Wednesday, 28 July 2010

Insulting patients improves health, minister suggests

So, the BBC is reporting (with stock photo of "headless fatty", of course) that Anne Milton MP (Conservative, Guildford), the Parliamentary Under Secretary of State for Public Health, is suggesting that the NHS should use the term "fat" rather than "obese".

The article has the typical "opposing" views of "It's a harsher term, which is better" and "It can be considered offensive, which is hardly productive for doctor-patient relationships". A third view of "I consider it a neutral description of what I am, and would much prefer to be called fat than the negative overweight or obese." doesn't get a look into the article.

I'd had some hopes that the new government was going to drop some of the previous government's panic about the "obesity crisis". Sadly not (while the Minister was speaking in a personal capacity, her opinions presumably indicate something about how she thinks her department should be run). She talks about "personal responsibility", which completely ignores the social and especially class-based issues regarding access to good food or exercise, and the genetic diversity of body shapes.

As is usual for assumptions that are embedded so deep into the majority culture that they can barely be spotted, this makes absolutely no sense with even cursory thought. The Minister's contention is that people will take more "personal responsibility" for their weight if they are told about it in terms they find insulting.

Let's falsely assume that:

  • All patients will in fact find "fat" more insulting than "overweight" and "obese".
  • There is a general health benefit to be gained from weight loss. While some health conditions are more common in heavier people some are more common in lighter people, and the overall effect on life expectancy is basically zero. Some people might benefit from losing weight. Other people of the same weight might not.
  • There is a way to cause long-term weight loss that doesn't have side effects worse than the health benefits of weight loss to this person. In other words, there's a "personal responsibility" that people can usefully take in the first place.

Even with those assumptions the idea that intentionally insulting your patients makes it more likely that they will follow your advice (as opposed to avoiding doctors entirely, or for those with sufficient privilege and luck finding a doctor who was awake in the "bedside manner" classes) is absurd.

Doctors have been advised to call their mountain-climbing patients 'sky-heads' to try to encourage them to avoid the hobby.

Patients will find "sky head" more insulting than "mountain climber". Even though they've never heard the term before because I just made it up. Mountain climbing generally increases health risks, and most people can easily choose not to do it. Nevertheless, no-one's going to suggest this approach.

Even for other cases where slurs previously existed related to a medical condition (plenty of disablist slurs to choose from here) or health-risk-increasing activity (lots of insulting terms for people addicted to drugs, for instance) it's not usual for ministers to hold up doctors who use them to their patients' faces as examples of best practice, as if there's some sort of debate to be had over whether it's a good idea.

(Ministers have other more socially acceptable ways to harm disabled people, drug users, and so on, which they'll use instead)

Yet another demonstration of how not only the "fat as super-dangerous" narrative is embedded, but also how the "fat-shaming is good" narrative is embedded.