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Before I get started on this, I want to point out that, in addition to my primary audience speaking with healthcare audiences about best practices for working with higher-weight patients, I also write and speak a lot about how higher-weight people can navigate weight stigma in healthcare. I always want to point out clearly that this shouldn’t be necessary and that, even when medical weight stigma becomes our problem, it is not our fault. Also, the ability to do this kind of self-advocacy is wrapped in many kinds of privilege. That said, as a fat* person who has to navigate weight stigma in the healthcare system, sometimes I have to test my own advice.
Today I have for you that tale of me trying to book a CT scan. For background, in 2021 I was undergoing surgery to remove a benign ovarian mass. After the mass was removed they ran the bowel (which is standard procedure) and they found an additional mass that ended up being cancer. They were able to remove it with clear margins. The upshot is that I didn’t know I had cancer until I didn’t have cancer anymore. But I’m still considered a cancer patient and I have to have a series of scans to monitor for any recurrence.
It was about time for another one of those scans and the place I usually go to didn’t have availability when I needed it. This meant calling around to find a place that had a CT scanner that would accommodate me. (Again, there is a ton of privilege in my having insurance that allows me these options, and that there are CT scans that accommodate me.)
My partner, Julianne, did most of the leg work on this. (In our division of labor as a couple, scheduling medical appointments typically falls under her purview.) She found a place and got me scheduled, she asked about the diameter of the tube and was told it was 50cm (which would be too small for me.) When she told me, it didn’t sound right at all. This is a state-of-the-art facility and most remotely modern machines have a gantry aperture (the diameter of the tube the patient goes into) that is significantly larger than that. I wasn’t sure if maybe the person who Julianne talked to was confused between gantry aperture and field of view, or if it was just some kind of ancient machine, but I was curious (and really wanted to be able to keep this appointment if possible!)
I called back and the scheduling assistant I talked to gave the same answer - 50cm. I mentioned that I was surprised by that (for the reasons above) and she did the right thing, saying literally “Your question is valid, but I don’t know the answer” and then offering to transfer me to the tech directly. I spoke with the tech who also said that it was a 50cm aperture. At this point I asked “how old is that machine?” and she said less than 10 years. I said that I was surprised (re-stating the reasons above) and I asked if she could please double-check. She sighed loudly and said, sounding annoyed, that she didn’t have a tape measure but could find out and call me back. To her credit, at this point (I later learned) annoyed or not she went to a site of some construction at the facility and asked the crew if she could borrow a tape measure. She called me back within the hour.
The gantry aperture was 85cm (she also confirmed that it was the field of view that was 50cm.)
While I was glad to be able to get my scan, this is obviously a troubling situation. A patient should not have to know anything about CT scanners in order to get accurate information about whether or not they will be able to get a scan, they certainly shouldn’t have to ask repeatedly. Happily, my scan came back clear, but this is one of the ways that medical weight stigma can be harmful and even deadly. A patient who didn’t have the privileges I do (including but not limited to knowing about CT scanners,) and who didn’t have the privilege of having options to go to different facilities may have made that first call, heard that the CT scanner failed to accommodate them, and thus not gotten their scan which, in this example, could mean missed early detection of cancer.
To add insult to injury when the cancer was found later and more advanced, there is a high likelihood that would be blamed on the patient’s body size and used as a justification for additional weight stigma.
For those who work in healthcare, I wrote this piece about what facilities can do to create inclusive imaging for higher-weight patients.
For higher-weight patients seeking imaging and running into these types of barriers, I just want to reiterate that this shouldn’t be happening and we shouldn’t have to research, make extra calls, and fight to get access to healthcare. I wrote a two-part piece about asking for accommodations here.
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More research and resources:
https://haeshealthsheets.com/resources/
*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
I love a happy ending! I am so glad you continue to be cancer-free.
But it's SO frustrating to have to be the expert on the things providers are paid to be experts on, only to have to constantly prove over and over again that they are not, in fact, experts. It also blows my mind that today, on the cusp of 2024 and in the midst of ZOMG_oBe$iTy_pAnIc where we can't go anywhere without being confronted in some way about how our bodies are need to be eradicated from the planet, and none of these so-called oBe$iTy_ExPeRt$ can be arsed to acknowledge that healthcare settings aren't designed for us, and instead choose to focus on how they can maximize profits rather than teach their colleagues how to better accommodate us. (Hilariously, their colleagues would also be more profitable if they weren't turning away fat patients, but that's neither here nor there and I have Big Feelings about the role of capitalism in modern healthcare.)
accessing a CT scan (or any other necessary test or treatment) should be as simple as calling up and scheduling (and IMO the onus should be on the scheduler to ask EVERY patient about access needs, every time)... and yet when we're well-informed (because we HAVE to be) and bring up this knowledge to the providers (again, because we HAVE to), we're labeled things like hypochondriacs or "Chronic Googlers."
I occasionally wish we could invoice them for our time when they waste it like this.
We should not have to deal with this garbage. I'm glad you were able to get a proper scan.
I think I've told this tale here before so I'll try [ha!] to be brief.
When my leg was infected with MRSA it was slow to heal and the damage was considerable. The doctors got a CT scan - whew! But they wanted an MRI for better imaging. It was 2003 and MRIs were not new but they were still in relative infancy for wide-spread use. The table of the MRI machine in the hospital would not handle someone over 250 lbs.
My doctor said he asked his office to find an MRI with a higher weight limit and they told me there were none anywhere nearby. He pulled out that old trope, "We might have to send you to the zoo." For those who don't know, this isn't just fatphobic garbage, it's a complete myth: No zoo will take the liability risk to examine a human being.
After 3+ weeks in the hospital I was sent home (I was supposed to go to a rehab hospital but that's a different clusterfudge). The first thing I did was hop on the computer and get online (I think I had DSL by then!) and search the still fairly new Web for info. I looked up the names of the companies that made most of the MRI machines, then looked up the company's fairly bare websites. And then I got to calling them.
I only had to call two of them before I found that they both had many machines in the city that would handle weights up to and over 300, even 400 lbs, and many of them were in the hospital's system. A couple were within a mile of the hospital I'd been in.