Owning It

Nov 03, 2015

The examination rooms at the healthcare center are unusually large. At least these rooms on the outside wall are.

The healthcare center seems like an old office building from the late 50s or early 60s, and the floor plan reinforces this impression. There are exam rooms on the outside wall and most of them are much larger than what what one would design for a medical office. I am sitting in a room on the northeast corner of the floor, and it is the size of what a proud middle manager would tell his wife is his new corner office. There’s at least six feet of empty space between the examination table and the door. There’s a small cabinet with a sink, a desktop computer, and a sanitary disposal bin 5 feet away in the other direction. It looks out of place along the long, otherwise bare, wall.

On the inside walls are tiny rooms, closer in size to what you would expect. Maybe even a little smaller. These rooms have the same furniture, but he walls are almost completely concealed.

I wonder what those guys told their wives about the jerk that just got promoted and how proudly he carried his red stapler and TPS reports into his new corner office.

I sit in the huge exam room, and I know what’s coming.

I like my doctor. He has an easy-going manner while at the same time not being afraid to say what needs to be said. (Although how he decides what needs to be said is about to come into question.) He is, however, incredibly busy and I get the feeling that he doesn’t remember who I am, or at least what my story is, until after our consultations begin. It’s obvious that he is looking at my file during the session for the first time since our last session.

This isn’t his fault. This is medicine in the United States. We blow away the rest of the western world in every metric you can imagine — when it comes to dollars spent. But when it comes to actual quality? Not so much. I live in an area that boasts what’s purported to be some of the best medical care in the country. But every office I’ve been to in the past decade feels overbooked, oversubscribed, and impersonal. I hear constant fears that our care will become “rationed” like it is in Canada. It’s already rationed by demand and by private insurers.

The last doctor I had that gave something resembling personal service closed her practice and went into research 8 years ago. She told me she couldn’t handle dealing with insurance companies.

The surgeon that repaired my right hand stopped taking insurance altogether a few months after the last round of surgery. Fortunately for him he’s good enough to get away with it.

My doctor finally makes it into the exam room and we speak. He asks me how I feel.

“Like I need to lose weight and I need help.”

I’ve gained over 70 pounds in 2 1/2 years. Actually I gained it in less than 2, after rotator cuff surgery pulled me off of my bicycle commute and into a painful recovery that has not gone well. Last year the doctor had pointed out a large weight gain to me and things have only gotten worse since then.

We discuss seeing their onsite dietitian and he does the examination part of the examination.

Then we get to my blood test, I was in a few weeks earlier for a fasting blood test and other sundries. My fasting blood glucose is 189.

That’s high. That’s very high. That’s diabetes high.

I am completely unsurprised. I made the appointment suspecting it was the case.

I had been experiencing some of the symptoms (dry skin, swelling, tingling in extremities, etc.) but being aware of the perils of self-diagnosis I knew it was time to have a doctor take a look.

I also knew that walking into a doctor’s office saying “Doctor, I think I have –“ is at best bad etiquette.

But when I open the appointment with needing to lose weight I am acknowledging what I expected, while at the same time trying to distance myself from it, like “I’m not here with the fat guy, but I know he’s a problem.”

So I knew being diagnosed with diabetes was coming, and I needed the diagnosis to get here.

He writes a prescription for Metformin, for seeing a dietician, and for a standing desk. (I ask for that while he has the pad out.) He tells me to schedule a follow up for 3 months.

And he tells me nothing more. No explanation of what the medication was. No explanation of what the “A1C” test he did there on the spot was for. No directions other than “take this medication and lose some weight.”

It’s clear I am going to have to stop waiting for someone else to tell me what to do and own this.

It’s not like I don’t know what to do. I need to stop being fat and lazy. I need to stop whining about my sore shoulder (which isn’t going anywhere) and get to work on my health.

It’s easy to make fun of people for being overweight. It’s easy to blame them for being fat and humilate them for it. It’s also mean-spirited and intellectually lazy.

It’s easy to make fun of Chris Christie for being fat. Pointing out how and why he’s the worst governor we’ve had in recent memory takes a few minutes to make a case.

Bill Clinton was given to a bit of a paunch during his administration, and the lifestyle required of a President did nothing to help, I’m sure. Jay Leno repeatedly made cracks about Clinton stopping at McDonald’s (while omitting it was for coffee) during his morning runs and overlooking, of course that the President was actually doing something about his weight by running anywhere at all, while Leno lazily told the same tired jokes over and over again. (Jay Leno also stopped being funny about a week after he took over Tonight and only people that were 60 years old by 1992 missed him when he left 20 years too late.)

But this doesn’t mean that overweight people shouldn’t take responsibility for their condition.

Human culture is a large and disorganized collection of extremes. For every like there is an intense dislike. For every ideology there is an antithesis. So it’s natural that, while examining any debate, one finds a bunch of false dichotomies.

If you think we need to raise taxes, you love big government. If you like standardized tests, you hate education. If you think beating the crap out of criminals is wrong, you hate cops.

Obesity has become a problem in the United States (and most of the Western World) and it’s hardly a surprise that there are polarized debates about why it is happening and how to deal with it.

I feel that at least one thread of the “obesity debate” is too quick to absolve people of responsibility.

Yes, it’s easy to get inexpensive, low calorie, unhealthy food, and for many people that inexpensive food is the only option.

Sure, it’s easy to just not exercise, especially in our increasingly car-friendly and pedestrian-hostile society. (What’s the solution to an increasing number of road deaths due to overcrowding? Have computers drive for us. I mean what else is there to do? Walk? Ride a bike like those socialists in Europe? Are you kidding?!?!?)

But these, and other factors, don’t completely absolve everyone, least of all me, of responsibility.

This isn’t about blame. Sure I do happen to blame myself, but that’s my fault (get it?) and another story. Accepting (or assigning) responsibility is not the same as accepting (or assigning) blame.

Coincidentally Seth Godin actually published this the day I started writing this post.

Confusing the two is a mistake often made and a mistake that frequently stymies progress since no wants to engage in icky “blamestorming.” It’s easier to assume everyone did their best and march onward to the next circuit of the same mistakes.

I have type 2 diabetes and it is time for me to accept responsibility for the problem. And fix it.

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