Monday, February 02, 2009

Student Health

Karen, over at Some of My Other Random Thoughts, emailed me an excerpt from one of her recent posts. Check it out:
Last week, I went to the student health center to get an allergy prescription. I'm a grad student and student health is free! I still have to pay for the prescription because I don't have health insurance for the moment, but the appointment is free! Maybe you get what you pay for, because it was a weird little experience that I've probably retold to five or six different people in the last seven days.

The nurse had me step on the scale in the hallway. I did, and watched the number appear, all digital style, the same number I've been frowning at when standing on the YMCA scale, jiggling the non-digital balance thingy, hoping it'll bounce up, er, down, a little.

The nurse, on the other hand, was shocked at the number. Not because she knows me (never seen her before) or saw that I'd gained a significant amount since my last visit (I haven't) or was even looking at my chart. She was shocked because, as she put it, "Wow. You do not look like you weigh that much!"

I chuckled or snorted or something, perhaps slightly uncomfortable, but not hearing the alarm bells that later reflection told me I should have heard. My people-pleasing kicked in, and I said, with a little slap to my, ahem, outer thigh, "It's all in my hips!"

"Seriously," the nurse continued, unable to impress this upon me with only one inappropriate comment, "You do NOT look like you weigh that much."

Heh, heh, I might have said. I went into the room, briefly chatted with the doctor, got my script, and I was gone. It wasn't until after class, on my hour-long drive home, that I thought, Huh. Something was not right about that.

I probably should write a letter to the medical director, as more than one of my post-event confidantes told me. I should probably include in that letter that no staff member should ever comment on a woman's (or any patient's) weight while weighing them and writing the number in the chart. If a comment needs to be made, as it might, about significant gain or loss, or concerns about medical complications, it should be made by the primary provider, in a sensitive, confidential way.

Here's the thing. I think she thought she was complimenting me. "Wow, you look skinnier than that number!" or "Wow, you look like you weigh ten pounds less!" But isn't there also a subtext:
"Wow, that's a high number!" or "Wow, you don't look that fat!" And what about this? What if I were recovering from or still dealing with an eating disorder? This is university student health. I know I'm 36 and don't flatter myself that I look 18, but eating disorders have been around since my college days. If it bothered me, who has never been particularly obsessed or concerned about my weight, what would it have done to someone who was finally at a "normal" weight after years of anorexia or bulimia. What if I'd heard negative things about my weight through my whole life from my mother or other important role models? (And isn't that A LOT of women?)
Reactions to Karen's experience?


Harriet said...

I'm astounded by the health professional's insensitivity sometimes.

My daughter took her 15 year old son to the pediatrician. They were concerned that he wasn't growing or going into puberty. He was very sensitive about his size and it was affecting his mental health and social life. The nurse came into the waiting room to call for him. When my friend's son got up to go with the nurse the nurse said "You're 15? You sure don't look 15! You're so small!"

Rachel said...

My student health care experience was not so great, either. I was finally getting serious about recovery and my therapist suggested I get a complete physical done because I hadn't menstruated in months and had heart palpitations. I was on the student health care plan at the time, which meant that I had to use the university's clinic. Keep in mind, the hospital attached to my university is a world-renowned level-five center.

I went and explained my past medical history, including my eating disorder, to the nurse and the doctor. They took my vitals and did all the obligatory stuff. When I told the doctor that I hadn't menstruated, she sent me for a pregnancy test despite my protests that I couldn't possibly be pregnant. That's it.

And I won't even get into the university's appalling mental health "services."

Laura said...

I once had the same exact comment made to me by a nurse at my doctor... when I was 16. Seriously, who SAYS that to an adolescent?!

PTC said...

It should just be a rule that no one should comment on peoples' weight. Even something that's meant to be a compliment can be taken out of context and if that's said to the "wrong" person it could do some serious damage.

JS said...

Yes, that is odd and inappropriate.

People of the same height and weight can look very different from one another--this should be old news to a HEALTH CARE PROFESSIONAL, though.

Leigh said...

Astoundingly rude - not just from a health pro but from a fellow female! I may be a tad more cynical than the woman who wrote this because I see the comment as a none-too-subtle dig from someone who probably has her own issues with weight. If I were in her position, I'd contact the manager of the clinic - if this nurse said this once, she's probably said similar things before and perhaps to others who might have taken her comments to heart.

ShelbyWoo said...

I am so lucky that I have yet to run into a health professional that has mentioned my weight. My doc's office always does weigh-ins, but no one says anything to me about it.

I do get from other the "Wow, you don't look like you weight that much!" due to my height. It's like they don't comprehend that it's still rude and insulting to comment on someone's body because they think they've paid you a compliment (though how "You don't look nearly as fat as you are!" is considered a compliment, I'll never know).

Sarah said...

I'm 32 and currently battling an eating disorder that did not appear until my late 20s. If I had heard a comment like that from a health care professional it would have been a serious trigger for me. My own mother has been known to tell me "I had no idea you weighed THAT much." For someone struggling with an eating disorder often the number on the scale can be more significant than physical appearance. This is a big deal and should be treated as such.

kilax said...

I would also feel a bit uncomfortable, but would have guessed she was trying to compliment me as well. Either way, it IS inappropriate.

azusmom said...

It's extremely upsetting and, unfortunately, not uncommon.
When I was in college I sprained my back. I was already self-conscious about my weight from years of negative comments (and I was also a theater major, which didn't help!), and a year shy of beginning my spiral into eating disorders. I went to the university health center. First, the receptionist yelled at me for not filling out a form, after I'd already filled it out and handed it to her. Then the doctor, who had never seen me before, and barely looked at me throughout the appointment, told me I looked "like someone who (had) gained weight recently." WTF?!?!?! (Ironically, I'd actually LOST a bunch of weight.)
the REALLY sad part was that this was at NYU, whose medical center is considered one of the best in the country. But not if you're a student!

Minna said...

People have this ideas as numbers telling them 'fat' or 'thin' or 'healthy' or 'unhealthy', and often don't even know what those numbers actually look like. I'm consistently underestimated by at least ten kilos, more often fifteen, and once or twice twenty five. And considering I'm under a hundred, that seems like a big difference to me. And I'm well unfit, so it's not the 'muscle is denser than fat' thing throwing people off.

And even all of that aside, what a wildly inappropriate comment, especially from a health care professional, who should damn well know better. :|

Tiger said...

Last week, when I went to see the Nurse Practitioner at my college to get a script for anti-depressants and an anti-anxiety med, she asked, as they always do about any appetite change/weight gain/loss. I told her the truth--that I'd lost XX lbs, and she looked at me and said "Congratulations! It's so much better for your body to be XX lbs lighter"
This, after we'd talked about the fact that I'm dealing with all the food stuff with my therapist.
insensitive much?

Jen said...

I have had the opposite said to me that I look like I weigh more than I do. One of my ex-boyfriends refused to believe me when I told him my weight. It's been a mantra that I've kept ever since and I use it to rationalize dropping to an unhealthy BMI. Somehow I'm fatter than other people at the same weight and I need to be significantly underweight to look normal. I'm about to turn 30 and I've just recently developed all this weight obsession from those stinging little remarks so...yes these little comments really prey on insecurities.

Jim Purdy said...

I guss men and women are very different. I would have taken her remark as a very nice compliment.

On the other hand, if she had said the opposite, as in "You look like you weigh MORE than that," I might have imitated Mister Spock of Star Trek, by raising an eyebrow ever so slightly.

Tanya S. said...

I don't know what it is about college health centers. The all seem to be bastions of incompetence. I had to have a physical before leaving on a church mission, and the health center took blood and urine a week before my appointment with the doctor. When I went to see her, she said, "Do you have a yeast infection?" I told her no. "Yes you do!" she replied all pissy. Ummm, okay.... I never could figure out why she approached it that way. Something like, "Did you know you have a yeast infection?" would make so much more sense.

My sister went to one once with a broken arm and they misdiagnosed it. It was apparently a very clear break (based on the x-ray she got later from another doctor).

My university's health clinic also prescribed Motrin for pretty much anything. It was a running joke amongst many of my friends and roommate. Broken arm? Motrin. Yeast infection? Motrin. Depression? Motrin.

Anonymous said...

My grandma once told me something along the lines of that.. Only she phrased it as "Wow, you carry your weight well."

And I've never ever been able to take it as anything other than "Wow, you're carrying around a lot of weight, you just could look a lot worse."

thanks, grandma..

drstaceyny said...

Wow, what interesting (horrifying?) stories. The running joke during my college years was that student health always thought you might be pregnant. They insisted you might be pregnant, even if you presented w/upper respiratory symptoms.

azusmom said...

Dr. Stacey, that is so true! Funny and sad at the same time. (I had to tell the doc that the only way I could have been pregnant was by Immaculate Conception. He finally got the point.)

Anonymous said...

This has happened to me before. I have had an eating disorder, and like your title says, I feel like I still have one, just not to the extreme that it used to be. I think a friend said this to me one day when I mentioned my weight, and I was flattered but also a little ashamed. Should I be a smaller number because I LOOK a smaller number? Is it muscle? Is that bad? I suppose the best I can do is take it as a compliment and move on. Good post! :)

Lindsay said...

I get a whole lot of those comments, but not usually from health-care professionals. I've done a whole lot of weightlifting, so I have a lot more muscle mass than most women do, which makes me heavier without making me take up that much more space.

I think part of the problem is, as ShelbyWoo mentioned, people tend to think of certain numbers as objectively Fat, no matter whose weight they describe. When they see a woman who doesn't look fat to them (or doesn't look as fat as they might expect a Fat! Woman! to look), and they find out she weighs some unexpectedly large number, it's almost like they look at her again to figure out where she's hiding the extra bulk.

Karen said...

It's amazing (and a little disheartening) to hear how many people have experienced similar inappropriate comments about weight! Especially by Student Health professionals, who work with a vulnerable population (young women!). Thanks, Dr. Stacey, for printing my story!

Minh said...

Thanks for your article. Struggling with an eating disorder can cause profound isolation, fear and hopelessness. Because this illness thrives in secret, people with anorexia, bulimia and compulsive overeating hide their behaviours from those closest to them, hoping that no one will notice whilst hoping that someone will.
In order to begin the process of recovery, secrecy must give way to self awareness and honesty, and this can only happen in a safe, structured and caring environment.

I would also like to suggest a website with lots more information about eating disorders as well as addictions .

Life Works Community Blog also gives a source of information and inspiration from some of the leading counselors at Life Works. Topics include: alcohol addiction and drug addiction, eating disorders ( anorexia, bulimia , and compulsive overeating ), depression and anxiety disorders , and compulsive disorders ( sex addiction , love addiction , gambling addiction , and codependency ).

E.F.F. said...

I think that Karen was probably right in believing that the nurse was giving a "compliment." But still, the nurse shouldn't have made any comment about it if she didn't have anything USEFUL to contribute by doing so.

I also like the passage regarding eating disorders. Plenty of people who are at "normal" weights or overweight are suffering or recovering from eating disorders. I myself have had terrible issues with food and am now at a point where I would like to seek help - but I feel like I'm now too fat to be taken seriously by health professionals, somehow. Just because I don't have pointy hipbones and my hair isn't falling out anymore, it doesn't mean that I don't still obsess and freak out over food. Ugh.

- E

brooklyn_bound_F_train said...

I just got this crap this morning going in for that joyful ritual known as a pap smear. Apparently at 5'4", 182...I 'carry' my weight well. i weight train with my hockey team so I also have giant biceps and triceps and solid quads the size of a Jessica Simpson's waist. Groan. This was my neighborhood health clinic though versus the health center at my University. I don't even dare go to the health center at my university. I tried to go there for low cost vaccinations to travel overseas. They perscribed chicken soup and sudafed thinking I was someone else. Double Groan.

VCK said...

It's unfortunate that so many people have had negative experiences with their university health care centers. At two separate universities I have experienced great care, and that's very refreshing.

Jessi said...

on admission for anorexia and depression at a mental health hospital, I was weighed by two nurses who commented "Oh your weight isn't THAT low is it?" .... of course being stuck in the middle of a long standing illness my response was probably something along the lines of nervous giggling or "no not really" followed by a shy smile. Luckily after 2 nights of inappropriate care I discharged myself.

Anonymous said...

the obvious is, of course, that it was insensitive of her to comment. i myself have had an ED for almost 5 years and refuse to be weighed so I am not triggered.


we are missing the REAL issue.

it was insensitive. we agree. but WHY??? why is that number so impactful? why was that statement impactful?

say you pick up a bag and it was much heavier than it appeared. and you exclaim "wow that weighs more than i thought!" should the bag be offended? no. that seems obvious and completely different. ... but is it really?

obviously karen was not overweight. she was healthy and medically sound weight wise. so... why was the number so important?

we put emphasis on the number. the label. i personally will not buy anything in 'large' (i have D breasts and am 5'9" so this is rather hard). why? just because the label SAYS i'm 'large.' i'm the same size as when i fit into another shirt that says 'small.' it's just a label. a number.

but it matters. why?

perception is perhaps the simple reason.

the short running 'starved' tv show dramady was about a group of friends all with different eating disorders (it was cleverly written with wonderful storylines and i have NO idea why it was cancelled!). in the first episode two of the main male characters were discussing a female. he expressed apprehension at her body type. the female in question was 5'9" and weighed 140. the men labeled her DEFINITELY fat. and the woman asked 'oh? what is a good weight for 5'9"?' the men agreed that '120' was just right. she laughed. 'you THINK you want 120. but what you actually want is 140' and she's right.

i AM 5'9" and know that at 120, my BMI would be 17.7. medically underweight. but the perception is that 120 would be ideal. this is perfect commentary on the way our minds have been conditioned to work.

labels, i'm afraid have never been able to fall off, and never will.