Listen to Your PatientsThursday, August 23, 2012
One of the benefits of taking a few days off and reposting old posts is that I get to reread and review some of the previous comments. I also receive new comments on old posts and see that not much has changed.
Although, I do not generally respond to most comments, I read all of them and, unless they are clearly defamatory or thinly veiled promotions for commercial weight loss scams, I let them pass.
In fact, for me, reading the comments to my posts is the most rewarding part of writing this blog. I’d be the first to admit that reading these comments (like listening to my patients) has thought me more about obesity than any textbook or research article.
Indeed, if nothing else, the comments reassure me that many of the topics I choose to write about are indeed relevant to the patients we are trying to serve.
Here is just one example of a comment that one reader (TinaUK) sent me in response to a post on weight bias:
“I was constantly frustrated by visits to doctors which involved me being lectured about my weight; disbelieved when I told them the problems I was having; having health issues constantly being put down to weight issues; gaining weight while following their advice, but having them disagree that what I said was happening was happening and the general failure to take my issues seriously enough to investigate them properly.
I was told to eat a low fat diet which I had been doing for some time. I was told to get exercise when I was going to the gym 3 times a week and walking 4 miles most days. I was told that the pain I experienced in my lower legs when walking was due to the female skeleton being inferior for walking purposes and that extra weight was compounding this ‘fact’. I was tired all the time and hungry too. My stress levels were very high and I believe that I may have been suffering from PTSD (never investigated despite enough information being available to indicate that this was a reasoable thing to look into).”
This comment highlights a number of the issues that I so frequently write about:
1) We should never assume that any complaint in an obese person is simply because of their weight.
2) We should not advise patients to just eat healthier and be more active without first taking a proper history of current eating or activity behaviour.
3) We should always make sure we properly assess and address the key drivers of weight gain (in this case fatigue, pain, stress, PTSD?)
Only too often, do we discount the information that our patients readily give us and jump to simplistic and ineffective ‘eat-less-move-more’ (ELMM) strategies.
Obviously, giving useless ELMM advise and then blaming the patient when it does not work is a lot easier than taking the time to fully assess and address issues like chronic fatigue (sleep apnea?), pain (fibromyalgia?), stress (time management? workaholism? ADD?), or PTSD.
Assessing and addressing the latter takes time and requires listening carefully to your patient.
Remember, obesity is a ‘sign’, overeating is a ‘symptom’.