When Political Correctness Affects Medical Treatment
I was intrigued by this article in the NY Times called Why Do Obese Patients Get Worse Care? Many Doctors Don’t See Past the Fat. Yes, we are in a world that loves to label uncomfortable conversations with accusations. Fat shaming is a popular term and I can see how mocking people on Twitter or Facebook for being fat can be very hurtful and damaging. I get that. But let’s look at the title of this article again. How can we, as doctors, see past the fat when the fat is causing many of the issues? It is part of the differential diagnosis when looking for the etiology of an obese patient’s symptoms. You CANNOT look past the fat because you would then be doing a poor job if not outright malpractice. Remember, as the article states, one in three Americans is obese. Obese!?! Can we even use that word anymore or will they take that away from us? Anyway, the articles uses this quote:
“Physicians need better education, and they need a different attitude toward people who have obesity”.
Maybe.
I think that there is a compromise here. Doctors are trying to survive in a crappy job and sometimes put too much blame on the patient’s obesity than is deserved. That is because they are rushed and overwhelmed (not all, but most). On the other hand ignoring the patient’s weight is inappropriate as well (as noted above). I think what the patient wants is time with the doctor to acknowledge other possibilities for their symptoms as well as their fat. It should be BOTH. So, the answer is getting more time.
Alas, the current system won’t allow for more time to knowledge both unless the doc does DPC. So, this “quick to blame the fat for all ills” will continue. But here is the beautiful part. Articles like this, however, will force more political correctness into the medical field and cause a new trend where doctors TOTALLY ignore the obesity issue altogether in order not to get in trouble. The pendulum swings again.
Another victory for medical political correctness!
I can’t believe our health system and providers would let a patient’s body habitus affect their assessment and treatment of their health concerns. This type of treatment of obese people would never be spoken of much less tolerated or even considered in a civilized country with universal health care principles….
oh…wait..
http://www.bbc.com/news/health-36101302
“Obese patients denied surgery in a third of areas in England”
Sorry — I appreciate doctors are under stress. But if they’re not going to be able to spend sufficient time with me to diagnose and treat my problem, it’s time for THEM to switch careers. Don’t do a half-ass job and say it’s not your fault.
The only way to do that is with Direct Primary Care. It cannot happen in this present system that was IMPOSED one them (with the help of the AMA, AAFP, Obamacare and a sheep mentality).
And who do you think caused that stress? You need to re-direct your displeasure where it belongs, because if you don’t there will indeed be a flood of physicians who will switch careers leaving patients like you no where to go.
Dick, did you support the ACA? Do you support the continued existence of Medicare and Medicaid? Do you think there is a “right” to health care? Do you think it’s okay for the government to force doctors to use electronic records, or for third-party insurance to tell doctors how to treat patients? If you answered yes to even a single one of these questions then, yes, it IS your fault.
David, what do you do? What would you do if you were continually given additional work – most of it pointless – and your overhead kept rising, without a commensurate increase in revenue? Tell us please, how would YOU handle this?
Pretty much summed up by Steve and Tom. The people who need the most help will not be getting it in the “Brave New World” of medicine.
Years ago there were a few orthopedists that tried to develop a a sub-specialty practice in doing joint replacements for the obese, having access to specialized equipment such as over sized OR tables. However, these are going by the wayside because the of mindless rush toward quality based evaluation and reimbursement. By not taking into account that obese patients have intrinsically higher complications rates, quality based programs are doing obese patients a great disservice.
You bring out a great point, Tom. When a measurement is constructed that describes an artificial definition of “quality,” and physicians are treated harshly for not “producing,” then nobody wants a bad outcome, so it creates pressure to “cherry-pick” patients. Instead of treating all the patients to achieve some improvement, the patients are, in a sense, “competing” for limited resources. People who cannot “perform,” whether it is in weight control, A1C targeting, you name it – the “excellent sheep” are selected for. Actually, the quality of care they receive may be unimpressive. It may take the greatest skills of a doctor to help the severely messed-up to get better. But they are low-scorers in the NewMedicine marathon – get rid of them, leave them behind.
In “Old Medicine,” a primary care doctor established a long-term relationship with a patient to effect the most improvement and support of their health. Drive the wolf from the door. But in “New Medicine,” you only want a panel of winners, because that’s how you get paid. Fatties are a red flag. And the criticism once again dumps on the “bad doctors” for BadThink, rather than sharing the responsibility across society for creating a bad structure of care.
If you put people in a camp and starve them, they act beastly. Then you can point them out and say, smugly – look at how primitive and nasty these people are! They will fight over a crust of bread! Really, we are so much better than them! It’s a tried-and-true habit of society over millennia; this is just one aspect of it.
The discussion of the person being overlooked in the context of their obesity is not surprising considering the way the innate way that we all view it. Remember the studies from years ago that showed that if young children viewed pictures of other children with either disabilities, facial deformities, or obesity that the ones with obesity were always liked least or that employers choose less qualified candidates if the more qualified is obese. I agree the answer is more time with the patient and getting to know them for who they are rather than what they are