When medical humor is not funny

By Kristen Fuller, MD | Fact-checked by MDLinx staff

Published August 5, 2022

Key Takeaways

As a doctor, one of the most critical things I learned about humanity was the importance of referring to a patient by their name—not their diagnosis. A patient is a human being, and should never be described by their disorder. It took me some time to learn this.

When I was an intern, my coworkers and I would describe our patients on rounds as “the CHF-er” (for someone with congestive heart failure) or “the diabetic.” (Even typing this out makes me cringe.) One of our attendings strongly objected to his type of labeling. She'd make us rephrase our words in “people-first” language, that, according to the Office of Disability Rights, “puts the person before the disability, and describes what a person has, not who a person is”—for example, “individuals with disabilities.”

Today, I am beyond grateful that she stood up for her patients and cracked down on us. We can all learn from her example.

A common problem

Sadly, many healthcare professionals not only label their patients by their diagnosis but also shame them by speaking poorly of their mental disorders, obesity, or addiction to other physicians.

Humans are interesting, and some medical cases are fascinating, so it’s natural to talk about patients, their disorders, and their quirks to coworkers. But it’s a slippery slope when we begin to judge and shame them.

I know I’m not the only doctor who has made problematic assumptions about individuals with obesity or a substance use disorder. I’ve heard many physicians rudely comment on a patient's body shape, size, social situation, and substance use, among other things. Hopefully, we can look back on these biases, feel remorse for the ignorance of our words and actions, and learn to be better for our patients.

Why ‘fat-shaming’ is harmful

In a 2022 op-ed piece published in Scientific American, medical student Ashley Andreou discussed fat-shaming patients and how it can impact their experience with healthcare professionals.^[]

“As she drifted off into a state of sedation, medical staff in the room could not stop talking about her BMI,” Andreou recalled. “People took turns gawking at the gaping hole in the patient's abdomen.”

“As the surgery ended, I couldn't stop thinking about the obvious yet ironic connection between the weight comments from the healthcare team and the patient’s reluctance before getting the surgery,” she continued.

"Why would anyone want to interact with a medical system that looked at them in such a derogatory way?"

— Ashley Andreou

Research provides some answers. In a recent study, 24% of physicians said they were uncomfortable having friends in larger bodies, and 18% admitted they felt disgusted when treating a patient with a high BMI.^[]

A 2016 study published in Clinical Diabetes asserted that physicians and other healthcare professionals have consistently demonstrated weight bias in recent decades.^[] This has become so problematic that patients have launched a campaign requesting they be weighed only when necessary—not at every appointment.

(For the record, I ask not to be weighed at doctors' appointments, and I am often criticized for this request.)

A threat to patients’ well-being

Patients should be able to trust us. Unfortunately, very few training programs actively train clinicians to avoid the cognitive bias of fat shaming, labeling, and stigmatizing patients.

"Our bias is not only disrespectful to our patients, but threatens their overall health—especially those new to the healthcare system."

— Kristen Fuller, MD

As a result, these patients may stop coming to us for help.

Frequently held stigmatizations about people with obesity are falsely associated with the idea that these individuals are lazy, noncompliant, or lack self-control. When these views come from trained medical professionals, they can cause tremendous damage to patients.

Obesity, addiction, diabetes, and other chronic diseases are complex and are often fueled by underlying triggers that are out of the patient's control. These triggers can include genetics, environment, and hormones.

Adopting new terms

"What we say matters."

— Kristen Fuller, MD

Let's not use disparaging language about conditions that are already stigmatized in US society.

In 2017, the American Medical Association took a firm stance on promoting people-first language for obesity, replacing derogatory terms such as “fat,” “obese,” or “morbidly obese” with terms like “individual with an unhealthy weight.”

The same goes for stigmatizing language associated with addiction. Instead of calling someone an “addict,” “drug user,” or “alcoholic,” we should call them “a patient with a substance use disorder.” Otherwise, we risk reducing a person to their condition.

Stigmatization in medical programs

Medical schools and residency programs should educate prospective physicians about how to avoid stigmatizing language in medicine.^[] Ignorance fuels bias, and unfortunately, many new physicians are ignorant regarding chronic conditions such as obesity, addiction, mental health disorders, and eating disorders.^[]

"We need to stop blaming our patients for their conditions."

— Kristen Fuller, MD

Physicians must comprehend that addiction and obesity are diseases. To understand their pathophysiology, social determinants, and appropriate treatment options, we need to know how to counsel patients without shaming them.