|My primary care physician, with a specific note on discussions about obesity
||[Feb. 25th, 2014|12:16 pm]
I'll put it behind an LJ cut because a lot of people just aren't interested in how the medical establishment looks at weight, but, personally, I think this one isn't actually so bad:|
To start with, let me observe that Dr Sagov, who's been my doctor since I was three or so, is passionate about educating new generations of doctors about family medicine. Throughout my life, I have rarely had a checkup without a resident doing a family medicine rotation, or even more often, a med student, present and actively involved. I'm certainly not able to do any doctoring myself, but I've spent a lot of time listening to doctors being taught, so I feel that I know enough to at least be able to ask reasonable questions. Certainly, I feel pretty comfortable that I know what my doctor is doing and why, since, whenever he is doing something, he's doing a running commentary about what he's doing and why, what other options there would be, why he chooses this method over that method, how other doctors in the practice do it, what the plusses and minuses are, what he's NOT doing because he doesn't feel there's enough evidence that it actually does any good, what he IS doing because, while it might not do any good, it certainly won't do any harm, and doesn't cost anything...
Anyway, so, he's got a third-year with him, and has let the third year handle the interview -- their physicals always start out with an open-ended conversation about how my life is going in general, since "health" is a pretty broad topic that includes one's body, mind, and social environment. The primary thing that Dr Sagov is trying to teach students is how to talk to patients in order to get an idea of what's actually going on, and what actually needs to be addressed: as my friend Dr Mary Kate DiTursi has said, when she's talking to a teenage patient about dating and sex, she's practicing much more difficult medicine than when she's checking a kid for strep. Even though the insurance company reimburses her more for the strep test than the discussion. And they're both vital to her patients' health.
(Dr Sagov's example of an "open-ended question" to open up the discussion, by the way, was, "So, nu?" Mind you, he only does that with me, because, like I said, we've known each other for my entire life.)
Anyway, one thing that we've been watching for a while is my weight, since my BMI is 38 -- well within the obese range.
But one thing I thought was useful: while we were discussing this, Dr Sagov turned to the student and said, "It's important to note that there are some people who are obese, even morbidly obese, but with no significant health challenges. Their blood sugars, blood pressure, cholesterol, and all other measures are completely healthy, and they have no increased morbidity or mortality than the general population, and no specific health risks. When you run their bloodwork, it's all completely normal."
Then he turned to me. "Unfortunately, you're not one of them."