On my obstetrics rotation as a third-year medical student, I had the incredibly frustrating experience of scrubbing in on a robotic surgery case to remove a woman’s uterus and ovaries. These procedures usually take around 3 hours. This particular one was 8 hours in and still going. Why? Because fat spilled from the vagina to the mesosalpinx and everywhere in-between. Every spare hand in that room was used hold back the thighs and the pannus–the “apron of fat” on the abdomen. Multiple retractors were used. And still, we fought against the fat.
During the operation, the doctors recounted “fat horror” stories. They talked about patients who had gotten pregnant only because they had friends hold back their fat while they you know, did it with their male significant others, removing the leaf from their dining room tables so that they could sit in the middle, and so on. What was unsaid was universally understood in that room: these fat patients were disgusting, made their own medical procedures more complicated, and made our lives harder.
Whether or not these patients deserved the blame, I’m sure that they’re not blind to our condescension. There is an entire blog dedicated to documenting stories of fat-shaming in healthcare, and the psychological and emotional impact on those patients. I’m sure it’s even harder on patients because so many providers, despite knowing that being too skinny is more dangerous than being too fat, have been taught to equate skinniness with health and fatness with poor character.
In a few cases, patients even had real medical problems that were missed because their symptoms were attributed to “weight problems,” which I can only hope must have been humbling for the provider.
This XOJane article makes the apt point:
This is not to say that a visual assessment isn’t useful as a part of an exam, but it’s just that — a PART of an exam, and insufficient for an accurate picture of an individual’s whole health.
Going back to that case of the obese patient on the operating table–despite it being harder than it had to be, it still got done. I think it could have been seen as a satisfying case because of the challenge of the patient’s anatomy, and instead of “this case is going to suck because our patient is fat” it could have been thought of as “we’re going to give this woman the good outcome that few other teams could give because we are so technically proficient and experienced.” I don’t think we had to resort to blaming the patient during the process.