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Memoirs of an Obese Physician

Tuesday, November 16, 2010 // Uncategorized

I’m not obese.  This isn’t about my essay.

 Since I exercise daily and watch my daughter at sporting events, I get sun exposure, more than I want.  Even with sunscreen, I get tanned.  Someone told me once that you should never trust a tan physician.    I countered with,”No, you should never trust a tan dermatologist or a fat cardiologist”.  It was a joke.  I came upon this essay in The Annals of Internal Medicine” today.

It will make me think twice before offering the last half of that advice again.

  • On Being a Doctor

Memoirs of an Obese Physician

  • Joseph F. Majdan, MD
  •  


    1. From Jefferson Medical College, Philadelphia, PA 19107.

    Because of society’s negative view of obesity, obese people continue to suffer indignities and prejudices even in this “politically correct” world. Physicians also harbor a similar prejudicial view of obese patients (1). As a medical student and now as an attending physician and as someone who has been obese for much of my life, I have had to face both simmering and overt prejudice from the profession I hold in the highest esteem. 

    I vividly recall that during medical school, a physician approached me as I stood with my tray in the cafeteria line. He said loudly for all to hear, “You know you should watch what you eat. Don’t you see yourself?” At morning report during my third-year medicine clerkship, there was too much light in the room for a slide presentation to be shown. A teaching attending yelled out, “Have Joe stand by the window; he can blot out the light.” At that moment, I wished my beeper would have gone off so I could have escaped from the laughter. During that same clerkship, our teaching attending regularly marched our whole team up 9 flights of steps on a humid summer day in Philadelphia because “one of you has to lose weight,” he said as he smirked at me. While putting on my scrubs during my surgery clerkship, an attending surgeon looked at me with disgust and sarcastically bellowed, “Hey, hey, hey, it’s Fat Albert!” As a result of these comments, I became increasingly self-conscious and with that ensued low self-esteem that persisted for years. I dieted and dieted again, a cycle that would continue to be part of my life in an attempt finally to become “normal” in the eyes of my profession. As a compulsive person, I was successful in losing weight, but as is the unfortunate fate of a large percentage of obese individuals (2), I always slowly regained it. 

    During my internal medicine residency, staff physicians would often—unilaterally and in the presence of colleagues and nurses—offer me their unsolicited opinions on how and why I should lose weight. I wondered why physicians would be so insensitive and callous. Some fellow residents asked me whether my lab coats were made by Omar the Tentmaker. I remember one call from a fellow classmate who was chief medical resident at another institution in Philadelphia; she asked to borrow my white intern trousers so that she could project slides onto them for a housestaff skit that she was organizing. She thought it “would be hilarious.” Instead of getting angry, I gave the excuse that I had thrown them away. To this day, I regret not telling her how unprofessional she was. My lack of self-esteem and feeling “second class” continued to haunt and to anger me. 

    I decided to pursue cardiology and started interviewing for a fellowship. At one interview at a university hospital in Philadelphia, the fellowship director eyed me up and down and curtly asked, “Do you have the stamina and health to survive a cardiac fellowship?” At another interview, a cardiologist told me to sit in another chair since “I don’t want to have to buy a new chair.” I learned quickly that the thinner the attending, the more disdain for my size. Yet, I sat there and accepted their behavior; I felt unworthy of respect. 

    I completed my cardiology fellowship and came on staff at the same university hospital. I quickly established myself as both a clinician and a teacher. I received 11 teaching awards from both students and residents, including the class portrait from the graduating class of 1986, the highest honor a faculty member can achieve at our institution. Even at this moment of achievement, however, a fellow attending took it upon himself to admonish me in the physician’s lounge by saying, “You look too fat in the portrait. You know, they should only paint portraits of those who have done something worthwhile for the university. How could you with your size?” As the portrait was unveiled, I wished I had been portrayed as thinner. 

    I continued my cycle of losing large amounts of weight by religiously following various diet programs: OPTIFAST, Medifast, Weight Watchers, Jenny Craig—you name the diet, I tried it. I was successful in shedding large amounts of weight, but each time it lasted only for a while. During these thinning cycles, fellow physicians and nurses would come up to me while I was getting my lunch and scan my tray, saying, “You don’t want to get as fat as you were, so I just wanted to make sure you were watching what you were eating.” Once I was even asked whether I had cancer. One patient told me of her request to her physician to be referred to me. The physician responded, “Why do you want to go to him? He’s fat.” She came to me nonetheless. Other physicians openly told my friends that they would never refer anyone to me because of my obesity. I felt I had to prove myself more than the “normal” physician. A surgeon stopped me on the floors and told me I needed gastric bypass surgery; another internist sat down next to me at a nurses’ station and openly guessed my weight, then pontificated on what my approach to weight loss should be. A fellow cardiologist stopped me on the street to tell me I looked “disgusting” and asked whether I “had no shame.” 

    This constant insensitive, unprofessional attitude of fellow colleagues who preached empathy to their students and residents and evaluated them for it caused me to see them as hypocritical. My low self-esteem rendered me silent to the comments, but it also made me angrier with myself for not defending myself. 

    Sometimes we have to teach others how to treat us. Physician attitudes toward obese patients have been shown to be negative, and they tend to stereotype their obese patients as being lazy (3). Another study found that physicians view obese patients as ugly, weak-willed, sloppy, and lazy (1). One editorial stated that attending physicians develop growing cynicism toward obese patients about convincing them to lose weight, because the physicians feel that their preaching goes unheeded (4). It is interesting, though, that physicians do not hold the same cynicism and negative views toward patients with diseases that are similarly resistant to therapy. When has a physician blamed the patient when cancer recurs? 

    An understanding of the causes of obesity, as well as effective treatment, remains to be discovered (5); more research is urgently needed in this area. Starting in medical school, obesity should be addressed and approached with a true understanding of the difficulties the condition presents, as well as treatment options. Professionalism and sensitivity toward obese patients must start with physicians. Equally important, attending physicians should be brought before professionalism committees for callous treatment of both their obese colleagues and patients. The obese patient demands the respect and understanding that all of us deserve. 

     

    Joseph F. Majdan, MD 

    Jefferson Medical College 

    Philadelphia, PA 19107 

    Article and Author Information

    • Requests for Single Reprints: Joseph F. Majdan, MD, Jefferson Medical College, 1001 Locust Street, Suite 409B, Philadelphia, PA 19107. 

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