Written by Sossity Chiricuzio.
Art by AllGo – An App for Plus Size People.
I have spent a lot of time in doctors’ offices throughout my life, and have had to educate almost every healthcare professional I have seen. I often feel I should invoice for services rendered minus their copay. Not that they would pay it. Not that they pay any respect at all to my work or my input. According to their math and world view, their medical degrees make them a more accurate authority on the body I live in than my experience living in it.
If I were to read the notes from my appointments I’m sure the common thread would be the phrase, “Patient was uncooperative.” For those of you lucky enough not to know this already, that is code for “patient spoke up for themselves” or “patient refused my advice.” In my particular case, this will most often refer to my refusal to let them frame my weight as the crux of every medical issue, or my refusal to take a prescription pain pill or metabolic enhancer they were selling as the solution to my problems.
“Selling” is the keyword there. Doctors are far too often incentivized by profit, which puts them arm-in-arm with insurance companies that are far more invested in status quo then holistic care. Insurance says patient’s BMI is too high, doctor prescribes diet pills (some profit) or weight loss surgery (more profit), patient loses weight then gains it back, possibly along with addiction or further health issues or eating disorders—or even loses their life. The diet and insurance and medical industries don’t see bodies as people; they see them as moments of profit or loss, and they work together to maximize their profits, regardless of the impact on those individual people or their bodies.
Perhaps you think I’m over-generalizing, or have already dismissed my opinion because I am a fat person, and you’re not even aware you’re doing it because it’s an unconscious weight bias. A pervasive phenomenon, it can wreak particular havoc when it comes to medical care. From the moment I arrive at the doctor and I am lead directly to the scale, to the chair that doesn’t fit, to the gown that doesn’t close, it is made clear to me that this space is not meant to fit my needs. Every time I refuse to step on the scale, or to sit in the chair, or to wear the gown, I disrupt this pattern, and make them think about why.
It is a powerful move to say no. It is also a privilege to be able to say no. Even though I am an aging, disabled, working class, fat, queer woman with a beard, I am also a white, educated, cisgendered woman with insurance who is living in a largely progressive city with many medical facilities to choose from. I have been working in healthcare-related services for almost a decade, and I know the language and the systems. I have had the resources to research my conditions and rights, and time to develop self-advocacy skills and a support foundation. I am fighting for my life, but I am also fighting for yours.
From the moment I arrive at the doctor and I am lead directly to the scale, to the chair that doesn’t fit, to the gown that doesn’t close, it is made clear to me that this space is not meant to fit my needs.
This is not a simple process, even with my experience and practice at it. I am often left shaken, or having to steel myself to speak up. I am frequently exhausted and depressed and furious afterwards. In fact, I am writing this article today because I spent most of my therapy session (another privilege) discussing the various medical procedures I need and what order I should prioritize them in for reasons of money, time and spoons, and how hard it is to keep my balance and forge ahead. My therapist reminded me of why it is not just necessary but worthwhile, and how it intersects my activism as well as my personal health. So, here I am, doing what I can, and asking you to do the same.
If you have power or privilege in a medical setting, figure out how to use it. Thin bodied? Pay attention to the equipment they provide, and challenge them to do better. Able bodied? Insist on ramps and accessible bathrooms and unscented products. White? Cisgendered? Straight? Notice who is filling the roles, the wording in their intake forms and charting, the assumptions they make about gender and race and class and sexuality and gender, and call it out. Don’t wait for it to be something that impacts your own health, or violates your own boundaries. Be proactive. Advocate for consent-based treatment and trauma-informed care everywhere. Say no when it’s called for. Fire healthcare providers who don’t treat you or others with respect and compassion.
They are authorities in their field, but they do not have authority over you. Remind them of this as many times as it takes. They have convinced themselves and us that we are lucky to have healthcare at all, and that they know best. We have to disrupt this system and insist on better.
Some example scripts for pushing back:
“I am not interested in being weighed.” And/or “Weight loss is not part of my treatment plan or up for discussion.”
“I have experienced _______ type of trauma and I need _______ type of support around it.”
“My mental health is best managed in ______ ways, how can you help me achieve that?”
“You need to modify your intake forms and my charts to reflect my actual name and/or gender and/or pronoun, and use it consistently.”
“This is my friend/partner/advocate and they will be sitting in on my appointment to make sure that I get appropriate care.”
“I need you to slow down and explain that again/allow me to take notes/answer my question/find me an interpreter.”
“If you’re not going to approve the lab/procedure/test I’ve requested, I want it noted in my charts that you refused my request.”
“I need the contact information for your patient relations department and/or supervisor.”
About the Author
Sossity Chiricuzio is a queer femme outlaw poet, a working class crip storyteller. What her friends parents often referred to as a bad influence, and possibly still do. A Lambda Fellow and the Creative Non-Fiction Editor for Gertrude, she writes about activism, connection, and survival, and is found in places like The Rumpus, Lunch Ticket, Crab Fat, Rogue Agent, and Argot. More info at: sossitywrites.com.
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