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.