Monday, March 24, 2008

UNC-Chapel Hill: Obesity May Keep Some Women from Getting Screened for Breast, Cervical Cancer

From Newswise:
A review of cancer screening studies shows that white women who are obese are less likely than healthy weight women to get the recommended screenings for breast and cervical cancer, according to researchers at the University of North Carolina at Chapel Hill’s School of Public Health.

The trend was not seen as consistently among black women; however there were fewer high quality studies that examined black women separately.
Let's, for a moment, ignore the disappearing of women who are not black or white and the curious "healthy weight women" remark, shall we? Within this study, women who are labeled obese are less likely to get pap smears and mammograms. When asked why, Sarah S. Cohen, lead author of the article, replied, "Our review doesn’t tell us why larger women are not getting screened as frequently for these cancers. It only reveals the trend."

I'd like to offer a couple of suggestions. Maybe it's because doctors make us feel similar to the little things that crawl out when you turn a rock over? (Until you get the stern "Shame on you, fat girl, you might die tomorrow!" lecture, you haven't experienced a doctor's visit!). Maybe because we're taught to hate our bodies and the idea of getting naked in front of anyone is terrifying? Maybe, deep down, given the fact that we're taught fat is bad from, oh, say, the womb, we might believe being ill is our just due for being fat?

Zan says what so many of us feel here:
I hate seeing new doctors. There's always the hesitation, the worry -- is this doctor going to take me seriously? Is she going to believe me when I describe my symptoms? Or is she going to dismiss it all because I'm a fat girl? Is she going to try to sell me on weight loss as the cure-all for my ailments -- which she doesn't even believe exist anyway.

I went to doctors for four years before I was initially diagnosed with Fibromylgia, then with Lupus. They all told me, to the man (and funnily enough, they were all men), that I was just stressed and overweight. If I learned how to relax and lost some weight, why all my pain would just disappear!

And so, I have a great fear of being dismissed and reduced to my weight when I see a new doctor.
And a couple of years ago, I talked about my experiences:
My PCP in my late 20s was a brusque woman who was absolutely appalled by my "choice" to be fat. I went to her for over a year, feeling that I deserved her insults, hoping they would spur me to do something. Some of the most memorable:
(When having me stand and stretch) "Stand with your feet together. Well, as close as you can get them."
(When I went to her crying with back pain) "You should really consider getting your breast size reduced. If you lose weight. As far as the pain, I'm not going to treat the symptoms if you won't remedy the underlying cause."
(During a routine check-up) "Your knees and back are going to be gone in a decade.
(During a painful Pap smear) "I'm sorry, but I have to press harder and really search for (whatever the hell she was looking for) in a woman your size.

Only after talking to some friends, who looked at me as if I was crazy when I talked about my experiences, did I realize I didn't have to take that treatment, that maybe every complaint I had was not an outgrowth of my being big. I mean, I went to the ER after the back fiasco and found out I had pulled a muscle and I'd never had a painful Pap before. I could be hurt or sick in a way unrelated to my size. That was amazing.

The latest incident involved an ER visit with a seemingly nice doctor who apparently decided I was a moron:
"What's bothering you?"
"Abdomen and lower back hurt badly. Really bad nausea. My doctor can't see me til Wednesday."
"Does it hurt when press here? Here? Can you jump? Does that hurt? Can you bend? Does that hurt? Has it gotten any better? Are you sure it's your abdomen and back? Do you think you could be pregnant?"
I answered each question patiently. Then he asks:"Have you eaten?"
"Because of the nausea."
"What about it?"
"If I eat, I'll throw up. If I throw up, I can't stop."
"Oh. Well, are you hungry?"
"Um, no."
"Okay. Would you like someone to bring you something to eat?"
"Fine. Are you sure you're not just hungry? Have you eaten anything?"
Five minutes of this until he decides that, despite the fact that I'm fat, maybe, just maybe, I'm not currently interested in food. Eventual diagnosis: bladder infection.
So many times, for me, going to the doctor has been like getting every negative message ever aimed at me for being fat condensed (and sharpened) into a 15-minute block. It's overwhelming, shaming, draining.

And it's why I hate going to the doctor's.


k8 said...

I had one of those doctors in the past. I really hated it. He was also my parents' doctor for years. I suspect that one of the reasons she put off going to the doctor for hip pain for way too long (she had replacement surgery probably 2 years later than she should have) is because he/the doctor would tell her that she needs to lose weight every time she went in with back pain or something else. This was during her 50s and 60s - people have pain for other reasons at that age. Anyway, she would decide to not go to the doctor because "he'll just tell me I need to lose weight." And this doctor was a good friend of theirs.

I love my doctor I have now, but I dread having to get another one once I get a job and move. She is very supportive about my weight struggles. She voices her concerns in a way that is caring and offers support for dealing with the weight (such as nutrition counseling, etc.). She's never been condescending and I dread that the next doctor will be.

RageyOne said...

wow. talk about a bad bedside manner.

Quiche said...

I HATE getting new doctors. Doctors rutienly dissmiss women--no matter what their weight is. I imagine that weight compounds this treatment.

I've had a doctor tell me I had a cold when I came in because of sinus pain. A week later I was rushed to the hospital with sever headaches. Problem: Sinus infection & asthma restricted flow of oxygen to my brain = PAIN. The doctor at ER listening to my lungs, "Your doctor didn't hear anything when he listened???!!!" Other doctor at the ER after looking at X-ray "how did your doctor miss that?"

I have some simple rules that might help out though: 1. NEVER go to a PCP for a pap smear. Just bad! 2. NEVER go to a male for a pap smear. Equally bad. 3. If a doctor treats you badly they really hate when you point it out to them. "Excuse me, I don't know what kind of bad day you've had, but do you realize you are speaking in a disrespectful tone to me and treating me like an idiot?"* ;) Be ready to fight though!

*true story

Summer said...

I think you've definitely hit on the nail on the head. I hate going to the doctor for exactly that reason. Also I had finally figured out a lifestyle that was healthy and happened to make me thin a couple of years ago after struggling with my weight pretty much since as long as I can remember. And I kind of forgot about those types of scenarios until I had 4 funerals in 6 months and had gained a significant amount of weight back.
I've just moved and I have an insulin disorder so I had come to a new doctor to get bloodwork done and while she was nice, she is insisting that I see a dietician even though I've told her I'm back to eating healthy now and clearly didn't believe me when I told her I get regular exercise. I haven't had anything happen comparable to the experiences above but I think that you are right that societal impressions concerning weight interfere with women's ability to get quality medical care.
Even my mother who is not overweight dreads going to the doctor for valid reasons because she doesn't want to step on the scale in front of people.

Anonymous said...

holy moses.

I am glad you are no longer seeing that sadistic jerk who said she wouldn't treat the pain until you lost some weight, or who DID NOT KNOW HOW TO DO A PAP SMEAR RIGHT OBVIOUSLY (I'm *not* a doctor but I'm pretty sure your cervix doesn't put on weight regardless). That especially is a loose-canon issue for me. When I was a teenager I had an experience like that with a male gynecologist (I've had crappy female ones too unfortunately), where it was basically my fault that he was hurting me during the pelvic exam, according to him.

Gah. I have anger that feels like hate right now. I'm sorry you went through all that, and it is criminal that people feel justified being cruel to people because of their weight. I feel like it especially happens to fat women, although I'm not saying fat men don't get shit too.

Kristi said...

I have not seen a doctor - a gp - in 2 or 3 years and I know I need a pap smear, my mom had cervical cancer.

This is the 2nd doctor I've went to though, who only wanted to state the obvious - you're overweight. Well duh. I am overweight enough that I would have to be a vegtable not to know that. So then they proceed to tell me how I should go about losing weight - diet and exercise. Oh gee thanks, like I am not broadcast that particular message 24/7 in this society.

And then she has to go and want to talk about it, and tell me what a calorie is. I'm an RN that was nursing before she went to college.

To make it worse, I asked her NOT to touch my foot -I've had a lot of problems and surgery and I have a couple of specialist that care for it - not once but 3 times, so what does she do? She keeps touching my foot and tries to hit it with the little hammer.

So obviously, I am a fat lady with a foot to this lady, with no working cerebrum.

I decided after today I will just have to die if I do get cancer. It would be better than paying to get treated like this.

Revelations and ruminations from one southern sistorian...