More on calling a patient obese

14

Category : General, Medical Rants

Saw the physicians interviewed on TV today. He is obviously intelligent and well spoken. He described his 1 year of fighting this battle as a Big Brother scenario, and then as Kafkaesque.

I like the Kafka concept. He was “reported” for telling a patient the truth. If we cannot tell patients that they are obese – and that they should do something about it – then can we tell patients to stop smoking, or stop drinking – or what about crack cocaine?

This story continues to confuse me. I really cannot believe that it is a story. What is the board of medicine thinking? Who called the attorney general – and why did he not just laugh it off?

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Comments (14)

I have a lot of problems with this story. If we’re not honest with our patients (honest, not rude or offensive), then we’re doing them a disservice. But I have seen things like this happen before, though not as severe as causing legal action against the doctor.

I remember when I was a third-year med student on the labor floor. I was sent to a patient’s room to consent her for a Cesarean section (I won’t comment on the fact that having a med student provide consent is not appropriate, in my opinion). She was morbidly obese, and I mentioned that she should try to lose weight, as there are serious health consequences. That’s it. Probably not the most appropriate thing for a MSIII to say, but it was done with the best of intentions. Of course, the patient complained to the chief resident on L+D, and I caught all sorts of hell for it. At that time (the 80’s), I suspect no one wanted to raise the truth with patients because it hurt. I also suspect that obesity is a subject that offends many patients because they may be in denial or at least don’t want to confront the truth.

But isn’t our job as physicians to be truthful? Again, physicians should never be rude or demeaning to patients, and I’ve certainly seen my share of colleagues and teachers who violated this rule over and over. But what this physician in the press did was certainly appropriate conversation and does not merit condemnation, legal or otherwise.

I suspect this has more to do with *how* the message was delivered than the message itself. From what I’ve heard, it appears that the physician in question routinely used an “attention-getting” dialog with his obese patients, which many people apparently considered rude and inappropriate.

A colleague of mine had a similar problem. When an obese patient consulted him about her knee pain, he allegedly told her “Well, if I were as fat as you, my knees would hurt, too!” Ouch! True, yes…but appropriate? No.

There’s a right way and a wrong way to deliver the message. We certainly don’t want to ignore the medical implications of a patient’s obesity. However, there’s little to be gained from alienating patients in our effort to help.

Whats next? Are you censorable if you tell a patient they have a documented STD? Some patients get upset no matter what you tell them,or how.

Whats the standard of care in NH now? Do you say,Gee your BMI is 48,I think you might be a little overweight? If your not too upset maybe we can talk about it.

A consultant told me about a practice in califonia he was reviewing. They had stopped checking BP’s because they didn’t want to upset their patients. These idiots would fit right in with the new NH Dr Feelgood standard. Whatever happened to Live Free or die?

There are a few things that make it difficult to comprehend this story. The first is that we don’t really understand what the physician actually said to this patient. Is this a situation where the physician stated his concerns plainly and the patient simply hated the information she heard? It seems possible and if so, then the physician already went beyond the call of duty by sending a letter of apology to the patient (but then, I have to wonder, why apologize at all?). Or, was there something distinctly hurtful about the way in which the physician confronted the patient? The coverage of the Board of New Hampshire is that they feel the latter was the case, but we don’t really know what he said.

The other challenge is that while there is considerable scholarship and learning on how to constructively engage patients in discussion about their behavior, most students, residents and practicing physicians have absolutely no access to that learning. It’s not in the formal curriculum. Physicians do know that they are supposed to tell patients about risky behaviors, but they are never really equipped with the tools to calibrate how they perform that task. It’s a little like telling doctors about the importance of conducting a timely appendectomy but not fully reviewing the related issues of anesthesia and sterile technique. So, doctors say all kinds of things that sometimes help and sometimes hurt, and for the most part we’re not in a good position to know if there might have been a better way to do it.

At one time I participated in a retreat for future Chief Residents, where we trained them to engage resistant patients in a judicious and sensitive discussion about drug abuse. One of us would play the angry, cussing patient, and the teacher would play out how to engage productively. I don’t think there is a perfect way through these discussions, but there are ways we can do this more effectively.

yeah, what about those “live free or die” licensce plates.
Aren’t they made by prisoners?

Another case of political correctness gone overboard. For a patient to be traumatized for being told the truth, and calling Big Brother to punish her doctor for doing his duty, is chilling that should send shivers to the medical community. I’m puzzled at why the Board of Medicine is even involved here.

I know there are ways to discuss sensitive matters with patients, obesity being one of them, and unless the doctor insulted this patient in any derogatory manner, I see no need for him to apologize. Just hoping she won’t be consulting a trial lawyer soon.

Like I’ve previously said: If telling someone that they are overweight (or even IF we assume “fat” for that matter) is what now passes as unprofessional conduct warranting prosecution by local/state law enforcement:

(1) I have several attendings I should have been ratting out to law enforcement long ago; and,

(2) THIS PROFESSION HAS FAR BIGGER ISSUES THAN MALPRACTICE REFORM.

When my mom goes into the dr they always get mad at her because she smokes. It is a yucky habit which will likely kill her however it is one of the most addictive drugs known.

So, sure, tell her smoking will kill her and she should stop. Offer to help her find a way to quit smoking. However don’t be the jerk who said “Why should I bother treating your high blood pressure/degenerative disk disease/hypothyroidism when you are just going to be dead in ten years?” It really happened.

I have had a recent experience with a surgeon in a hospital close to my home, I went to him for a counseltaion for a possible thymectomy on recomendation from my neurologiest as I have myasthemia gravis, this doctor made comments to me about how I aloud myself to become so obses and that if I wasn’t so obses I would not have myasthenia gravis, when telling him my sysptoms one being horness his comment to me was you have no problem swolling food. Keeping in mind that I’m sitting there in his exame room with only a hospital gown on, with my husband being ridaculed by this doctor I left in tears and no offer of any help for myasthenia gravis, but told I should consider bareactric surgery, more was said but this will give you an idea of my view, and yes I.am obese but I was not there for weight loss consultation.

I read on another board – and I don’t know if it is true -that one of the things this doctor said was that she is likely to outlive her husband and that her prospects to find a new husband will not be good because most men will find her unattractive. Something like this. If this was indeed said, it doesn’t sound like a proper medical advice to me; it is way worse than telling her that she is going to die if she doesn’t loose weight. The latter may be a doctor’s professional opinion, but the former is completely inappropriate and unprofessional (unless the doctor is in the matchmaking business and comments on the market).

While I believe that involving Attorney General is way out of proportion, one cannot blame the woman for complaining, if this was what the doctor said.

The initial report I read on this story said that the complaint included information that the physician had said something along the lines of “you are probably going to outlive your husband and when you are single you will find that no men will be attracted to you because it’s a well known fact that men are not attracted to obese women”. This was listed as the reason the woman was so offended.

I don’t know if it is true as reported, but if so I don’t think this would be the most appropriate argument to make for weight loss. I do know that I don’t think it is actionable!

Obesity has hit epidemic proportions, and the morbidity therefrom is astronomical. Early in this field — yes, as early as 2nd year of medical school — we are counseled to find an effective technique to motivate individuals to lose weight, quit smoking, cut back on too much alcohol, etc…. I would wager that outliving your spouse and then trying to find another mate might be an effective strategy for some.

I don’t think I would have done/said what this physician did/said. I am NOT making judgments about the propriety of what was said because I obviously don’t know the complete story, but SHEESH!!! — tell the woman to get a life and just change doctors. Referring this matter to local law enforcement — from of all places the state medical board — is shocking beyond belief.

In the scales of life, I wonder which is worse: hurting someone’s feelings OR desperately trying to reduce their morbidity — which is VERY high. While the two are not necessarily mutually exclusive, … I mean, God forbid I insult someone in an effort to help them.

I’m fat. My husband is fat. It’s unhealthy. Fine.

The relationship between doctor and patient is economic. *You* may think you have some sort of metaphysical guardianship of my health. *I* think I’m paying an alleged professional to provide the service of telling me things I may not already know about my health—like a tumor or something, and to provide the service of treating the illnesses I complain of in the most effective way possible *regardless of the behavior I choose in my personal life*.

Why should Doctor X treat my high blood pressure if I’m just going to be dead in ten years because of my weight? Because that’s what I’m paying him for!

Priesthood is a sacred trust. Medicine is a profession.

If you aren’t going to alleviate my symptoms or treat my problem with the best technology available regardless of my behavior in my personal life, then show me the door and don’t charge me for the visit where you tell me so.

I’ll go find a business where the professional I hire will do his job instead of whining at the customer.

I know being fat is unhealthy. And when the pharmaceutical companies come up with a medical treatment that lets me stay slim with the same level of effort and personal discomfort slim people go through, I’ll lose weight. Fat people may lose weight eating the same amounts as skinny people, but restricting our intake to those amounts is much more unpleasant, every hour of every single day, week, and year we do it. It’s living in hell.

I know I’m fat. My husband knows he’s fat. You know what? I’m not going to live a living hell, and neither is he, just for the sake of not being fat—and don’t tell me that’s not what it takes because it *is*.

If you can’t do your job for a particular customer because our behavior offends you, then don’t take us as customers.

If you do choose to take me as a customer, don’t lie to me, just don’t waste my time nagging me about behavior I know damn well is unhealthy—just treat my ills as best you can working *around* my behavior in my personal life.

Professional: You need to lose sixty pounds in a responsible way. Your extra weight is causing or worsening [list of problems]. I want you exercising like so, I have a brochure on how to eat right. Please read it and, if you have any questions, ask. Now, about your cholesterol levels, here’s what we can do medically with the situation as it stands…. Your weight problem is at the level that bariatric surgery may help you. If you don’t follow this diet I can’t keep your blood sugar down and you could lose your eyesight or your limbs. If working together we can’t get fifty pounds off of you, you could have a heart attack at any time and fall over dead. If we can’t get fifty pounds off you, it could kill you within ten years no matter what else I can do for you. If you don’t think you can handle hearing about it today, I’d like you to schedule time with (me, specialist, whatever) for a weight loss consultation.

Unprofessional: You’re fat. If you don’t lose weight you’re going to die. If I was as fat as you I’d my knees would hurt, too. Why should I treat your cholesterol with pills when you won’t take off the weight? What you need isn’t this ingrown toenail fixed, you need bariatric surgery.

If I wanted to pay money to be insulted and punished, I’d hire a dominatrix, not a doctor.

By the way, I have bipolar disorder. It is well known that this medical condition causes uncontrollable carbohydrate cravings, and severely increases risks of obesity, type II diabetes, and heart disease.

So don’t try to tell me that it’s just as easy and mildly unpleasant for me to lose weight as it is for the skinny chick in the waiting room. It’s a known medical fact that that’s not true.

My doctor is truthful with me about my health risks from my weight. She is helpful in recommending what kinds and level of exercise are medically appropriate, and what food choices will help if I can manage to make them.

I need to know that, so I know what exercise I should do now, and what I should eat now, instead of what weight loss efforts would be actively dangerous.

The line between professional and unprofessional conduct is when truth becomes divorced from compassion, and when practical advice is replaced with blame and rancor.

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