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Using the Power of Story to Improve Patient-Centred Care
"Well, I'm not going to be surprised if you have diabetes."Yep, I'm fat. It's true. It's a statement of fact the same as ‘he has blue eyes'. But the blue-eyed person doesn't confront negative stereotypes related to their eye-colour, and they certainly don't have assumptions made about their health based solely on the blueness of their eyes. Yet, as a fat person I do. People assume I'm lazy, don't exercise, eat poorly or am somehow undisciplined particularly in how I approach my health. At some point as a fat person you expect this of most people, but it's harder to accept when it's a health care provider who can't see past what they see and make often unfounded assumptions based solely on their visual perception. While it's true, obesity is a major cause of illness and disease it is not the only cause, and each person deserves to be treated as a whole person, not a series of risk factors walking through the clinic door.
Several years ago I ended up in clinic feeling unwell. Without going into the specifics, it felt a bit different than a cold or flu and was difficult to describe. I connected first with the nurse who asked me some questions and as we talked she said ‘Well, I'm not going to be surprised if you have diabetes'. I was a bit startled and asked her why she thought so. ‘Well with your size and all it seems to me it's a likely option.' I was shocked. There was no clinical basis for her ‘diagnosis' just that she saw a fat person feeling unwell, so it must be that I'm diabetic right? Well as it turns out, wrong. What ailed me was, very fortunately, nothing serious.
I know that this nurse, and all health care providers, approach their work from a point of view of caring. You wouldn't do what you do if you didn't care. I also know that obesity and diabetes are linked and that this nurse was, in her own special way, trying to help and offer an answer. What I question is assumption based on what had been a mere three minutes of conversation about non-specific symptoms. This nurse knew nothing of my history of disordered eating, knew nothing of the many years I'd spent hating my body, alternatively making myself vomit, not eating and compulsively exercising. Nor did she have any idea about the years I spent believing people who told me that my value would increase if only I were thin. These are the things you don't see by looking.
The truth is to this day I have normal blood pressure, normal blood work and most days get 6km in on the treadmill. I also no longer make myself vomit, don't over-exercise and have come to learn that my value is not commensurate with a smaller jean size. Maybe next time instead of diagnosing me based on what you see, you can actually take the time to see me.