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My primary care physician, with a specific note on discussions about obesity - Bartender Geek [entries|archive|friends|userinfo]
Xiphias Gladius

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My primary care physician, with a specific note on discussions about obesity [Feb. 25th, 2014|12:16 pm]
Xiphias Gladius
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."

[User Picture]From: the_siobhan
2014-02-25 05:36 pm (UTC)
Well that last sentance is a little worrying...

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[User Picture]From: pekmez
2014-02-25 06:18 pm (UTC)
We have been going to Dr Sagov's practice too! (But I think I'd have to have been with them since age 3 to have him as my doc, rather than someone else in the practice. Dr Zucker is pretty cool though :)
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[User Picture]From: vvalkyri
2014-02-25 06:25 pm (UTC)
:-/ great doc; sorry to hear about numbers not so good
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[User Picture]From: xiphias
2014-02-25 08:47 pm (UTC)
Numbers aren't BAD yet. It's that they're not where they would be if I WAS one of those people.
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From: jehanna
2014-02-25 06:35 pm (UTC)
Your doctor is awesome. I hope he can get your numbers to a happier level, too.

I'm one of those "nothing wrong with the bloodwork" fat people. The only immediate concern in my case seems to be that I would like to not have to have knee replacement surgery somewhere down the line.

I take it your doc has made suggestions about what changes you might try? I'd be curious to hear them and see how they compare to my own doc's.
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[User Picture]From: xiphias
2014-02-25 08:46 pm (UTC)
Dr Sagov has, himself, lost a bunch of weight since I last saw him. For him, simple mindfulness has helped: he has an app on his phone where he just writes down everything he eats and the accountability has helped him: his problem had been eating mindlessly.

He, and the med student, both made the comment that, when I was ready to make changes, they have a nutritionist on staff who is really good, non-judgemental, and comes up with things that people actually are able to do. But that it wasn't worth going until I was ready to actually do something about it. Which I'm not.
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[User Picture]From: yehoshua
2014-02-25 09:51 pm (UTC)
I have two of those apps. LoseIt, which has better food/calorie tracking, and fitbit, which pairs with a little bluetooth fob in my pocket to count steps, flights of stairs climbed, time/quality of sleep, etc. They're not the end-all, be-all of dieting, but they do give me a pretty good idea what changes I've made that have worked and what hasn't over the last year and a half, and I'm down about two stone in the last 18 months.
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[User Picture]From: delerium69
2014-03-03 04:55 am (UTC)
You have a kind and wise physician
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From: (Anonymous)
2014-03-03 05:49 am (UTC)
My cardiologist has been concerned about my weight too and urging exercise, but at the moment I have some "getting around" issues.
Since my heart, blood pressure, cholesterol, etc. are all doing fine at the moment, what he told me at my last visit was "I don't care if you're fat, as long as you're fit," and suggested some sitting exercises I can do to keep things moving.
That works for me.

My primary physician has much the same philosophy. It's about your health, not, specifically, your weight.

Of course if there ARE health issues, then those need to be taken care of. :-)
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