Doctor's diagnosis of patient: You're unemployed and fat

"When I got home, I was very upset about the way I was treated by him," the patient wrote in a private complaint to the board. Efforts to contact the patient were not successful.

Sunderhaus, who describes himself as a plain-spoken old German, escalated the conflict by later writing the patient to drive home his points using numbered paragraphs and signing it "sincerely." Then, he fired off opinionated missives to the board, which called him to Raleigh on Thursday for a closed-door meeting.

Sunderhaus' point — that doctors need to advise patients to lose weight, because obesity is not just a personal issue, it's a $147 billion public health crisis — may have gotten lost in the delivery.

The board, which licenses and disciplines doctors, has not decided whether to charge Sunderhaus over the patient's complaint. The worst that could happen is he'd lose his license.

Most problems arising from an insensitive comment are handled with a quiet tut-tut by the board — perhaps a recommendation that the practitioner take a refresher course in effective doctor-patient communication, said Jean Fisher Brinkley, the board’s spokeswoman.

Usually, doctors appreciate the confidentiality.

Sunderhaus, by contrast, stormed the beaches in defending his honor.

He wrote North Carolina Gov. Bev Perdue, referring the patient's "irresponsible orgasm" that resulted in children whose medical care is provided by Medicaid.

He fired off numerous letters to the medical board, noting that its rules make him nauseous and, among other things, that "the biggest hoax on mankind" is the Drug Enforcement Agency.

Sunderhaus notified McClatchy that he was about to be "screwed" by the medical board, admitting he told the patient that thick eyeglasses would not cause her to go blind, "but her thick thighs and diabetes would."

"I poked her thigh to emphasize that diabetes is the leading cause of blindness," he said Thursday. "People have got to accept criticism without getting their bowels in an uproar."

Sunderhaus, a trim man who appeared before the board wearing cargo pants and sporting a backpack, makes no apologies for his actions. He blew off a psychiatric test the board arranged and flouted protocol by talking about his case, which the board likes to keep secret.

At the end of a conversation with this reporter, Sunderhaus offered $20 for her efforts. She returned it, but not before he tucked it in her sweater.

After 30 years of practice, Sunderhaus said, he is prepared to take whatever discipline the board issues, even the loss of his license.