Are Doctors Shaming Patients?

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In the September issue of “Women’s Health Magazine”, there appears a feature titled “The Doctor Will Judge You Now”.  (1)  It included stories of four women who related how they were shamed by their doctors while seeking medical care about sensitive topics. One story relates how a transgender women felt shamed when her doctor asked her if she had a PAP smear, and couldn’t understand why she didn’t need one. Another was shamed for being overweight and yet another for having multiple sex partners. The final story was an African-American woman who failed to be properly diagnosed and instead labeled a drug-seeker because, as she believes, her race.

On reading these articles, I agree that these women were not treated appropriately. Their doctors failed to provide adequate care. But, I also feel that it is wrong to be so judgmental of all doctors based on these sad stories of a handful of patients. The truth is that the vast majority of us doctors do care about our patients and try to give them the best care possible.

I feel bad that these women felt shamed by the system when they turned to a trusted physician for medical help. Let’s be real, though.  There are bad apples in every group, even doctors.

I always tell my patients that they should never be treated by a doctor they do not feel comfortable with, even if that doctor is me. Doctors are human and we have our own personality quirks. Sometimes personalities just clash.

As a doctor, I know my patients trust me to give them the best medical care that I can. In medical school and residency training, it was stressed upon us to not cast judgment on our patients. We need to treat them all the same. I have had the privilege to treat patients who were homeless, some who live in  mansions, others who were great leaders in the community, and a few who were transferred from prison just for medical care in my practice. Every one of them received my best without judgment. Most doctors are the same way.

There are often uncomfortable questions that a doctor needs to ask patients in order for them to receive the best care. Questions do not necessarily mean judgment.

For example, a woman who has multiple sex partners is at risk for a whole host of diseases including HIV, hepatitis, Chlamydia, gonorrhea and others so it is reasonable to ask her about her sexual activity. I do not know if she is at risk unless I ask. Sometimes we need to tell patients what they don’t like to hear –  not to shame them but to treat them. For instance, a patient who is having knee pain would do better if they lost weight if they are overweight. But they may be sensitive about their weight and not want to hear that…

The important thing is making sure these conversations are conducted in the right way. Doctors need to realize the sensitivity of these issues and keep judgments out of the exam room. We need to treat all our patients the same, as human beings in need of help, regardless of who they are, what they look like, or their background. Anything less is unacceptable.

I feel particularly bad for the patient who discussed shaming because of race.  She should not be labeled a drug-seeker without benefit of previous records or diagnostic studies.  Physicians often find themselves in a tricky spot, as we are facing a huge epidemic of prescription drug abuse and more and more people are dying because of it. I see young teens in my practice that are addicted to IV heroin.  These children started off abusing pain killers. As doctors, we must balance the need to keep our eyes open in an effort to end this epidemic. However, this should not come at the cost of innocent patients like the one who related her story in the article. I also want to stress that even if a patient were a drug seeker, they still need our help. They did not get addicted to pain medications on their own and would benefit from a treatment program.

While this series of articles tries to show how doctors are overly judgmental, I find it highly ironic that the article turns around and judges all doctors in a bad light. Patients should not be pre-judged and neither should doctors. Articles like this only serve to drive a wedge in the doctor-patient relationship. Yes, we need to hear these stories and realize there are bad doctors out there as we strive to #StoptheShame, but please present this in an unbiased light.  Do we ever hear anything about the good doctors who go above and beyond for their patients, every day?  Those physicians who spend hours after work updating charts, fighting with insurance companies until necessary tests are approved or working a worried mother and baby into their already packed schedule?  It’s disheartening to see a series of articles that could be so powerful stoop to the level of the physicians they’re exposing.

Articles like this only serve to raise fear among patients and are (dare I say) dangerous, as they may discourage others from seeking medical care when it is truly needed.  A responsible article would have also given women tools to avoid and deal with medical shaming and show them how to search out doctors whom they can trust.

Isn’t it time we were all more responsible?

 

1) http://www.womenshealthmag.com/health/doctor-shaming-weight

 

Dr. Linda Girgis MD, FAAFPdr linda headshot is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University and other institutions.  Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University where she was recognized as intern of the year.  She is a blogger for Physician’s Weekly and MedicalPractice Insider as well as a guest columnist for Medcity News and HIT Outcomes. She has had articles published in several other media outlets. She has authored the books, “Inside Our Broken Healthcare System” and “The War on Doctors”.  She has been interviewed in US News and on NBC Nightly News.

Comments

  1. says

    I wish I could believe it was only a handful of doctors that were shaming patients about their weight. But my experience does not bear this out and neither does the research. It was only a few weeks back that the extremely popular Kevin MD website posted a horrible video displaying dozens of hateful stereotypes of fat people. (He took it down the next day but it says something about the culture that he felt he could post it at all.) http://fatchicksings.com/2015/07/24/doctor-posts-joke-video-demonstrating-stigma-that-kills-people-wheres-the-hippocratic-oath-when-you-need-it/ The Rudd Center for Food Policy and Obesity has been involved in multiple studies related to weight stigma and the medical profession. In one study 24 percent of nurses reported being repulsed by obese patients and 12 percent preferred not to touch fat patients. In another study, 48 percent of nurses reported being uncomfortable treating fat patients and 31 percent reported a preference for not having to care for obese patients at all. Yet another study involving doctors found that two-thirds reported that their obese patients lacked self-control, and 39% stated that their obese patients were lazy. We are not talking about a few isolated cases here. We are talking about widespread, deeply held beliefs. And we are not talking about doctors who simply bring up the issue of weight. We are talking about doctors who routinely prescribe weight loss for conditions that are widely treated with other methods in thin people. We are talking about patients who are told they can’t have necessary surgeries until they lose a lot of weight even though the medical profession has yet to document a method by which a simple majority of the people will lose a lot of weight and keep it off long term. We are not keeping fat people away from going to the doctor because of a few scary stories. We are recognizing what fat people go through at the doctor’s office every single day and assuring them that they are not the only one who feels this way.

    • says

      Thank you for the feedback and I hear your concerns. I appreciate the studies you included.
      I actually agree with much of what you are saying but I think this more a problem in the whole society rather than in just the medical field.
      More and more research is bearing out the fact that obesity can lead to or worsen many medical problems such as diabetes, hypertension, asthma, COPD, and many types of cancer. It is important that it be discussed when treating patients .
      I agree that it is wrong to judge patients for their weight or to make them feel ashamed. I am saddened to hear that you believe so many doctors are like this. Your research seems to bear out what you are saying, We do need to have these conversations.
      And, yes, we need to be more sensitive about it. Not only those in the healthcare field but in society as well.
      The fact that a doctor does not want to do surgery on a patient because of their weight does not necessarily mean they are judging or discriminating against the overweight patient. For example, studies have shown that knee replacements in patients over a certain weight. tend to fail.
      That being said, I do think the article presented an unbalanced viewpoint and tends to demonize doctors. Many are not like that. Also, it did not present any solutions to the problem.
      Perhaps, this conversation can help us to work together to find some.

  2. says

    The point is, larger sized patients are already being kept away from healthcare providers in droves because of the stigma often perpetuated in healthcare settings, and campaigns like #StoptheShame are an attempt to educate healthcare professionals and the broader community about the impacts of stigma in healthcare.

    The studies showing the prevalence of weight stigma in healthcare professionals are numerous and growing. There are stories upon stories of people not accessing healthcare because of fear of weight criticism, or if they are brave enough to face a visit with the doctor, not getting treated for their presenting issue because a diagnoses of ‘obesity’ is laid on them as a blanket diagnosis, and the only advice they are given is to diet – an option that has a 95% failure rate.

    If anything, campaigns like this will help people to realize 1) they are not alone in their fears in seeing healthcare providers and 2) embolden them to either find a healthcare professional who treats them with respect or are able to advocate for themselves with the provider they currently have.

    And I encourage you to check if the studies you referred to (in relation to diabetes, etc) have controlled for physical activity. What we are realizing more and more, is that if we are looking for a proxy for health, physical activity is a much more reliable indicator than body size. A fit fat person has better health outcomes than an unfit thin person. Making this shift would go a long way in helping heal the patient doctor relationship, because supporting patients to increase fitness is something that is doable and measurable ….as long as we make the shift to indicators that aren’t tied to body size and shape (ie: metabolic fitness, cardiovascular health, blood pressure, blood sugars, etc) All of these indicators can be improved with increased physical activity, whether or not weight changes as a result.

  3. Susan Smith says

    The shaming goes way beyond weight issues.

    I will never ever seek medical help again for anything due to the constant shaming. Anything other than a “yes” answer when doctors “suggest” testing is treated with shaming to force patients to submit. They ignore allergic reactions, ignore other health issues and fail to fully inform patients about risks. I have been shamed by way too many doctors to believe it is rare at all!

    Doctors still have this sense that they know better than the patients. If a patient shows any knowledge at all, they are shamed and put down.

    Instead of a partnership, medical care is still paternal. Patient concerns and risks are ignored and minimized to the detriment of the patient.

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