Fat Girls' Guide to Dealing with Doctors
Per charlottecooper's request, I'm drafting a guide for fat girls to make the most of their healthcare. This is more of a behavior guide for maximizing your experience rather than a list of services that are of particular use to fat girls. It uses fairly personal language instead of detached healthcare language, which I have mixed feelings about. I will probably make a couple more versions of this, so if people have suggestions, let me know!



When I was eighteen, I had a bogglingly rare form of kidney cancer. Before that, I had recurring ulcers. Since my late childhood, I have also been treated for anorexia and bulimia, chronic urinary tract infections, a host of both common and unexplainable gynecological problems, asthma, immunity and endocrine problems, broken bones, anxiety, insomnia, allergies, and depression. I have been fat for the vast majority of my life, and am also queer and freaky-looking. I am very effective at dealing with doctors, which is not the experience reported by most people who are like me. Family and friends remark upon what seems like my magic powers with healthcare providers when they see it in action. However, it's no magic! It's just practice and a few behavior strategies I know how to use to my advantage.

Doctors are people who are very invested in power dynamics. The way that medical education works is extremely hierarchical and almost militaristic. As patients, in this particular world, we have the least power of all. However, my adventures in sadomasochism and radical left politics have taught me that power differences are both a practical reality and a complete illusion. Whereas doctors live in their crazy, abusive, psycho subculture, I don't, so I don't have to play the role that they dictate to me.

Medical professionals are legally bound by patients' consent. However, this is easy to miss. People often feel coerced and bullied into medical treatments because they assume doctors know what's best for them, and because there is a looming morality around managing "health." This is utter bullshit. Doctors know a piece of the puzzle, but really, only part of it. The trick to dealing with them is understanding what their piece is and trying to extract it from them, while simultaneously dismissing the rest. This requires a high level of commitment to responsibility for your own health, safety, and well-being, which is understandably terrifying. However, the way I see it, most people I know have been doing this all along anyway, so it just requires a shift in thinking.

Practically speaking, the first thing to do is to learn how to decline services. Don't want to be weighed? Say "no," or, like I do, "I'm going to decline to be weighed." Even if it were true that there's some information in weight measurements that could help in gaining a picture of your body's well-being, which is questionable, you still have the right to say "no." Most western women have much, much more data about their weight fluctuations than doctors could ever gather. This is likely for fairly sick reasons, but it is also just objectively a statistic that we are more on top of than they are. It's probably not a part of the puzzle you need. You are the authority.

There are a number of things that happen that I find useful in the interaction around declining to be weighed. Saying the complete sentence "I decline to be weighed" clearly, calmly, with a slightly bored and impatient edge to your voice, while looking into the eyes of the nurse who is leading you to the plank establishes your dominance like nobody's business. If you're not feeling it, pretend you are acting in a play in which you are the star. That sentence is also bona fide legal terminology, which makes all medical professionals nervous. If the nurse gives you guff, now is the time practice taking care of yourself before you take care of other people. You might empathize with her because she's an underling, and while my everyday politics are not aligned with this behavior, I treat nurses as if they are my servants. Practice being respectful and haughty at the same time. I am normally a very loud person, but when I am giving crucial orders and directives, I am quiet and I enunciate very clearly. Never look down and always force yourself to meet a nurse's gaze.

Again, the medical world is not an egalitarian one. Your job is to get more information about your health and to get back over the threshhold of the doctor's office with your self-esteem intact, and while you normally may think of yourself as a champion for equality, you can return to this work when the door shuts behind you. You may perceive that a nurse is fearing the doctor's perception of her own competence when you decline to be weighed. While it is perfectly reasonable to ignore this, sometimes I like to handle it by saying, "If the doctor gives you a hard time, tell them to talk to me." This is dismissive, yet effective. It establishes that not only are you the dominant person in your relationship with the nurse, but that you are dominant in your relationship with the doctor.

Keep at it, and don't let your guard down. If a nurse grabs your arm and starts putting you in a small blood pressure cuff, rip it off and ask her for a large one. Often medical professionals will grab and touch your body without asking, and you need to be vigilant in not letting them do this. I never act exasperated or hostile in this situation, which tends to make women project craziness, but I always maintain eye contact whenever possible. This usually keeps them away and makes them speak before they touch me. Sometimes I make up a need or request if a medical professional doesn't perceive boundaries between us, just to train them. Too cold? Ask them to turn up the temperature. Ask for magazines. Always be exceedingly polite and act entitled.

Chances are, after the nurse escorts you to the examination room, she will talk to other nurses and the doctor about your difficulty as a patient and special needs. This is on your side! Generally, the more doctors walk on eggshells around you, the more information and better treatment you will get. It is important to note that there are circumstances that this can go awry. When dealing with specialists, surgeons, anesthesiologists, and anyone who could possibly kill or hurt you acutely, balancing dominance with certain submissive behaviors becomes more important. But this is advanced. For most healthcare, fat women generally need to get more dominant.

There are certain things that can help with this. I find that my size is on my side. The bigger I make myself and the more space I can take up, the better. I tend to wear dark-colored, more conservative clothing than I normally do, and makeup. I wear tall shoes so that I can loom over people. While these particular strategies won't work with everyone's style or gender, the basic idea is to use whatever physical power and privilege you have, and use it hard. Similarly, I engage my educational background and access as much as possible. I read up on studies. I try to use specialized terminology whenever I can. I try to keep myself on top of every type of test result I have had recently, both memorizing specific numbers and understanding what they mean. I own copies of all my medical records for all time, and I have studied them extensively and sometimes bring them to appointments to refer to.

Doctors tend to respond really well to patients being educated about their own problems, except when those problems are so bizarre and extraordinary that no one understands them at all. I try to deport myself with directness and authority with doctors. They often respond poorly to signs of vulnerability, so whereas usually I am an emotional hothead, on any first visit with a doctor I pretend to be reserved, quiet, and dignified.

I almost always make a list of what I want out of an appointment. When a doctor comes in the examining room, after formalities, I usually start in immediately with this list, as in: "I'm here because I am having menstrual irregularities and I want to 1) Stop bleeding; 2) Understand why these irregularities are happening; 3) Understand the intersection of my treatment options with my medical history; and 4) Get a referral to a specialist." Keep them on task. If they stray to something that seems ridiculous and unrelated, like treating your athlete's foot by offering you a specialized weight loss diet, bring them back to your enumerated list. Say, "I want help treating the acute issue of my athlete's foot today." It's often helpful at this juncture to invoke consumer mentality in your own mind. There is a company that you are paying for this service if you're an American, be it your HMO, the doctor's office itself, or your employer. If you live in a country with nationalized healthcare, possibly you are both paying a company for your healthcare and the government with your taxes. With that payment, ostensibly you should be rendered a high quality of service. Give the doctor a chance, but if the service is bad, leave. Always know in your mind that you can reject the doctor's advice and walk out at any point.

If this type of thinking and behavior is clunky for you or doesn't come naturally, bring in reinforcements. Tape record your conversation with your doctor. Take notes. Figure out how your friends and family can help you. If you can't loom, bring in your tallest friend. If you have a friend who studied chemistry or biology, bring them to help you understand test results. Lawyers are especially useful as support people for the intimidation factor alone. And this may hurt, but sometimes men can help women get a higher quality of care than when we go by ourselves. Personally, I find that being alive makes me a better feminist. The bottom line is, take responsibility for your own healthcare and survival, and if you have a resource, use it.


Doctor's Visit Cheat Sheet:

1) Be big. Stand up straight and use your size to your advantage.

2) Dress sharp.

3) Be direct and dominant. Always keep eye contact with anyone who is going to take statistics from your body.

4) Decline services when necessary and appropriate.

5) Demand modifications when you need them. This can be asking for a large-size blood pressure cuff, a bigger hospital gown, a warmer or colder room temperature, or anything that will contribute to the accuracy of your diagnosis and comfort of your experience.

6) Know your shit. Gather as much information as possible on your particular set of conditions.

7) Make a list of what you want from the doctor, and stick to it. Guide the doctor's interaction with you from your list.

8) If you are getting poor service, leave.

9) Use your resources to help you maximize your experience. Tape record the visit, take notes, bring your smart and physically intimidating friends and family with you.

10) Know that you are looking for a piece of the puzzle of your health and well-being, and keep your eyes on the prize.