Sizing you up

I like walking round the hospital with the Giant. He's so tall, it's like having your own bodyguard. Almost a one-man entourage. When I gave up rapping to concentrate on the medicine, I thought I'd left my "bling" lifestyle behind, so this is quite a treat.

Not everyone takes so well to his enormous height. A small Filipino nurse started screaming at him to "BACK AWAY, BACK AWAY NOW", startling everyone in the vicinity. Turned out she just had a bad neck and staring up at his face from a close distance was giving her serious pain.

In hospital, I think everyone's judged on their physical appearance. Patients judge doctors, doctors judge doctors, and doctors definitely judge patients. "You look better"; "this guy looks dehydrated", "that doctor's nervous". It's part of the clinical assessment.

Sizing someone up isn't always so straightforward. Take obese people. Aside from the negative social stereotype, it's more difficult to treat a patient who's overweight. It's harder to take blood, harder to get their wounds to heal, and much harder to interpret test results. We had a patient who had to be referred to a different hospital just because he was too big for our scanner. He literally couldn't have a CT scan because he'd break the machine. There was talk of sending him to the Imaging department at London Zoo: a serious suggestion, because it's been successful before.

It goes both ways: there's evidence that patients trust obese physicians less than thin ones. So while I'm wondering why you didn't stop eating Big Macs after your second heart attack, you might be wishing you had a junior doctor without a pot belly.

Maybe this isn't any different to a normal social encounter. People respond to the way you look and dress, and you expect that. But when it comes to health, size really does matter, and doctors need to be able to take a dispassionate look at an expanding waistline without the interference of a social stigma. I just hope that there's enough appetite there to take on the obesity epidemic.