You seem the type of physician that most people seek out – someone who cares, someone who wants to fix things instead of assigning blame. But the observations I make will note the many MD & even RN behaviors toward patients, behaviors you likely find as appalling as I do.

As long as there are autoimmune diseases, congenital conditions, exposure to things that end up, years later, as being carcinogenic, even those who make “perfect” lifestyle choices will still need you to diagnose & treat them, & RNs to help them make sense of their diagnoses & learn coping mechanisms. They’ll need us to help them manage their conditions to optimize QOL.

That’s nobody’s fault, is it? It’s just a fact of life, a very unfortunate one, & one I hope someday will be resolved so that our services are unnecessary.

But I hate what I’ve come to call “Karma medicine,” the theory that somehow, even a patient whose health habits are perfectly in accordance with current medical knowledge will never become ill, & conversely, that anyone who gets sick has done something wrong, something about which they’re lying, & so they somehow deserve it. In this type of medical practice, every illness is somehow traceable to something the person did wrong – & if you get a doctor who follows an Eastern religion, even your thought patterns are suspect-positive thinking will cure everything, so if you’re sick, you’re not thinking positively & your illness is your own fault. Yes, mindset is important – I was determined that I wouldn’t cave in to the illness at all, if possible; & if I did cave in, it would be after the best fight I could muster. I wouldn’t have lasted as long as I did had I not tried to eat right, exercise, get enough rest & recreation, & kept positive thoughts (in my case, focusing on my faith in God).

As for things on which illness is blamed, only obesity receives no compassion. Patients following rigid strict diet & exercise programs have the same problem as those who cave in to weight loss surgery – they usually lose 60-80% of their excess weight, meaning they’re still (at a 20-40% over ideal body weight size) considered obese. Any weight that won’t come off past that is obviously because the patient is lying about how much he/she eats or how much they exercise; no one is willing to admit that diet & exercise as a sole method is an epic failure. Gastric hormones, DNA, possible viral triggers, get little if any research attention beyond their discovery. All the “before & after” pictures on diets & in weight loss surgery brochures feature people who were able to lose more than 80% of the excess blubber – along with, in fine print, the disclaimer, “Results not typical. Your results may vary.” In other words, don’t count on losing all your excess weight. Yet, even with all that medical evidence, obese people who diet & lose even 80% of their excess weight are obese, & reminded constantly of that fact. If they have an illness that strikes people of all ages & sizes, only they would have avoided it if they hadn’t been fat. It’s so ridiculous! I see those stats that doctors don’t counsel their patients on weight loss – what a laugh! They do little else in my experience; fat people aren’t considered attractive, while other substance abusers are generally normal sized to very thin. Doctors therefore rush evaluation & hand out the 1000 calorie diet sheets & a list of exercise programs, even for severe bronchitis, to fat people, while they are attentive to substance abusers & do detailed assesments & actually treat the person’s illness – along with their substance abuse problem.

So, why again are substance abusers given compassion for their rehab,when they never have to touch their drug of choice again to live, but fat people, many of whom are food addicts, are expected to take in just a little of the substance of abuse & no more? And succeed?

And, why is most weight loss “research” simply some reiteration of “diet & exercise” & “bariatric surgery”? It’s rare to see much research into gastric hormones. With respect & compassion to those afflicted by AIDS, it receives the lion’s share of research funding. The fact remains it’s the most preventable disease on the planet, acquired by risky behaviors. Yet, at the expense of research into oncology, cardiology, congenital illnesses (Cystic Fibrosis, Lou Gehrig’s Disease, etc.), musculoskeletal, & neurologic diseases get the dregs & must rely on private donors to finance more research? AIDS breakthroughs have done some good for other illnesses, but not enough to justify the volume of resources we put on it.

And it’s funny, isn’t it, that AIDS patients continue to have unprotected sex & don’t disclose their condition to their current partner when they have casual sex, but are not considered to be attempting murder (& with multiple partners, serial killing) for their own pleasure. Also, isn’t it funny how we tell people condoms will protect them from AIDs & STDs (many of which are multi-drug resistant) when condoms are only 85% effective in preventing pregnancy. Viruses & bacteria are much smaller than sperm. And while we believe we can train kids to say no to drugs, somehow we don’t think we can train them to say no to sex outside marriage – despite the fact it’s the safest way to live, & despite the fact that we have a desperate need for volunteers. Hasn’t it ever struck someone besides me that the decrease in volunteer workers coincided with the idea that sex urges are not controllable? That excess sexual energy was channeled to do some good for society back when people were expected to keep their clothes on.

Plus, doctors throughout history, when confronted by baffling symptoms (especially in female & often minority patients), have made pronouncements that diseases are “imaginary.” Currently, fibromyalgia & ME/CFS, both of which cause severe, widespread pain & fatigue (much of the fatigue likely being exhaustion from dealing with the pain), are considered “imaginary” by physicians. How much drug & alcohol abuse is an attempt to get relief from legitimate pain when treatment has been refused for an “imaginary” illness? Do your readers know, & do you & your colleagues admit that, less than a century ago, sickle cell anemia was considered “lazy” African-Americans looking to get out of work, not sick people in desperate pain? Or that, until the WWII era, Multiple Sclerosis (which hits females in a highly disproportionate rate) was called “hysterical paralysis,” & like today’s fibro & ME/CFS patients, psychiatric counseling was considered the only cure? And yet, this type of behavior continues with every disease for which all tests come back normal & which the medical establishment can’t figure out. Instead of figuring it might be something new that requires new research methods, new diagnostic tests, & treatment of the symptoms.

I’ve seen poor minority patients receive substandard care – I empathize because, like the poor, the obese & those with mysterious illnesses all too often receive substandard care that lacks a shred of compassion & spreads a lot of blame.

And, if you’re like me, that saddens you, because people are going to do stupid things. And it bothers you that it’s OK to have unprotected sex when you have AIDS, genital herpes, or hepatitis, but it’s not OK to have smoked at any point in your life, even if you haven’t touched tobacco in decades. It’s OK to participate in extreme sports without regard for, & preparations to deal with, unsafe conditions; it’s OK to go into restricted areas to perform your extreme sports; but if you’ve ever been fat (even if you’re one of the lucky ones for whom diet & exercise worked), it’s your own fault you’re sick (if you’re really sick at all).

How about we change what we can – how we perceive our patients, the diseases we come across, their size, bad habits (past & present), their hobbies – & focus on changing the worst disease out there: judgmentalism -> poor care for all but the physically attractive.

perhaps i see things on the plate that you don’t, dr. charles. things like:

well baby checks, camp and sports physicals, pain made manageable, blood sugars under control, fears addressed, cancer screened, cardiac rehab, bones stronger after the break…