Are We Really Responsible For Health?
Rooting Out Blame In Helathcare
12th March 2025, Dr Asher Larmie
Last month, we explored how health is not something we can fully control. This month, I want to take that discussion a step further: if we can’t control our health, then we can’t be held responsible for health outcomes, and therefore, we cannot be blamed for them.
The question of whether we’re truly responsible for health is central to how our medical system operates. This may seem simple in theory, yet it remains such a struggle for many healthcare professionals to accept. Whether you’re a healthcare provider yourself or someone who isn’t receiving the care you deserve because you’re being blamed instead of cared for, understanding who is responsible for health matters deeply.
The Weaponization of Blame: Who Is Responsible For Health?
When we lack control over our health, that vulnerability gets weaponized through blame. Society tells us we are responsible for health outcomes, which creates a perfect environment for self-blame and medical gaslighting. When we’re diagnosed with a medical condition, especially one associated with weight, most of us immediately blame ourselves. We blame ourselves because others blame us, because we’ve been told that being responsible for health is somehow entirely within our personal control.
This self-blame appears in thoughts like:
- “If only I had done this, I wouldn’t have gotten sick”
- “This wouldn’t have happened if I had better self-control”
- “If I hadn’t eaten so much…”
- “If I had gotten off the couch more often…”
And of course, doctors are excellent at reinforcing this blame. They warn us in advance: “If you don’t lose weight, you’re going to get diabetes.” Then when you get diabetes, you inevitably blame yourself.
I know this first-hand because it happened to me. I was made to feel entirely responsible for health conditions that were largely outside my control.
Why No One Is Fully Responsible For Health
In my last blog post, I argued that being held responsible for health makes about as much sense as being blamed for the weather. You can check the forecast and come prepared with an umbrella, but you can’t stop it from raining. Similarly, you can’t stop yourself from getting sick. The idea that we are individually responsible for health ignores this fundamental reality.
One thing we must understand about illness is that there’s never a single cause. That’s far too simplistic. Even with something seemingly straightforward like viral meningitis, not everyone who comes into contact with the virus will develop the condition. It’s always more complex than we like to think.
With chronic illnesses, there are always multiple causes. More often than not, we never get to the bottom of it. Patients frequently ask me, “Why did this happen to me?” They’re still under the illusion that if they do certain things and avoid others, they won’t get sick. But it doesn’t work that way.
What we do know is that health is influenced by:
- Genetic predispositions
- Environmental exposures (especially at younger ages)
- Epigenetics and transgenerational epigenetics
- Hormones
- Stress levels
- Mental health
- History of trauma
- Timing and chance
The Story of My Great-Grandmother
My great-grandmother survived a genocide, smoked every day of her life, didn’t speak a word of English (though she lived in England for over years), was fat, and was born in 19th century Beirut. With all these factors that “should” have made her unhealthy, that woman lived to be almost 90 and was always in good health.
She didn’t have problems with her liver or lungs despite smoking daily and drinking a tumbler of whiskey every night. She didn’t suffer from joint pain and was crocheting right up until the last few weeks of her life.
Sometimes it’s just good genetics. More often than not, there’s an element of timing and chance. Some people are lucky, some aren’t. That’s just how it is. I know we don’t like to think of health as random – we prefer to think of it as something concrete that we can control. But it’s not.
How My Frozen Shoulder Changed My Perspective
I currently have a condition called Frozen Shoulder – just one of those really awful, bad-luck things that people get. One of the worst things about having frozen shoulder is how difficult it makes pulling up your pants after using the toilet. It hurts, I can’t lie on one side, and I can’t do certain movements and exercises I used to do. I haven’t had a good nights sleep for months.
When I got it, I immediately wanted to know: Why did this happen? What did I do wrong? How could I have prevented it?I knew frozen shoulder is more common in females between 40 and 60 who are diabetic. So of course, I thought, “If I hadn’t been diabetic, this wouldn’t have happened – it’s all my fault.”
I blamed myself. Every time I felt that horrible pain, I thought, “It’s my fault.” Every time I had to ask my partner to help me pull my pants up, cut my food, or turn off a light switch, I felt deeply ashamed and responsible. I thought, “If only I hadn’t been diabetic this wouldn’t have happened. And if only I had taken better care of myself, I wouldn’t have been diabetic in the first place.”
Of course, that’s not true. But self blame is a common coping mechanism for people who have experienced a lot of medical trauma, and that negative inner critic is reinforced repeatedly by the medical profession.
One day, I realised that the blame and shame was way worse than the actual pain. I decided I was tired of letting my inner critic rob me of my joy and peace. I’d like to tell you that it all worked out and I lived happily ever after. But life is not a fairy tale, and the reality is that I continue to grapple with these thoughts on a regular basis. But it gets easier with every month that passes. There’s hope yet!
The Hidden Cost of Making Patients Responsible For Health
When healthcare professionals make patients solely responsible for health outcomes we cause a tremendous amount of damage. Blame carries costs we can’t easily calculate, unlike how we calculate the supposed “cost of obesity” to the NHS. it’s a lot harder to quantify, but let’s consider the multiple ways blaming patients costs us as a society:
1. Emotional Impact
Some might say, “Who cares about emotions?” But we should. It’s practically written into our contracts as healthcare providers that we should care about our patients’ emotions. We shouldn’t be responsible for causing shame, guilt, or diminished self-worth in the people who look to us for help and relief.
2. Behavioral Consequences
When we blame patients, they stop trusting us. They avoid seeking care: “I don’t want to bother my doctor. They’re just going to say it’s my fault.” This delays treatment and puts lives at risk. There is no place for blame within the consulting room.
3. Social Effects
When people blame themselves for their conditions, they withdraw and isolate themselves. They conceal their symptoms because they think it’s their fault. If you don’t blame yourself, you might tell others about your condition. But if you think it’s your fault, you keep it secret – which is dangerous. Concealing symptoms and avoiding healthcare puts lives at risk.
4. Physiological Impact
When you blame someone for their condition, you become a threat to their wellbeing, and their stress response is activated. Congratulations – you’ve just created an environment of long-term chronic stress, which impacts healing, immunity, and increases long-term risk of heart problems, cancer, and other conditions.
Why would you want your patients to be stressed about their illness? They’re already struggling. Adding blame, shame, and guilt makes everything worse and actually prevents healing.
A Simple Reframe: Who's Really Responsible For Health?
What if we turn things around? Instead of making patients responsible for health outcomes, what if we consider how the healthcare system might be failing them? What if we acknowledge that being responsible for health is a shared obligation between systems, providers, and patients?
What would happen if I asked myself: “Am I delivering the care and support that my patient needs?” rather than blaming my patient for being there in the first place?
It’s a small shift, but a significant one.
During my training, I absorbed an arrogance from senior doctors who behaved like gods. They knew everything, treated patients as nuisances, and showed little compassion. The attitude rubbed off on me: “If only you had done this or hadn’t done that, you would have made my life easier.”
The more stressed and overwhelmed we are as healthcare providers (and we are overwhelmed, of that I have no doubt), the more defensive and blame-oriented we become. But what if we reframe each patient encounter with questions like:
- Is there any way I might be letting you down?
- Am I failing you in some way?
- Am I delivering the care you deserve?
- Am I spending enough time with you?
- Have I done a good job taking your history?
- Have I examined you properly today?
- Are there tests I should be offering?
- What do you actually need from me?
A Minor Shift In Attitude Goes A Long Way
In my current practice, I ask questions like:
- “What do you want to get out of this consultation?”
- “What are you hoping for today?”
- “What do you feel you need?”
- “What do you think is going on?”
- “What do you think is causing your symptoms?”
- “What are you worried about?”
Here’s one thing I can promise you. When you start asking questions like these, the answers come quickly, and your job becomes much easier.
Who Gets Blamed vs. Who Gets Care?
Socioeconomic privileges shield some people from blame. I experience this regularly – I’m not made to feel as ashamed of my medical conditions as someone else might be because I have “doctor” before my name. When people see me in the street, they treat me one way; when they find out I’m a doctor, they treat me differently.
But it goes beyond socioeconomic privilege. Who gets blamed versus who gets treated with empathy depends largely on appearance. It’s about body hierarchies. If you look a certain way, you’ll get more respect, empathy, and care from your doctor. If you look another way, you’re more likely to be blamed.
That’s not okay. How you look shouldn’t impact healthcare this way.
There’s very little evidence that our individual choices significantly impact whether we develop a condition, how we manage it, or whether we develop complications. Yes, personal choice may affect outcomes slightly, but it’s a very small factor compared to those outside our control.
In our minds, health feels 95% under our control, when it’s probably closer to 5%. Rather than berating people for not managing the 5%, maybe we should focus on the other 95%. This completely changes who we consider responsible for health – shifting from blaming individuals to examining systems, environment, and access to care.
For Those Being Treated Unfairly
If you’re experiencing discrimination and stigma in healthcare, here’s what you can do when your doctor tried to hold you responsible for health outcomes or blames you for your condition:
- Recognize when you’re being blamed and don’t second-guess yourself. If you feel blamed, you probably are – even if it’s through non-verbal communication.
- Call it out directly: “You’re making me feel like this is my fault. Did you intend to do that? Are you trying to make me feel guilty?”
- Redirect the conversation: “Talking about whether it’s my fault is not at all helpful. Can we discuss treatment options instead?”
- Bring an advocate who can speak up when you can’t: “It feels like there’s a lot of blame happening here. I don’t think that’s helpful.”
- Find a provider who won’t blame you (though I recognize there aren’t many of us, and there are a lot of you).
I have a free script available to help navigate these conversations. It includes phrases like: “In the past, doctors have made me feel like I’m to blame, and that has impacted my ability to communicate and led me to avoid healthcare.” Stating this at the beginning of the consultation makes it harder for a doctor to spend the next ten minutes blaming you.
Other useful phrases include:
- “I’m looking for solutions that work with my circumstances”
- “I don’t want an explanation of why I’m ill; I want solutions not blame.”
- “This is what I’m looking for, and this is what I’m not looking for”
In Conclusion
Can we please stop blaming people for their symptoms? Illness is not a personal failure. The notion that individuals are fully responsible for health outcomes is scientifically unsound. Health just is what it is – complex, multifactorial, and often outside our control.
The question of who is responsible for health requires a complete reframe. Rather than placing the burden solely on individuals, we need to recognize the role of healthcare systems, genetic factors, environmental influences, and socioeconomic conditions. Being responsible for health is a collective endeavor, not an individual burden.
This post was adapted from Episode 10, Season 5 of the Fat Doctor podcast. You can listen to it wherever you stream your podcasts or watch it on YouTube.
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