Help me deal with my condescending doctor!
February 16, 2005 9:59 AM   Subscribe

Need help with a condescending doctor. This may be girls-only so if you have a problem with words like "ovaries," goodbye. It also involves my being a fat girl, so if you have the HURF DURF BUTTER EATER attitude, goodbye as well. [a lot mi]

I recently moved and got new health insurance, and with that a new gynecologist. This was a weird step for me, as the only gynecologist I'd ever had before was the guy who delivered me as an infant. My old doc was fabulous and actually diagnosed me with PCOS (at a time when it was tremendously underdiagnosed) and helped me quite a bit with that.

Now, the new guy, I just went in to see for a Depo shot. No exam needed, I had one three months ago.

The moment I walked in, the man started with the judgments. He took my weight (I weigh about 250, I'm six feet tall, I've maintained this weight for roughly 3 years), then instantly launched into a diatribe on how I needed to lose weight. He recommended both a low-carbohydrate diet and skipping meals(!).

I patiently explained to him that in addition to the PCOS, I have exercise induced migraines, and have for well over a decade. They've done all the tests to make sure it's not a brain tumor or something else like that. I haven't "grown out of them." Exercising regularly doesn't get rid of them, it just puts me into constant misery.

I also told him that I walk 2 miles a day (1 mile to and from work) every weekday, and I figured that's more exercise than most people get.

His recommendation? "Increase that to about two hours of exercise a day by exercising for 45 minutes before you leave for work and 45 minutes after you get home."

Then he launched into the dietary stuff. "Stop eating beef!" he said. "eat more fish and chicken. No fast food."

I contemplated this, then told him I hadn't eaten beef in over a month, and had eaten broiled fish (which I enjoy, especially living here on the gulf coast where it's fresh!) three times in the week. He's like "oh, but I'm sure you're eating a lot of candy and junk food." Uh, no. Sorry, doc. The closest thing to junk food in my house at the time (I've received valentine's chocolate since!) was Terra sweet potato chips. Strike two.

Then, he started to tell me that I should "know my own body" and that it was surely my lack of awareness of my own exercise and diet that was causing my weight issues. I'm thinking, I've lived in my body for a good 20 years. I know it pretty well. You've known me for 45 minutes. What gives?

So AFTER he'd lectured me for literally an hour, talking about how I'd inevitably develop diabetes and such unless I followed all his recommendations and that I probably had never really looked at my food intake, he THEN took my blood pressure. It came out at 138/89, at which point he said "See? Your blood pressure is already elevated beyond what it's been in your other checkups in the last year. Obviously the weight is contributing to poor health."

I wasn't sure what good sputtering at him would do. I felt patronized and like I was about a foot tall. No matter what I told him about my body - or even what the medical records said - he didn't listen and just kept on going.

Here's what I want to know.

1) Am I right to be really frustrated/upset by this whole situation?

2) this seemed to be pretty far out of the scope of a gynecologist's duties, especially when I had only come in for birth control. He was refusing to give it to me until he'd lectured, though, and it would've taken me another 2 weeks to get an appointment elsewhere, and by then I'd be late for the shot and at risk for pregnancy. And he knew it.

3) Do I have any recourse here other than finding a new doctor?

4) How do I make sure I avoid having this kind of problem in the future? I have good insurance and can take my pick of a bunch of doctors. Saying to a co-worker "who's your gyno?" strikes me as...a bit personal. How do I manage to find someone who won't do this same crap?
posted by u.n. owen to Human Relations (75 answers total) 14 users marked this as a favorite
In the UK we have a support group called Verity (). They are great. It might be worth posting a message on the bulltin boards there to see what info they can give you (?)
posted by cantthinkofone at 10:05 AM on February 16, 2005

At the very least, you should find a new doctor and report this dude to your insurance company. What an asshole. You are completely justified in being outraged. (I'm a boy, but I am outraged too.)
posted by goatdog at 10:05 AM on February 16, 2005

1) Yes.
2)That's utterly obnoxious of him.
3) Not sure what other recourse you have, but whatever you do, find another doctor.
4) I, a man, asked female co-workers if they knew of a good gyno for th' wife when we moved to a new area (yes, I asked if she wanted me to do it). I wasn't embarrassed and neither were my co-workers. Neither should you be: it's no worse than asking them to recommend a dentist. And this was in Reading PA, the heart of Pennsyltucky. Still, your personal comfort level on this may vary (and the mores might be a bit different in Florida).
posted by PinkStainlessTail at 10:14 AM on February 16, 2005

I, too, am a guy, and share your outrage. It was unprofessional behavior.

1) Am I right to be really frustrated/upset by this whole situation?
Yes. He was being a prick.

2) this seemed to be pretty far out of the scope of a gynecologist's duties, especially when I had only come in for birth control. He was refusing to give it to me until he'd lectured, though, and it would've taken me another 2 weeks to get an appointment elsewhere, and by then I'd be late for the shot and at risk for pregnancy. And he knew it.
I agree. He's a prick.

3) Do I have any recourse here other than finding a new doctor?
Not that I can see, unless you want a well-meaning prick for a doctor.

4) How do I make sure I avoid having this kind of problem in the future? I have good insurance and can take my pick of a bunch of doctors. Saying to a co-worker "who's your gyno?" strikes me as...a bit personal. How do I manage to find someone who won't do this same crap?
My women friends say that's how they found theirs. It's an important question, and not too personal at all.

(Oh, and 6'? Sweet!)
posted by Floydd at 10:14 AM on February 16, 2005

Response by poster: Oh. there really was supposed to be a question at the end of #2, which was: does a gyno have any business doing this sort of thing unless I'm asking about diet/exercise/whatnot?
posted by u.n. owen at 10:15 AM on February 16, 2005

Response by poster: Oh, and when I say "other than finding a new doctor" I mean "over and above finding a new doctor" because I am NEVER going back. I want to know if I can have his head on a platter, frankly.
posted by u.n. owen at 10:15 AM on February 16, 2005

Hmm, perhaps there's some sort of professional association where you can register a complaint? I'd check into that, or maybe some MeFite can provide the info. I'd also send him a letter explaining why you won't be back.

And poll your female acquaintances to see if anyone has a doctor she likes. Don't be embarrassed about it - although you might want to ask when there aren't any lads within earshot.
posted by orange swan at 10:26 AM on February 16, 2005

Clearly the doc was out of line in his attitude.

OB/GYNs sometimes consider themselves to be primary care docs for women, so the fact that he was addressing other issues outside of reproductive health is not out of the norm. The fact that he was being obnoxious unfortunately represents the kind of discrimination fat people face all the time.

There's a lot of interest and advocacy around this issue - if you search for weight based discrimination you'll come up with a lot of source material on how this fight is being waged.

As far as having his head, it sort of depends. Is he part of a medical group? Most physicians are for insurance purposes. You could complain of discrimination to the person in charge of the medical group. If you have insurance that's paying for the visit, you could complain to your insurance company. You could also find out about the licensing authority in your locale, and have a friend who's a lawyer draft a letter of complaint in which you recount your visit and the hostile attitude with which you were treated. Send a draft of the letter to the doc and demand an apology.
posted by jasper411 at 10:28 AM on February 16, 2005

You are perfectly justified in being pissed.

Even doctors have bosses. Find the head of OB/Gyn in that hospital, write him a letter and tell him exactly what you told us. Send another copy to the chief of medicine or surgery or wherever OB/Gym falls.
posted by bondcliff at 10:33 AM on February 16, 2005

Create a web page explaining what happened and listing his name and office address. Make sure it's indexed by Google. If nothing else, a certain number of potential new patients will do a search on him before making their first appointment, choose a different doctor, and be spared that kind of experience.
posted by bac at 10:33 AM on February 16, 2005

I think he's being honest, which is difficult, especially because you seem like a genuinely nice individual. It's not bad advice, and for someone to present you with the reality that you, the patient, have developed work arounds for ("I have exercise induced migraines," "etc.) can be a a splash of cold water.

What you decide to do is up to you, of course, but I wouldn't add "the obnoxious doctor" to your already growing list of reasons why 'it's not my fault.'

I say stick around, maybe he's the motivation you never knew you needed.

I also think you are using Metafilter as a way to reinforce your existing methods of not dealing with reality, by asking us to agree that the doctor is a big jerk and you are as healthy as you can be.

I hope you don't think I'm a big jerk too, this is just how things are being presented to me.
posted by Mean Mr. Bucket at 10:34 AM on February 16, 2005 [1 favorite]

I disagree with trharlan (and, on preview, with Mean Mr. Bucket, strongly!); I think you do have a right to be pissed off about the basis of the discussion. It's not as much of a secondary health issue as he thinks, and as he would have known if he had listened to you, u.n. owen, or read your file. All of your perfectly valid arguments (walk 2 miles a day, don't eat beef, etc.) were ignored, and at that point the doctor should have reassessed his "basis" and maybe decided he was wrong, or that his sense of urgency or authority over the situation as misguided, at least.

Also, I adore "HURF DURF BUTTER EATER attitude." I am going to have to use it, and try to remember to have your attitude about it when people get that way with me.
posted by librarina at 10:40 AM on February 16, 2005

Is he part of a group practice? Send a letter of complaint to the group. Even if nothing is done, he'll be as embarrassed as he tried to make you.
posted by FunkyHelix at 10:41 AM on February 16, 2005

if he was truly abrasive, you should definitely switch. when you switch, perhaps a nonconfrontational "i am switching doctors because i felt you weren't listening to my responses when you inquired about my health habits to the point that you seemed judgmental rather than interested in addressing the reasons i was in your office in the first place" conversation with the doctor (or the managing doctor of the practice) could be appropriate.

my gyne is all about the whole body and i really like her for it. (my prior gyne was also my GP and that was by far the best doctor-patient relationship i ever had; alas, i moved and am back to the "different doc for every body part" crap) she always comments on my weight fluctuations &c and asks about diet, exercise and general care of myself. she would never, however, refuse to listen what i had to say in response to her questions. if she was, i'd switch. i do not think it's out of line for a specialist to look at your overall health, but i do think doctors shouldn't patronize their patients.

i know i'd feel a little weird asking my co-workers to recommend a gyne, but if i didn't have friends/family in the same health plan to ask, i'd have to do it. i think i'd frame it with a "hey, i'm new to the health plan and was hoping you'd have something to share about the doctors available to choose from"
posted by crush-onastick at 10:43 AM on February 16, 2005

u.n. owen, I'm afraid I don't know how to help you get his head on his platter, but I have some thoughts about part 4 of your question. My husband's co-workers (he's in a female dominated industry) volunteered info about local GYNs for me when we moved, and they gave great advice. Don't be shy about it - I think most women want to help each other find supportive, skilled docs and avoid jerks like the unfortunate one you found on your own. Be sure to ask a few women, since everyone's idea of a good doc is different. A couple of acquaintances of mine adore the same gyno who told me my ovarian cysts "couldn't possibly be very painful" - this when I was a teenager literally passing out from the pain of bursting cysts!
posted by katie at 10:44 AM on February 16, 2005

Time to find a new doctor. If he is part of a group I might write a letter to the group, but otherwise it is probably best to just move on. I don't think you will find this kind of behavior in another doctor, it's really out there.
posted by caddis at 10:51 AM on February 16, 2005

Since you have PCOS, you might want to look up a support group in your area, as the women will likely have a lot of input on good doctors.

I too love the HURF DURF BUTTER EATER attitude, and will have to remember it later.
posted by sugarfish at 10:51 AM on February 16, 2005

As a male, I overcame long ago the anxiety of buying tampons, vaginal cremes, even panties, so UN, go ahead and ask your female coworkers for gyn references. It's just another part of life.

(I have to admit I snickered at the blood pressure bit. At that point, it was ONLY 138/89??? heheh)
posted by mischief at 10:54 AM on February 16, 2005

Except, Mean Mr. Bucket, PCOS has a number of symptoms which can include weight problems and high blood pressure, so maybe the good doctor really IS the asshat that he appears to be. Of course, I could be wrong.
As far as any recourse, perhaps contacting/complaining to your state's medical board? Here's a list.
posted by bachelor#3 at 10:55 AM on February 16, 2005

He sounds like a jerk. My GP is the same way, but I keep going to him, because, besides his bedside manner, he is an excellent physician. You don't have to do the same.

I don't think you can do much, other than switching gynecologists (which you are already doing) and sending him a letter telling him exactly why you are switching. I doubt it will do much.

You are absolutely right to be upset and pissed off. He was insensitive and boorish in the way he delivered his opinion. Was he an older gentleman? I find that this type of patriarchal attitude is more common in the old guard of practitioners. Despite his rudeness, I do believe he was genuinely concerned about your health. He just had no idea how to convey his concerns in an even remotely effective manner. However, even if he is 'only' your gynecologist, he is absolutely correct in raising an issue that he believes might negatively affect your health. Where he screwed up was in acting like an insensitive jerk.

Unfortunately, we don't have much influence on how our health care professionals deal with us, beyond complaining and switching doctors.
posted by sid at 10:56 AM on February 16, 2005

mean mr. bucket:

I also think you are using Metafilter as a way to reinforce your existing methods of not dealing with reality, by asking us to agree that the doctor is a big jerk and you are as healthy as you can be.

i think that un owen was looking for support -- a thing which, i realize, is on occasion difficult to wrest from members of metafilter.

one's interpretation of "reality" aside, clearly this doctor is not the doctor for you, owen. finding a doctor who doesn't charge for bad attitude is one thing ... for another, may i suggest a female doctor be your next try?
posted by moz at 10:58 AM on February 16, 2005

When we moved I had a co-worker who's husband is a specialist Doc attached to a large local hospital. As we had a list of insurance-approved doctors he was very helpful with giving a first level evaluation. It doesn't hurt to ask to find out who's in the know.

Beyond that, my wife, who had been going to a specialist gyn before we moved, ended up with a woman doctor GP here who had more understanding than any male MDs she had to that point. Gender shouldn't make a difference when it comes to docs, but it might be worth a try.
posted by SteveInMaine at 10:58 AM on February 16, 2005

Depo causes weight gain, I understand, so I don't think he was out of line to be concerned with your weight when you were asking for Depo. Weight also has impact on fertility and diet has a lot to do with other gynecological problems, like cervical cancer. So talking to you about your weight and diet seems to be completely in line with his duties.

To me, the biggest concern is that you felt he was threatening you with not giving you the Depo shot unless you sat through his lecture quietly. That's not appropriate at all, and you should tell him so.
posted by insideout at 11:00 AM on February 16, 2005

1) Yes, sounds like he was a jerk. Don't go back.

2) Many physicians generally seem to regard all of your health as their concern, not just what you came them to see. A few won't treat people who ignore their other advice. It might benefit you to find a medical professional who would help you address the other health issues brought up here. Not this guy, though.
posted by grouse at 11:00 AM on February 16, 2005

Yes, you're right to feel frustrated and yes, you should ask your co-workers for a recommendation. You also might try going to Planned Parenthood; I found that I get better service and a better bedside manner there than anywhere else.


You should expect that any new doctor (even if it's just a gynecologist) will want to discuss your weight with you, probably before dispensing any medication. Just because this guy was an ass at it doesn't mean that he was entirely in the wrong.
posted by stefanie at 11:01 AM on February 16, 2005

BTW: PCOS. For people like me who didn't know what it was.
posted by PinkStainlessTail at 11:02 AM on February 16, 2005

Response by poster: My "work-around" of exercise-induced migraines has been a problem for me since age seven, Mean Mr. Bucket. My pediatrician at age nine recommended I exercise daily for six months. Migraine. Every day. Six months. When you've lived with that, please tell me how my perception of reality is warped and awful. Jeeeeeeesus. It's nice that you can dismiss actual verified medical issues as "workarounds" for a weight problem, but the migraines started before the weight was an issue. So could you please can the assumptions and condescension, too? Would it KILL YOU to ask beforehand "hey, is it possible the migraines are a workaround" instead of just stating it as demonstrated?
posted by u.n. owen at 11:03 AM on February 16, 2005

Response by poster: Mmm. I'm a big advocate of Planned Parenthood, used to go there for my shots all the time. Unfortunately, there is none nearby (thanks conservatives!). I will have to look to see if there's some sort of local equivalent.
posted by u.n. owen at 11:04 AM on February 16, 2005

if he was truly abrasive, you should definitely switch. when you switch, perhaps a nonconfrontational "i am switching doctors because i felt you weren't listening to my responses when you inquired about my health habits to the point that you seemed judgmental rather than interested in addressing the reasons i was in your office in the first place" conversation with the doctor (or the managing doctor of the practice) could be appropriate.

She certainly doesn't owe this doofus an explanation! I'd just move on and let them make other people miserable. Chances are he wouldn't be disciplined or anything, I doubt.

unowen, how you feel is how you feel. It's ok for you to not like him. (I personally wouldn't go to a male gyn, but that's just me.) Find another gyn, don't waste your time or energy on this guy.
posted by scratch at 11:04 AM on February 16, 2005

A conscientious doctor will bring up any side issues that they deem problematic, and that’s actually a good thing, but there are definitely better ways to go about it than this particular doctor did. I think your one-doctor-all-your-life situation is rather unusual, and probably why you’re surprised at finding an arrogant doctor. Many of us, myself included, are used to having to go through a few doctors before we find one we’re comfortable with, and encounter a lot of arrogance along the way. In my case, I find that I’m most comfortable with a female gyno; they at least have the parts they’re treating. Complain if it makes you feel better, but it’s more important that you embark you’re your search to find a better doc. You’ll find someone who treats you properly, it might just take a few tries.

Oh and yes, expect to hear about your weight from any new doc. Hopefully it'll just be handled in a better way.
posted by boomchicka at 11:06 AM on February 16, 2005

Response by poster: I fully expect to hear about my weight from a doctor. But not the way it was presented there. There's a right way and a wrong way. Right way: asking questions about lifestyle/diet/etc. Wrong way: assuming everything up front and giving a "one size fits all fat people" speech. Observe Mean Mr. Bucket for example.

The other problem I had is that his dietary advice, including the aforementioned skipping meals thing, just struck me as so anti-conventional-wisdom that it was weird. I've never seen a dietician that said "skip meals, yeah!" -- in fact, most advocate, particularly for people with hyperinsulinemia associated with PCOS, smaller and more frequent meals. So I think the guy was likely talking out his ass anyhow, unless I've missed some crucial new research.
posted by u.n. owen at 11:12 AM on February 16, 2005

1) Am I right to be really frustrated/upset by this whole situation?

Yes, he was an asshole.

2) this seemed to be pretty far out of the scope of a gynecologist's duties, especially when I had only come in for birth control. He was refusing to give it to me until he'd lectured, though, and it would've taken me another 2 weeks to get an appointment elsewhere, and by then I'd be late for the shot and at risk for pregnancy. And he knew it.

It can be, or it can not be. Depends on the area - when I first started going to the gyno, she became my primary care physican - this was because it was a small town and she took the time with me and would see me for colds and whatnot. I was a bit surprised and dismayed after moving to a big city and finding out the attitude at my new gyno - vaginas vaginas, ovaries, uterus, babies and that's it. They basically refused to talk to me about anything else. So it's a toss up.

3) Do I have any recourse here other than finding a new doctor?

FIND A NEW DOCTOR. If there's one thing I've learned, it's that doctors should LISTEN to you and talk to you like a person. If they don't, they don't need your business. I know it's a hassle to find someone else, but it's not worth it. If they won't take the time to listen, they don't care, in my opinion.

4) How do I make sure I avoid having this kind of problem in the future? I have good insurance and can take my pick of a bunch of doctors. Saying to a co-worker "who's your gyno?" strikes me as...a bit personal. How do I manage to find someone who won't do this same crap?

I would ask co-workers. It might seem a bit personal, but people don't really mind, usually. It's how people find doctors, and it's definitely the way to go to find someone who isn't a big meanie.

Sorry you went through that. What a jerk.
posted by agregoli at 11:15 AM on February 16, 2005

I'll add to the "your doctor is a jerk" chorus. Do you have a primary care physician? I ask because not every healthcare plan is structured that way. If you do, I'd consider asking their opinion along with the various other suggestions here. In particular, if your primary care doc is a woman, ask her where she goes.

Don't panic about the blood pressure, though don't ignore it. It's not necessarily an indicator that you're in poor health or caused by your weight (my wife is overweight and her bp is normal).

My bp was similar to yours (though my diastolic was higher) even though I'm of normal weight and work out three times a week (there's been a change in the definition of "high blood pressure" and I went from monitoring to medication).

My bp is always high when I first get to the doctor and declines the longer I sit and relax. Being torqued off isn't going to help. Have it checked again once you find someone you can be comfortable with.

Good luck with finding a new doctor.
posted by tommasz at 11:17 AM on February 16, 2005

Your doctor was doing his job as he saw it, perhaps without a sufficient degree of tact, but nevertheless.

These days, all doctors are being trained and nagged to administer anti-obesity and anti-smoking lectures to EVERY overweight or smoking patient who comes in their door, regardless of cause.

It's even more pointed for OB/GYNs -- they are encouraged to regard themselves as the de-facto primary care physician for women in their care, who rarely see another doctor on a regular basis, and they have long been trained to use their status as birth control gatekeepers to extract compliance with other kinds of medical procedures, tests, and advice.

Consider it from the perspective of a malpractice suit: he sees you every few months for a couple of years, and then you suffer a hypertensive stroke or acute diabetic episode which results in some permanent impairment. With no lectures on your chart, your OB-GYN would be an easy target for a HUGE lawsuit from you. With the lectures on your chart, he's completely protected.
posted by MattD at 11:18 AM on February 16, 2005

For what it's worth, I think he was wrong, etc. etc.

For a moment, I'm trying to imagine his point of view:

What if he was the only physician you saw this year? The next five years?

And you developed some heart/obesity problem?

Would he be liable for malpractice? That's the condition we have many physicians forced into. "If I don't mention this, I could be liable."

He has to go on until he's either convinced you or annoyed you, else it wouldn't be memorable.

Once we disagree in society, and disagree again, whatever relationship we have becomes strained.

So, if he was just plain nasty, yeah, he was wrong. But he might have been trying, to the best of his abilities, to help you.

Oh, find another doctor, and brief him/her when you arrive.
posted by filmgeek at 11:29 AM on February 16, 2005

just chiming in to say HURF DURF BUTTER EATER is the funniest thing I've read all day, and I too intend to work it into conversation at the next possible opportunity.
posted by scody at 11:33 AM on February 16, 2005

I agree with those who suggested above that you write letters addressed to the head of this doctor's hospital department and to the customer service branch of your insurer. If this guy's attitude toward even ten percent of his patients is as domineering and abrasive as you described, you will be not only getting this off your chest, but doing a public service by helping to establish a record.

If you follow through on the letters, compose electronically so that you can edit and adjust and get the draft just so. For maximum impact, you will need to balance your presentation of how angry and threatened you felt by his behavior, with a dispassionate descriptive style. E.g., he said X and Y which you find disturbing for reason Z. His lecture took approximately X minutes, and continued despite roughly Q attempts to bring it to a close. Conclude by stating that you will find another OB-GYN (and for cat's sake, do it!) and that you expect a response to your concerns.

I advise this because dramatic language, even if 100% accurately reflective of reality as you know it, will make your complaints easy to belittle and dismiss. But a solid, serious letter-- I can tell you with some authority, that will make someone at the hospital very uncomfortable, and it will make the rounds at the insurer as well.
posted by clever sheep at 11:35 AM on February 16, 2005

He's a dick, find a new doctor, but I don't think having his head on a platter is feasible, or justified. Complain to his boss, or the insurer, if you want, but it might also help to write him a letter of complaint: "You were an asshole and this is why you lost me as a patient." It's a little less vicious than going over his head.

Of course, he may be fully aware he's an asshole and not give a damn. C'est la vie.
posted by IshmaelGraves at 11:37 AM on February 16, 2005

Yes, the doctor was a jerk. If it makes you feel better, write a letter to the practice the doctor belongs to, describing what happened, how you felt, and how his dismissiveness cost the practice a patient.

Do ask around for referrals. The first time I did that, it felt strange, but the people I asked didn't seem to mind, and the ones that said "oh! I luuurrve my wonderful gyno!" were absolutely right, and I was glad I asked.

You might consider, going forward, setting up a consultation visit first: call ahead, or write, and set out your facts: the PCOS, the exercise-induced migraines, the fact that you've maintained a steady weight for three years. Include the fact that you have encountered arrogant and dismissive physicians and that you are looking for someone who will work with you in a supportive manner. Framing the interaction that way from the outset may make a big difference. It might take more time that way, but it ought to spare you the dismissive hectoring.
posted by ambrosia at 11:38 AM on February 16, 2005

He's really only guilty of having an abraisive style. Just find a new doctor. Any complaint you register won't be worth your time. He wasn't negligent-- he was just insensitive in addressing an issue that you're uncomfortable about.

If he treats all of his patients like that, he probably doesn't keep them long. So he was probably grumpy or rushed. Which is not say that you should keep him.
posted by Mayor Curley at 11:39 AM on February 16, 2005

Except, Mean Mr. Bucket, PCOS has a number of symptoms which can include weight problems and high blood pressure...

It's by no means clear whether "PCOS" causes weight gain, or weight gain causes PCOS. It's similar to diabetes and sleep apnea in that regard. It's another condition which has apparently become much more common in the general population concomitantly with obesity.

It sounds like the migraines are the best candidate for root cause of your health issues. Do you have a neurologist?
posted by mdn at 11:51 AM on February 16, 2005

I agree that the doctor lacked good bedside manner, but he was being diligent when he addressed your weight issue. All good doctors should address any and all health issues that they observe or suspect. Not only should he touch on weight, he should also tactfully ask about domestic violence.

You didn't like his attitude and either do I as you've presented it. But come on, he gave you an HOUR of his time for what was probably booked for 15 mins max (AFTER he'd lectured me for literally an hour). Do you know how difficult it is to find a doctor that will spend that amount of time with a patient, especially one that's only coming in for BC? Okay, you didn't like his approach, but there was value in the message.

Several options have been presented to you: find a new doctor, write a letter, contact your insurance co. etc. I suggest that you use this situation to learn how to be assertive. There was absolutely no reason for you to sit in that doctor's office for one hour listening to a doctor that you feel is talking to you inappropriately. You have the option of ending the appointment and walking out. You have the option of saying "Dr. Jones, I am on a tight schedule today. Please give me the shot and any literature that you would like me to read. I have another appointment in minutes." I know that docs can be intimidating, but suck it up girl and empower yourself. Try it, it feels good.
posted by Juicylicious at 12:04 PM on February 16, 2005

Create a web page explaining what happened and listing his name and office address. Make sure it's indexed by Google. If nothing else, a certain number of potential new patients will do a search on him before making their first appointment, choose a different doctor, and be spared that kind of experience.

VERY good suggestion there - this is how I decided that I wasn't going back to my ENT (Ear/Nose/Throat) doctor. I Googled him, and found a "review" written by another former patient. In emails to that person, I found out that said doctor pushed tracheotomies as his "cure all" for patients with sleep apnea. I'd told the doctor I wanted to see how CPAP worked first, and he was a bit put back and annoyed by it.

That was four years ago, and the CPAP has been great. No need for a hole in my thoat, no thank you.

As for the OP - yeah, the gyno's an asshole. Good luck finding a better doctor.
posted by mrbill at 12:05 PM on February 16, 2005

Also, "HURF DURF BUTTER EATER" made me laugh. I'm a big guy. :)
posted by mrbill at 12:31 PM on February 16, 2005

Is it possible your new doctor is unfamiliar with PCOS? From what you said, it sounds like he just brushed off anything you said. Not knowing you or the symptoms of PCOS, he may have assumed that you were making excuses and trying to rationalize an indulgent lifestyle. Of course, he didn't have to be a jerk about it.

I would definitely get a new doctor, but before you go, maybe it would help to explain your history in advance; could you get your old doctor to send over medical records or call the new doctor?

I also like juicylicious's advice. Don't let that guy waste your time; just ask for your treatment, repeatedly if necessary, and get out.
posted by chickenmagazine at 12:33 PM on February 16, 2005

Response by poster: Thanks for the support/suggestions. I've swallowed my pride and mentioned to a coworker or two that I had encountered a jackass gyno and needed a good recommendation.

None of the coworkers thought it was odd, and they ALL recommended a single place (Coastal Ob/Gyn). So that's good, I'll be booking an appointment with them shortly.

Insofar as other things people have brought up: my blood pressure is nearly always low-normal. My mother (also overweight) has low BP and my father has high BP. It seems to have come very close to evening out in me. Even a month before this visit, I had normal BP when tested.

The gyn could easily have seen that I already have a primary care physician and have been seeing docs regularly, so I don't quite think the doomsday "only doctor" scenarios apply. But he could have thought they did, somehow.

Thanks again for the support. Almost all of you guys rock.
posted by u.n. owen at 12:34 PM on February 16, 2005

I don't think the issue here is obesity or even bedside manner -- I think it's poor advice and conduct. Should a oncologist go on for an hour with a patient about, say, heart disease? And withhold chemo until they hear the whole lecture?

I expect every physician I visit to mention my weight, but I also reserve the right to think that it's more ethical for Random Physician to refer me to an endocrinologist, nutritionist, or other licensed professional than say (true story) "Uh.....have you tried Jenny Craig?"

And finally....I heard about my current ob/gyn at a baby shower. So I can recommend that method highly.
posted by gnomeloaf at 12:52 PM on February 16, 2005

He recommended both a low-carbohydrate diet...

Are these really considered healthy?
posted by goethean at 12:56 PM on February 16, 2005

Wrong way: assuming everything up front and giving a "one size fits all fat people" speech.

Could it be that what he was giving you was a "one size fits a large percentage of people" speech? I have a hard time faulting him for this even if you are outside that percentage, as it seems like doctors generally have a hard time getting patients to listen to them. As several people have pointed out, an ob/gyn seems to be the de facto primary care physician for many people (and it sounds like one is for you), and I'm sure they realize this. It's part of a pcp's duties to worry about the overall health of their patient. In my mind, this kind of doctor, even if they are wrong about particular suggestions, and even if they are tactless, is far preferable to the kind of doctor who caters to patients who basically don't want to deal with their health problems (my dad seems to have one of these), and tell the patient only what they want to hear.

I'm also a little confused as to what the question is here. It could be "am I right or what," since the outside of the question effectively tried to screen anyone who would say no. It could be "how do I find a good ob/gyn", which seems to be the way many people have taken it (this may really be the only answerable part). It might also be "what are the limits of what a doctor should do for those they have in their care", and this question has also been screened, and the poster has gotten upset at the few who have suggested that what this doctor did may be well within those limits.
posted by advil at 12:57 PM on February 16, 2005

Your doctor was a jerk, but FWIW, I just changed gynos because mine's staff was atrocious, and besides, she dealt too much with pregnant women, and had some sort of freakish need to discuss fertility with me. Don't be afraid to play musical doctors til you find a good one. Going to the GYN isn't exactly optional, and you need to be able to go and be comfortable, even if it's not the most fun trip of the year. Also, I would never have a male GYN. It seems completely counter-intuitive to me that I should see a male doctor for this service. YMMV, obviously.
posted by Medieval Maven at 12:58 PM on February 16, 2005

Just a note re: BP--

He tested you after he'd been shaming you over your weight for an hour. It would naturally be high. I'd completely ignore his number, and go with your history, and what you test as next time.
posted by frykitty at 1:00 PM on February 16, 2005

Response by poster: advil, I got mad at one specific person. the people who've said it's within his scope of duties, I've said that yeah, it seems weird but he could be thinking he's primary care or something. I could understand that.
posted by u.n. owen at 1:08 PM on February 16, 2005

Let me try to give a doctorly perspective here, if I can.

a) The doc sounds like a bit of an ass, with a not-very-good bedside manner. This doesn't make him a bad doc, by the way. OB/GYNs are indeed trained that they're supposed to be primary care for women, which has always struck me as an extraordinarily silly and arrogant thing for a surgical subspecialist to undertake. They bring their surgical attitudes to the clinic and it just doesn't work. I mean, I work in a clinic every day, but I don't try to operate on my patient's ovaries - you see my point? It's hard enough not to ligate the ureter when you mean to clip the ovarian artery, without having to worry if your bedside manner is good enough too.

b) I'm sure he thought he was trying to be helpful, even though obviously he didn't succeed. He's right that losing weight is healthful, even for people with PCOS. It may be that he doesn't really appreciate how difficult it is to lose weight.

c) There's lots of new thinking on PCOS and the right way to treat it that didn't exist when I was in med school only 10 years ago. Oral antihypoglycemics, for instance, are now standard of care. Maybe you need to see an endocrinologist?

d) Correct me if I'm wrong, but it sounds to me like your exercise-induced headaches are altering your lifestyle for the worse, and a primary care doc has failed to help you with it. That means you need a neurologist. Headaches aren't like PCOS - I can lick any headache that comes to see me, guaranteed (with the possible exception of headaches from malignant brain tumors. And even then I can make the head stop hurting.) I bet I could have you exercising pain-free within a month, as could any halfway-competent neurologist.
posted by ikkyu2 at 1:30 PM on February 16, 2005

Er, I meant 'antihyperglycemics', if anyone's keeping track at home.

posted by ikkyu2 at 1:36 PM on February 16, 2005

Are [low-carb diets] really considered healthy?

Very few long-term studies have been done on them, so it's hard to say one way or the other. Many people's lipid profiles and other symptoms do improve quite a bit on such regimens, and they can make you feel really good as well. Your body doesn't actually need carbohydrates in its diet; it can manufacture them from protein in sufficient amounts for anything short of serious weight training. Many doctors do recommend these diets.

I can't think of any reason to dismiss them out of hand.
posted by kindall at 1:45 PM on February 16, 2005

This may not be relevant and it is purely anecdotal, however I once drove my best friend (a former stripper) to her gynecologist (a painful change in her menstrual cycle). As I waited, another girl who worked with my friend came out from the examining rooms, and someone I knew from a different club arrived.

I remarked about this coincidence, and my friend said, "Oh no, he only treats dancers."
posted by mischief at 1:48 PM on February 16, 2005

Your doc is a nutter, I think. Obviously the food we eat affects us a lot, but your gynecologist should be worying about your vagina, not your weight.
posted by delmoi at 1:53 PM on February 16, 2005

I tried atkins for a while, and when I went off of it, I felt horrible for a couple days. But was just too boring.

Anyway, what do I know. I havn't had medical insurance for years.
posted by delmoi at 2:05 PM on February 16, 2005

I hope you told him off or something. My blood is boiling just reading about this. I do have you topped though. Read on.

About eight years ago, I was 15-20 pounds overweight. Just a little pudge, you know. Anyway, I had to take my son to a highly recommended pediatric neurologist, who was to give him a battery of tests to determine if he had a problem that needed addressing. She sent him into the waiting room to play with her assistant, and asked me to come into her office. She drilled me for about 10 minutes about things that were absolutely none of her goddamn business, and told me in no uncertain terms, even though it had absolutely nothing at all to do with my son or his problems, that I needed to lose weight, and she pulled a paper out from her desk that outlined a specific diet I was to start following. Now keep in mind, this woman was my SON'S doctor, not mine. She weighed about 80 lbs. herself, and was at least 70 years old, and kept bragging to me that she was nice and slim and that her husband really appreciated the fact that she took care of herself, and that my husband would appreciate it too. I'm getting pissed off all over again just typing this. She told me that we were such a "nice family", and that everyone in my family would be happier if I lost weight.

Can you believe that shit? From a pediatrician? I was really angry when I left, and she knew it, but she didn't care. I reported her, and found out (via someone that worked for her) that she was anorexic and a recovering bulemic. She had a lot of issues with food, and tried to project them onto me. Perhaps your doctor has similar issues. You really need to let him know how much his manner insulted, belittled, and disempowered (word?) you if you haven't already, u.n. It sounds as if you quietly left his office, and this has been simmering ever since. Maybe that's something that's bothering you - that you didn't tell him off? It's not too late! Call him. It'll make you feel soooooo much better.

Oh, and congratulations!
posted by iconomy at 2:07 PM on February 16, 2005

He wasn't negligent-- he was just insensitive in addressing an issue that you're uncomfortable about.

Which is a considerable problem, because it runs counter to the entire purpose of health care. Lecturing, attempts at shaming, and assuming are never useful tactics for a doctor, regardless of the subject or their specialty.

If this guy had asked questions and made an assessment rather than a snap judgment full of unsupported conclusionss about u.n. owen's diet, activity level and personal awareness then he may have been justified in offering her advice about how to improve her health. The fact that he did not do so coupled with his absolute bullshit advice (skipping meals?!) and blackmail with the Depo shot is evidence of both an unredeemable arrogance and disgusting incompetence. It is not acceptable to withhold treatment until you're done lambasting a patient ignorantly and he should know it.

u.n. owen, write a letter, cc'ed to the insurer, the head of the medical group and the idiot himself, explaining exactly why you will never see this guy again. Consider a complaint to the state medical board, as well. Go for the gusto, it can't hurt, and it may well help another woman who truly needs help that this guy is unable to give because he can't get out of his own head enough to do his damn job acceptably.
posted by Dreama at 2:22 PM on February 16, 2005

Response by poster: Wow, iconomy, yep, that tops everything I've ever heard as far as doctor-visit stories goes. It turns out -- upon talking to a couple of girls in the office who were waaay sympathetic and nice (thanks for giving me the courage to ask about something like that, everyone - I'm so open about sex in my non-work life but I'm always terrified to mention it at work!) -- that this same doctor has done similar lectures before. To people a lot thinner. He went so far as to tell a co-worker who was having trouble getting pregnant that she'd never get pregnant at her current weight (she is tallish and weighs I'd say around 220ish pounds). Her year-old baby would beg to differ, I'm sure. So this has been an enlightening day all around.

Yeah, dreama, that's what bugged me too -- the whole assuming thing seemed pretty cocky. That's like saying to someone who's choking on some food "oh! Coughing. probably allergies, in this weather. Here, have a prescription." Docs are supposed to infer from evidence given, not make instant snap judgments.
posted by u.n. owen at 2:29 PM on February 16, 2005

Response by poster: (and it is good to know that "HURF DURF BUTTER EATER" should be making it into the cultural lexicon soon.)
posted by u.n. owen at 2:30 PM on February 16, 2005 [1 favorite]

He went so far as to tell a co-worker who was having trouble getting pregnant that she'd never get pregnant at her current weight (she is tallish and weighs I'd say around 220ish pounds). Her year-old baby would beg to differ, I'm sure.

Sound's like he's nuts.

To me it seems like your doctor has latched on to some idea (like food is the end-all-be-all of health) and dosn't want to hear anything that runs counter to it. A doctor should be a scientist, and he's acting unscientificaly, to be sure.

He probably thinks anyone without an MD is a total moron, too. That would be my guess, anyway.
posted by delmoi at 2:49 PM on February 16, 2005

I have nothing to add that hasn't been said -- but I am baffled by the "HURF DURF BUTTER EATER" phrase. Can someone dumb it down a shade for me?
posted by davidmsc at 2:53 PM on February 16, 2005

as suggested above, see an endocrinologist for current PCOS treatments - it's definitely moved from something managed gynecologically (usually with birth control pills) to something managed endocrinologically (with things like metformin). good luck.
posted by judith at 2:58 PM on February 16, 2005

It's not just the OB/GYNs taking it upon themselves to play at PCP. Some insurers now allow you to designate an OB/GYN as your PCP if you prefer it. There's a growing acceptance that it's the reality for many women. For a lot of basically healthy women, the annual gyno/PAP/mammo exam does end up being the majority of our contact with the medical care system. Plus some women are willing to disclose intimate medical concerns to the Ob that they wouldn't dream of mentioning to the "real" PCP. And then of course there's the horrible prospect of a specialist faulting too far in the opposite direction, treating "their" one body part as if it exists wholly independent of the larger system and the doc's responsibility for your health is neatly limited to a single organ. *shudder*

This guy leapt to conclusions without evidence and didn't bother to entertain the evidence even when it was given to him--that's unacceptable and downright scary.

On the other hand, to whatever extent that he believed your health was in danger, it's comforting that he didn't just dismiss that as someone else's problem. Too bad he presented whatever those concerns were so horribly! I don't know whether Depo is contraindicated for PCOS, diabetes, etc (??), but IF it were that the case then it would be responsible to make sure the patient is educated about such a risk before administering the shotr. So....theoretically possible good intentions, but still with horribly counter-productive execution.

Please---for the sake of others who won't come as well-armed with enough knowledge and case history to fend off his bullying (and downright bad advice?)---do submit a simple factual complaint to some supervising authority. Here are some possibiles:

-state medical licensing board
-if he's board certified, then to the agency that grants his cert (some give lifetime certifications; others require renewal every so many years)
-local Better Business Bureau
-medical associations (AMA is national, but there are probably also ones for your state, region/county, and locality/city)
-if a group practice, the practice's medical director and "quality management" director
-your insurer's customer service dept
-hospitals where he holds privileges
-if the medical facility is accredited, the accrediting agency (ex. JCAHO)

Not that you necessarily need to pick more than 1 or 2 of these unless you really want to. But there's plenty of options if you're in an envelope-stuffing mood. :-)

Oh, and call back his office and ask them to send you their list of patient rights and responsibilities. In the future, get that upfront when you see any new doctor. If s/he starts going over the line, it'll be easier to maintain control over the situation when you can calmly point to their own policy stateing you have the right to talk to a different doctor, to be treated respectfully, to know the medical justification for a recommended treatment, etc. It's your body, and their malpractice worries don't give them the right to flatly ignore your history and health decisions.

Personally, I wouldn't do the website. What if that backfires on you? IANAL, but couldn't he retaliate by trying to claim that you're conducting a libelous smear campaign? Without a third party who saw everything happen exactly as your website explains, he could at least make an effective nuisance of himself and perhaps make your formal letter of complaint look less credible. You deserve to be able to simply get a better doctor and move on with life. So getting a complaint letter into his file, where a licensor or malpractic insurance adjustor can see it, seems like a more effective way to keep the focus on his unprofessional behavior rather than open up any opportunity for him to deflect attention by making it out to be some random "HURF DURF BUTTER EATER" with an ax to grind.
posted by nakedcodemonkey at 3:56 PM on February 16, 2005 [1 favorite]

The short answer is, if you don't feel comfortable with your doctor, for any reason, you should find another one.

I read through your story and the comments and I think I have a less harsh assessment of your doc. Like someone said, if your doctor is willing to spend a solid hour with you outlining what sounds like are some excellent general health tips, you are getting more attention than most.

I tend to believe that doctors aren't there to be your friends. They should be friendly, yes, but also be frank. I had dinner with two doctor friends last night who were telling me about people self-diagnosing from web sites and how difficult it was to convince a patient of something if they had already made their mind up coming into the appointment.

From your story, it sounds like you had already decided that you do not have any problem with your weight, that you are already doing the maximum amount of excercise that you are able to do and that your diet is as healthy as it could be. Is there anything that any doctor could say that would convince you otherwise?

I assume that you are 20 (from your comment that you have had your body for 20 years)? Is it possible that your body is changing as you get older? There might be things going on that you haven't seen before, and a concerned doctor might be able to help.

Bottom line though, if you don't feel comfortable with your doctor, go elsewhere. There is no reason for you to stay with a doctor that you feel gives bad advice and that you don't feel like you can be honest with.
posted by jonah at 3:58 PM on February 16, 2005

I don't know what type of institute you were going to for care, but at my hospital, we have a patient care advocate. I would see if the office you went to had one as well. I would also contact the chair of his department, or the administrator. Things like this need to be addressed. If you had a hard time swallowing this, imagine someone who is half as outgoing or intelligent. They will feel shame and internalize it, not push it back on the doctor, who is the one with the problem. Best wishes to you in finding a caring and understanding physician.
posted by blackkar at 4:17 PM on February 16, 2005

I am shocked that MeFites are so divided between "he was doing his job" and "what a jerk." Interesting. To me, the issue is not whether a doctor should counsel someone on obesity, it is that he was making assumptions and not listening to you at all. He obviousy knew nothing about PCOS (which by default means that you need a different doctor. One of my good friends has PCOS and sees a specialist who she loves. Unfortunately in NYC.), didn't think to ask about it or your lifestyle, nor beleived anything you said!

I recently read a really great NYer article ("What happens when patients find out how good their doctors really are?") about how there is a bell curve in abilities of doctors (and yes, I beleive that customer service/sensitivity is part of a doctor's job) when we are all just supposed to agree that seeing one is just as good as seeing any other. Doctors don't want to be criticised or graded so they can be assholes, unfortunately. It has gotten better in the last 10 years, but I would say get into a PCOS support group and ask them what doctors they see. Also as discussed in that NYer article (and mentioned above), you should probably be seeing a specialist in PCOS/endocrinologist.
posted by scazza at 8:22 PM on February 16, 2005

I agree that you should find a better doctor, but that doesn't mean that everyone would hate this guy or that you should try to sink his career.

I would be totally pissed in your situation, too. My mom, though, likes asshole doctors. She thinks they're authoritative. Unless her doctor is an asshole, she doesn't think he knows what he's talking about. An authoritative, arrogant doctor is probably the only type that could convince her to deal with a medical problem.

Me, before I find a doctor for the first time I always interview the receptionsists about the doctor's sex (for intimate issues, I want a woman), age (older than me, but young enough to know modern medical techniques -- so usually early 40s) and personality. If I don't like what I hear, I don't set up an appointment.
posted by croutonsupafreak at 8:27 PM on February 16, 2005

Everyone else's advice is good, and so I'm just going to say "Aw, honey." and hug you. You don't pay doctors to treat you that way, you fire them.

If you don't want to ask around, perhaps consider the Craigslist Women's Issues or Health forums as a place to get referrals for a doctor who isn't a douchebag.
posted by padraigin at 10:18 PM on February 16, 2005

A little late to this question, and a bit off-topic, but I wanted to point out that this gynecologist might know something about polycystic ovaries. His suggestion re: low carbohydrate dieting could have been partly based on the hypothesis that PCOS is associated with insulin resistance.

A quick search for PCOS low carbohydrate diets reveals a number of women who have some had success treating their PCOS symptoms by reducing their carbohydrate intake. (Always consult a physician {you have faith in} prior to radical diet change...)

While I certainly don't approve of the doctor causing you to feel judged as opposed to cared about, the fact that he actually spent an hour (misguidedly/clumsily) trying to help you out---instead of mechanically offering the birth control and kicking you out the door---suggests that he may actually have cared. I wouldn't at all let that stop you from finding a physician you can have a comfortable relationship with, but I'd at least take it into consideration before trying to nail this guy's career to the wall.

In any case, I am sorry you had such an awful experience.
posted by johnjoe at 4:08 AM on February 17, 2005

1,$s/some had/had some/gc
posted by johnjoe at 4:15 AM on February 17, 2005

The following is not intended to justify the doctor's behavior, which I think was incredibly rude.

I did want to point out, however, that as legitimate as your migraines and other conditions probably are, they do resemble excuses that some people use to justify lazy and unhealthy behavior. The doctor was understandably skeptical, but that's no reason to be disrespectful as well.

I grew up with pretty severe asthma, migraines (not exercise related, though) and countless allergies. I regularly encountered people who thought I was using them as excuses not to run, not eat certain foods, etc. As simple as it sounds, I put them in line by mentioning that "I probably sound like someone making an excuse, but my asthma really is acting up".

Unfortunately, many people do exploit these conditions. Many people have seen this enough that they simply assume it's insincere by default. By anticipating and understanding their reaction, I could make things a bit easier. Respecting their skepticism helped them respect my medical conditions.

Down the road, I realized I was making some excuses, but the majority were legitimate. I found all of them were eventually beatable, too. This particular doctor won't help you overcome many obstacles, though, as his advice is terrible, and delivery even worse.
posted by yorick at 4:17 AM on February 17, 2005

The point of my anecdote was that he may be cherrypicking his patient roster, but now that I understand he spent an entire hour with you, that assumption loses validity. Besides, we only have your side of the story here, and that only increases the speculation factor.

Anyway, you worked up the courage to ask someone for recommendations, and you are taking steps to find a doctor more suited to your situation. That's what counts. Good luck!
posted by mischief at 5:37 AM on February 17, 2005

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