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I Don’t Want To Go To the Doctor

            I got a call on the answering machine (yes, they still exist, as do land lines), cancelling an upcoming appointment with the cardiologist. And I was thrilled! It’s not that I particularly hate my cardiologist, but every time I go to a doctor, whether it’s my primary care doctor, or a rheumatologist, a pulmonologist, an endocrinologist, a cardiologist, etc., they weigh me and then tell me that my real problem is my weight, and proceed to lecture me on how to go on a diet.

“I’m not fat, I’m fluffy.”

            I have been on every diet, and read every diet book, and lost and gained weight multiple times, and now I am working on Intuitive Eating with a Nutritionist and trying to undo all of that damage, but even so, every time I see a doctor they insist that if I just ate less and exercised more it would all be fine – as if my problem is that I’ve never heard of a diet before.

            Or as if my weight is my primary medical issue, which it’s not; the added weight is a symptom of both the psychological trauma of my childhood and the medical disorders I have had to deal with as an adult (and the medications I need to take to manage both). I’ve said this to my doctors over and over and over again, but it doesn’t seem to make a difference.

            When I told my nutritionist about all of this – and about my rage at the doctors, and adults in general, who encouraged my eating disorder when I was a child, and who have continued to push me into disordered eating as an adult, without ever feeling shame or responsibility, let alone bothering to educate themselves about an alternative way to address issues of nutrition and weight in their patients – she said, well then, that should be our next project.

            Huh?

            She said, you need to practice setting boundaries with your doctors around weight, and even try to educate them about the pervasiveness of the Diet Mentality and the endless Mobius strip of weight loss and weight gain that they seem to think of as such a wonderful idea but that has actually been shown to cause more health problems than remaining steadily overweight your whole life.

            But I’ve tried, and they never listen to me, and it’s not fair, and why don’t they have to learn this in school, and why is it my job to teach them and…

            And she agreed with me, and listened to me, and said, we need to work on setting boundaries with your doctors around the subject of weight.

            But, but, but…they never learn, and they keep repeating the same things, and whenever they tell me that I should just stop eating so much I believe them and…

            Oh.

            I had the aha moment at the same time she did: the real problem is that I don’t have confidence in what I already know and have worked so hard to learn, so that when they challenge me, I give in.

“Never give in!”

            I’ve worked so hard this past year to learn how to hold my ground when the “You just need to stop eating,” and “You’re less of a person because you are overweight” messages are said by movie stars, or social influencers, or random people in my life; but when a doctor says it, the ground under my feet still gives way. I sit there feeling small and hopeless and I forget everything I know, and believe everything they tell me – that if I would just stop eating so much I’d never have health problems again.

            Depending on how brittle the doctor is in presenting their message on my weight, it can take me hours, or days, or even weeks to get back to solid ground and remember that, actually, my weight is not the problem. And diets have never been a long lasting solution even to the weight issue, never mind for my health overall.

            So what can I do to fix this? And can it be fixed before my rescheduled appointment with the cardiologist which is coming up way too soon?

            The nutritionist suggested that I remind myself that, on this subject, the doctors don’t know me better than I know myself. She said to tell them – I know you’re going to bring up my weight, but I am working with a nutritionist on Intuitive Eating and I am making progress at my own pace, and, for now, your advice is not helpful on this subject. My weight is the least of my problems, and if we can focus on the physical pain and exhaustion that make life so difficult for me, and the connective tissue and auto-immune disorders that cause the pain and fatigue, and numerous other symptoms, that would be a more productive use of our time together.

            But I’ve said all of that, or at least most of it, to my doctors, and they just talk over me. Though maybe I haven’t said it with confidence. Maybe I’ve said it with my eyes on the floor, afraid of what they would say in response, afraid of their disapproval. Because even when I’ve said “the right things” I’ve only said them once; and when the doctor, inevitably, pooh poohed it, I shut up. Because I freeze in the face of their disapproval. I forget everything I know, and I let them talk down to me and blame me without contradicting them. And, no, it’s not my responsibility to teach them, or change them. But if I could stand up for myself, maybe I wouldn’t be so negatively impacted by each doctor visit.

            But how do I get there? How do I hold onto what I know when I start to feel shaky and small? How do I convince myself that I do know my body better than they do, and that I have done the research and I’m not just believing what I want to believe because it sounds easier?

            The temptation to just cancel appointments, or to go but shut off my brain for the duration, is very deep, because I don’t feel strong enough to stand up for myself effectively.

“Yeah, let’s stay home.”

            I wish I could promise myself that next time will be better, and that I will be different. But I don’t know how to make that happen. I had hoped that writing this essay would give me the confidence to believe that I can stand up for myself, but instead it has made it clear to me how much more work I need to do.

“Oy.”

If you haven’t had a chance yet, please check out my Young Adult novel, Yeshiva Girl, on Amazon. And if you feel called to write a review of the book, on Amazon, or anywhere else, I’d be honored.

            Yeshiva Girl is about a Jewish teenager on Long Island, named Isabel, though her father calls her Jezebel. Her father has been accused of inappropriate sexual behavior with one of his students, which he denies, but Izzy implicitly believes it’s true. As a result of his problems, her father sends her to a co-ed Orthodox yeshiva for tenth grade, out of the blue, and Izzy and her mother can’t figure out how to prevent it. At Yeshiva, though, Izzy finds that religious people are much more complicated than she had expected. Some, like her father, may use religion as a place to hide, but others search for and find comfort, and community, and even enlightenment. The question is, what will Izzy find?   

                        

           

           

           

           

           

           

          

         

           

           

           

           

           

           

           

           

           

About rachelmankowitz

I am a fiction writer, a writing coach, and an obsessive chronicler of my dogs' lives.

102 responses »

  1. Many thousands of readers have your back, Rachel. I’m not terribly smart or wise, so I wish I could wave a magic wand to make your troubles disappear. *** I’ve had angst over eating and weight all of my life since about 12 years old. All that comes to mind now is to remind you that health professionals of all stripes are working for YOU. They are not all -powerful beings, and sometimes should indeed have some challenge and push-back. They can learn from the likes of us if they listen.

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  2. You have my sympathy. A close family member developed an eating disorder after a terrible abuse situation. She got thinner and thinner and people told her she was gorgeous! Seriously! I was worried she was going to DIE and they are all telling her she looks gorgeous. She admitted herself into a recovery facility and she did recover .She readily admits that she has to always be aware of triggers and the fact that she could slip back anytime ,But so far, several year later, she has not. I know what you are saying about doctors. They pigeon hole all of us and ignore what we are saying about how we feel. Hang in there .You can do this.

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  3. Drs don’t bother to educate themselves on discussing weight issues so they should shut up on that subject and stop intimidating. They are out of order.

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  4. Never give in, stay in, OY!!

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  5. Yea, they really harp on the weight. I recently had a weight loss of 70 lbs, but it took me 3 years to do it. And I’m doing it my way, which is…eat less, mild exercise – sorry. And I’m still fighting. I do take fewer meds because of it, so in my case, weight was a factor, and every day, all day, I have to remind myself that I want to be physically healthy. I had a crappy childhood, and most of my adult life I have been doing the yo-yo dieting lifestyle. Ultimately, for me, it was fighting against the doctors and their never-ending stream of more medications that never seemed to work and actually made me feel worse. I still have another 20 pounds, and it may take me another 3 years for that to happen, but what else are you going to do? Rachel, if you have to, write down on a piece of paper essentially what you said here, and hand it to them. Make them keep it. They have to put it their records. If they continue to harp, cut them off, and say something like “What else?” or “Are we done?”. I know, we’re taught from a very young age that doctors are so educated that they’re going to know more about everything in the world than you, but it has just recently dawned on me that they don’t – and I’m 58 years old! Know that you are worthy, and yes, you have a right to cut them off. I better stop. You do what you need to, girl.

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  6. on a practical note, might it be possible for someone to go with you to your appointment, or ask if you can record the appointment to send to your nutritionist – just to see if this makes the doctor more sensitive…?

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  7. Oh my, I hope your doctors would truly understand what you’re going through.

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  8. It’s amazing to me that they persist in harping on your weight! Can you tell them “I’m not here to discuss my weight, I’m here to discuss xyz (whatever it is.) You seem quite clear about your needs and they should respect that. If they don’t maybe it’s time to switch doctors.

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  9. We tend to believe that Doctors know more than actually they do!

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  10. Hang in there, Rachel, for your own body integrity. I won’t try to recount my negative experiences over decades with doctors on this issue. Suffice it to say that you are addressing it the best way that works for you. God bless you.

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  11. It’s the favorite advice of the doctors; loose weight, stop smoking and drinking.

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  12. Good luck whipping those doctors into shape. My Dad was a doctor snd I come from a family of healthcare pros and I got to tell you there is no group more stubborn, bullheaded and wedded to yhr notion they are infallible as doctors. And I say that while happily admitting they can be fantastic, wonderful and genuinely caring miracle workers. Oy, the dichotomy. I don’t have any advice except to echo what you already said: nobody knows your body like you do. So, you do you.

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  13. I wonder if there is value in practising with trusted people in your life who might be able to role play and help you develop the words and the posture to deliver them with confidence and boldness.

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  14. My rheumatologist just told me I was obese – his scale weighed me 22 pounds more than my home scale. When I told him that, he told me my scale was wrong. To put this into perspective, I’m a size 8-10. 🙄 Went to my gastro the next week, made a comment about the scale (which weighed me 7 lbs

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  15. I just wonder–after reading your comment that you wish you could just cancel the appointments–do you need to see all the doctors? Stressing yourself each time cannot be good for you. Sometimes you just have to say, ‘Screw it. Enough!’ It’s hard to try and tell something–anything!–to a doctor. They know it all and they will be sure to tell you. Cut out what you can, Rachel. Make it easy on yourself.

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  16. I feel your pain. I can’t count the number of times I have been told that my disabilities would be lessoned if I lost weight. I can’t disagree, but the reality is that my pain makes it next to impossible to maintain any exercise long enough to do me any good. I actually stopped seeing a rheumatologist because their scale was right in front of the office desk and it was awful to be weighed there. I love your script about what to say. It is spot on. I have responded with, will losing weight make my RA, OA, IC, etc go away? When they say losing weight will help, I respond with give me an exercise I can do that does not involve my afflicted body parts. They say walk. I say I cannot walk because of my 30 year struggle with plantar fasciitis. They usually just respond with, well you need to find something. You know you. I think using a nutritionist is awesome.

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  17. Could you just say “No” when they want to weigh you? (I always find it funny that doctors are willing to weigh you with your heavy clothes, snow boots and winter coat while you’re also carrying a purse, then comment on what you weigh.). 🙄

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  18. I’m glad your nutritionist listened to you and made useful recommendations about managing your doctors. Hope you find the confidence to give them a blast at the right time.

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  19. Hi Rachel – As many of your readers I understand where you are coming from with some doctors. They are often well-meaning BUT patronising and like everyone else they are sometimes wrong. When my son was young we came across a hearing specialist who was awful. A friend recommended a tip which I tried, she suggested remaining standing while they sit. Physically at least it helped us feel in control and it did knock this patronising man’s confidence when I politely declined the offer of a seat and stood where my son and I felt comfortable. We had a much more discursive and useful consultation after that. Good luck and love Marieca xx

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  20. Good morning Rachel, just something to think about . . . do doctors earn money with a healthy person? no, they don’t, so it’s in their best interest to keep you at least thinking you are sick. Just a little example: some years ago, I started to get really terrible pain in nearly all of my joints. So I went to the doctor and asked what could be done. Quote: “Oh there is nothing that could be done, but you can have some pain killers.” (pain medication is a constant income for the doc and the pharma industry. Not to mention that it’s very harmful to your body. So I just declined, turned around and walked away. Instead of that I just changed my diet, I cut sugar out, and don’t get me wrong now, I didn’t do it for weight, for me it’s about eating the right things, and I cut down on carbs. Not long all pain was gone and never returned. If the doctor gives you unhelpful and first of all not asked for “advice” turn around and walk away. There are plenty of other who respect their patients. Chin up girl!

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  21. “Doctor, I appreciate your repeated advice about losing weight. However, at this time, my goal is to be as overall healthy as I can be. I am already working with a nutritionist on Intuitive Eating already, so I’d like us to focus solely on (whatever issue you are seeing that doctor for) so that it can contribute to my overall health.” I’m thinking that something like that says that you do understand that you have an issue with your weight and are actively working on it and you’d like to work on your other medical issues as well.

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  22. Just forget all that stuff and live your life. Nobody lives forever, and you should enjoy however long you have in this life without all the stress and worry. The whole thing is an ‘Industry’. It sucks you in, rotates you around a well-proven system to get your money, then moves on to the next person.
    Just say no.
    Best wishes, Pete.

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  23. Your nutritionist sounds great! Is there some way you can get your nutritionist and your Doctor working together?

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  24. Could you not take your nutritionist with you or write a letter advocating on your behalf from one medical professional to another?

    If you feel unable to speak out you could give them a letter detailing your issues and asking respectfully that they take this into account.

    Can you take someone in with you? I see someone else suggested this, even if they don’t interject on yr behalf having someone there who’s got your back is helpful.

    Imagine you’ve got someone powerful by your side to be there for you – who would you have? Nelson Mandela, Madam Curie, Winston Churchill, Jane Goodall? They will help you kick their butts!

    Finally, you got every single person who has sent encouragement with you – singularly we may not be much but combined we’re a powerful force backing Team Rachel x

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  25. I hate doctors. You are so right that many of them look at your weight and just stop there. I’m just not going to any for the foreseeable future, because my insurance sucks, but that may not be an option with your issues. It might help if you practiced what you are going to say to them. Picture yourself being confident and assertive; that can be surprisingly effective. Also, don’t be afraid to repeat yourself if they don’t listen the first time. I understand it is difficult for you, but you have overcome a lot in your life. You can handle this.

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  26. In my estimation, many of my past physicians have had narcissism issues.

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  27. Take a look at your doctors. Do they look skinny to you? I’ve known a lot of fat doctors, and in fact, my own internist has lost and gained weight over the 25 years that I’ve known him. We’ve even discussed his own issues and what he does to lose weight. He has, on several occasions over the years, mentioned that my own weight gain has probably exacerbated some of my health issues. He never harps, but plants the seed and lets me do what it takes to be healthier. And yes, I’ve lost and gained weight over the years, just like most everyone.

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  28. Perhaps, Rachel, it’s time to find a doctor who practices holistic medicine. I now go to a wonderful osteopathic doctor who truly listens (I only get small problems, not like yours) and respects my opinions. While there may not be an osteopathic cardiologist, etc., at least then you could say, “My primary care doctor says…”
    And, I know several people (and animals) who, when they were carefully weaned off all those meds the docs had them on, began feeling so, so much better! Maybe something to think about. It may be a cycle where the meds are making you gain weight which is making you even sicker. Anyhow, I’m no expert, as you know. Just my thoughts. As always, my best to you.
    Amy

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  29. Good luck with the doctors! I have gotten lucky with my primary care doctor as she listens. I hope that you are able to regain your confidence in yourself. You know yourself from the inside out and they should respect and use that knowledge to help you. Big hugs!

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  30. oh, I can SO relate! GPs were always telling me to lose weight and I got so disheartened and depressed about it. When one said I would only lose weight on 300 calories a day, my second word was off and I stormed out, never to go back. WHY don’t they accept that we are not all tick list perfect? That our best efforts go unrewarded and that we are seriously trying with the eat less and exercise more? I made myself ill and when we moved found a decent doctor who told me to forget dieting (though eat sensibly) because my system was so screwed up from so many half- assed diets I’d tried in my desperation to lose weight.
    Finally, in 2016 and a free 3 month subscription to Slimming World, I began to understand food better. Yes, I did take comfort in the wrong foods, but at least with SW they were not off the menu which would generate cravings and failure. I had the right idea too about eating fruit and veg, but not in the right quantities and how some work better for you whereas others are just good for you.
    It’s hard work keeping on track, but I’ve been at target for over 2 years so finally getting to grips with it all. If you’ve found something that is working for you Rachel. stick with it. We are all different, our bodies respond differently to different things, and so far I have not met a calorie that can read a GP’s tick list to comply.

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  31. In my job as a parish nurse (now retired) I found that doctors frequently mad it hard for patients to speak up. Maybe you can get someone to go with you who is willing to speak with authority such as your nutritionist. I also have trouble speaking truth to power which is what you are trying to do. Sometimes I write down what I wan to say and read it and tell the person they just have to listen until I am done. People that I have worked with said they always worried when I came in with something written down. If the doctor still won’t listen try and find a new doctor. You shouldn’t have to suffer fools.

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  32. I was going to ‘like’ and go on, because when I comment on your blog, I always write too much. But the whole post today resonated. The phrase “small and shaky” chimed loudly. I’ll just speak to that phrase and what surrounds it, because I’ve been there and done that too (just not with doctors, with family. Family is harder IMHO, because the fall-out will be longer and more personal). Anyway.

    Standing up for your point of view and saying things like “You’re not listening to me!” are valid statements and reactions. Society has just taught us that those sorts of things aren’t POLITE.

    But. The whole boundary issue is so hard to learn as an adult (IMO) especially if you never were encouraged to have boundaries growing up or weren’t allowed to have them because you were told you were ‘stupid’ or ‘mistaken’ when you tried to make one.

    Last year (or the year before –dang things are blurring together time wise) I finally had enough crap from my nearest relatives and I stood up to them. Small and shaky? I almost threw up, it was that scary. But I also have come to value myself a bit more, and I know if I don’t stand up for myself nothing changes. My nearest and dearest can’t use me as a whipping boy any more and I made that plain. I suspect doing that sort of assertiveness will be easier next time, and I won’t feel quite as small nor shaky. because it feels good to respect yourself enough to demand others do the same.

    Demanding respect and to be treated in a respectful way isn’t wrong, people can have differing opinions about something and still don’t have to rip somebody to shreds proving their view point is the right one.

    I wish you the very best in your new challenge to make healthy boundaries with your physicians. You’re not alone in avoiding the doctors and finding reasons to cancel appointments. I do that too. It’s not good for me and I know it, but Covid helped my introversion to grow big and strong and demanding. Putting that back into perspective will take a LOT of work I think. (See? I wrote too much again. Sorry!)

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  33. Diet – Oh you will love my diet (NOT)

    Pre Breakfast – Coffee black with two sugars
    Breakfast – Coffee, Black with two sugars
    Post Breakfast – Coffee, Black with two sugars

    Lunch – Chicken Noodle Soup
    Coffee – black two sugars

    Mid afternoon – probably coffee

    Dinner – Cheese and Onion egg omelette
    Mid evening – of course… Coffee

    Annabell – whatever she wants me to cook for her,, that I will do. She tells me the night before and I take what she wants from the freezer

    Oh – and my dog Benji and I walk about 35 miles a week.
    That’s my diet and I would not recommend it to anyone – unless they are crazy and I’m sure you are not. :o)

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  34. One suggestion I would make for you is to take a written statement with you and read it to the doctor if the question of weight comes up. That way you have your cue card on hand to remind you of all you want to say. Unfortunately, if the doctor is prescribing medication for you, they do need your weight to make sure they give you the proper dose. Even clothed your weight is close enough for that purpose.

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  35. I think i like your nutritionist.

    I’m reading, and watching you plod along. You’re figuring stuff out and plotting your course as best you can. You’ve got a good process, i think, and you tweak things and make amendments when you get new information. You just keep at it, unravelling knots and shoring up defenses. This is good stuff, and helpful to read.

    Hang in there.

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  36. I really feel for you. If you want to Google Paul McKenna on weight loss. He just got in my head (he’s a hypnotist) that no food is forbidden. I stopped dieting 20 years ago and never put weight during Christmas or holidays. I can only manage one chocolate a day and one biscuit. I think he hypnotised me with a CD. I eat anything but stop before I am full because I can eat whatever I like whenever I like, so no deprivation. I can also relate to the doctor thing. I have slightly raised cholesterol and a doctor shouted at me over the phone that it’s all because of those greasy English breakfasts I eat! I don’t eat breakfast at all. I felt deflated.

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  37. One thing is clear, you communicate your position beautifully in writing. Hoping and praying for your success with your physicians and your health.

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  38. Before I see my doctors, I always attempt to show them some real written evidence of a medical goal I am trying to achieve. Let’s just say I try to fight for my own interests and show them a plan. Good luck on your own efforts here.

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  39. I understand completely the problems with getting doctors to listen to you without bias. One member of my family let a very serious heart issue go on for way too long because he felt the doctors would just fuss at him about his smoking. Another member of my family has had many of her medical issues ignored and disparaged because she is overweight; it is clear to me that her health care is compromised because of this bias in her physicians. I have struggled with this myself because I have a rare autoimmune disease that has led to even more rare complications (exercise-induced pulmonary hypertension that was being impacted by a hole in my heart!) and my doctors just keep saying I was okay and that I should be tested for sleep apnea. You can work really hard to turn around your weight, but you also deserve to have data driven discussions with your doctors that are about your actual symptoms without them falling back onto the “lose weight” stance that they are prone to. Hugs!

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  40. Not sure if you would be interested in these: https://more-love.org/free-dont-weigh-me-cards/ I saw these in a group I was in.

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  41. My goodness, I can imagine your frustration during these visits and the delight when you got the message from the cardiologist. Reading the various comments, how about writing your own statement that explains the work that you are doing with the nutritionist and that you are looking for a healthier regime for you body and your mind. Print out your statment and get it laminated (or some other form of preservation for it). You can then hand it to the doctor (while standing possibly – what a good idea that is). You could also ask them to put a copy of it in your notes. I think it’s about taking charge to some extent and while listening to their comments and advice, being able to have a sensible two way conversation about practical and productive solutions. Good luck and do whatever you need to be as well as you can.

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  42. There should be no shame or scolding in weight loss. I’m sorry this is happening to you. Hold firm and hold a vision of yourself as healthy, regardless of weight. Happy New Year, Rachel!

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  43. I think sometimes focusing on the weight issue is the default for clinicians because it is easy. It is much harder to get to know a patient and her history and understand the layers presented by recent tests, medical history, in person Q and A. From what you have shared your situation is complex medically and psychologically and no wonder you feel trivialized, reduced to a caricature by the throw away advice to just lose weight, as if that will solve everything. Cut them off by saying “my nutritionist is handling that element of my situation, but she cannot help me with ___________ (insert cardiac issues, immune issues, whatever) which is why I am here. Can we discuss those please?” Throw the ball back to them. I know this is harder than I am making it sound. But I believe in you. You can even practice before you go. You got this. XXOO

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  44. How very wrong to need an advocate in a place where we go to be healed, or at the least helped. They wield such power over us, these little gods who have sworn to do no harm, yet still they wound us with their one size fits all test results, thoughts, attitudes.

    It sounds like PTSD, Rachel – I have that doctor dread, too. Gentle hugs xo

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  45. Rachel, there are many fat doctors, fat nurses and fat dieticians. If it was easy to be slim, they would be too. In my surgery you could lose half a stone from going from the scale in one room to the scale in the other. Regarding doctors……What is the difference between God and a doctor. ……….?

    God knows he isn’t a doctor.

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  46. How about handing your doc a written note, emphasizing that they are not listening to you, so that you are handing them this note to set boundaries and emphasize how unhelpful their focus on your weight is?

    Tell them that you are working with a nutritionist on your weight in the note, appreciate their concern, and remind them to butt out?

    You did a great job telling us, and sometimes written notes get through when nothing else works. Hugs to you during this difficult time.

    Reply

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