(no subject)

[sebastienne]

Dear NHS,

I came to you yesterday with some kind of flu-like illness. I'm going to leave aside the dismissive way in which the GP listened to my chest, said "you're fine", then switched and gave me high-dose antibiotics like candy when I said "I've been feeling a bit feverish as well" (don't, I don't know, take my temperature or discuss any of my other symptoms or anything); having dealt with Dr Sylvester at 19 Beaumont St (really, is there a person registered there who doesn't have a horror story about him?) I know I can cope with unprofessional GPs.

No, NHS. What I want to talk to you about is the obesity register. Never mind the overtones of things like the sex offenders register and [removed so as not to invoke Godwin's law] - I'm used to being treated as sub-human because I'm fat. (If you are thinking (and I know some of you are, it's too culturally ingrained, I won't hate you for it) that this is OK, necessary even, because obesity causes all sorts of diseases - please go here (warning: angry) or here (warning: heartbreaking) and start to educate yourselves.)

I'm resigned to all of that, NHS. All I really want to know is what it is for. Judicious googling has brought up very little explanation, except for a delightful Daily Express opinion piece containing the line, "According to this GP, he is paid a bit extra by Gordon Brown to put his larger than life patients onto the scales and then add them to a mysterious ‘obesity register’."

So, NHS? Why, when the GP opens up my record, does a little window pop up saying "patient on obesity register" ? Is it so that I can be reminded of my transgression, in case I had forgotten to feel shame leaving the house that morning? What purpose does it serve? Is this why every diagnosis I've ever had, from glandular fever to anaemia, has come after a test for diabetes?

Comments

[vass]

WTF? That's fucking scary.

[stronglight.livejournal.com]

*hug*

Most medical doctors get very little training on things like nutrition and fitness. They learn about diseases. They see fat people with diabetes and heart disease and they don't tend to see the ones who are heavy but healthy, so most don't ever notice that it's possible to be that way. It's stupid, but it's true.

Last night, at a conference dinner full of psychiatrists, a trained medical doctor (granted a psychiatrist, but still should have full medical training) asked me if it was difficult getting enough vitamins being a vegan. I'm sorry, wtf? I mostly eat fruit and vegetables. It's basic nutrition.

They are really very ignorant about some things.

Basically from some quick research I think the obesity register is to allow them to monitor the health of obese people to better understand the links between weight and disease. Which, while frustrating that they've basically signed people up to a research study without asking, at least means that hopefully they'll realise that fat can be fit, in some people, when the data comes in in a few decades... I guess...

[queerpup.livejournal.com]

Whilst this is of little help, diagnosis (or rather, lack thereof) of my problems has usually involved a test for diabetes too, and I am of "normal" weight / height.

[penguin-worship.livejournal.com]

I fell out with my London Doctor a few years ago when i went to him because i was basically throwing up and then having diahorrea most nights...i went to him to discuss it. He took measurements, and said "well its because your obese". I explained to him that as at that time i was going to the gym 3 times a week and trying to give up smoking i wasnt too worried about that but was worried about the symptoms i had decribed.... He insisted the problem was being obese. I then shouted at him - as i felt his statements could be intepreted as encouragement to develop bulimia, and potentially i could then give up the gym and smoke to my hearts content, as when i did that i was just below the magic 30 mark. I then back home discovered he had managed to record my height as 5'5 (i am 5 7') and his measurements were therfore WRONG. I never went back to him and am still scared to talk to any doctor about "those kind" of symptoms.

The simple BMI system is frankly rubbish, as it doesnt take into account things like muscle/lifestyle/whether the patient s taking exercise or not.

Seems like the Obestity register move is more about statistics and overall management of caseload in each district rather than related to patient care from the googling i just did.

[vampire-kitten.livejournal.com]

Also, obesity, not exactly a hidden problem. It's not as though the doctor is not going to have a good estimate at your weight the moment he sees you - why does he need an additional reminder every time he opens your record.

This year was the first time I'd ever had doctors start commenting on my weight. Years and years of being "dangerously underweight" according to BMI and not a blink, but go one pound over "normal" and it all you should be thinking about your diet...

[vampire-kitten.livejournal.com]

I fell out with my London Doctor a few years ago when i went to him because i was basically throwing up and then having diahorrea most nights...

I lost faith in my Oxford doctors when I went to them about me vomiting/feeling ill every morning for the last year. He suggested I was pregnant, and no amount of me telling him I was both on the Pill and having no penetrative sex with men, and using condoms even then it was damn unlikely, would stop him sending off a pregnancy test.

When it came back negative, he basically ushered me out of his office. As long as I wasn't pregnant, vomiting for months was fine ...

[pozorvlak.livejournal.com]

I'd guess it's just part of the general obsession to record everything and store it in a big shiny database because $db_vendor plays golf with the civil servant in charge. But maybe that's just the No2ID activist (and former government contractor) in me speaking.

But yeah, suck.

[pozorvlak.livejournal.com]

no amount of me telling him I was both on the Pill and having no penetrative sex with men, and using condoms even then it was damn unlikely, would stop him sending off a pregnancy test.

Patients lie. Haven't you ever seen House? :-)

Still, I'm sure he could have found a less insensitive way of doing it.

[vampire-kitten.livejournal.com]

Well yes, but I would ahve had to be pregnant for over a year. Lie I might, secretly be an elephant less likely.

[vampire-kitten.livejournal.com]

Also not so bothered by the accusation of lying. Doctors tend to do that as a matter of habit.

It was the ignoring what was wrong the moment the most obvious theorum didn't fit.

Similar to when I was talking to a doctor last year about sleeping 20+ hours a day. Everyday. Basically he said, oh dear, there is nothing I can prescribe for that. Umm, go away?

[alakaholic.livejournal.com]

Hey, I thought I'd put my two cents in as I work at a general practice and have to deal with this kind of stuff on a daily basis.

Basically there's this thing called QOF (Quality Outcomes Framework) which is a points-reward system relating to disease management. It's divided into several registers, many major like coronary heart disease, stroke, diabetes, epilepsy, and some minor, like smoking and obesity. These divisions then have subdivisions, e.g. the Atrial Fibrillation register has three:
-the practice can provide a register of patients with AF
-the % of patients with AF diagnosed after 1 April 2006 with ECG or specialist diagnosis
-the % of patients with AF who are currently treated with anti-coagulation drug therapy or anti-platelet therapy

The Obesity register only has one:
-the practice can produce a register of patients aged 16 or over with a BMI greater than or equal to 30 in the last 15 months

So as part of QOF, all practices have to produce a register of patients with BMI of 30 or over. It's not meant to be judgemental I think it's just for monitoring purposes, because if you have high blood pressure or high cholesterol and things like that as a result/byproduct it's a risk factor for more serious conditions like heart disease and diabetes. So that probably explains why you've been tested in the past.

Hope that explains it a little bit more. Sorry to hear about the dismissiveness of that GP though. A lot of them, unfortunately, do seem to be very much shoo-you-out-of-the-door, and more focussed on fiddling the numbers to achieve their targets without actually paying attention to patient care.

[sebastienne.livejournal.com]

It's not meant to be judgemental. I think it's just for monitoring purposes, because if you have high blood pressure or high cholesterol and things like that as a result/byproduct it's a risk factor for more serious conditions like heart disease and diabetes.

Then why not have a "high blood pressure register" and a "high cholesterol register"? As you say, those things are much better indicators than BMI.

[alakaholic.livejournal.com]

If you have consistently high blood pressure you'll be put on an 'essential hypertension' register, and if you have consistently high cholesterol you may be put on a 'primary prevention of ischaemic heart disease' and given a statin. But until then, obesity goes together with smoking as one of those things that's good to know about as potential risk factors because of the link to heart disease/diabetes etc. Obviously, as someone else mentioned, there's probably a better way of doing it as someone could be clinically obese but otherwise fit and healthy, but then you get fit and healthy smokers too I guess. I dunno!

[sir-rosealot.livejournal.com]

When I used to work at a doctors' surgery, these registers (the one we were doing at the time was the smokers' one) were just used to submit data to the local NHS headquarters; they wanted to have smoking statistics for a certain percent of the patients so that they could tick it off on a box and give the practice some money for reaching the target. I suspect that this is the same sort of thing.

As for popping up on your record, the only times we used that function (as I know since I had the misfortune of being the person who programs them in for a while) was for people who were HIV positive, or who had arrived recently from countries with a high percentage of HIV infection but had not been tested yet, allergies to common drugs, possible confusion with patients with the same name so check D.O.B., etc. Things that would be important if the doctors missed them. I very much doubt that being on the obesity register would fall into this category.

[ex-leighwoos982.livejournal.com]

An obesity register sounds like something to respond to the perpetual media scare of the 2000s- Fat Kids. If Brown sanctions against the publicly reviled body type he can quite criticisms and appease party members. It all sounds pretty useless- why not invest in training people to take better care of their diet, or have GPs refer people to subsidised exercise classes? Because that would target root causes and superficial policy makers are terrified of tackling root causes because that would eventually deprive them of something to talk about.

Off on a tangent re media scares. Is the language used to describe underweight women more active- implying that self starvation is a form of misguided achievement while the language used to describe obesity imply that it is a state (of inertia) and worthy of condemnation?

[frodomorris.livejournal.com]

why does he need an additional reminder every time he opens your record.

Trying to play Freecell while someone in the same room is whining about their problems is hard enough, without having to look up from the screen at them too. When you're on such a low salary as £106k you expect to be cut some slack.

[deathbyshinies.livejournal.com]

Despite not having anything more intelligent to say than I did a few hours ago at pridehouse, I am going to add my voice to the chorus of general WTF-ery.

[foxjazz.livejournal.com]

At least your treatment for messed up hormones did not depend on you losing 5% of your body weight first *grin*

On the bright side, as soon as you've lost that, and are taking their little insulin regulating pills, they can then go back to dismissing everything that's wrong with you and wait a while longer.

Am I bitter? Goodness no, cos, see, if they'd retested my messed up hormones, once I'd gone through their "lets get thinner" routine twice (once just wasn't good enough apparently) they might have told me that I could, in fact, now get pregnant.

Am I bitter?

[foxjazz.livejournal.com]

incidentally, I sleep 17 hours a day, many days, and generally lack energy because...

i'm lazy

because...

i'm overweight

I've been instructed by the GP not to join a gym though. He was quite clear on that.

he ordered a full blood count (I used the fortnightly vampire meeting to tag on the other blood work that would test for sensible things, like a thyroid problem - hello, I'm overweight, let's be logical - and mono - cos, well, I'm just lucky like that.)

sometimes, GPs drive me more insane than I normally am.

I share your rant darling.

[pinkweasle.livejournal.com]

Let me take the opportunity to share my similar experience of the folks at number 19.

Me: My mum has polycystic ovarian syndrome. So have both my grandmothers. I was concieved through IVF, both parents and all 4 grandparents only children. I have the symptoms now myself: facial hair (thank you immac)unexplained weight gain around middle, mood swings, joint pain, irregular-to-non existant cycle...

GP: all of these symptoms could be a result of your weight. At 5'' 3 and 11.5 stone you are technically obese.

Me: I'm a size 10-12. *look* at me.

GP: types ?aggressive and in denial? into database.

Take no fucking notice.

second to that

[pinkweasle.livejournal.com]

I read the stuff above about national registers. Notably the HIV stuff. I have come to the conclusion that 19 B. Street is well up on these things. I had an HIV test there when I returned from Africa. In a 'field-hospital' in Botswana I had been unconscious and delirious with fever for several days, a complication of a bone infection in my broken arm. I was given injections while unconscious in a country where a high proportion of the population has AIDS, I did not see the needles unwrapped. I needed peace of mind.

Now I have anxiety issues before finals. No shit. Any time I have reason to discuss my mental health with these the Beaumont doctors, the first question is always:

How promiscuous are you?

Doesn't matter what I tell them. They don't believe me.

Take no fucking notice.

[singingpatient.livejournal.com]

it would be a great irony if you had lupus.
let's hope you don't! (because sometimes it *is* lupus!)
as much as you despise the obesity registry (an idea which should be reserved for felons, IMO), i despise this running joke of "it's never lupus," when I've gone into kidney failure, got fired, lost my hair, and suffered chronic pain from lupus for 16 years.

Re: I share your rant darling.

[singingpatient.livejournal.com]

this is the kind of thing that makes me want ot bring my own laptop to the appointment and type in "insensitive and asshole-ish."

[singingpatient.livejournal.com]

oh by the way i wrote a song called "the national a**hole directory"
this is where we should enter these doctors!
that would be hysterical.
GP: what are you typing?
me: oh just entering you into the national asshole database.

the song (listen free):
http://thefump.com/fump.php?id=1031