Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

One can’t always assume congratulations are in order

Anonymous
Conditions
August 29, 2021
15 Shares
Share
Tweet
Share

“Congratulations on losing that much weight! Whatever you’re doing, keep it up,” my attending says as she bobs her head vigorously in approval, then turning back to the EMR computer to type up some notes.

And all I could see was the patient slightly shifting on the exam table, their face smiling — but their whole body seemingly screaming discomfort and dismay.

Before my attending sailed into the room, the patient told me everything that had been going on: Their 10-inch bust causing severe lower back pain and preventing upright posture, the inability to find clothing that fit or bras that support anything more than minimal exertion, the weight gained during pandemic depression, the weight lost from anxiety about university dining halls leading to missed meal after meal until they could finally brave the thought of prying eyes. They pepper their explanation with apologies for overreaching, for saying that they might have body dysmorphia or an eating disorder or anxiety or breasts that need reduction, all this without first obtaining a physician’s approval. They hurriedly preempted my questions about eating habits, exercise and sleep. Or how they’re doing better, but obviously, of course, rest assured, they know not enough yet.

I’m left to think — if they offer up their medical sins unprompted, perhaps they will appear to me as a “good” fat person, one who endears themself by knowing the wrongness of their habitus. They protect themself from me if they’re hard on themself first, taking away any reason to invite my unwieldy medical dissection that might hit a nerve and provoke pain.

All of these details get remorselessly trimmed away from the lean, essential details in my oral presentation to the attending like these details are the same fat they anatomically and emotionally describe. I wince as my attending chews over the above 35 BMI, emphasizing as a teacher that a BMI this high when this young requires targeted communication because of our duty to care. We don’t talk about what kind of BMI it is, a number that obscures disabling breasts, physically induced dysphoria, distress exacerbated by a pandemic and college shock and earnest efforts to find ways forward to health.

My attending enters, introduces herself, and says, “So Jade has been telling me what’s been going on.” And all of a sudden, I’ve been identified as the messenger. Anytime my attending strays from what the patient thought they told me, I’m at fault, in this game of telephone between patient and attending separated by the soundproofed clinic door. Any attention, understanding, validation the patient remembers from my interview before they turn sour at the idea that behind the door, I retold everything as a doctor would — measuring the clinical distance from the goal rather than the efforts and vulnerability that brought this patient to the here and now.

“Whatever you’re doing, keep it up!”

Recent unintentional weight loss, fevers, chills, night sweats. Red flags that scream danger is lurking in the body. Note the word unintentional, an acknowledgment that not all weight loss is loved in this time of obesity. That there are types of weight loss that signal the train going off the tracks rather than back on, that the suffering of the body has increased rather than abated, that the shrinking of the body is proportional to its consumption by disease.

Don’t keep that up.

Maybe I’m projecting. Because I remember, at this patient’s age, not leaving my college dorm room days at a time because I was too anxious to get food with my overweight body as a vehicle. Running in almost the dead of night to protect my jiggly movements from the eyes of others. Stressfully sweating in-between classes not because of the exertion but by how I occupied space, with my most sensitive vulnerability on full display for anyone to notice and judge without invitation. Periods of disordered eating for which I never got a stamp of authenticity from a physician.

Losing almost 30 pounds to the delight of my parents, my extended family, some no longer close friends, and most importantly, my primary care physician. The skinny spoke louder than any of my distress could, provoking congratulations that trampled the opening for me to say, “No, things haven’t been going well.” And I politely accepted in the face of seeing my loved ones and physicians celebrating my obvious efforts towards improving my health.

And though I claim to know the suffocation of assumption intimately, I am not immune to trampling others in my healing practice. Meditations on language, intention and perception do not come easily when treading water to meet the minimum clinical needs of an encounter — the history, the assessment, the differential, the planning, the time constraints.

Until recently, I used to say “congratulations” to every pregnant individual or any patient with a newborn. A way to communicate I cared, intending to connect with them through their joy, an easy transformation from stranger to a friendly face.

Easy, simple, and undetectably estranging. Those who experienced or know of miscarriages, vanished heartbeats, sexual coercion, abuse, childfree lifestyles, restrictive abortion laws, closed or open adoptions, wrong timings, tumultuous situations, complications, or simple lack of want probably wince at this mention of unsolicited celebration. Missing where the patient is, I find myself mistakenly alone in that place of joy I imagined for them, denying space for any hurt the patient might have brought for care.

My meditation is this: One can’t always assume congratulations are in order. There are no certain joys or certain sorrows in medicine.

How do you feel about that?

The author is an anonymous medical student.

Image credit: Shutterstock.com

Prev

If I already had COVID, do I need the vaccine?

August 29, 2021 Kevin 4
…
Next

A data-first strategy to recovering surgical volumes [PODCAST]

August 29, 2021 Kevin 0
…

Tagged as: Medical school

Post navigation

< Previous Post
If I already had COVID, do I need the vaccine?
Next Post >
A data-first strategy to recovering surgical volumes [PODCAST]

More by Anonymous

  • Do residents deserve the title of physician?

    Anonymous
  • Breaking down barriers: How technology is improving diabetes management in underserved communities

    Anonymous
  • The patient who became my soulmate

    Anonymous

Related Posts

  • Qualifying conditions for medical marijuana

    Patricia Frye
  • Settlements in the opioid cases need these non-negotiable conditions

    Rosanne Aulino, RN
  • What does Kelly Loeffler’s health plan do to coverage for preexisting conditions?

    Robert Laszewski
  • Should only infectious disease specialists be allowed to prescribe antibiotics?

    Craig Bowron, MD
  • The culture of perfection in medicine is a disease

    Andy Cruz, MD
  • How COVID is exposing poor working conditions in the U.S.

    Irene Martinez, MD

More in Conditions

  • Overcoming Parkinson’s: a journey of laughter and resilience

    Cynthia Poire Mathews, FNP
  • The untold struggles patients face with resident doctors

    Denise Reich
  • Maximize sleep efficiency with stimulus control

    Pedram Navab, DO
  • The endless waves of chronic illness

    Michele Luckenbaugh
  • Surviving and thriving after life’s most difficult moments

    Rebecca Fogg, MBA
  • The surprising power of Play-Doh in pediatric care: How it’s bringing families together

    Alexander Rakowsky, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • The hidden truths of hospital life: What doctors wish you knew

      Emily Stanford, DO | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The hidden truths of hospital life: What doctors wish you knew

      Emily Stanford, DO | Physician
    • 10 commandments of ethical affiliate marketing for physicians

      Aaron Morgenstein, MD & Amy Bissada, DO | Finance
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Providing Abortions in Alabama; FDA's Formula Woes; Unread Claims Rejected
  • Resiliency Starts With High-Reliability Healthcare Systems
  • 'No Safe Place': Shooting Hits Home for Nashville Doctors
  • FDA OKs First OTC Product for Reversing Opioid Overdoses
  • Asthma, Eczema Tied to Osteoarthritis Risk

Meeting Coverage

  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Less Abuse With Extended-Release Oxycodone, Poison Center Data Suggest
  • Novel Strategies Show Winning Potential in Ovarian Cancer
  • Children Do Well With Fewer Opiates After Surgery
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • The hidden truths of hospital life: What doctors wish you knew

      Emily Stanford, DO | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The hidden truths of hospital life: What doctors wish you knew

      Emily Stanford, DO | Physician
    • 10 commandments of ethical affiliate marketing for physicians

      Aaron Morgenstein, MD & Amy Bissada, DO | Finance
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

One can’t always assume congratulations are in order
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...