Some doctors refuse to treat fat patients: Is that ethical?

[OhioChick]

May 17, 2011 12:37 PM

CBS) No fatties allowed! That seems to be the policy of some doctors in Florida - and medical ethicists are crying foul.

In a poll of 105 obstetrics-gynecology practices in South Florida, 15 said they refuse to treat even healthy patients who exceed certain weight cut-offs. Some practices set the cut-off at 200 pounds.

Why the no -fat-patients policies? Some practices said their exam tables and other equipment couldn't handle the extra load, the paper reported. Others said they avoid fat patients because they are more likely than thinner patients to develop hard-to-treat medical complications.

"People don't realize the risk we're taking by taking care of these patients," Dr. Albert Triana, whose South Miami practice declines to treat obese patients, told the paper. "There's more risk of something going wrong and more risk of getting sued. Everything is more complicated with an obese patient" when it comes to gynecological surgery or pregnancy.

More: http://www.cbsnews.com/8301-504763_162-20063541-10391704.html

Original story (thanks to Blue_Tires)

Some ob-gyns in South Florida turn away overweight women

http://articles.sun-sentinel.com/2011-05-16/health/fl-hk-no-obesity-doc-20110516_1_ob-gyn-gyn-obese-people

[Taverner]

1. Yes, but its been SOP for a while

Not just the overweight, but many gays have had similar experiences. And I have known towns in the South where the town doc does not treat "coloreds"

And this is today, not in some book By O'Connor or Harper Lee

[Blue_Tires]

13. Yeah, their little generic "reasons" have that one-size-fits-all flavor

which could be easily morphed to keep out any 'undesirables' of their demographic choosing

I'd love to know if they have ever turned away an overweight wife or daughter from a wealthy/influential family...

[Taverner]

15. Oh I'm sure if any of the 'undesireables' came with cash, they'd make an exception

[WinkyDink]

45. I could use some links, especially to the one about the South.

[cordelia]

56. That would be appreciated.

[Cid_B]

2. It's a sue happy world...

First time a 300 pounder slips off the examining table because it can't contain her there are going to be some lawyers involved.

[whathehell]

21. Maybe they should not use "one size fits all tables"...just a thought. n/t

[Cid_B]

32. Yeah but whats the upper limit....?

Saw a woman at 5 guys and fries last weekend. Couldn't fit in a single chair. Had to put two together...

Should they just have chairs large enough to accommodate the worlds fattest mobile person?

Not really arguing with you but mostly thinking out loud...

[whathehell]

36. I'd say about 300 pounds...Two hundred is not that unusual, especially for men. n/t

[Cid_B]

38. Seems reasonable...

... but no matter what you pick someone will not be satisfied.

[WillowTree]

61. One can only presume that you missed the fact that the story is referring to OB/GYNs.......

Think about it for a minute. I'm sure the significance will sink in.

[whathehell]

89. One could presume that.

[Maraya1969]

92. Trying not to get to detailed here but is it hard to "see" what you need

to see during an exam with an obese woman or harder to access the area? I never thought of that but maybe it's true. Then again it would be very hard for an obese woman to get her legs in the stirrups just in a mechanical way.

I don't know how I feel about this. If it is much more difficult for the doctor than maybe they have a point.

[Goblinmonger]

23. Way to push the RW tort reform talking points.

Any actual evidence to back you up that this type of case would make it to court and actually succeed?

[libodem]

3. NOT

Smokers are parriahs as well.

[HappyMe]

10. Good point. nt

[Maru Kitteh]

24. I don't know of any medical conditins that can cause one to become a smoker.

Other than bad decision + addiction.

[HappyMe]

26. Well, that's true.

But what about food addiction? Isn't that bad decision + addiction.

[Maru Kitteh]

64. one must eat to live

Smoking starts with a bad decision, punished horribly by a wretched addiction that can be so hard to break it takes many people several times to quit and leaves others so terrified of being without the things they will rationalize and twist logic into knots so twisted they make interchanges in Tokyo look as quiet and sensible as a Kansas country mile.

Eating, in of itself, is not a bad decision. Not all obesity begins with a bad decision. All smoking/tobacco addiction does.

In my opinion, everyone should be entitled to medical care for whatever their condition is - no matter if that is alcohol/tobacco/drug addiction or obesity due to any cause, or whatever they need - and they should be able to receive that care without being stigmatized by their healthcare practitioner.

This doesn't mean freedom from being reminded about the risks of continuing certain behaviors or refusing to treat certain conditions. Discussions should be frank, but respectful and informative.

[eridani]

72. I'll confess to being a multiple substance abuser

I'm addicted to food, water and oxygen--the big three.

[Skittles]

67. ...

http://psychcentral.com/blog/archives/2006/03/15/special-report-on-smoking-and-schizophrenia/

[Maru Kitteh]

69. Cause - not react to.

I think most people understand very well that nicotine has many actions in the body and that the body has natural receptors to nicotine compounds.

But a condition cannot cause you to take up smoking, only facilitate and further reward your addiction.

This differentiates it from a condition like, say, Cushing's for example.

[CTyankee]

30. a very well respected OB-GYN in my area will not let her patients continue

with her if, after age 50, they don't stay up to date on their colonoscopies. She simply won't continue her gyn care of them and they must go elsewhere...

[Mojorabbit]

44. My neurologist

won't keep you as an MS patient unless you go on one of the expensive medicines to treat it and says that is the going thing because of liability.

[Demeter]

70. That's Insane

after age 50, who needs a ob-gyn? Go with a regular internist. Certainly don't need one with that kind of attitude!

There IS over-testing. Just because there is the ability to test, doesn't mean here is the need to test everyone, all the time, for everything, especially invasive or radioactive tests.

What are the individual's odds of contracting an illness? An honest physician will do a profile and a few diagnostics, and not waste everyone's time, money and patience looking for zebras in the polar ice.

[CTyankee]

79. Over age 50 you may need a gyn to do annual Paps (unless you haven't had

a problem with Pap tests in the past). And you need regular exams for early detection of ovarian or uterine cancer. Obama's mother died of uterine cancer in her mid 50s. She might have survived if she had had preventive exams, but she had no health care insurance, or it wasn't enough.

[Ilsa]

90. Also, for me, the OB/GYNs do it more comfortably for the patient.

And since they palpate dozens of abdomens a day, they are more likely to detect an abnormality.

[Drale]

4. No it is completely unethical

In fact is is breaking the Hippocratic oath. Do no harm, that is what medical doctors take an oath to do, and by not treating "fat" patients, they are doing long term harm.

[jp11]

51. I disagree they are not harming people by not treating them, harming them would be

if they refused to treat someone dying before them. Now if it becomes SOP for all doctors to refuse treatment to obese people that does them some harm, especially if they refuse to ever help them, ie in dire need of medical help. Not taking on a routine patient for care isn't harming them and there is the fact that the person can take actions to remedy the cause for their being refused, ie lose weight.

You might as well be saying if a doctor doesn't take your insurance they are 'doing harm' of you refuse to pay.

[Union Scribe]

54. Do you feel the same about pharmacists that refuse to fill certain prescriptions

Like birth control or the 'morning after' pill?

[Brickbat]

5. No, it's not. A 200-pound cutoff is, in fact, just stupid.

[K8-EEE]

49. If you are 5'11 and pregnant you're gonna get over 200 lbs

without being fat!

[Brickbat]

59. I'm 5'10 and over 200. In fact, according to BMI, I'm clinically obese. When I tell people that,

they are amazed. I'm not a model, but I don't look "fat."

[K8-EEE]

60. Doctors who don't want anybody with health problems...

Um, what good are they?

[KansDem]

6. This article isn't written well...

Some practices set the cut-off at 200 pounds.

Is this for all patients? The article isn't clear.

So if I'm 5'0" and weigh 199 pounds, I pass, but if I'm 6'4" and weigh 201 pounds, I don't pass?

I'm 6 feet and weigh 225 pounds so I shouldn't expect to see a doctor in Florida?

[Blue_Tires]

9. Yeah, you'd think BMI would be the gauge

This whole arbitrary 'weight cutoff' number just makes it weirder...

[Scout]

18. BMI is bullshit too n/t

[Obamanaut]

41. BMI is nothing more than a height/weight ratio. Nearly meaningless. nt

[truedelphi]

27. I took it to mean if you were two hundred pounds above your

Average weight for your height.

Not that you weighed more than two hundred pounds.

[KansDem]

28. That makes sense...

Thanks! :hi:

[Blue_Tires]

7. original story:

http://articles.sun-sentinel.com/2011-05-16/health/fl-hk-no-obesity-doc-20110516_1_ob-gyn-gyn-obese-people


My father was a doctor like the ones in the piece, and I'd never known patient weight to ever be an issue for him...Although malpractice insurance continues to be a serious concern, I have the feeling these doctors are using it as a smokescreen for discrimination...

I'm also curious to know why the reporter didn't contact ACOG or the Florida Board of Medicine...I'm sure they would have some thoughts...

[OhioChick]

11. Thanks....I added it above. n/t

[LiberalLoner]

8. Well, I agree with the last line, if they refuse to treat overweight/obese patients they will

be out of work pretty soon. We have a weight problem in this country.

I think a lot of it might be due to how we eat out so much of the time (fast food, pizza, etc.) and it's all high calorie, high fat, and the portions are so much bigger than they used to be in the 60's. On top of that, no one goes for a walk anymore except the fitness buffs, no one plays sports, etc.

[KamaAina]

12. Sure. Blame the exam tables.

Most of them aren't accessible to wheelchair users, anyway. So get new ones.

[seabeyond]

14. i dont think so. but the upside. a fat patient would nto want a doctor that thought so little of

them

i would imagine

[Scout]

17. correct. the lazy doctor's diagnosis for everything that ails you: "you're fat"

i was told for more than 20 years that my back problems were because i was fat.

funny, i'm still fat but after seeing a chiropractor, my back is fine.

my sister has had doctor's who made snotty comments about her weight when she was there for bronchitis ... she turned to the nurse and asked, "is there a REAL doctor here that i can see?" ... nurse stifled her laughter well, and my sister saw a real doctor :-)

[seabeyond]

19. ya. that. and who wants to give someone money that is ugly. nt

[whathehell]

22. Good for your sister!

[REP]

53. Been stabbed? With proper diet and exercise, you could have prevented that!

I know someone who went to see a doctor about a problem unrelated to weight. He asked her not about her symptoms, but how long she'd had a weight problem. She asked the 5'1" doctor how long he'd had a height problem.

[housewolf]

16. I see... so for the doc's now it's become "all about ME"

instead of patients in need

Grrrrrrrr....

[damntexdem]

20. Take away their licenses to practice medicine.

And I really doubt that any exam tables have weight limits as low as 200 pounds.

[ProgressiveProfessor]

25. No basis to do so under today's medical structure

Doctors in private practice can refuse to accept a patient for many reasons, though overt racial discrimination etc is not allowed.

[provis99]

29. so gynecologists only want to touch slender sexy women.

I guess I know their motivation for going to medical school.

[CoffeeCat]

31. I can understand a doctor...

...being concerned, if not fed up, with the way some people abuse themselves
with food. It causes heart disease, diabetes and a host of other health
problems.

However, a doctor should use their concern and passion to HELP people and
to try to change their lives. Inform them.

To refuse to have any patient who weighs more than 200 lbs is mean spirited,
and frankly, ridiculous. I know plenty of people at or above 200 lbs who
are healthy. It doesn't take much for a man to be over 200 if he's above
6 feet tall.

[Skidmore]

33. Some people should be given medical licenses.

[liberallunatic]

34. If they wanted to treat only thin beautiful people

they should have gone into plastic surgery.


We have become a cold blooded nation, and the worst part of it is, people actually think being that cold blooded is somehow righteous.

[Xithras]

35. My doctor had me sign a "treatment contract"

It's basically a list of things he requires in order to be his patient. That includes mandatory changes to your diet and exercise habits, if he determines that it's required for your health.

As he put it: If you disagree with his treatments and don't want to follow them, then he's not going to waste his time treating you.

I don't think he has an upper weight limit, but it's a given that any obese patients will be put on a diet and exercise regimen to bring them down to a healthy weight. If they don't cooperate, he drops them.

[Cid_B]

39. Sounds pretty reasonable...

They can choose to not go there and he can choose to not treat...

[Scout]

40. wonder what he does if they follow his regimen and it doesn't work for them... n/t

[Xithras]

43. He finds another regimen, I suppose.

Of course, as he's told me, his goal is never "skinny", but simply "healthy".

There's nearly always a way to bring an obese person down to a healthy weight. Obesity is a symptom, so it's usually just a matter of finding the correct cause and treating it.

[REP]

57. ...unless he's prescribed Tolinase, Actos, Metformin, Prednisone, etc

Just a few drugs that have weight gain as a common side effect; also make weight loss extremely difficult (especially the first three; and those on hypoglycemic agents really can't cut meals or carbs). If it were that easy, no one would be fat - as much fun as the ridicule sounds, I really doubt many set out to become or stay fat.

[eridani]

73. Oh, bullshit. A diabetic friend of mine used to weigh 385#

She got into an employer-sponsored exercise program and lost 100#, and was able to go off insulin except for situations like being under stress or having the flu. She maintained at that weight and never lost more.

Just a note to snotty math-challenged health nazis--285# is STILL FAT! Is it any wonder that so many fat people don't even want to be bothered with learning healthier habits? Why would they if the result of losing some weight and improving your health is that you experience absolutely no diminishment of constant vitriolic public abuse?

[PeaceNikki]

48. I wish more doctors did this

And I wish insurance covered gym memberships, trainers and dieticians. Doctors always push medication before pushing lifestyle change. My doctor tried and I am showed him I could bring my numbers down without that crap. And I look and feel like a different person. :)

[Skittles]

68. are you assuming what works for you works for everyone?

[PeaceNikki]

77. Of course not

But my doctor didn't even put it on the table as an option. I did and he still wanted to push meds. And he said he didn't think I could do it... but I did. I have lost 50 pounds and counting and he admits he was wrong.

[eridani]

74. Oh, right. My skin gets a lot lighter if I stay indoors during summer.

If black people who want lighter skin do that and don't get the same results, why, they are just doing it wrong, as my personal experience conclusively proves.

[PeaceNikki]

80. If you read my reply I was talking about *my* situation and about docs pushing meds as the FIRST

plan of action. In my case, I put on 40+ pounds in a few years, was sedentary and it resulted in horrible cholesterol numbers. I have no other condition that would prevent me from using diet and exercise as a course of treatment for my condition. We rail and scream about big pharma and the dangers of medicating symptoms instead of addressing root cause. In MY case, my numbers were a wake up call to get my shit together and my doctor didn't even discuss it as an option. He prescribed Lipitor. I left confused and upset at the idea of being on meds for the rest of my life and I was only 37. So I didn't fill the Rx and I addressed the root cause. I was carrying a lot of extra weight. It made me feel like shit, look like shit and my lab tests shit. I feel better, look better and my numbers no longer scare me or my doctor. It's taken 2 years, I am still working on it and will for the rest of my life because I didn't fall for some fad diet. I changed the way I think about food and the work I put into my health and body. My point is, was and always will be that I wish more people would get the encouragement and support (emotional, physical and financial) they need to do the same. Had I not taken it into my own hands, I would still be seriously overweight, prone to bouts of depression and poppin' pills daily to make my lab tests look better. Meanwhile, my weight would have likely stayed the same or gotten worse and I probably would be seeing elevated blood pressure and looking down the road at type 2 diabetes.

So... yay me!

[Pacifist Patriot]

82. Yeah you indeed!

I had a series of doctors throw meds at my chronic fatigue and all-body myalgia for years. It wasn't until I stumbled upon a thread here about Elizabeth Hasselbeck's plagiarism charges involving a book on celiac that I started to put the pieces together on my own. When I asked my doctor for a celiac screening she said, "you know I thought of that last year but you didn't have the GI symptoms." No kidding. Over half with celiac don't. All I had to do was eliminate gluten from my diet to leave big pharma and specialists in my rear view mirrow. I feel like a completely new person. Sadly, I think too many doctors are conditioned to throw meds at problems rather than look for root causes that might be addressed with simple lifestyle changes.

Good for you!

[PeaceNikki]

86. Thanks and good for you as well!!

:toast:

[eridani]

91. You still are indirectly belittling those who don't lose enough weight--

--to fall into the "healthy weight" category. Eating healthier and exercising more improves glucose control and blood pressure even in the complete absense of weight loss. There is zero correlation between the amount of weight loss due to such regimens and the associated improvements. In fact, those improvements begin to occur immediately, before any observable weight los--therefore weight loss is not causing them.

So why in fucking hell is the first thing you and other folks focus on weight, rather than behavior changes in and of themselves? What is the point of belittling people who change their health for the better while getting nowhere near a "healthy" weight? You "look better," so therefore you ARE better than someone who may have lost less weight than you while doing better at lowering blood pressure?

[JoeyT]

37. A business refusing a group of customers as large as that one?

Sounds like someone is making too much money and needs price controls.

No, I'm not ok with a no fatties rule, just like I'm not ok with a no women rule or a no minorities rule or a no poor people rule.

[laundry_queen]

42. Horribly unethical

says the over 200lb person who had 4 fairly uncomplicated pregnancies, and 3 uncomplicated c-sections.

With my first pregnancy I had a doctor who was fat phobic - I was under 200 lbs at the time actually. I had developed gestational diabetes, however not until late late in pregnancy and then it was borderline. He flipped out. Thought the baby was HUGE, and when I had a trace of protein in my urine he freaked out. My BP did go up a bit at the end so he was bound and determined to induce me because this baby was going to be giant (according to him). He let me know, numerous times, that birth weight correlated with maternal weight. He did all kinds of things for me to go early, including repeatedly stripping my membranes from 37 weeks on. I finally went into labor at 40 weeks and when I did not progress as fast as he thought I should, I got hooked up to all the gadgets. I ended up with a c-section, because the 'baby was obviously just too big'. The baby was 6.5 lbs when she was born. :eyes: He blamed the c-section on my weight, oblivious to the fact that the way he treated me led to it, not the fact that I was fat! When I took him to task later, he 'fired' me as a patient! My next doctor was horrified that I was treated that way, and with my next pregnancy I went on to vaginally deliver a 7 lb baby. First doctor was full of shit. If these idiot doctors are seeing more complications with their obese patients, maybe they need to look at the way they are treating them!

[lynne]

46. Wait a minute - how can it be okay for a Dr. to refuse to treat a patient -

- for personal reasons yet its NOT okay for a pharmacist to not carry certain drugs - usually birth control related - for personal reasons?

Sorry, what's fair for the Goose is fair for the Gander and I hope an overweight person sues for discrimination.

[Missy Vixen]

55. My doctor is wonderful

We didn't have to embark on the pregnancy merry-go-round because we didn't have kids, but the guy is just great. I might also mention that he's not especially svelte, either.

He listens to what I have to say about my health. He does his best to keep up on the latest research about a chronic illness I suffer from. His equipment seems to be sturdy enough to handle his patients, and it's nothing different than any other doctor's office.

I am sorry that any woman needs to see a doctor more concerned about his profit margin (and his own biases) than her health.

[Luciferous]

47. No. If anything, I would think that fat patients would need more

help, not less.

[Modern_Matthew]

50. Refusing to treat anyone should result in a lengthy suspension of your license to practice. nt

[jp11]

52. No matter what?

IF they spit on you, attack you, refuse to pay, don't carry insurance you take, refuse to take the medication you instruct them to take, refuse to do what you tell them they need to do to get better/take care of themselves?

[Cass]

58. I don't think its ethical, and I wouldn't want one of these doctors if I did meet their criteria.

Its discriminatory first and foremost, but it also sounds to me that they want the easy cases and would rather leave the more challenging patients to other doctors. I'd rather go to the doctor who isn't afraid to take on the more challenging cases - likely to be a better doctor imo.

[Incitatus]

62. Some gynecologists only want to practice their love on thin women

sick, unethical bastards

[Iris]

63. lol!

[L0oniX]

88. +1

[RagAss]

65. First they came for the smokers......

[Maru Kitteh]

71. .

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=439&topic_id=1120218&mesg_id=1124464

[Skittles]

66. beyond unethical

inhumane and sickening

[Sen. Walter Sobchak]

75. The potential liability involving high-risk pregnancies is just too high

Obese women have a disproportionate number of high-risk pregnancies and by refusing to take them on as patients they can dramatically lower their insurance rates.

Call it the downside of the American lawsuit casino culture. Doctors are put in an untenable position where taking on certain patients who have preexisting conditions that are predisposed to serious health problems put them at risk of being sued when the consequences hit.

Perhaps there should be an indemnity fund for doctors treating high-risk patients, but until then doctors have to cover their own ass first.

[Maru Kitteh]

84. "American lawsuit casino culture" - That's my sister and her husband in a nutshell right there

I was shocked to hear the lengthy list of trivial, piddly things they thought they were owed great fortunes over. Things like minor side effects my sister experienced from a drug she was prescribed - not adverse reactions - minor, predictable side effects clearly spelled out for them in the handouts they were given. Things like expecting a doctor-on-call who had never even met her somehow not being able to predict (with his psychic powers, I guess) that she was going to have a full-on psychotic break 24 hours later based on her husband telling him "she's been acting a little different these past couple days" and little else. He did a short neuro exam on her that apparently checked out fairly fine, and told them to make an appointment or go to the ER right away if things got worse. I asked what he did so badly that they thought he could be sued for and was told "He shoulda known. He shoulda dome some tests."

I think the only thing that's stopped them is a tough set of state laws and being in a town that's large enough to have several lawyers but small enough that those lawyers know when to tell a client they don't have a worthwhile case.

I would never assert that providers should not be sued for negligence or malfeasance, but I do know that there are too many people out there like my sister, waiting for her payday.

[AtomicKitten]

76. My pulmonologist refuses to treat patients who smoke which is entirely reasonable IMO.

[RegieRocker]

78. What a crock of crap

[CBGLuthier]

81. Is this because they are only in it for the money and

don't give two shits about actual health care?

I imagine a truly DISCRIMINATING doctor could treat only 100% healthy people and have himself an easy job.

It's called a fucking challenge. These so-called doctors are a god damned disgrace.

[Bake]

83. If it were smokers they refused to treat, you'd all be cheering.

:popcorn:

Bake

:smoke:

[Maru Kitteh]

85. .

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=439&topic_id=1120218&mesg_id=1124464

[DainBramaged]

87. The Country has gone flat nucking futs.....

:crazy: