A quick note on medical anxiety

[kaberett]

Content note: weight-shaming, medical consent, disordered eating.

I tend to be very nervous when I get my blood pressure taken, because medical appointments are stressful even when they're with people I know: I'm a complex patient, I ask for things doctors aren't always comfortable with, and people can't always (or even often) tell me what's wrong with me. Being an expert patient can get very lonely. Better even than that, usually the person who's checking my blood pressure is someone new, doing intake, with whom I have no trust and no rapport and no pattern for how the appointment is likely to go.

I am always congratulated on my blood pressure being slap bang normal to low normal, even after I've told them I'm anxious. The only time I've ever had a plausible reading is after an outpatient medical procedure: I was sleep-deprived, I'd been nil-by-mouth for somewhere in the vicinity of six hours, and I'd been given IV sedatives without anyone checking in with me about the idea first. I was sufficiently far into "low blood pressure" that the nurses insisted on keeping me in for observation. It was eminently avoidable, if they had only thought to seek appropriate consent.

I have a history of disordered eating. I am still astonished every time someone touches my stomach and I don't flinch. I don't actually know how to process that sometimes I enjoy people touching my stomach: my brain just... shuts down around the idea, and I don't want to push it.

I benefit from thin privilege. I pretty much always weigh the same amount, regardless of how much activity I'm doing - exercise shifts my body composition but doesn't tend to make any difference to numbers. I cheerfully wear twinky tight-fitting clothing.

A few months after I started antidepressants, I had an appointment with a GP. "Oh," she said, looking at me, happy and congratulatory, "you've lost weight!" "... I'm pretty sure I haven't," I said, and moved rapidly onwards.

I had not lost weight since the last time she saw me. I had gained it because the antidepressants were working and I had started eating again. I was happier. I was comfortable. I was proud.

And I have a history of disordered eating, and being praised for having lost weight when (1) the exact opposite had happened, (2) this was a good thing, and (3) weight loss would have been cause for serious concern was... unhelpful.

I am periodically reminded of this incident by my awesome fat-activist friends talking about their activism and their own experiences, and I don't have the words to explain how resentful I am that that GP diminished my capacity to listen and empathise and provide support.

Comments

[kaberett]

I think I failed to make clear that the link between the two halves of this post is "being praised for things that should raise concerns" (it is written as a counterpoint to the common experience of "flailing panic over things that really aren't even a tiny bit of a problem").

[jelazakazone]

I think that many of us (esp women) have been praised for "losing weight" or "being thin" to the point that when people are sick, they are sometimes praised for it. I have learned to be careful about that and try to pay attention to how people are expressing themselves. When I see someone who has lost a lot of weight recently, it actually concerns me and I usually try to ask them (if I can) if they meant to lose weight.

Also, I read this awesome article about the most amazing self-educated patient recently. I'll see if I can find the link.

[jelazakazone]

Found it! Woman uncovers her genetic flaw

[steorra]

Interesting story - thanks.

[jelazakazone]

Ah, you are welcome!

[hilarita]

Eh, would like to comment, but not in right place right now. But, yes, anxiety disorders and medication and weight issues make medical appointments so fucking unfun.

[redbird]

My worst "oh, good, you've lost weight" comment came when I actually had: I was on prednisone for Bell's palsy, and the doctor reasonably wanted to see me fairly often. So I was in the office for the second time in I think nine days, and the scale showed I had lost ten pounds, and the nurse told me this in tones of "hey good news." And then she took my blood pressure, having given me just enough time to think "unexplained weight loss, what does that mean!?" (I was fatter then and could spare the weight, but it was scarily fast.) Fortunately, the doctor understood my concerns, and was willing to retake my blood pressure after I'd had a few minutes to calm down. (My weight stabilized once I was off the prednisone, so that's okay.)

[davidgillon]

Being an expert patient can get very lonely.

This!

I'm always somewhat surprised when my blood-pressure comes in as normal, both from anxiety over needing to manipulate the GP into doing what I want and from the up and down of heading into the GP's office from reception tending to make my heart race (I don't have a POTS diagnosis but won't be surprised if I eventually get one).

My somewhat lazy GP tends to be relatively uninterested in my weight, I suspect she only checks it when her computer prompts her, but GPs as a whole are fixated on the weight-loss=good thing, and I wonder if sometimes they read 'patient looks better' as 'patient must have lost weight' (this also assumes they remember who you are, which is by no means guaranteed, I've had a consultant forget he'd seen me before, even though it was barely a fortnight between appointments).

Worst inappropriate comment I've had was a junior A&E doctor responding to 'I have HMS' with 'Oh, have you got any party tricks you can show me'. It's always nice to find a doctor who actually knows what HMS is, but when I'm in A&E over a heart scare* probably isn't the appropriate time....

* Evil Uber-Boss at Evil Aerospace Inc had managed to boost my resting pulse rate to How High!?! levels.

[jesse_the_k]

Wow. I've been collecting inappropriate physician comments for many decades (not all personally, thank goodness) but that "party tricks" line is horrible.

[davidgillon]

He was very young and his bedside manner was otherwise excellent, I suspect I may have been the first HMS patient he'd met and his enthusiasm got away from him into something spectacularly inappropriate.

[davidgillon]

Added for those not familiar with Hypermobility Syndrome, 'party tricks' is pretty much accepted terminology for demonstrating our extreme range of motion, mine is putting the sole of my foot flat on the crown of my head, but it's also medical convention that we should be encouraged NOT to demonstrate them as they're a good way of damaging joints (and the last thing a bendy needs is more joint damage).

[jesse_the_k]

I hope he appreciates your open hearted forgiveness.

But then I've tumbled into spectacularly bad thoughts myself a time or two.

Content note: suicidality

[kaberett]

I have taken to patiently explaining to new doctors that there is no point whatsoever in restricting my access to psych meds, because (1) they and I both know it's functionally impossible to off yourself with SSRIs and (2) I work in a lab with access to HF. How they respond to this tells me a lot about how well we'll get on...

[cosmolinguist]

I absolutely cannot do words about this right now, but I didn't want to say nothing, so let clichés like "yes" and "thanks for writing this" stand for the detailed reply I'd like to give.

[kaberett]

You are welcome.

[khronos_keeper]

Ughhh oh no I hate it when doctors encourage weight loss or dismiss patient concerns about weight loss out of hand without inquiring why the patient would be anxious about it. I am so sorry this happened to you.

I'm going to give you an example below of my own experience. If you feel this will be uncomfortable, let me know and I'll edit it out of the comment. I'm not going to mention any numbers or figures or anything like that.


About a year ago, I had two upper respiratory infections back to back. My immune system was in fact so compromised that I had one infection that lasted 3 months, until I caved and went to the campus health clinic to get checked out and possibly some medication.

The nurse weighed me. Now, I have always been more robust for my height than normal people, because I have been working on a farm since I was a small child and therefore have a high amount of muscle mass. So the number she put down was both a.) incorrect, because I was wearing 10 lbs of clothes, and b.) wayyyyy too low for me.

I brought my concerns up to the doctor that I had lost all this weight from infection,. And he's like WELP IT HAPPENS. Next time I came in (for another infection), I was asked if I had regained the weight? My response was negative. The doctor didn't push the issue, because it was normal for my height, so therefore good.

The real problem is that I've actually experienced a decent amount of muscle wasting, contributing to the weight loss. I'm not actually sure how to bring this up to a medical professional, because I'm afraid my concerns will be dismissed again. And I've always sort of viewed the doctors office as something like a run in with the police-- once you're labelled negatively by the authorities, the suspicion about you remains. So if I'm considered an alarmist by one doctor, I'm afraid that will stick with me.

So, uh. I'm stuck in this probably bad situation because I'm too chickenshit to stand up for myself at the doctors.

[davidgillon]

Had a similar situation while seeing a spinal surgeon after HMS-related c-spine issues led to a frozen shoulder. I'd had a physio referral and gotten most of my range of motion back, so this specialist takes a quick look at the shoulder and says 'your ROM is completely normal'. I just couldn't get her to listen to the fact that it wasn't normal _for me_. Even with an MRI showing a disc protrusion and a check of the nerves in my arm that resulted in a diagnosis of 'well clearly something's not quite right' (don't you just love precise diagnoses!) her conclusion was not to do anything, and I wonder if it was the ROM thing that swung her that way.

[firecat]

Fat person here. Breaking in new doctors is kind of like lion-taming. Except the lions are probably more predictable.

And I don't want to even think about how many people have died because doctors focused too much or not enough on their weight.

[shehasathree]

I think the worst part is when you think you've got them well-trained and then they relapse. (My GP was actually *good* about weight and not-mentioning-it (including putting a note in my file to make the nurses stop insisting on weighing me every time i went in for anything for no reason) until the Diabetes thing. /o\)

[firecat]

**YES** They do that all the time.

[shehasathree]

RARRRGH.

[jesse_the_k]

There are not enough ugly vowels in the universe to express how wrong that interaction was. Or how damn common. I'm so sorry.