Physical examination ‘a violation’
Holly (not her real name) had been seeking answers for seven years for her chronic pain when her GP referred her to the rheumatologist (who RNZ is not naming).
She said what followed was months of insults and constant pressure from the medical professional when her treatment was not achieving the results she claims he promised.
It began with their first appointment.
Holly had been told to wear appropriate clothes - she wore gym shorts and a top. On her medical file, there was a note she had a patch of dermatitis on her chest.
“It was immediately like, ‘Take the clothes off. I need you to take the shirt off so I can see the area’. And then it was immediately, ‘Take your bra off and then take your pants off’,” Holly said.
She said it felt rushed, and he had examined her quite forcefully between her buttocks and under her breasts, which felt like “a violation”.
Holly received bruises from the examination, and said she faced similar treatment in each of the four consultations they had.
“[He would] make me stand there and physically, like: ‘Lift your breasts, move them this way, move them that way, lean forward, lean back’.”
Holly was diagnosed with psoriatic arthritis and, despite feeling violated, she cried hopeful tears that day, thinking she finally had answers.
“I wasn’t expecting a diagnosis on the spot. And he kind of gave me the sense of like - if you stick with me, we’ll get you fixed.”
‘He’d say things like, ‘Does your husband want a fat wife?’
Holly was told to begin a diet of highly-fermented food, but three months later she was not feeling better so was prescribed a new medication. But then she started getting side-effects - chest pains, hair loss, nausea.
When the drugs failed, this was when the doctor’s pressure on Holly to cut calories and change her diet really ramped up, she said.
Weight loss has been shown to improve psoriasis and chronic pain conditions in some cases.
However, later medical testing from a different rheumatologist confirmed she never had psoriatic arthritis.
Meanwhile, Holly booked another appointment with the doctor - this time at a different location, and said she was told by him not to bring a support person because of Covid-19 restrictions.
In order to reduce her pain, Holly was told to begin a keto diet, significantly cut her calorie intake, and do daily cardio.
“He was certainly more harsh with his words this time,” Holly said.
“He’d say things like, ‘Does your fiancé want a fat wife? Does he want a wife in a wheelchair? Does he know he’s signing up to be your carer?’” Holly said.
“I [...] had to stop and actually be thinking to myself, ‘Should I even be getting married if I’m putting my husband through this kind of horror?’”
Three months in, Holly was feeling miserable - losing weight, feeling nauseous and tired.
“I was basically drinking water to stay full,” she said.
She sent the rheumatologist her weight each week - and her calorie intake was slashed again.
Holly said the doctor told her she was “obviously lying” about following his diet plans, so she gave him access to her food and exercise app to prove she was following it.
The rheumatologist said he believed she was prediabetic.
“He said he was really concerned for me and my weight, and I’m thinking, ‘Oh my God, this is really serious, I need to get this under control’,” Holly said.
She booked an appointment with a dietician to help her manage the strict regime.
The dietician told her, at minimum, she should be eating twice as many calories as she currently was to stay at her basal metabolic rate - the minimum calorie intake level needed for the body to execute its basic functions.
Holly said testing also confirmed she was not in prediabetic territory.
The dietician offered to provide a letter to the rheumatologist explaining why Holly’s calorie intake should go up, but Holly instead told the rheumatologist herself and said the suggestion made him angry.
“He said, ‘Look at yourself, you’re not going to starve’,” Holly said.
Holly claims after this he suggested reducing her calorie intake further, to what’s often called ‘The Fast 800′ - an extreme and controversial from of dieting.
A number of times over the course of these months, Holly says the rheumatologist would suggest she take a break from all her medications, including those unrelated to treatment under his care - something which deeply terrified her.
Holly started feeling suicidal when she thought of how life might be without her pain medication.
“I was thinking, ‘If this is what life is meant to be like when I’m on treatment, then maybe I shouldn’t be alive’.”
Things reached a breaking point when she threw up and fainted at her gym and was asked by staff to pause her membership.
Holly said her husband intervened and helped her make the decision to leave the rheumatologist’s care.
Shortly afterwards, in December last year, Holly lodged a formal complaint to the Health and Disability Commission (HDC).
‘It’s professional suicide to call patients fat; I’m not so silly.’
The rheumatologist, claiming that Holly’s complaint to the HDC had been dismissed, said he believed she was running a “concerted campaign” against him.
HDC confirmed that the complaint was still in process, almost one year after Holly submitted it.
The rheumatologist denied groping Holly.
“The examination is where I ask patients to lift up the lower edge of the bra so I can inspect the area under the breasts for psoriasis.
“For obvious reasons, I don’t handle the breasts myself, same for the buttocks. This is part of best practice,” he told RNZ in a statement.
The rheumatologist also denies making harmful comments to Holly about her weight.
“It’s professional suicide to call patients fat; I’m not so silly,” he said.
The rheumatologist said he has never declined someone bringing a support person unless they refused to wear a mask, but Holly disputes this.
He again disputed the dietician’s recommendation for Holly’s diet, saying their plan was “hardly going to make anyone lose weight”.
“The request to lose weight was as the young woman was becoming diabetic,” he said.
The rheumatologist did not respond to RNZ’s follow-up requests for comment.
Weight shaming an issue in society
Rheumatologist Association president Dr Vicki Quincey said some of the rheumatologist’s practices were standard, including repeated physical examinations.
“Patients commonly ask their rheumatologist about diet and weight loss. If this is an important factor, it is not unusual to be referred to a dietician for specific advice.”
Helen Gibbs, a dietician with over 25 years of experience, said she was appalled but, unfortunately, not surprised by Holly’s story.
She said Holly’s low calorie level and fainting episode were clear signs she was being starved of nutrients she needed at the time.
Aotearoa has an issue with weight shaming - a belief that’s rooted in thinking it was a choice.
“If weight management was as simple as eating less and being more active, we wouldn’t have an obesity crisis,” Gibbs said.
She said all medical staff should have regular nutrition education.
Arthritis New Zealand chief executive Philip Kearney said many doctors understood the need for sensitivity about weight loss.
“We do know that losing weight can be very difficult, and consumers need support and encouragement to help them in what can seem a daunting task.”
The organisation was not aware of many instances of harmful comments about patients’ weight made by medical professionals.
Holly has had to undergo therapy for her eating disorder and low self-esteem.
While she said she was still traumatised by what happened, she has felt the pressure release.
“The hilarity is, once I got out of his care, I’m now 18 kilos down and I’m going to be doing my first 10-kilometre run next month.”
- RNZ
