Challenging Stigma & Bias in a Doctor’s Office
Person fishing at the edge of a lake.
Finding comfort and building trust.
This NYT article discussing fat-shaming in our society came across my feed this morning and it made me want to revisit the third point in a recent blog post, Does your chiropractor make you feel comfortable?
I want to jump in and discuss overcoming bias, shame, and stigma in a doctor’s office setting.
Lower back pain is not simply from being overweight. It’s just not. Chronic lower back pain can be a result of too much activity or not enough or too much of the same activity, a trauma, congenital disorders or any number of other factors. Judging a book (or patient) by its cover is not a way to practice medicine.
I have heard countless times from patients who present with lower back pain that their physician told them flatly, “Maybe you should lose some weight.” Patients are rightfully upset and angry that their pain is so casually associated with their weight and that no further potential cause of their lower back pain is even investigated. Every time I hear an iteration of this story it breaks my heart.
Listening to the evidence
Part of why this situation is frustrating is because doctor’s know that weight discrimination exists, the same way that racial and gender discrimination exist in treatment and pain diagnosis. When discrimination is present in the medical field it directly and immediately impacts the health of patients being discriminated against. Compliance and outcomes are negatively affected. It’s hard to hear, but not everyone is listened to or cared for in the same way. This is unacceptable. It takes humility to admit we doctors are not perfect and is important that each of us work towards undoing and overcoming these biases in our own practices. Blanket statements such as, “just lose some weight”, “you’re just getting older”, “it’s probably just growing pains” and others within the same vein of thinking are all simply unhelpful. Those responses do not listen to the concerns or address the goals of the patient. Furthermore, that type of response takes away all steps and actions a patient might take in co-management of the problem with their doctor. Instead, we need to help our patients understand the actual underlying causes and stresses contributing to their diagnosis and accessible actions we can take together.
Taking steps towards change
Tackling obesity, lifestyle and habit changes as well as other health related changes is never a quick fix. A small pill is still not the answer. Time, compassion and education all play a part in helping our patients compound small changes to achieve their larger goals. It takes hard work.
My goal as a practitioner is to create a mindful office space. I want the space to feel calm and reassuring. Welcoming everyone regardless of gender, age, race or beliefs is incredibly important to me. I hope to build a community that is warm and comfortable and welcoming. I foster a relaxed pace to visits so that patients can open up without feeling rushed and we can more easily build rapport. Often it just starts with listening and an open mind.