I’m a little late to the discussion, but I wanted to make sure I gave this topic the thought it deserved. Two weeks back, I - like many others - shotgunned House of Cards over the course of a couple days. I’d come down with some sort of ebola-esque virus, rendering me unable to do much outside of consuming massive quantities of over-the-counter medication and equally massive quantities of Netflix. Thus, in a perfect storm of “why the fuck not” I decided to devote what little energy I had to seeing whether House of Cards was really all Netflix professed it to be.
Here’s the short answer: Yes, House of Cards may well be the most important and influential piece of content this year - but for many reasons that I hadn’t predicted. While it’s very existence was enough to make it interesting from a business perspective, there were certain aspects of its execution that really pushed it beyond curiosity and into importance. No, I’m not talking about the oft-cited breaking of the fourth wall (which you either buy into early or spent the remaining 12 hours or so hating everything about) but rather, certain other aspects of the final product turned out to be significant game-changers for both the creative and business models of television as a whole - and the implications are staggering.
I had a patient this past weekend who was, by any definition, a Big Girl. Several inches over six feet, broad and strong in proportion to her height, and well over 300 pounds. She’d had a crazy-ass, rare clot in a weird place that had landed her with us. She also had a relative who, while well-meaning, was a royal pain in the patookus in regards to her weight. The relative, incidentally, was also tall, but very, very slender. And had an obsession: her relative’s—my patient’s—weight.
So I’m in the room, talking to the patient about her Cray-Cray Clot, and the relative starts in about the patient’s weight. “You need to tell her she’s fat,” the woman says, “and that she needs to lose weight.”
This is true. She is fat. She’s way the hell over what any rational person would consider a healthy weight.
Nonetheless, she had recently finished a half-marathon. She played tennis twice or three times a week, and led a water-aerobics class a couple times a week. Her mobility was not impaired. Her lipids and blood pressure were normal. Medically speaking, she had no problems at all save an extra hundred pounds.
So I turned to the patient. “Do you own a mirror?” I asked. “Yes” was the reply. “Do you know that you’re fat?” I asked. “Yes, of course” said the patient. “Are you aware of research that finds that extra weight can lead to health problems?” “Yes.”
“There. Done” I told her relative.
Which brings me to my first rule of dealing with fat people: Do not treat them as though they don’t know they’re fat.
As a fat person myself, I am constantly reminded that I’m fat. I can’t buy clothes from straight-size stores, I am always the largest person in any group picture, and there are some things I find uncomfortable to do because of my weight, like going down stairs. (Going up stairs is easier on the knees, and my aerobic capacity means I’m often outdistancing my skinny colleagues. Still…)
If you’re fat, you know it. Please give us fat folk the benefit of the assumption that we have brains.
Then the relative asked me straight out if the Cray-Cray Clot was due to the patient’s weight.
It wasn’t, and I told her so. It was due to the fact that the patient has a rare clotting disorder that hardly ever shows up in women.
In asking that question, Relative had fallen into the same trap that all the doctors who’d seen Patient had fallen into for months. Despite an unyielding headache and neurological changes, the docs who’d seen her hadn’t looked at her brain; instead, they’d blamed her weight for her symptoms. Doing so had led to a three-month delay in diagnosis, incalculable damage to her brain and spine, and a lot of pain.
This is Rule Two: Not everything that is wrong is due to excess weight. Do not be blind to the fact that there might actually be a problem that can’t be expressed in BMI. Back in the day, doctors blamed wandering uteri for everydamnthing that went wrong with their female patients. This is exactly the same thing: blaming the most obvious factor for all the trouble ever. Fat equals wandering uterus in today’s medicine. Do not blame fat: look for an underlying cause. Examine your patient’s general health and activity level. Dig deeper.