WebMD Community Talk Show

Angry this doctor placed a weight limit on patients?



You think she has no right to deny heavy people of healthcare?



Please consider the following...







Let's talk about "Malpractice Insurance"



OB-GYNs, for years, have declined to see pregnant women who are overweight, typically referring them to specialists, instead. The reason: Obese patients are more likely to develop surgical and post-operative complications, thus, increasing risk to malpractice lawsuits.



Ultrasounds are more difficult to perform and interpret in obese patients. If they miss-read an ultrasound due to a patient's obesity, a plaintiff's attorney will argue that the patient should have been referred to someone with more experience under those circumstances.


Drug dosing is another area of great concern for physicians. Dosing must be modified for a morbidly obese patient; however, this is not simply a matter of larger body equals larger dose. The physician must differentiate between fat-soluble and water-soluble medications, and obtain an estimate of the patient's weight and body mass index to determine the proper dose of any given medication. Many times, determining proper dosing of drugs for the obese can be a stressful and dangerous guessing game.





In South Florida, ob-gyns who pay some of the countries highest rates for medical-malpractice insurance have decided on a different strategy to combat litigation bought on by patients"026More than half go without malpractice insurance coverage, altogether"026

http://www.msnbc.msn.com/id/5234637/ns/health-health_care/t/doctors-going-without-malpractice-insurance/#.UEffV5ZbTKc


excerpt: "...The phenomenon of practicing medicine without insurance, or "going bare," is most rampant in Florida, where health officials say more than 3,000 of the state's 89,000 licensed physicians have dropped their coverage..."


Dr. Rene Loyola says he has given up just about everything to keep practicing medicine.
The surgeon owns no home or land, and has no savings other than a retirement plan after 29 years in the profession. He says he frequently has to turn away patients who need his help the most.
Loyola blames all the trouble on soaring malpractice insurance rates that forced him to join the thousands of other doctors nationwide who have dropped their liability coverage.
"On paper, I have nothing. I'm a pauper. My wife owns everything," said Loyola, who made the changes to protect himself from lawsuits. "It's a good thing we get along"026"



Now, let's talk "nurses" and support staff at private practices and hospitals"026

Today, its estimated 2 out of every 3 hospital patients weigh between 200 to 300 lbs; 10% of all hospital patients weigh between 300-500 lbs.


OSHA guidelines state the maximum safe limit a nurse is supposed to lift is 35 lbs"026


A recent study on hospital workplace safety found that floor staff of hospitals (orderlies, CNAs, RNs) routinely lift 1.8 tons during the course of one 8 hr shift.

• Nursing staff have among the highest back and shoulder injury rates of any occupational group in the country.
  
• In a 2003 study by the state of Washington, based on Washington workers' compensation data, the average annual workplace musculoskeletal disorders (WMSD) claim costs for hospitals and nursing homes is approximately $32.8 million.
• 2011 health and safety survey by the American Nurses Association showed disabling injuries from lifting are a top concern among 62% of nurses.
  

The problem is so serious, nurses are transferring to other medical related fields that don't require lifting"026medical coding, dialysis, case management, and pharmacy.




Now, let's talk about "additional costs" when treating the obese...(cont.)

(cont."Additional Costs")


The Centers for Disease Control estimates that the cost of caring for an overweight or obese patient is an average of 37% more than the cost of caring for a person of normal weight. This adds an average of $732 annually to the medical bill of every patient.


Why?


Earlier, I discussed the difficulties for doctors using ultrasound on obese patients. Have you ever had an MRI or CT scan? Have you ever wondered how in the world big people fit inside those things?...


They don't"026Need special scan equipment...$$$


Have you ever lied down on a standard examining table in a doctor's office and felt it rather shaky and unstable? Have you ever wondered how in the world could a really big person could fit on such a table in complete safety?...



Not possible"026Need special reinforced table with higher weight rating...$$$


Have you ever noticed how tiny the examining rooms at a doctor's office are? Its crowded for three people (one nurse, one doctor and one patient"026spouse has to wait outside).
Have you ever wondered how an obese person in need of assistance in moving from a lying position to a seated one can receive any assistance in a room so small?



They can't"026Need newly remodeled examination rooms that can safely accommodate 6-7 people or equipped with special hoisting equipment...$$$







Physicians, like any business, can decline service to whomever they choose for any reason as long as it's not discriminatory.

If it was choice between practicing medicine without malpractice insurance and workers comp for my nurses and choosing patients that present less risk, less cost...plus, I had two kids I needed to send to college...


What would you do?

I don't like this policy at all. If a patient is mobile there should not be much of a problem. I know a person that barely weighs 100 pounds but can't help with mobility due to dementia . This person is dead weight. Maybe it is more difficult to deal with that than with an overweight person who can help himself. In a truly difficult situation, where lifts are needed, there may be a need to refer the patient to a practioner that can handle it.

I think this is ridiculous... what's next!!! It's so amazing to see what this world is coming to. Well now if you think about it theres ppl out there that have all kinds of disorders that could be way more dangerous to be around but your right we should be cautious of the over weight people they might break my toe if they step on it..... but dont worry about that person with split personality that shot some one for looking at him the wrong way or the person that has depression and suicidal thoutghs that might try and hurt them self with something in your office or the most common one the cluts that might trip over your foot and sue you.... wow maybe we should not see or treat anyone in person. There are so many ways patients and medical staff may get hurt this is just so out there i can't even think about how hurt or embarrassed this women feels... or how it makes so many others feel bet the familys will be able to sue you when your policy causes some one to harm them selfs or worst... think about that one... JUST SAYING PEOPLE!!!!

A doctor is allowed to choose patients who he/she can best serve. If I was over 200 lbs and knew a doctor felt he couldn't give me adequate care and viewed me as a liability, I'd rather he not see me and waste both of our time.

Where does it say anywhere in this article that this doctor even feels like patients who are over 200 lbs shouldn't have a doctor AT ALL? I mean, even in the quote in this page all they seem to be saying is that their office can't accomodate it.

I don't see anywhere where anyone (besides ironically, the people commenting against this policy) said that heavy people shouldn't be able to have their medical issues addressed. The issue in this article refers only to this one practice...I mean, this doctor probably wouldn't serve a cat either, not because they feel a cat doesn't deserve to live, but because they are simply not equipt to deal with a cat.

It's really easy, in matters of weight, to take things personally and be offended where no offense is meant. I don't have any bias against heavy people (and have been called a chubby-chaser numerous times ) but that doesn't mean I'd want a huge person on the other end of my seesaw, either. I've found the people hardest on the obese are the obese, imagining judgement where there isn't any or feeling morally judged where the issue refers only to the logistics of weight.

As a formerly obese person (who only a few months ago earned a normal BMI because of a huge lifestyle overhaul), I just want to encourage people with weight issues to not seem to SEEK disapproval. It's easy to become sensitive about as one poster put it, such an "apparent" problem, but most people in the world have their own lives to worry about, and have better things to do than hate on people for their fondness for cake or thyroid issues or whatever.

Love thyself!

As an overwieght person I am a little offended. However, I believe the doctor should offer to help the patient acheive a healthy weight. If they are unwilling then the doctor can simply ask the patient find someone else to treat them.

So, those people who NEED medical attention to HELP lose weight you agree should NOT receive the necessary treatments because they are obese? THAT is absurd! ALL people should receive medical attention if they need it. To discriminate against weight is the same as discriminating against race, creed, religion, or TAX BRACKET. MOST doctors smoke, drink, (some do drugs), and a majority of doctors I've met has weight problems themselves. You are ridiculous. I hope you never need a doctor and they refuse you on your stupidity level!

I explained, above, the financial aspects of this doctor's decision, yet, you continue to rant "discrimination".

Where does she say, fat people don't deserve healthcare?

Here's the main reason, imo, why she made this decision, though...

Nurses are the "horses" of healthcare. They're the ones that do the bulk of the work. They're the ones that administer care to patients. Its a fact. The more direct contact nurses have with patients, the better the patients health outcomes. Period.

In a small private practice, an experienced & highly trained nurse is like gold. They cannot miss work or the entire staff workload is in shambles. Other nurses must scramble to cover the overload.

Kids can't be picked up daycare...Lunches are skipped... Dinner is burgers...

Its a mess. imo, this is why this doctor made this decision. She has to protect her staff from injury. She has to protect her staff from burnout. The number one cause of short and long term disability of nurses?

Lifting too heavy patients. Period.

Hey, harli1965, are you willing to pay a higher copay so this doctor can hire more full-time nurses to cover for unforeseen injuries to her staff?

Well, are you?.....



...Yeah, that's what I thought...

"Most" doctors have weight problems? Cite the source for that, please.

And even if a doctor has a weight problem, they're almost definitely NOT having their nurses carry them around. Which is the problem in this scenario, that nurses were getting injured on the job.


And discriminating because of something like race isn't the same as discriminating against weight because weight is something that you can change, whereas race isn't.

"Clinics and Dr's offices should be equipped with at least one personel that could manage a large person." So a doctor refusing to treat people based on weight is wrong, but they should be limited to hire staff based on how strong they are (which would remove most overweight profesionals from consideration)? Isn't refusing a job to a medical profesional who is physically disabled or aged past his or her prime as bad as to refuse treatment to "certain races, creeds, religions?"

To those who have never tried to physically lift a person your own size who is unable or unwilling to help, please understand it is difficult and dangerous for everyone involved. When that person is 50% or more larger than yourself there is the potinal for life altering injuries and death for everyone involved. Find a friend your own size willing to experiment and give it a try. Try to lift him/her from a bed to the floor and vice versa. I dare you.

CAMMSNP provided math to show the bare minimum cost of keeping a staff to move 200 pound people (of which I am one btw) and pointed out the injuries caused when 200 pounds of mass in the form an incapacitated patient falls on another person. I don't see how you get burn out or lack of profesionalism from math and physics. Please explain.

Just currious. I've noticed a large difference between the comments from medical profesionals and non-medical professionals. How frustrating is it to you that so many people have such strong emotions about this while knowing almost nothing of the details and mechanics and risks involved in treating obese people?

I've worked with the mentally ill for years. Nation wide they almost never randomly/intentionally shoot or stab medical profesionals (to state that happens/could happen is exceptionally bigoted and narrow mindedly ignorant). Injuries and deaths: probably under a dozen a year. Known suicidal people are never left alone and are never put in rooms with potental weaons. Clumbsy people slip and fall and sue so much there are already laywers who specialize in the practice but that isn't medical treatment related.
The injuries caused by falling patients are not broken toes but deep soft tissue damage of the back, compressed disks, torn ligaments, ripped tendons. And there are hundreds of thousands of related injuries caused specifically from heavy people falling on hospital workers and from lifting heavy people even when they are lifted correctly.

His whole attitude. The majority of the doctors I have worked with show concern for the patient along with the staff. His whole justification is money and lack of equipment and his injury along with possible injury to staff. His bias againts obese patients is showing. He still holds a grudge against the patient that caused his injury. If you were to check his patient load it would most likely be a healthy population.
Jo H