Wednesday, January 19, 2011

Self care... it's a right, not a privilege

The New Year's Revolution Challenge for Thursday, January 20, is: 
Pick up the phone today and make that medical or self-care appointment you keep meaning to schedule!

When we don't feel good in our own skin, or we have had the experience of being humiliated, lectured, and scolded time and time again by medical professionals, or we feel ashamed of parts of our bodies, it's easy not to feel worthy of, or entitled to, medical care or self-care or those little physical luxuries like massage or pedicures. 

I'm here to remind you, and myself too, that we are all entitled to compassionate medical care and decadent pampering. Our bodies do not disqualify us! I have finally, after 10 years of searching, lined up a Primary Care Physician and a pedicurist (two of my most crucial care providers - more on why pedicurist is on that short list later!) that make me feel I can get medical care when I need it, preventive care before I need it, and regular pedicures so my chronic ingrown toenails are kept under control - and my feet look pretty and make me feel all girly and happy.

It actually takes two doctors to make one Primary Care Physician to see to my needs. First, there's my official PCP - a family medicine physician I'll call Dr. H, who practices at the local giant non-profit full-service medical clinic (think Kaiser, but local not national). Dr. H is a lovely woman, and seems to care about me deeply. I like her, too, and always ask about her kids and really feel I have a relationship with her. Unfortunately, I've been seeing her for years, and despite trying again and again to bring her up to my HAES standards, she can't or won't get on board. When I tell her about problems she doesn't know how to solve for me with a pill or a needle, she resorts to recommending weight loss because she's so desperate to do something to help me. I even had her talk to my HAES-expert therapist, and all Dr. H got from it was "Dr. B thinks you should exercise, too." Uh-huh... not exactly the full picture of Dr. B's explanation of HAES.

So why do I stay with her? Well... it comes down to the devil you know. I considered leaving - actually tried another doc - and the new one was WAY worse than the old. She actively pushed the issue of WLS! So I did some soul-searching, and decided that I just didn't have the sanity points in my life (or the money or the time to take off work!) to try meeting with a dozen - or a hundred - possible PCPs in order to find the one in a million who truly 'gets' HAES. Or more likely, is incrementally better than Dr. H but still not the HAES guru of my dreams. In the meantime, I've thrown away a person who truly cares about me and my health and happiness, who has a (admittedly major) blind spot but is otherwise really helpful and good to me.

The reason I'm able to settle for less than perfection in my official PCP is because I have another person on my team. I've been working with a naturopathic doctor, Dr. J-L, for the past six months or so. She, too, is less than my perfect HAES guru. (What can I say? I have high standards...!) But she's less indoctrinated in Western medicine, obesity-epidemic-booga-booga than a standard doc - to the point where she understands that a "morbidly obese" person such as myself can also have an eating disorder, and because of that understanding, she will not cross the line and give me weight-loss focused nutritional advice. In fact, she's so careful that several times I've had to explicitly say, "Please, go on... I'm totally open to your advice on nutrition. The only thing I don't want to hear is calories or pounds. General nutrition guidelines are welcome!"

So after one too many weight-loss discussions with Dr. H, and the terrible WLS discussion five minutes after meeting Dr. E (that's the new potential PCP I met with once - the 'E' is for evil!), I went to Dr. J-L and proposed a deal. I told her I'd like us to agree that as far as the two of us are concerned, she's my *real* PCP, and Dr. H is my Western Medicine Liason. We can't tell Dr. H this, of course. But I realized that if I 'manage' Dr. H by avoiding talking to her about things that will trigger her fears and stereotypes about "obesity" (back pain, knee pain, foot pain... things she associates with curing by weight loss, or has no good way to help with other than prescribing weight loss), she can give me great care on other issues, the kind Western medicine is good at (sinus infections, PAP smears, etc.). And now, I have Dr. J-L to help me with those issues Dr. H isn't so good at, so I had the luxury to do so.

The upside? Dr. J-L is helping me feel better on a day to day basis. Dr. H is there to prescribe me antibiotics when my sinuses go haywire. Everybody wins.

The downside? Dr. J-L isn't covered by insurance. Not even a little bit. And I have good insurance through work! And of course, I still don't have my HAES guru. Or rather, I have many HAES gurus, but none of them is my PCP.

But hey... it's working for me. At least until I come up with something better. Now if you'll excuse me, I need to plan my next pedicure.

1 comment:

  1. Great Post.... I think sharing our strategies for dealing with medical needs after we take the brave HAES step of acknowledging calorie restriction doesn't work is important. I am very lucky to have doctors that understand my position on intentional weight loss and who respect my choices. I know that is not the case for many of us.