a picture of a headless fatty (eating, no less—the horror!) with the caption, “Look like this?” next to a picture of a male and female model in bathing suits with musculature consistent with a body fat percentage in the single digits, with the caption, “Learn how to look like this!” followed by the information for the talk.  No no no no no NO.  I couldn’t go to the talk due to a previous engagement, but the flyer haunted me for days.

Second presentation was “Lose Weight In Medical School?”  Okay, I have to point out how ridiculously close that comes to one of those cheaply printed signs one sees on interstates and nailed on telephone poles, short of saying, “Ask me HOW!”  And even then, the flyers they put out specifically said, “Hear personal success stories of weight loss in med school, how they did it and what they recommend.”  I had every reason to believe that I might have spontaneously combusted if I went to that presentation, and in all honesty I like the people whose “success stories” were being showcased so had I become a feverish drooling case of pseudorabies on their asses I would have ultimately felt really bad.

Now, remember, this is about being “Fit For Life.”  I must absolutely, unequivocally state that I am ALL ABOUT people being able to eat pesticide-free fruits and vegetables, naturally-raised animal products if they so desire, whole grains as their GI systems can stand them, and a wide variety of foods they like for whatever reason they have.  I am ALL ABOUT shifting our concept of physical fitness to disclude painful, joyless exercise regimens in which one partakes because otherwise they’ll die die die, and to include movement of all kinds that gives the physical and emotional body the numerous benefits associated with stretching, strengthening, challenging, expressing, and loving the activity.

I just think it’s incredibly fucked up to say I have to or else I’m a Bad doctor/you’re a Bad patient/we’re Bad people.  I think it’s incredibly fucked up to say that these things don’t matter if we don’t look like we do those Good things.  I think it’s incredibly fucked up to tell physicians-in-training that anything less than these judgments are malpractice, not standard of care, not in the patients’ best interest, and why don’t you just go stomp on kittens while you’re at it?

That’s why I’m cranky.  Mr Phledge wisely noted that, “if you’re not pissed off, you’re not paying attention.”

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Comments»

1. vesta44 - April 15, 2008

Yeah, and I can’t handle being pissed off all the time over what I read about the obesity epi-panic, so there are times when I don’t pay attention on purpose (have to save my sanity somehow).

2. Meowser - April 15, 2008

And a funny commenter on that page mentioned that getting a bad haircut is the responsibility of the barber’s barber, not his own doing.

HAHAHAHAHAHA. Oh, and also: HAHAHAHAHAHAHA.

Sooooo…what happens if a doctor gets cancer? Or has some other kind of devastating illness? Do they hang it up for good, because now their “I know how to make everyone healtheeee guaranteed” cred is shot? Or are only thin doctors presumed to have illnesses that are “not their fault”?

And I loooooove that an educational/credentialing process that requires people to STAY AWAKE FOR 48 to 72 HOURS AT A STRETCH has the frigging GALL to proselytize about “healthy lifestyles in medical school.” Do they have any idea how HARD it is for someone to actually do that, especially repeatedly? I would guess that there’s a lot of, um, not-exactly-healthy behavior going on as a result of those requirements.

3. HeatherRadish - April 15, 2008

I SO want you for my doctor when you graduate. You’re right–there’s nothing in a doctor’s size that says they’re going to be competent, compassionate, knowledgeable, not an asshole, etc.

As an aside, my dad is a D.O. and he paid an orthodontist with crooked teeth a lot of money to make my teeth straight.

4. wellroundedtype2 - April 15, 2008

Oh, you so hit the nail with this:
The unfortunate fact is that my weakness (if that’s what you want to call being fat) is visible, like a bad haircut or dental caries, while others’ weaknesses—beating their spouses/children, abusing both legal and illegal substances, engaging in high risk behavior such as speeding, gambling, and unprotected sex, or just generally being a tool—are easily overlooked. Oh, and that my “weakness” doesn’t hurt ANYONE ELSE while, well, there’s some shit that just won’t fly when it comes to keeping your license (although if Dr Marathon had his way it’d probably be grounds for revocation of licensure to be faaaaaat).

I grew up in a family with some hardcore dysfunction and yet, it seemed like everyone was all about trying to make me un-fat. The hypocracy of it would drive me crazy, and still does. Just because my “flaw” is visible, even though it hurts no one, I would get massive shit from family and peers, while all sorts of behavior that harms other people would go untreated.

5. wellroundedtype2 - April 15, 2008

Oh, and, I would definitely see a fat doctor if I could. Not that it would guarantee compassion but at least some basic understanding might be there, you know?
A fat female ob/gyn would be awesome. My ob/gyns (there’s a whole practice full of them) are great, but slender. My primary care doctor, who I also like very much, is a slim guy. As is my primary mental health care person. But they have all made me think that I can’t assume that if a health care provider is slim they will automatically be a slugsucking, fat-hating jerk. Unlearning stereotypes, that’s what I’m all about.

6. Mercy - April 16, 2008

Can you move to Germany after you finish, so I can have you as my doctor?

Like wellroundedtype2, my ob/gyn is a thin woman, as is my endocrinologist, and my primary care doctor is a thin man. However, they’re all three of them focused on OMG Teh Fatz! Bleah. Well, the endocrinologist less so, but she forgets what she’s treating me for between visits.

7. Rachel - April 16, 2008

I think that kind of message and visuals are extremely irresponsible on a college campus where estimates place 30 – 40 percent of college aged women as having an eating disorder. It sounds more like scare tactics than an educational campaign – Don’t get fat! If you’re fat, lose it! Now!

There is nothing wrong with promoting healthy eating and increased physical activity – but leave obesity out of it. These are things everyone can benefit from.

8. Cindy - April 16, 2008

My partner is in medicine. She still hangs with classmates a lot.

Her best friend from school works in a family practice. She and her doctor boyfriend, neither of whom are overweight, are taking Adipex. She exercises compulsively, and they are both the picture of health. Positive role model my dimpled ass. Self-prescribing weight loss meds when neither of them needs it? Compulsive exercise? Doctors are human, and it’s better to admit that than to impose lifestyle dogmas like this onto talented human beings. I go to my doctor because she has the training and expertise to diagnose and treat my illnesses and can monitor my health. I’m not looking for a damn guru.

My partner’s best friend spent 20 minutes the other night at dinner trying to get me to let her give me adipex. No thanks. My mental health is important, too.

9. jaed - April 16, 2008

Is anyone else really bothered by the phrase “fit for life”?

I know it has a double meaning – “be physically fit for the rest of your life” and “be a suitable person to go on living” – but the part of the meaning that always jumps out at me is that only thin people are fit to live – if you’re fat, you’re unfit to live, shouldn’t be alive.

10. phledge - April 16, 2008

Oo, Jaed, great point! See, I was kind of thinking of it as “that which gives life” and that’s why I was kind of pissed that they were distorting that message. Ugh, your way is worse! Right on with that interpretation.

11. Robotitron - April 16, 2008

I was so excited when I found a DO within walking distance of my house. I made an appointment — I needed a shot — and I was really, really disappointed to find a big ad for OPTISLIM shake program in the waiting room.

Can you be my doctor when you graduate? 🙂

12. A.T. - April 16, 2008

I am so glad my friend sent me this link. We recently had a “Fit for Life” event at my osteopathic school also and ours was done totally differently. We simply passed out pedometers and tried to get everyone to take at least 10,000 steps a day. I think that what this all comes down to is how you do what you do. I believe that the AOA’s goal is to promote a healthy lifestyle for the physicians as a way to help them encourage, empathise, and better serve their community. Unfortunately, we’ve done it the wrong way with a figure head that, to put it lightly, is too feverent about health for his own good.

My personal understanding comes from my decison recently to quit smoking. I smoked for ten years on and off. I am now a first year student in an osteopathic medical school and decided in October that I had no choice… I had to quit smoking. Not did I want to quit (I had tried many times unsuccessfully) but I felt like it was my responsibility as an advocate for health to do what I could to promote it in the general population. I also felt like I woudn’t ever be able to advise my patient to quit smoking if I wouldn’t do it myself. This is why the AOA is focusing so much on getting physicians “fit for life”. The execution is the problem.

I am relatively active and healthy… I run any where between 2 to 3 miles 4 or more times a week, I walk to classes and home (a quarter mile each way) and I try to take the stairs and park a little further away from my destination. I try to maintain a concious diet full of veggies, whole grains, limited meat dairy and limited salt and sugar… despite this, I am classified as “morbidly obese” and I am ok with this….

One thing that I remember as a future osteopathic physician is that every patient is more than just a chart, numbers, lab results, history, and insurance papers. Each patient is a person, an individual with individual desires, needs, and a unique situation.

I hope that we can as an osteopathic community and a medical community, in general, see this in the future and try to promote optimal health for each individual and not set our goals for health care based strictly on a generalized set of numbers.

13. phledge - April 17, 2008

AT, I’m glad your friend gave you this link, too—welcome! I think what cheeses me about the FFL campaign is the implication that we can’t be good physicians unless we’re good role models, and then disregarding the ways in which medicine makes it difficult or impossible to live healthy lives. It sounds like you’re following HAES and that’s awesome (because I sure haven’t gotten the hang of it in school yet)!

14. A.T. - April 17, 2008

DUDE!! Forget the rest of these people! I want you to be MY DOC!! I had never even heard of HAES! How do you find these things.


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