My Fat Ass and the RNP from Hell

My primary with my HMO was an RNP (Registered Nurse Practitioner), but she went toIraqa couple of years ago (Reserve) and has not returned (folks at the HMO tell me she’s doing fine, but they don’t know when she’ll return).  So I chose another RNP.  From time to time, she would order blood tests, I would go to the lab, and the results would come in.  I never met the woman face-to-face.

Until yesterday.

OMG.  Now this woman is self-admittedly “overweight” (her choice of words, not mine), and yet she is one of the most fat-phobic, weight-centric medical professionals I have had the misfortune to run into in a long time.  Let me repeat. OMG.

She had me come in because my HgA1C has (finally) crept up into the diabetic range.  Okay.  I can deal with that.  Diabetes is a condition that is treatable.

However, her explanation for everything going on with me is my weight.  Not my age, not the hormones I was taking for 6 months, not the other prescription drugs I am taking, not my recently diagnosed sleep apnea, not my torqued pelvis.  The answer to everything is lose weight. 

I told her I was not willing to make weight loss a focus.  I was not willing to diet.  I told her, basically, what my husband told his doctor:  I will focus on what I can control – my behavior; I will not focus on what I cannot control – how my body will react to my behavior.  Her response was to try to make me promise that the next time I came in I would not have gained another pound.  I told her no, I will not make that promise because, as I already had told her, I had experienced significant unexplained weight gain over the lest several months (her explanation for that was my metabolism must have changed – well possibly, but why?). 

She would not admit that diets don’t work, and she kept saying she’s not talking about “diet” anyway – she’s talking about food choices – calorically reduced food choices to promote weight loss.  Hello?  Do I have stupid tattooed on my forehead?

As you can imagine, the sparks flew.  We were together for an hour (the HMO only allocates about 15 minutes per visit), most of which was spent butting heads. 

She kept telling me her own experience with her weight – which apparently has not been good, she has bad knees and hypertension.  I explained that that was not my experience, that I was not her. 

She also kept telling me horror stories of other patients who were “saved” by weight loss.  I kept asking what would happen to those people in 5 or less years when they were fatter than ever?  I also asked her if she thought it might possibly unethical for a healthcare professional to recommend a treatment with a 95% failure rate.  (OK, low blow, but by then I felt like I was fighting for my sanity; and besides, low blow or not, it doesn’t make it an invalid question.)

When I left, I knew her weight, her husband’s weight (!), and the fact that the guy who cleans her house and does her yard work, who is a runner and quite lean, was trying to lose 20 pounds before his next race.  I asked if she had pointed out to him that that might not be very healthy for him. 

What I didn’t know was why the recent weight gain, when I should be using my glucosometer (my fingers are feeling and looking like a pin cushion), and what do the readings I’ve accumulated mean.  I did not have a good blood pressure reading – because when using the machine, I get a reading that is about 20 points too high and she didn’t take a manual reading as I requested. 

We had “agreed” that I would up my amount of exercise, that I would have referral to physical therapy for my pelvis (it was a battle to get that), and in 3 months I would have my blood taken and see how my body is doing.  By “agreed”, I mean, I told her this is what I would like, and she complied (unhappily).

When I left, I knew that she was not about to change her approach to healthcare.  She obviously had no interest in listening to what I had to say about my own body and had no respect for anything I could bring to the table. 

Now, I have always advised people to get a new doctor if their current doctor is fat-phobic, weight-centric (you know, everything this RNP is).  But I felt like if I fired her and chose a new primary, somehow she would “win”. 

But after a night of worrying about it, I realized, if I keep going to her, I lose.  Because it’s my health, and my wellbeing at stake.  So I followed my own advice.  My HMO lets you change doctors online, and you can read each doctor’s professional and personal bio.  I chose a new primary, and sent her an e-mail letting her know what I am looking for; and you know what, if this isn’t a good match, I’ll keep looking because I am worth it.

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12 thoughts on “My Fat Ass and the RNP from Hell

  1. And people wonder why many fat patients simply stop going to the doctor until something catastrophic happens. Why go when you can get the same lack of treatment, for free and with less blame/scorn, simply by not going?

  2. I did not have a good blood pressure reading – because when using the machine, I get a reading that is about 20 points too high and she didn’t take a manual reading as I requested.

    And, let’s be honest, who knows how accurate your manual reading would have been if that’s how she was treating you. Mine would have been through the roof!

    I hope you succeed in finding a better doctor – at least your system lets you check out providers relatively easily; I’m with a decent surgery now, but I never had the courage to speak up about bad ones in the past (not weight-related, but like the guy who put me through umpteen inconclusive blood and urine tests because he couldn’t see clinical depression when it was sitting in front of him) , and I wouldn’t have a clue how to go about it.

  3. Good for you for switching!! Now, write a letter complaining about the other one. Give specifics. Realize that the bigwigs in charge will see wt loss advice as legit, given the diagnosis, BUT emphasize her combativeness and her single-minded focus on weight as the cause for every problem. Emphasize your willingness to work on a treatment plan, but not with someone you have to fight with every minute and who won’t recognize your right to refuse a particular course of treatment.

    As we discussed before, get a ferritin reading soon. Really low ferritin levels can artificially elevate blood sugar readings, specifically the glycosylated hemoglobin test (HbA1c) that you took, something not every care provider knows. So it would be good to rule that out as a factor here, esp since you’ve been so tired etc. Doesn’t mean you don’t have diabetes, but it would be good to be SURE you have an accurate picture of your blood sugar levels.

    And be sure you write that complaint letter. You may not get satisfaction to your face, but they do hear and notice these complaints. If you can be calm and reasonable in the letter, and can include some research citations about the poor long-term success of weight loss (and how it often actually causes weight GAIN in the long run), that might also be helpful in them taking your letter seriously.

    Tell them you understand it’s standard-of-care to recommend weight loss when blood sugar issues are diagnosed, but that’s not the ONLY approach possible and shouldn’t be pushed to the point of harassment. Tell them you want a provider who will work WITH YOU to find the best course of treatment, not one who will impose their own ideas and issues on you and cannot be flexible about options for treatment.

    I’m afraid more and more of us will be experiencing treatment like this. They are trying to push persistence and not taking no for an answer to break through “resistance” and “noncompliance” to wt loss suggestions….they think they can make us more compliant if they just push hard enough or scare us enough.

    We just have to keep reminding them that this is OUR body and we always have the right to informed refusal of a course of treatment (use that language, it carries legal significance) and the right to consider alternatives, and they have the ethical obligation to help us develop a course of treatment that is acceptable to us, whatever their personal viewpoints are.

  4. My husband has type 2 diabetes and I joined 2 diabetes lists so I could educate myself about it and be able to help him (he doesn’t test as often as he should). From what I’ve read, most type 2s test just before each meal, then again one hour after, and two hours after each meal, and before bedtime.
    What I did was create a spreadsheet on the computer with columns for time of day, blood glucose reading, what was in each meal he ate, then 2 more blood glucose readings after each meal, and one for a bedtime bg reading. Then I asked him to test at a different time each day (I could only get him to test once a day) so that I could see how various foods affected his blood sugar. For instance – potatoes and rice don’t seem to raise his blood sugar as much as having a cookie will, and a philly cheeseteak sandwich doesn’t raise his blood sugar as much as a bbq pork sandwich does. The amount of exercise he gets also affects how what he eats will raise his blood sugar – if he has a harder day at work, his blood sugar is lower when he comes home than if he has an easier day.
    When he was on oral meds only, this wasn’t as important, but it became vital when his doctor started him on insulin. He’s squeamish about giving himself shots, so I have to do it for him, and I’m the one who counts his carbs and figures out how much insulin, long-lasting and fast acting, he needs.
    So those numbers you’re getting after meals are telling you how the different foods you’re eating are affecting your blood sugar. The more carbs you eat, the higher your blood sugar is going to be after a meal, depending on how much fat and fiber you had with the carbs (fat and fiber slow down the digestion of carbs and the conversion to glucose and lessen the rise in blood glucose after a meal).
    DH’s doctor recommends that he have no more than 45 grams of carbs per meal, but I try to keep meals to around 30 grams, unless we’re eating out.
    Hope this helps.

  5. I’m sorry about your experiences with this woman. If I were in a situation like that, I would also choose to see someone else. Your health is more important than feeling like you have “won” some kind of battle. I think that in any doctor’s office, there needs to be an equal amount of talking and listening and I agree that doctors in general should be doing more listening to the patient than what they do nowadays. However, to be fair, I can understand why she seemed unhappy. You basically wouldn’t take her advice so you offered your own, and by her agreeing with you, she’s putting her job at risk. If I were a doctor, I would never agree to something a patient suggested that I didn’t agree with. Instead I would refer them to someone else. If I were a patient, I wouldn’t have wasted an hour arguing with them. I would have just left and sought the assistance of someone else who I could be more on the same wavelength with.

  6. You’re absolutely right. Sticking with this woman would be a form of capitulation. You deserve a health care provider who respects your choices and offers helpful support rather than shame. Best of luck finding a new RNP!

  7. I appreciate your willingness to go head-to-head with your doctor and have a discussion about the futility of dieting. It’s awful that she won’t take the time and look for the real cause of your health issues.

    That said, I do think you are doing the right thing by throwing in the towel and finding a new doctor. Her fat hate isn’t going to change because you disagree with her; someone so entrenched in that system of thought isn’t going to change her mind and you need to take care of yourself, not waste your time with her.

  8. Have you gotten your CPAP for your sleep apnea yet? Just by getting some really good sleep, your numbers could improve without any changes at all. Also, when you start getting good sleep you are going to feel like you can conquer the world, so go conquer because the feeling doesn’t last forever. (I don’t think the feeling goes away, I think it just becomes the “norm”.)

    Yes, yes, yes, get a new doctor. Good for you for standing up for yourself, I think I would have just slinked away and cried in the car.

  9. Yup, when it boils down to it, is having to fight every time you get medical attention really doing your health any good? And what happens when you don’t have any fight in you? Besides, it’s just lazy “medicine” to crap on about weight without proper investigation into what is happening with your health.

  10. I’ll reiterate what a good friend, a medical professional herself, told me once. When our caregivers don’t listen to us, don’t believe us, don’t hear us, we are not receiving medical care. We are receiving veterinary care.

    Good for you for standing up for yourself. Your health comes first.

  11. I don’t know if I could have held it together for a freaking hour. Good for you for sticking to your guns, not calling her an idiot to her face, and switching doctors afterward.

  12. Your unexplained weight gain may be due to you developing diabetes- overweight people are more likely to get diabetes but it is hypothesised (not absolutely clinical fact yet but under clinical trials) that the weight gain comes first, before the person is diagnosed, without changes in lifestyle, and it is an early symptom of type 2 diabetes rather than a cause.
    I am a medical student and I cant wait to qualify basically so I can do better (Is that arrogant-sounding at all. I hope it isnt.. I dont mean it like that) Doctors need to be empathetic to thier patients needs. Even if this doesnt agree with thier clinical training. The patient comes first. ALWAYS. If your patient doesnt want to diet, you dont mention dieting and concentrate on actual health indicators (eg blood sugar or triglycerides or activities of daily living fitness) which are perfectly malleable irrespective of weight. At least thats what we have been taught
    thanks for not blowing your lid at her I wouldnt have been so restrained.

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