Fire all the fat patients

Ida Davidson, of Shrewsbury, Mass., started seeing a new primary care doctor but on the second visit, she was told by Dr. Helen Carter that she needed to find another doctor. The reason? Davidson weighs 246 pounds, give or take the occasional fluctuation, and Dr. Carter’s policy is to turn away any new patient who weighs 200 pounds or more.

Discriminatory? Davidson certainly isn’t happy about it. “I have never heard anything so ridiculous in my life,” she told WCVB-TV of Boston last week.

Policies such as Dr. Carter’s might not be common but they’re not unheard of. When the Miami Sun Sentinel conducted a survey earlier this year among obstetrics-gynecology practices in South Florida, 15 of the 105 clinics that responded said they refuse to take new patients who weigh too much.

It seems to be completely legal. After all, there’s nothing that obligates physicians in private practice to see any and all patients who come through the door.

But as stories like these pop up from time to time, medical ethicists have expressed uneasiness over such policies. At the very least, it violates the spirit of the medical profession, some ob-gyns told the Sun Sentinel.

“No doctor should be unable to treat patients just because they are heavy” was the assessment of Dr. Bruce Zafran of Coral Springs, Fla.

Medical ethicist Dr. Arthur Caplan said doctors have a duty to provide care regardless of the patient’s health issues. “Simply saying ‘I’m not gonna take someone who’s obese,’ is, I think, not the way to approach the whole challenge of obesity, either for that person or for any American,” he told WCVB-TV.

Doctors who set weight limits for the patients whom they’ll accept into their practice say they have reasons for their policies. Some of the Florida ob-gyns told the Sun Sentinel that heavy female patients are more likely to have complications and are too much of a liability. According to news accounts, Dr. Carter decided to stop seeing patients like Davidson because three of her staff were injured while caring for obese patients. She also felt other facilities were better able to meet the needs of these patients.

Fair enough, but it makes one wonder where the line should be drawn. People who are aging or have higher-risk medical conditions also can be more prone to complications; should physicians stop seeing them? If it’s too much trouble for a medical practice to accommodate the special needs of overweight patients, should they also stop accommodating patients who are frail, who use crutches or wheelchairs, who don’t see well, who have low literacy or don’t speak English as their first language?

Although back injuries are a very real occupational risk for those who work in health care, proper training and equipment can go a long way toward making it safer to handle overweight or obese patients. And to simply dismiss overweight patients without first attempting to assess their willingness or ability to lose weight seems unfair (as well as an inaccurate generalization that these people couldn’t possibly have health issues or health-related goals other than their weight).

Sadly, numerous studies have documented that anti-fat bias is as prevalent among health care professionals as among the rest of the public. The typical medical school training also tends to be woefully short on education about nutrition and physical activity, with the result that many doctors are ill-equipped to effectively help their overweight patients.

So what – if any – should be the physician’s role in working with this population? A consensus report issued in May by the Institute of Medicine tackles this question and concludes that although policy and environment are significant areas that need to be addressed, doctors also play a key part in reducing and preventing obesity.

The report calls on doctors to be more systematic in assessing body mass index in their patients and talking to them about nutrition and physical activity. It recommends focusing on the patient’s overall health goals, not just weight loss, and providing advice and support to help patients meet their goals.

It doesn’t say anything about refusing to see these patients or delegating them to someone else’s responsibility.

Ethics aside, if doctors profess to be serious about reducing the incidence of American obesity, it’s hard to see how the “it’s not my problem” approach would meet this goal. An opportunity to forge a doctor-patient relationship with Ida Davidson and help her take care of her health was squandered here, and nothing positive was accomplished.

4 thoughts on “Fire all the fat patients

  1. Pingback: REALLY?? Can doctors do this?? - 3 Fat Chicks on a Diet Weight Loss Community 300+ Club

  2. ONe can understand the reasoning behind the physicians desicion regarding the example of Ida.
    Ida is accepted as a patient and is prescribed a diet plan and program to get her weight down for 246lbs to 225lbs in 5 months. Ida does well the first two months but has to have a hospital stay of two days because she was too rigid in her quest. Ida is re-educated by the hospital as to strict adherence to the guidelines of her prescribed diet program. She also revisits her physican who also re-educates her on the program she accepted as prescribed. Close to the end of the 5 months, Ida needs another two day hospital stay but is still 10lbs shy of her goal.
    Under the ACHA, the physician and the hospital have had the responsibilty of Ida losing weight under a prescribed plan treansferred to them rather than IDA having the responsibility. Yes, Ida is disappointed but the physician and the hospital will be penalized because Ida did not first follow the prescribed plan by the physician and then the re-education by both the physician and the hospital.
    Why did this happen?( sorry this is so long but will continue in next comment).

  3. Thank you for your patience.
    In the AHCA, a “value index” will be written by HHS which contain three areas called “quality of care metrics” which are mortality, morbidity, and readmission.
    The physican will receive reduced reimbursement as Ida failed to achieve her prescribed program as the physician continues to prvide services to Ida.
    The hospital will also be penalized by lower reimbursements because of the “value index” regarding the number of readmissions on this patient.
    Since we now have an increasing concern of patient of “early releases” due to comparing costs of stay with reimbursement, there would a growing concern on how serious is the concern for a readmission. My concern is – would our rural hospitals be able to survive such rules and regulations to stay open?

    One can see the concerns of physicians and of hospitals combined with the conflicts of the Hippocratic Oath and that of government rules and regulations.

  4. Apparently some doctors are doing so well financially that they can afford to turn away certain classes of patients, eh? Wow, this is just (almost) unbelieveable … but not shocking, given the aforementioned fat bias that people have. Ridiculous.

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