To the old doc learning new tricks: thank you for being open to learning and for your humble self-awareness. It gives this old, fat, traumatized patient some hope.
I’ve absolutely avoided the doctor because I had gained weight. I’m not aware of any health issue that got worse because I waited but I did eventually change doctors after the PA told me to work out before my baby woke up at 6:30. And also randomly talked about cutting carbs. Since I generally only have annual appointments because my health has been good overall, it makes me hesitant to switch providers off one comment but I don’t feel like I should have to brace myself for health advice.
I think I just said umm no I won’t be doing that but we do go on walks! Now that he’s 8 there are times I’ve worked out at 6 am but I absolutely wasn’t doing it when he was still waking up at night.
I’ve got one to add. My weight is stable, but recently someone measured me and discovered that, like many people in their 60s, I have lost a little height. Now, several of the doctors I see are panicking and insisting on giving me weight loss advice, despite my continual and on-record request not to discuss this. The worst was one who has never mentioned my weight before, and so I had trusted them not to be weird about this, but because my BMI appears to have gone up, they’re suddenly on the weight loss shtick as well. Let’s just add this to the reasons not to use BMI as a measure of health (or even weight change)! As well as not to give unsolicited advice.
As a doctor myself (and a regular reader), I'm 100% with you on the weight stuff. I do not counsel pts on weight loss and am very candid with pts who start the topic themselves / are gushing about the diet they're on.
I also 100% agree with you we need to be aware of the patient's boundaries.
On the other hand I think it's bad medicine to not bring up unrelated stuff I notice. If I'm consulting a pt about stomach pain I will absolutely bring up a suspicious looking mole I noticed on the pts stomach during the exam. I've actually caught early melanomas that way a time or two, and not-yet-melanomas that nevertheless the dermatologist thought should be urgently removed as well.
When a pt brings up a mole they are worried about, it would be unethical to not counsel them to slap sunscreen on it and the rest of their skin - I agree a lecture on what they SHOULD HAVE done is disrespectful but we are trained on actively looking for hidden trouble.
For me, weight is a special issue because how much judgement / stigma there's around it and because in my experience and understanding, most people cannot control their weight so I don't advise anyone to lose weight anymore than I'd advise them to get taller...
... and also as someone with a family member with melanoma, I'm bringing up this stuff, as well as vaccinations, and colonoscopies.
To the old doc learning new tricks: thank you for being open to learning and for your humble self-awareness. It gives this old, fat, traumatized patient some hope.
I’ve absolutely avoided the doctor because I had gained weight. I’m not aware of any health issue that got worse because I waited but I did eventually change doctors after the PA told me to work out before my baby woke up at 6:30. And also randomly talked about cutting carbs. Since I generally only have annual appointments because my health has been good overall, it makes me hesitant to switch providers off one comment but I don’t feel like I should have to brace myself for health advice.
Work out before the baby wakes at 6:30? Has this person ever lived with a baby?
I think I just said umm no I won’t be doing that but we do go on walks! Now that he’s 8 there are times I’ve worked out at 6 am but I absolutely wasn’t doing it when he was still waking up at night.
I’ve got one to add. My weight is stable, but recently someone measured me and discovered that, like many people in their 60s, I have lost a little height. Now, several of the doctors I see are panicking and insisting on giving me weight loss advice, despite my continual and on-record request not to discuss this. The worst was one who has never mentioned my weight before, and so I had trusted them not to be weird about this, but because my BMI appears to have gone up, they’re suddenly on the weight loss shtick as well. Let’s just add this to the reasons not to use BMI as a measure of health (or even weight change)! As well as not to give unsolicited advice.
As a doctor myself (and a regular reader), I'm 100% with you on the weight stuff. I do not counsel pts on weight loss and am very candid with pts who start the topic themselves / are gushing about the diet they're on.
I also 100% agree with you we need to be aware of the patient's boundaries.
On the other hand I think it's bad medicine to not bring up unrelated stuff I notice. If I'm consulting a pt about stomach pain I will absolutely bring up a suspicious looking mole I noticed on the pts stomach during the exam. I've actually caught early melanomas that way a time or two, and not-yet-melanomas that nevertheless the dermatologist thought should be urgently removed as well.
When a pt brings up a mole they are worried about, it would be unethical to not counsel them to slap sunscreen on it and the rest of their skin - I agree a lecture on what they SHOULD HAVE done is disrespectful but we are trained on actively looking for hidden trouble.
For me, weight is a special issue because how much judgement / stigma there's around it and because in my experience and understanding, most people cannot control their weight so I don't advise anyone to lose weight anymore than I'd advise them to get taller...
... and also as someone with a family member with melanoma, I'm bringing up this stuff, as well as vaccinations, and colonoscopies.