The first time Dawn Jett met with a cardiologist in Las Vegas, the doctor didn’t introduce himself, shake her hand or review her files. Instead, he looked at her and asked, “Why are you fat?” remembers Jett, 39, who made the appointment to check on her heart murmur, which she has had since childhood. Her response? “I just woke up this morning and decided to be fat.” But inside, Jett says, “I was very uncomfortable.”
It’s no secret that some health care providers hold biases against patients who are overweight or obese. A 2009 study in the Journal of General Medicine, for instance, found that the higher the patient’s body mass index, the less respect the physician reported having for him or her. And it’s not just physicians: A study presented last year at the American Association of Nurse Practitioners’ annual meeting found that more than half of the 358 nurses surveyed endorsed statements such as “overweight people are not as good as others” and “overweight people have family issues,” even though about that same percentage was overweight or obese themselves.
“In the medical field, you’re supposed to do no harm, and when you’re treating people this way, you are doing harm,” says Jett, who’s 274 pounds and serves as vice president of a National Association to Advance Fat Acceptance chapter in the Las Vegas area.
However, most clinicians’ biases are more subtle, says Dr. Kimberly Gudzune, an assistant professor of medicine at Johns Hopkins Medicine who studies how obesity affects the patient-physician relationship. “[Physicians] may not endorse these overtly negative attitudes,” she says, “but if [they] still harbor these subconscious biases that may influence how [they] really interact and engage with people.”
And that can affect patient care, her research has found. In a 2013 study analyzing 208 patients’ appointments with 39 primary care providers, Gudzune and colleagues found that while physicians delivered the same information to overweight and obese patients, they built significantly less “emotional rapport” with them. That’s a problem, since empathy is associated with a variety of positive outcomes for patients and physicians, Gudzune says. “If you think about patients with obesity, counseling on lifestyle and weight loss are really critical. If we’re not making that connection, our counseling might not be as effective in these folks,” she says.
It’s not just overweight and obese patients who are at risk for comprised care based on their looks. Underweight patients can be unfairly judged too, says Jett, whose mom dropped to 76 pounds before physicians diagnosed her with hyperthyroidism. “They thought she was a drug addict, an alcoholic, a bulimic before they did the first test,” Jett says. “Sizeism happens on both ends of the scale.”
Race, ethnicity and perceived socioeconomic status can also affect how your doctor treats you — whether he or she knows it or not, says Dr. Leonard Egede, a professor of medicine at the Medical University of South Carolina who directs the university’s Center for Health Disparities Research.
For example, a 2014 review of studies in the Open Journal of Nursing found that minority patients who seek care at the emergency room for pain are less likely to receive prescription pain relief than Caucasian patients with similar complaints. Why? Clinicians might be more likely to assume minority patients are exaggerating their pain in order to get a drug prescription, some of the studies suggested. Other research has found that African-American patients are more likely to be labeled with schizophrenia than Caucasian patients, who more often are diagnosed with a mood disorder like bipolar disorder. “The direction of treatment varies based on that assumption,” with African-American patients more likely to be sedated or restrained, for example, and Caucasian patients more likely to receive counseling, Egede says.
Patients with kidney diseases also face racial disparities in treatment, says Dr. Michael Kraus, a nephrologist at Indiana University Health. While in-home dialysis is associated with better outcomes than treatments in a clinic, non-white patients are more than twice less likely to receive in-home treatment, according to recent analysis of National Institutes of Health data. One potential reason? “[Physicians] look at the black patient and assume that they don’t have the support or the socioeconomic status or the cleanliness or the ability for home therapy,” Kraus says. In reality, however, “all of that can be overcome with proper training, proper care.”
The good news? “We’re moving positively in the health care environment to more patient empowerment,” Kraus says. “We’ve gone from the state where the doctor was never questioned to the stage where we educate ourselves.”
Here’s what you can do if you think your doctor’s judging you:
1. Get educated.
Before going to the doctor, do your homework. Search for the latest research on your medical condition on a reputable website such as the Centers for Disease Control and Prevention, the National Institutes of Health or the U.S. Department of Health and Human Services, Egede recommends. “Patients should take it upon themselves to do some more research about the treatment they are receiving to be sure that this is the most appropriate treatment for them,” he says.
2. Ask questions.
Once you’re in a doctor’s office, demonstrate that you’re an empowered patient by asking questions such as, “How am I doing compared to my last visit?” “What can I do to improve?” and “Do you need to change my medications?” Egede suggests. “By asking questions, you actually let [doctors] know you’re informed, so they’re more likely to think twice about decisions they make as they apply to you.”
3. Ask around.
One of the best ways to know how a doctor might treat you is by talking to people who are your race about their experiences. “If you’re African-American, if you’re Hispanic, you want to be sure the provider you’re seeing is somebody who has a track record of working with people from other groups and seems to do well with them,” Egede says.
If you’re overweight or obese, asking friends, family or co-workers with similar body types how their doctors treat them can give you insight, Gudzune says. “Not just are they a good doctor at treating a cold, but are they building that relationship with you?” she says. You can also identify empathetic doctors through the National Association to Advance Fat Acceptance or by asking the office staff if a doctor is “size-sensitive,” Jett says.
“There are people who are emphatic and interested in treating obesity,” Gudzune says. “It’s just a matter of navigating a complex system until you find that right person.”
4. Speak up.
Before ditching your doctor due to an insensitive comment or cold attitude, consider talking to him or her about what made you uncomfortable, Gudzune says. “Sometimes in a busy practice, we may make a remark and we don’t intend it to be what someone has felt,” she says. “If you can clear the air a little bit and establish how you’d like to be treated, that would be a really great goal.”
While you should never stay with a doctor who consistently makes you feel crummy, there’s reason to try to make it work: Too much “shopping around” — which is common among overweight and obese patients — can result in poor treatment, Gudzune’s research has found. “They’re lacking continuity of care, and so they end up in the emergency department more for things that could have been taken care of in the primary care setting had they had that relationship,” she says.
5. Listen to your gut.
Sometimes the best thing to do is move on. “If you’re feeling so judged that you’re avoiding the doctor … that’s not a good situation for anyone to be in,” Gudzune says. You are always welcome to get a second opinion.
Jett recommends interviewing doctors before committing to them. “Doctors provide a service, and you are hiring them to see to your needs. As with anyone else you would hire, you have a right to interview them first to see if there is a fit,” she says. With her current doctor, interviewing him first “made it easier to get a feel of how he operated and made for a better working relationship,” she says.
Taking the time to find a doctor you jibe with is especially important when it comes to primary care, Gudzune says. “It’s so critical to have that advocate and that person who’s in your corner because you’re going to be really seeing them ideally in the long term — maybe decades.”
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Is Your Doctor Judging You? originally appeared on usnews.com
