Transcript
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On this episode of Big Sexy Chat, Asherlee and Murph dive into the depths of medical fat phobia with Dr Robert, a doctor of osteopathic medicine and family practice physician with over 10 years in the medical field.
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Did you know doctors can prescribe penis pumps?
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Let's dig in.
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Hi, welcome to Big Sexy Chat.
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I'm Crystal, I'm Murph.
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We're just two rad fatties sitting around chewing the fat Twice a month.
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We'll be chatting about current events hot topics sex, sex toys, fat politics, fat community cannabis, cbd you name it.
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We're going to talk about it.
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We are very excited to have you a part of our community.
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Welcome and enjoy.
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Hey everybody, welcome to Big Sexy Chat.
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My name is Asher Lee and I am the temporary host for today, and right with me is the lovely co-host, murph.
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Hi everybody, how you doing, and today we have a really special guest to me.
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Really special because my doctor is here with us, dr Robert, and I'm going to give him a second to introduce himself and tell you a little bit about who he is.
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Hey, so I'm Dr Robert and I'm a board-certified family physician.
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I think people ask me kind of like what I do and what makes me different as a doctor when they're interviewing me to be their doctor.
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What makes me different as a doctor when they're like interviewing me to be their doctor?
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And the thing that's always been really important to me is they wanted to create a place where patients can come that don't feel like they are fitting well into the medical system or they're either not being heard or there aren't resources to solve the problems that they have.
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Um, and I've spent a lot of time trying to find practices where I can do this, and Ashley will attest to that.
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We were just talking how she's followed me through four different practices and always trying to find ways to sort of create a place for patients like that.
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I trained in Las Vegas, I've been practicing for about 10 years and that's sort of who I am.
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Great.
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Thank you so much.
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And I will just say, before we really get started in this, I want everyone to know the very first thing and this is for all of our fat babes out here the very first thing that Dr Robert said to me when I walked into his office the very first time I ever met him was don't worry, weight is not going to be something that we talk about.
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It is not something that bothers me, it is not something I'm concerned about.
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Let's find out what's going on for you.
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And those words have stuck with me for five, six years now, and it's the reason why I have followed him from practice to practice to practice because, as most of us know, it is very difficult to find a doctor who will listen, who will care, who wants to know what's really going on for us and isn't just going to blanket diagnosis with obesity as the cause for everything.
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No, it's not because I'm obese that my arm is broken, thank you.
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So you know this is the thing that has really kept me with Dr Robert, the thing that has really kept me with Dr Robert, and I'm so happy that you're here to talk to us about medical fat phobia, because I love that.
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This is something that you're also passionate about and sharing with your own community, online and people and within your practice.
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So with that, I'm going to hand it over to Murph to ask our first question and kind of get things rolling.
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So I have one thing I want to say, though, is that I hope that you collect unicorns, Dr Robert, because you are a unicorn.
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That is such a rare feat in every fat person's experience that I've ever heard about is having a medical provider that treats them like a human and not whatever the scale number says.
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So, Ashley, that's your job is to get him a unicorn that he can put up in his office.
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We have several really cool providers in our office.
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There's one provider that I really love and she is on Peloton and does like those exercises and her screen name on Peloton is Needs More Body Diversity.
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Love it.
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And I just think that's amazing, absolutely.
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So we have a few of those.
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I've noticed it's not even just the doctors, because even the staff they're not a staff of you know, completely in shape people who are like snubbing their noses at people.
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No, no, no, there's some big girls up in there that are like, hey, it's nice to see you, and they're so warm and wonderful, like the first day that I walked in that office.
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I was like, well, you're my best friend and you're my best friend and you're my best friend, so it's, it's, it's pretty wonderful place.
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I'm not, I'm not gonna lie, I'm pretty biased, but Well, speaking of you know how it impacts everyone, and you have to have a practice where you have people that greet you at reception with good customer service skills and all those types of things.
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It sounds like those are learned behaviors, which is fabulous, but when it comes to medical school, this is something that's always kind of piqued my interest.
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When you go to medical school, how much training is really spent talking about body diversity and anti-fatness?
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Is that something that's even discussed?
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Is this something that is in the curriculum?
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That's interesting.
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So the vast majority of the curriculum is just hard sciences, you know, learning metabolic pathways, learning pharmacology, learning anatomy, things like that.
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And when I went to medical school, we basically had one professor whose job was like to teach us to be good human beings and to interface with people and we just had one professor and we had a class with her, like once or twice a week, where we would learn these sort of bits like mannerisms, how to talk about difficult subjects, how to do things like that, and I don't know if in any of that we ever had a specific lecture or even a bullet point in a lecture that specifically talked about pathophobia.
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That was never something that specifically came up.
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We talked a lot about your general diversity and inclusion topics that are brought up often things like race and things like religion and things like sexual orientation but we never really had anything to talk like how to be mindful and use language appropriately around people that are not.
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That was just never really something that's come up and it's something that I have, you know, tried to learn as I've been practicing and it's something that I've learned with a number of patients.
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I had one patient I think about her a lot because this was probably before I was going to this, or, you know, before I was as tried as I should, and I remember that she just did it from every direction.
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She was seeing mental health and she was seeing orthopedic surgery and she was seeing me and she was just getting so much messaging that it was like, oh, your wildest dreams will come true, you would just lose the weight.
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And she would cry at almost every appointment because that's all she knew how to talk about with the doctor.
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And after a couple of appointments like that, where she just assumed, for whatever ailment that she came in that we were going to talk about her weight um, and that's the first thing she would bring up and talk about how hard it was for her to lose weight that I started thinking.
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You know, we're being pretty lazy thinking about how to help this patient, so lazy to the point that she doesn't even know she can talk about anything else.
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And that's that's actually when I really started thinking about this stuff.
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And as far as, like, our education on fitness or obesity or you know, the thing that sticks out of my mind is at the end of every like disease state that we learn about, we learn about risk factors for those disease states and obesity, obviously.
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Obesity, smoking, old age, low socioeconomic status, like it just pops up more and over and over.
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It's like this is the thing that puts you at risk for this disease and it's looking back at how drilled that was into us is something that's kind of interesting.
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I would say that was with my medical education.
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That's just over and over, learning how obesity puts you at risk for disease and that's about it.
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Do you see any deficits in that training, like I mean and if so, I mean really, where are they and how could they be addressed?
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I mean, it sounds like no one really talks about it.
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So I mean, is there room in school and in the training to have something about that really as part of the education that medical providers receive?
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I think there's a huge part of it.
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You know, I think we're doing a huge disservice when we talk about risk factors.
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The way that we talk about risk factors, so like smoking, comes up a lot right, and so if you smoke, you're at risk for lung cancer, but it's not like every patient that comes in that smokes that we're like well, probably all of your symptoms are your lung cancer, right?
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It's unfortunate, I feel, like people that are obese, that we just assume that they're already neck deep in a plethora of chronic disease states.
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Well, actually that's not true.
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You know, certainly there are, you know there's.
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You know there's osteoporosis that's associated with being too thin and there's, you know, lung cancer that's associated with being too thin and there's lung cancer that's associated with smoking.
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And there are some disease states that are associated with obesity.
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But that doesn't mean that the patient has them and that doesn't mean that you can attribute symptoms to them at the get-go.
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And I feel like going all the way back.
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You have to think harder than just quickly attributing disease states that the patient is maybe at risk for, and that's one thing I think we should talk about more.
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And then the other thing that's really interesting is you know I've been thinking a lot about obesity for like the past five years and the thing let me kind of like organize my thoughts here for just a second around this there are, there actually are, and you can look at the studies.
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There are things that are beneficial about being obese and there are hormonal processes that occur that encourage obesity in people to their betterment.
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You know, one of the one of the scariest things for me when I would do hospital work is when, like just this skinny little person would come into the hospital because I knew they didn't have the reserves.
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I knew it would be hard to keep them nourished.
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I knew that they would develop a lot of bed sores, because that's what happens when you have a lot of bony prominences sticking into the bed.
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You know, and there's almost you know, like you talk about, that will be like anybody.
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That's not this ideal body weight.
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You're like I must fix this huge problem that.
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So you know that I can attribute everything to.
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But really, you know, a lot of times there's there's benefits to it.
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There's this whole study it's called bitten fat of people that are overweight, that are surprised living great lives and don't have diabetes and don't have high cholesterol and stuff like that, and it's not like everybody, it's a it, it's a risk factor.
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Yes, and so is.
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You know, there's a lot of other things that puts you at risk for diabetes, like low sensory, economic status and certain you know ethnicities and things like that, and um it just I'm kind of rambling, I apologize, but you know, there's just we're not thinking hard enough about it and that's what I feel like.
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I think when somebody I think there's a few diagnoses, like for women, unfortunately it's anxiety and it's obesity, and if I can immediately attribute the symptoms that you're having to either one of those disease states, it's just a quick, easy appointment.
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For me there's no, you don't run like an obesity lab or you don't run an anxiety lab, right, you're just like, oh, this is what it is, here's a pill for that, here's therapy for that, you fix that and all your dreams will come true.
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And I think it's just such lazy thinking.
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And I could go into some other issues.
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I just think doctors are rushing so much and trying to find the fastest, easiest diagnosis that requires the least buy-in and bandwidth from them.
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And obesity, unfortunately, it's just a low-hanging fruit that you can.
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Just, you don't have to run into this.
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You can just look at someone and a lot of times those people aren't even obese.
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I follow this rugby player on the USA team and her BMI is like 31.
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And she has like 150 pounds of lean muscle of her like 180 pound body right, she's anything but unhealthy body right, she's anything but unhealthy.
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But it's funny and she talks about this in her social media about how people get on her comment section talking about how fast she is, and it's just, it's wild.
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It's wild how we just look at people and attribute problems to things that aren't even there.
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And yeah, there's yeah, so I?
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So the short answer is yes, there's huge deficits and we need to think harder and we need to go farther.
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I think one of the things that is so helpful in that is the personal stories.
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You know, when I talk to other, so I work in health care and I'm a therapist and so I run a therapy program, but I'm integrated into a community health clinic and so I'm engaging with providers pretty regularly and one of the things where I see there's options for change is really having those personal stories shared, because it kind of takes away the medical terminology and the.
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You know, I'm just I've got to get to that Occam's razor quickest answer, get you going, you know, get out in 15 minutes.
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But when you share that personal story or you share an example that resonates it makes such a difference for the provider.
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It helps them kind of really go back into that whole person care, like looking at the whole picture In your experience, like you've already shared an example with us that I think was probably pretty transformative to you.
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But are there other things in which you feel like, okay, I'm learning this or I'm expanding my learning, how you took on that information and how you're applying it to your practice now?
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So I think one of the experiences that's really personal to me is my own family and some people in my family, especially older generation, like baby boomer gen X, who have struggled with their weight and struggled with doctors getting their healthcare needs met.
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And now that I'm a doctor, I go to these appointments or I go to the emergency room with these family members of mine and have to, every once in a while, put people on point.
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So I go to the emergency room with these family members of mine and, you know, after everyone's like put people on point, be like, well, you know, probably atrial fibrillation is not from obesity, right, like that's, those, those, those.
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There's actually a huge, strong correlation between those things and so that's been really helpful for me.
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But the thing and helpful and also heartbreaking, because every time one of those things comes up, I can see these family members really like, really embrace it, really take it in.
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Yeah, you're right.
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You know, if it wasn't that I probably would be fine, and I think that's the part of me that really breaks my heart and just being like, no, it's not, you're a strong, independent woman.
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It's not, you're a strong, independent woman.
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That's the only more I'm thinking of and the situation that you're in is not you being overweight, and I just think it's really hard.
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My wife's grandmother just recently passed away and she spent her whole life being overweight and at the end of her life she got some really awful care and she had actually lost a ton of weight because of the disease states that were going on.
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And during some of those last few months I remember, just you know, being with her in care facilities or in hospital beds and just you know her attributing all of this to all these issues that she was dealing with in that moment, to her being overweight all of her life, where a lot of the times had nothing to do with that, and that's something that's been really transformative to me and something that has really motivated me, is it?
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Just it breaks my heart that, just like the doctors are being lazy about the ways that they think these poor patients don't have any other explanations or understanding of what's going on in their body other than broken because I'm fat and I think it's just sad.
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So I don't bring up obesity with patients unless they bring it up, unless somebody says I'm worried about my weight.
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I want you to help me fix it.
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I don't bring it up because you know there's probably both of you know like people.
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They're aware that that's a heavy part of their life.
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They don't need me and the doctor to bring that up.
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That's not what they're there to talk to me about.
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And the thing that's really funny to me is it's almost like this elephant in the room, like the patient's waiting for me to bring up obesity, and then they get so uncomfortable that I haven't that they'll just bring it up theirself.
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Like well, my knee probably hurts because I'm fat and I have to.
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And then I'm like, no, I'm actually not worried about your weight today.
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I think we need to really evaluate your knee and figure out what's going on.
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Now, you see how part of that you know there's, there's stuff there, but that's not, even if that is a factor, that's not going to solve any problems today.
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Right, like, like pointing that out, I need to get x-rays, I got to manage the pain, we got to figure out what we're going to do with physical therapy, like it's not even relevant, even if it is relevant today, if that makes sense.
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So that's, that's the other thing.
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Okay, that's the last thing I wanted to say about that in that moment.
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Well, I think so I have a question.
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But before I have a question, I want to say and actually kind of ties into it, I will say even still, even after five, six years of being with you because of all of the programming before, and even like, not with you but right, like the, the cardiologist that I went to see, that that I got referred to when you and I were trying to figure out everything going on for my body, right, bad, the bad one the bad, dr Robert, there is, there are still times that because of that I I come in and I'm like you know, look at all the good things I'm eating, dr Robert, you know, and and you're like I don't care about that.
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That's not what we're talking about, and I think so.
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So that really leads me into the part that I want to know, um, outside of what I know of you, and maybe tell people what you've done in your practices to really kind of help bridge that gap between between what experiences a lot of us fat people have had and how to, and how you've kind of worked to really care for bigger bodied people.
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Yeah, I think you know this is going to sound like so dumb and so jaded and like is, but I I think the thing that really has affected me a lot is just listening to patients and you hear this over and over.
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Like just listen, even like this TV show house, like house is always just getting on everyone.
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Just take a decent history, you know.
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But when you sit down and you talk with somebody and they have symptoms and you're talking to them about how they need to lose weight, there was a moment that everything changed for me.
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Actually.
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So there's two moments.
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Okay, there's one patient that really put me in check and she wasn't fat, but she had diabetes and she was coming in and she was taking the medication and her numbers were still awful, her A1C was still really high.
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And I'm like well, listen, you don't really gotta work on your diet.
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And she like stopped me, like angry, stopped me.
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Doctor, listen, I don't eat any carbs, I eat protein and fresh vegetables and that's it.
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And my blood sugar is still in the 300s.
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It's not my diet.
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I need you to hear me.
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It's not my diet.
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And she was confident enough that I actually like was like, oh okay, let I need to.
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I'm getting lazy in the way that I'm thinking.
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And we ran some tests and she actually had a somewhat rare form of diabetes, of diabetes type 1.5.
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And it's the autoimmune diabetes that occurs usually in kids but sometimes can happen in adults.
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But can happen in this really slow, insidious way that looks like type 2 diabetes, in this really slow, insidious way that looks like type 2 diabetes.
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And if I had just rested on my laurels of diet and exercise will cure diabetes, she might have died, because there was no amount of dieting that was going to solve her problem.
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She needed insulin, her body didn't make insulin, and so that moment was really seminal to me.
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When, like when patients tell me what they're eating, I need to believe them.
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So when patients come in and they tell me I'm exercising, I'm eating right, I'm doing all these things, I used to be like well, you know, let's really look at it and see what you're saying.
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And now I'm like, okay, well, you're doing all these things and it's not improving whatever symptom you're trying to improve, or you're not achieving weight transformation if that's what you're trying to do.
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So we need to figure out what else is going on.
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And then I've had a number of patients that come in to me and they have symptoms and previous doctors have told them that they need to lose weight and they've tried to do these body transformations and they can't.
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And then they really struggle with it and it would be very lazy and easy of me to just be like, well, it's because you're doing it often, even though the research shows that the doctors are basically worthless at helping patients lose weight.
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When it comes to diet and exercise, this is not me just like making this up.
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If you look at the data and so diet doctors giving diet and exercise tips, by and large, as a group, we were awful at it.
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The data is there and solid, and so that's when I started like, when I started looking at this and I started listening to this patient.
00:21:06.685 --> 00:21:10.766
So I started listening to the stupid advice that people were giving about how to lose weight.
00:21:10.766 --> 00:21:24.190
All of these things were really seminal to me and I think the thing you know after having these experiences where I was like, well, I should learn how to do this, and I started reading the data, I'm like and basically just said you don't know how to do this, you're not going to be able to do this.
00:21:24.905 --> 00:21:37.971
That was really important to me and I was kind of like my energy is wasted telling people these low carb diet or Atkins diet or vegetarian or vegan, and are drawing the diabetic plate and you know what's my favorite one?
00:21:37.971 --> 00:21:41.176
And I I still hear this don't eat things that are white, you know.
00:21:41.176 --> 00:21:43.380
Avoid rice, avoid no ice cream.
00:21:43.380 --> 00:21:45.148
I'm like ice cream's not white like I think.
00:21:45.148 --> 00:21:45.990
What are you talking about?
00:21:45.990 --> 00:21:46.973
This is so stupid.
00:21:46.973 --> 00:21:58.945
Um, and so just like hearing, like all of these stupid diet things the doctors were saying, thinking they were making a difference, and realizing that it's all just, it's just a waste of everybody's time.
00:21:58.945 --> 00:22:11.537
You need to talk about what the patient's there to talk about, and if they want to talk about diet and weight loss, you should actually probably refer that to somebody else, because you're not good at it, and that's been something that I realized during all of this.
00:22:12.565 --> 00:22:23.710
Yeah, that's intense to think of, like okay, I'm trained in this profession, like I feel like I've got a good grasp on these things, and then it's like, oh crap, I have to unlearn some stuff here.
00:22:23.710 --> 00:22:51.714
This is not good, but I really appreciate you being humble and recognizing that, because I think you know there's a certain percentage of providers that are like I went to school and I got the degree, so I'm the one who you know, like I get to tell you what to do, and when you challenge that, it becomes, you know, a hostile relationship or no relationship at all.
00:22:51.714 --> 00:23:06.540
I'm curious, though do you find that there are other like genres of health where doctors have gotten lazy, or that it feels like there may be some implicit bias where there needs to be extra training?
00:23:07.464 --> 00:23:10.976
I mean, we all need to get better at almost everything.
00:23:10.976 --> 00:23:13.874
That's a really big, big, big question.
00:23:13.874 --> 00:23:21.159
I think I kind of wish medicine was broken up a little bit different than it is.
00:23:21.159 --> 00:23:30.476
There are a lot of doctors want to see a patient immediately with the problem and want to know immediately what the solution is and give it to them, and we've actually done studies on this.
00:23:30.545 --> 00:23:31.369
What makes a good patient?
00:23:31.369 --> 00:23:32.757
I think it's two things.
00:23:32.757 --> 00:23:34.846
Are you familiar with the disease state the patient has?
00:23:34.846 --> 00:23:37.471
Is there a treatment plan for the disease state?
00:23:37.471 --> 00:23:38.996
Does the treatment plan work?
00:23:38.996 --> 00:23:42.651
Is the patient grateful and can the patient pay for your services?
00:23:42.651 --> 00:23:46.188
Researchers would be like go to directors and show them the patient panel going out.
00:23:46.208 --> 00:23:55.965
The good patients these were the attributes that the good patients had right, and I think that's really unfortunate that there's a lot of doctors that that's the patient that they're looking for.
00:23:55.965 --> 00:24:04.374
They have a disease that the doctor knows, there's a treatment plan for it, the treatment plan works, the patient's nice and they'll pay you for it, and that does not make them a lot Like.
00:24:04.374 --> 00:24:10.638
There are a lot of people that fall into that category, and so I think we need a lot of training around.
00:24:10.638 --> 00:24:14.162
What do you do when you actually don't know what to do.
00:24:16.625 --> 00:24:17.686
That's a huge deficit in healthcare right now.
00:24:17.686 --> 00:24:23.778
It's like unless you can put a diagnosis in a 15-minute visit and come up with a treatment plan, you're doing something wrong.
00:24:23.778 --> 00:24:40.356
That's where attributing things to obesity, anxiety, lack of discipline or whatever you know it's because the patient has an array of symptoms that the doctor kept behind a you know, a good overarching diagnosis for a treatment plan.
00:24:40.356 --> 00:24:57.586
We need to think harder about that, because it's interesting, there's a lot of ways that you can treat people even if you don't know what the diagnosis is, and a lot of times the treatment process helps you find the diagnosis, and so I think we need to get trained better in saying I don't know.
00:24:57.586 --> 00:25:01.654
I think we need to get trying better and asking patients what have you found?
00:25:01.654 --> 00:25:04.647
And so I think there needs to be like a foundational change.
00:25:04.807 --> 00:25:19.144
I want to just stop for a second and point out how interesting it is to me that in an industry that is about caring for people, there are studies on what makes, or studies results on what makes a good patient.
00:25:19.144 --> 00:25:22.311
But it's like okay, well, what about what makes a good doctor?
00:25:22.311 --> 00:25:27.411
I'm a person, so I'm a patient and I need care, so that should make me a good patient.
00:25:27.411 --> 00:25:30.057
Like, what about finding a good doctor?
00:25:30.057 --> 00:25:32.288
What's where's that, where's that study?
00:25:33.230 --> 00:25:34.894
yeah, you know it's.
00:25:34.894 --> 00:25:36.616
It's funny I am.
00:25:36.616 --> 00:25:38.469
I don't know if I've ever told you about this.
00:25:38.469 --> 00:25:44.240
Actually, I I used to work for a major HMO and I really struggled because they put us.
00:25:44.240 --> 00:26:00.335
It was a grind, like you were seeing lots of complicated patients every day, and so they put me in this training, because they put me in a communication intensive because I was spending too much time in the room with patients, and they're like we need you to go learn how to communicate better with patients.
00:26:00.335 --> 00:26:07.487
In the opening day of that communication intensive they're basically like well, here's, you know, this is something that everybody should know.
00:26:08.108 --> 00:26:09.993
Doctors aren't very good at communicating with patients.
00:26:09.993 --> 00:26:15.710
On average, you will interrupt a patient 11 seconds after they start talking, and I think that time has actually gotten shorter.
00:26:15.710 --> 00:26:15.894
They've already done these studies.
00:26:15.894 --> 00:26:16.056
And it's gotten worse after they start talking.
00:26:16.056 --> 00:26:16.291
And I think that time has actually gotten shorter.
00:26:16.291 --> 00:26:20.130
They've already done these studies and it's gotten worse.
00:26:20.130 --> 00:26:22.436
And they're like so we need to learn how to not interrupt patients.
00:26:22.436 --> 00:26:27.791
And it turns out everybody that was at this communication intensive had the opposite problem, like they were pissing off patients all the time.
00:26:27.791 --> 00:26:31.695
So they had to like train them and act like human beings.
00:26:32.185 --> 00:26:33.250
It was a bizarre experience.
00:26:33.250 --> 00:26:36.749
I could do a whole podcast on that, just like a little glimpse into it.
00:26:36.749 --> 00:26:46.832
The first day they're like we're going to talk about empathy and how to show empathy, and so all we want you to do we're going to present you a difficult patient and we want you just to show empathy.
00:26:46.832 --> 00:26:50.453
You're not solving the problem, you're not diagnosing the patient, you're not coming up with a treatment plan.
00:26:50.453 --> 00:26:53.893
You just want the patient to know that you're empathetic to their situation.
00:26:53.893 --> 00:27:06.307
And they they gave us this test patient like a like an actor who was pretending to be a pain patient um, a patient that needed like opiate pain medications and was really abrasive about it.
00:27:06.307 --> 00:27:12.569
You know, like I'm in a lot of pain, you doctors don't care, I can't get my pain meds, I can't work, it's all your fault.
00:27:12.569 --> 00:27:18.136
You know this kind of patient and um, all we had to do the whole assignment was just to tell the patient.
00:27:18.136 --> 00:27:20.688
You know, but I understand that sounds really hard.
00:27:21.289 --> 00:27:29.847
That was the whole assignment, okay, but they went through like 15 people and every single one of them, in less than 11 seconds, got into like a conflict with this patient.
00:27:29.847 --> 00:27:33.416
Like it's not my fault, you're paying, you know, like these sort of things, like they don't have the truth.
00:27:33.416 --> 00:27:34.127
I can't solve your problems.
00:27:34.127 --> 00:27:35.932
You've been in pain your whole life and I'm like you're a broken machine.
