Posted by Pattie on 8/26/2005 02:32:00 PM

The Physician Role and Patient Compliance

A New Hampshire physician is in trouble because he told a fat woman that her husband would die before her and that she would be a lonely widow because men don't like fat women. This story has hit several major media outlets, including CNN, which had Marilyn Wann on last night as the counterpoint (that they could look "fair" while giving the good doctor a chance to clear his name.)

The thing that has struck me most vividly about this controversy is how mundane the conversation between the doctor and the patient really is. Someone has asked would he have this conversation with an alcoholic, a drug addict or a person who is to thin. My answer would "most likely."

I've been the only sociologist at a table of health care professionals on several occasions in my career and while physician rarely were present (physicians don't seem to like to be on health care task forces), many at the table were deeply steeped in the medical model.

When I brought up questions of social stigma, most of the people at the table had two reactions:

1. Using the stigma to motivate patients is a perfectly legitimate thing to do.

2. Solving stigma is a perfectly impossible thing to do.

They see social stigmas as always going to be around and as highly motivating when getting a patient to comply with medical advice.

Any stigmatized population (most of my research addressed questions of aging) will hear ridiculous claims about their social standings in order to motivate them to do what the health care worker believes is in their best interest.

In the same way that many fat people do not want to go to a doctor because this kind of inane advice is given, many older persons will put off going to a doctor because they don't want to hear about their inevitable decline. The putting off, of course, contributes to the decline, which only reinforces the fear.

BUT THE FEAR IS LEGITIMATE. And that is the thing most health care professionals at the task forces overlooked. Doctors do threaten to take away freedom and livelihood in the name of health care.

The most shocking thing about this particular case is that it is being regarded as some sort of exception. I think this doctor probably doesn't know what hit him because I think this doctor was taught through example and explicit instruction that it is his job to get the patient to comply with his orders. He is probably saying to himself, "Didn't I do what was right?"

As usual the media is missing the bigger picture. Something fundamental needs to change in the physician/patient relationship in this economy.

Respect for the patient is one thing. Declaration of patient's rights has been a step in the right direction, but more needs to be done. Infantalizing patients is not a method that should be supported.

I, for one, am happy to see the medical board take this woman's complaint seriously, but I would love to see a larger debate about physician/patient interactions and the need to de-glorify the physician.

Doctors certainly play an important role in this relationship, but ultimate respect of the body of the patient and the desire to "do not harm" seem to be higher principles to which we should aspire than the "doctor is always right."

Fat people are right in the middle of this issue, no doubt. the stigma place on fat is rooted in the so-called medical knowledge of "obesity." But it is a larger issue than obesity.

Medical authority must be questioned and few reporters feel competent to do so. This makes for a big mess in health care that costs people not only their dignity but their lives.