This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing! A friend of mine who is a full-time wheelchair user (and who asked me to write about this and gave full permission to share her story) sent me an email with the subject “Wouldn’t this be something?” Attached were the notes that she was given at the end of her recent doctor’s appointment. Under “Recommendations” she had highlighted “walk for 30 minutes a day, three days a week.”
I recently went to the doctor due to having shortness of breath for no reason. I'm normally fit and active so I was concerned because I was getting out of breath after walking to the bathroom and back to bed. The walk from my car to the doctor's office left me out of breath and feeling like I had just run 5km.
At one point the doctor said to me that I should go for a walk every day because it'll give me endorphins and I actually yelled at her. I know all about endorphins and I would have loved to go for a walk every night with my love but the breathlessness made it impossible to walk a block without needing a long rest. I literally went to the doctor because I couldn't go for a walk and that's what she told me to do. 🙄
So very true. This flippant comment is akin to the "try yoga" when one is experiencing depression or having other mental health difficulties. Big EYEROLL!
I strongly suspect that "Recommendation: Walk 30 minutes, 3 times a week" is now part of the software that some doctors use and gets automatically added to the post-visit report. The last time I saw my primary care doctor (whom I like very much), we discussed the fact that, despite a neuromuscular disorder that makes walking painful, I walk 4 miles daily to try to preserve my mobility as long as possible. We discussed that this takes me nearly 2 hours, since I have to stop and rest frequently to let the pain in my legs calm down, but since I'm retired I can and do make the time for walking. The doctor listened to me, was very impressed by my adherence to my walking goals (which I, not she, had set for myself), and so on. When I looked at the post-visit report, there at the bottom was "Recommendation: Walk 30 minutes, 3 times a week." It just almost HAS to be boiler-plate language that the computer program adds to the report -- my doctor could not have written that herself after the conversation we'd had.
So so true! I am a part-time wheelchair user and I’m so tired of being told to “just walk a little bit.”
I have never once in my life been asked if I’m in pain or if walking causes pain. Just once, I’d like a doctor to ask and then really listen to the answer.
Even in my pre-chair days, I’ve never been asked if I have safe or affordable access to movement. I’ve definitely been told I “need to make time,” even after I told them I was working 60-hour weeks at a very physical job.
Just the other day, my partner was told he needed to add “150 minutes of exercise” to his routine (an oddly specific number of minutes) even though he has an extremely physical job that’s put him in the best athletic shape of his life.
I thought not making assumptions was a fundamental part of a basic differential diagnosis. Why isn’t it part of basic treatment recommendations, too?
I deeply appreciate this writing, Ragen. I have a part that is guilty of saying this, too, and am indebted to "ask patients if they want to discuss movement as an option to support their health." It's taking me back to asking permission in Motivational Interviewing and now in Internal Family Systems, the model I use exclusively with my clients. Clinicians are so socialized to these types of questions. In addition to removing gender and all anthropometric questions from my questionnaire, I'm leaning into taking off the movement options.
I recently went to the doctor due to having shortness of breath for no reason. I'm normally fit and active so I was concerned because I was getting out of breath after walking to the bathroom and back to bed. The walk from my car to the doctor's office left me out of breath and feeling like I had just run 5km.
At one point the doctor said to me that I should go for a walk every day because it'll give me endorphins and I actually yelled at her. I know all about endorphins and I would have loved to go for a walk every night with my love but the breathlessness made it impossible to walk a block without needing a long rest. I literally went to the doctor because I couldn't go for a walk and that's what she told me to do. 🙄
So very true. This flippant comment is akin to the "try yoga" when one is experiencing depression or having other mental health difficulties. Big EYEROLL!
I strongly suspect that "Recommendation: Walk 30 minutes, 3 times a week" is now part of the software that some doctors use and gets automatically added to the post-visit report. The last time I saw my primary care doctor (whom I like very much), we discussed the fact that, despite a neuromuscular disorder that makes walking painful, I walk 4 miles daily to try to preserve my mobility as long as possible. We discussed that this takes me nearly 2 hours, since I have to stop and rest frequently to let the pain in my legs calm down, but since I'm retired I can and do make the time for walking. The doctor listened to me, was very impressed by my adherence to my walking goals (which I, not she, had set for myself), and so on. When I looked at the post-visit report, there at the bottom was "Recommendation: Walk 30 minutes, 3 times a week." It just almost HAS to be boiler-plate language that the computer program adds to the report -- my doctor could not have written that herself after the conversation we'd had.
So so true! I am a part-time wheelchair user and I’m so tired of being told to “just walk a little bit.”
I have never once in my life been asked if I’m in pain or if walking causes pain. Just once, I’d like a doctor to ask and then really listen to the answer.
Even in my pre-chair days, I’ve never been asked if I have safe or affordable access to movement. I’ve definitely been told I “need to make time,” even after I told them I was working 60-hour weeks at a very physical job.
Just the other day, my partner was told he needed to add “150 minutes of exercise” to his routine (an oddly specific number of minutes) even though he has an extremely physical job that’s put him in the best athletic shape of his life.
I thought not making assumptions was a fundamental part of a basic differential diagnosis. Why isn’t it part of basic treatment recommendations, too?
I deeply appreciate this writing, Ragen. I have a part that is guilty of saying this, too, and am indebted to "ask patients if they want to discuss movement as an option to support their health." It's taking me back to asking permission in Motivational Interviewing and now in Internal Family Systems, the model I use exclusively with my clients. Clinicians are so socialized to these types of questions. In addition to removing gender and all anthropometric questions from my questionnaire, I'm leaning into taking off the movement options.