Our Most Vulnerable Patients Get the Brush-Off

The rise in obesity isn’t news — but its impact continues to unfold. Ten percent of all medical malpractice suits now involve obese patients, and 26 percent of settled claims list obesity as a factor, based on a review of claims from 2011 to 2013 by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer.

Among nearly 7,000 recently reviewed cases were circumstances where treatment was delayed or impacted by a patient’s excess weight. For instance, in one case, a patient who was too large for the MRI machine waited too long for transport to another facility. Her family claimed no one seemed concerned with making the transfer; the hospital claimed it had no control over the one ambulance service with appropriate equipment.

Overweight patients say they wait longer to get medical care, fear retribution for their weight, and are treated disrespectfully.

In other cases, diagnosis of serious illnesses were missed, as the physician focused on the patient’s weight rather than the current complaint.

Another tragic outcome occurred when a patient was left a paraplegic after two different ambulance services could not handle her size. This patient’s condition worsened over the course of four days of waiting for a transfer to a facility that could do the tests she needed; there was impact on her spinal cord as she continued to wait.

Related: How Our Kids Can Beat Obesity

Many hospitals don’t maintain contracts with other facilities that have the open MRI equipment for scanning extremely obese patients. Others are located in areas where the appropriate facility for the patient is not a 24-hour facility or available for emergencies.

Medicine has had to adapt to larger patients in many ways — particularly with specialized equipment and accommodations. Still, there is a prejudice toward obese patients, according to both patients and health care workers.

Overweight patients say they wait longer to get medical care, fear retribution for their weight, and are treated disrespectfully.

Sixty percent of overweight patients are never told by their doctors they have a problem, while those who are told get little useful advice.

Doctors, nurses, and health care workers are in a tough spot, too. They claim frustration when discussing weight loss with a patient — or encounter them during an emergency, when it’s too late for that discussion to help the situation. Sixty percent of overweight patients are never told by their doctors they have a problem, and those who are told get little useful advice. Preventive medicine is often not covered by health insurance.

“Stigma and bias against people who are significantly overweight have been documented for decades in society in general and in medical professionals,” according to Dr. Sara Pascoe of Bournemouth, England. “[These people] are much more likely to be treated poorly, denied treatment, dismissed and disbelieved than non-obese patients. People are not imagining it. And this stigma hurts the overweight individuals, making health outcomes worse.”

A 2009 study investigated physicians’ perceptions and attitudes toward obese patients; it found that as a patient’s BMI increases, the physician’s respect for the patient decreases. Sandy Knutson, a registered nurse in San Francisco, has battled weight herself. She sees her coworkers exhibit bias and admits she has difficulty with it as well.

[lz_ndn video=31231786]

“I’ve seen it among people I work with, even if they don’t say anything,” Knutson told LifeZette. “Another factor is the weight can interfere with our ability to help the patient. Lifting patients, turning patients … sometimes that isn’t safe for the staff.”

Knutson says obese patients do carry the label of “difficult.” “Have I experienced demanding and inappropriate behavior from obese patients? Absolutely yes. Sometimes, it’s so disgusting, I don’t want to repeat them.”

Pascoe sees another side of the demanding label. “Given that studies show obese people are more likely to be denied treatment and their symptoms are more often dismissed, any individual in this situation may be more fraught and desperate to be heard.”

As a psychologist, Pascoe encourages medical personnel to have appropriate empathetic training. “People don’t like to think of themselves as biased, or xenophobic. But as products of any given society with its particular biases at that time in history, we are all imbued with some false beliefs.”

Related: Your Child’s Beating, Hurting Heart

She also encourages obese patients to be prepared to stand up for themselves.

“Patients who are significantly overweight can prepare themselves for medical appointments by having a simple, direct sentence ready, should they feel dismissed or disregarded,” she said. “Practice it aloud beforehand. This will make it a lot easier to say it. It is perfectly acceptable, and within your rights, to ask to be treated by someone else, and to raise a formal complaint.”

Policymakers insist the person, not the obesity, should be the focus of treatment. As obesity becomes more widespread — that may be easier said than accomplished.

Pat Barone, MCC, is a professional credentialed coach and author of the Own Every Bite! bodycentric re-education program for mindful and intuitive eating, who helps clients heal food addictions.