September 2, 2015

the HAES® files: Malpractice with a Side of Victim Blaming

by Health At Every Size® Blog

Note: ASDAH is grateful to Ragen for speaking to recent critiques of the #StopTheShame campaign. All quotes identified below are from said critique, which can be found here.

by Ragen Chastain

In response to an article pointing out the issues with shaming of Women of Color, fat women, Trans women, and women with multiple sex partners, Dr. Linda Girgis has penned a spectacular tribute to derailment, tone-deafness and victim blaming.  Let’s break it down:

In the September issue of “Women’s Health Magazine”, there appears a feature titled “The Doctor Will Judge You Now”.  (1)  It included stories of four women who related how they were shamed by their doctors while seeking medical care about sensitive topics. One story relates how a transgender women felt shamed when her doctor asked her if she had a PAP smear, and couldn’t understand why she didn’t need one. Another was shamed for being overweight and yet another for having multiple sex partners. The final story was an African-American woman who failed to be properly diagnosed and instead labeled a drug-seeker because, as she believes, her race.

Even this opening paragraph is concerning – “felt shamed”, “as she believes, her race.” I feel like right off the bat Dr. Girgis is falling into the trap of not believing these women.  And it goes downhill quickly.

On reading these articles, I agree that these women were not treated appropriately. Their doctors failed to provide adequate care. But, I also feel that it is wrong to be so judgmental of all doctors based on these sad stories of a handful of patients. The truth is that the vast majority of us doctors do care about our patients and try to give them the best care possible.

I feel bad that these women felt shamed by the system when they turned to a trusted physician for medical help. Let’s be real, though.  There are bad apples in every group, even doctors.

First of all, where is she getting her figures for “the vast majority?”  Let’s be real – the stories in Women’s Health are representative of stories I hear all the time from women in these populations, or at least I hear them until they swear off going to the doctor because of incidents like this.  I hear from my blog readers around the world daily about experiences exactly like those outlined in the article, and worse.

I’m not saying there aren’t good doctors, there certainly are and perhaps the doctor who wrote this article is one of them. Or, perhaps she would be if she would stop derailing a discussion of an issue with medical treatment in this country to instead make it about her.  This is about putting the resources and attention where the problem is.  For example: if my neighbor is having a heart attack, it’s not appropriate for me to demand that the paramedics spend equal time paying attention to me even though I’m perfectly fine.  In the same way, when people who are being mistreated are discussing the doctors who mistreat us, it is not appropriate for other doctors to insist that we spend equal time patting them on the head for doing the bare minimum required by their professional ethics.

There are often uncomfortable questions that a doctor needs to ask patients in order for them to receive the best care. Questions do not necessarily mean judgment.

For example, a woman who has multiple sex partners is at risk for a whole host of diseases including HIV, hepatitis, Chlamydia, gonorrhea and others so it is reasonable to ask her about her sexual activity. I do not know if she is at risk unless I ask.

Again, Dr. Girgis is trying to minimize the inappropriate treatment these women received in order to construct her own narrative about how it’s really the women’s fault. Nobody said that doctors should not ask these questions. The story is clear: this woman honestly answered these questions without complaint.  The problem was what happened next, which Linda conveniently left out of her account.

Sometimes we need to tell patients what they don’t like to hear – not to shame them but to treat them. For instance, a patient who is having knee pain would do better if they lost weight if they are overweight. But they may be sensitive about their weight and not want to hear that…

Or maybe the patient is “sensitive” about being treated with evidence-based medicine. Maybe the patient is educated and knows that not a single study exists where more than a tiny fraction of people lose weight long term, and that the most common outcome of weight loss attempts is weight gain and so knows that this doctor, while insisting on her competency, is recommending an intervention will almost certainly fail, and the majority of the time leads to the opposite of the intended result.  Maybe her patient is frustrated that the many thin patients who present with knee problems are given many options for treatment – options that have a high chance of working for fat patients quickly, unlike the diet they are prescribed which, even if they are in the tiny fraction of people who succeed, could take years.  (I talk about this at length here.)

Articles like this only serve to drive a wedge in the doctor-patient relationship. Yes, we need to hear these stories and realize there are bad doctors out there as we strive to #StoptheShame, but please present this in an unbiased light.  Do we ever hear anything about the good doctors who go above and beyond for their patients, every day?  Those physicians who spend hours after work updating charts, fighting with insurance companies until necessary tests are approved or working a worried mother and baby into their already packed schedule?  It’s disheartening to see a series of articles that could be so powerful stoop to the level of the physicians they’re exposing.

Note that in her list of things that “good doctors” do, none of the items involve providing proper care to the populations addressed in the article.  Also blaming “articles like this” for creating issues between doctors and patients – suggesting  that the problem isn’t that it happens, but that those of us to whom it happens speak out about it – is completely tone-deaf, derailing, and an illustration of the problem.

Articles like this only serve to raise fear among patients and are (dare I say) dangerous, as they may discourage others from seeking medical care when it is truly needed.  A responsible article would have also given women tools to avoid and deal with medical shaming and show them how to search out doctors whom they can trust.

What is actually dangerous (and |I do dare say it without asking permission) is this kind of victim and activist blaming as self-defense and misdirection.  The thing which discourages people from seeking medical care when it is needed is the fact that this kind of unconscionably poor care happens to us on a regular basis. The problem is that it happens and that when we point out that it happens, doctors like Linda get whipped up into a “NOT ME!” frenzy and do everything they can to derail the conversation and blame the victims.

As far as what a responsible article would do, I would suggest the article isn’t irresponsible: Linda and doctors like her are irresponsible – not only blaming their victims for our own mistreatment, but expecting us to solve the problem as well.

Instead of asking why the article didn’t give women more tools to deal with medical shaming, I’d like to hear what Linda is doing to stop the problem of medical shaming created by members of her profession (and supported by her #notalldoctors attitude.)

Don’t worry Linda, I’ll feed you, baby bird. Here are some questions doctors can ask themselves.

  1. Do you and your staff get regular education on how to provide compassionate, evidence-based care to oppressed populations FROM those populations?
  1. Can these populations see themselves represented in a positive light in the art in your waiting room, the magazines on your tables, and the charts on the walls?
  1. Can these populations see themselves represented in the doctors and staff in your practice?
  1. Is your practice open about its affirmation of members of these oppressed populations – and would members of these populations know from your website and practice information that they will be affirmed and treated with compassionate, evidence-based care by people who are educated about working with them?
  1. Are you insisting that your continuing education include training about working with diverse populations provided by members of those populations?
  1. Are you certain the specialists and other doctors to whom you refer your patients also meet these most basic criteria for an inclusive, appropriately-educated practice?

Linda sums it all up in one neat victim-blaming bow by asking: “Isn’t it time we were all more responsible?” No Linda. It’s time for doctors like you to be more responsible, stop victim-blaming, derailing, and distracting from this conversation, and start working on solutions to make sure any patient who goes to any doctor can expect to be treated with the evidence-based, appropriate, compassionate care that the ethics of your professional demand.


Leap credit Richard Sabel.JPGRagen Chastain is a trained researcher, three-time National Champion dancer, and marathoner who speaks and writes full-time about body image, health and wellness. Ragen has spoken at venues from Google Headquarters, to Darmouth and CalTech, to the We Are Girls conference. She is the author of the blogs DancesWithFat and IronFat, and the book Fat: The Owner’s Manual. She is the editor of The Politics of Size – Perspectives from the Fat Acceptance Movement, published by Praeger, and co-editor of the work in progress “Throwing Our Weight Around:  Real Stories of Fat People in the Fitness World.”

Ragen is a feature interviewee in the documentaries “America the Beautiful 2 – The Thin Commandments,” released by Warner Brothers,  “A Stage for Size” released by USC Films, and “Ragen’s More Cabaret” released by PBS, and a movie about her time as a fat competitive dancer is currently in active development. Ragen lives in Los Angeles with her partner Julianne and their adorable rescue dogs Bu and ChadShannel, and in her free time she is training for her second marathon and her first IRONMAN Triathlon.

(Photograph by Richard Sabel.)

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