Obesity discrimination

[Aidey]

http://www.cnn.com/2010/HEALTH/01/21/obesity.discrimination/index.html

I'm not trying to start a huge debate, and I know that this isn't entirely EMS related, but this made me think of the recent thread on the 500lb MVA victim.

The gist of the article is that doctors and other healthcare workers discriminate against the overweight by refusing to do things like surgery, or prescribe medication until the person has lost weight.

It also discusses the difficulties with imaging technology and some cancer treatments in overweight patients.

So my question is, is that bigoted discrimination? I would agree that it is discrimination, but I see it more as discriminating between what treatments are most appropriate for what patients at what point in time.

Is it discrimination to tell an overweight patient "Your BP is borderline high. There is a medication I can give you, but first I would like you to loose 20lbs and see if that brings it down"? Or to ask that a patient loose weight before a surgery?

Is this any different than asking a diabetic to control their BS better before surgery? For example, when I worked in a GP clinic we had a patient who needed surgery, but he had a A1C that was 13. The doctor told him that he needed to get it to 8 before she would sign off on the surgery.

With more and more hospitals being held personally responsible for complications like infections is it out of line for doctors to require that patients do things to minimize potential complications before they perform a non-emergency surgery?

The whole thing on IVF was interesting too, when it comes down to it, IVF is an elective procedure. Do patients have a right to demand doctors perform elective procedures regardless of the woman's underlying health? Who should ultimately have the decision if a procedure should be done, the patient or the doctor?

Something I found interesting was the statistic that only 11% of patients received weight management counseling. I wonder how they obtained that number, from seeing what billing codes doctors used, or from asking patients.

I know when I was overweight, my weight was usually mentioned to me and I usually brushed it off with something like "I know, thanks" or "I'm not interested, thanks" if they offered information, and that was the end of it. Sure, I didn't receive counseling, but it wasn't the doc's problem, and I doubt it made it into my chart that my weight was even mentioned.

I've got a pretty different view on weight because I used to be significantly overweight. I educated myself about nutrition and I've lost enough now that if I had been a contestant on The Biggest Loser I would have come away quite a bit richer, lol.

 

[Basic101]

Is it discrimination to tell an overweight patient "Your BP is borderline high. There is a medication I can give you, but first I would like you to loose 20lbs and see if that brings it down"? Or to ask that a patient loose weight before a surgery?

I don't believe it's discriminatory. There are enough studies and scientific literature out there to support how losing weight and improving your diet will improve your BP and health. So the notion by of losing weight (via diet and exercise) prior to giving drugs/surgery is Doctor who is actually doing his job. Doc's get payed by giving out drugs/surgery if you lose weight you may not need the BP drugs so he will lose clients if he tells them to exercise.


Obesity being perceived as discriminatory with normal people/patients is actually # 1 demanded criteria on the list of being hired as an EMT/Paramedic. This is 100% fact.

 

[BLSBoy]

Overweight people should be taxed more.
Same with smokers, alcoholics.

You contribute to the downfall of your own health, and you should have to pay.

Counciling should also be available to beat the weight/cigs/ETOH/drugs.
You refuse or make zero progress, ante up pal.

 

[triemal04]

If they are refusing to treat/do something for a patient soley because they are obese, then yes, it's discrimination. As in, "I won't give you a tetanus shot because you're fat."

If they are refusing to do something for a patient because the treatement would be harmful, to dangerous because of the patient's weight, or the patient would be better served by losing weight which would have to same effect as the treatement, then no, it's not discrimination.

 

[grich242]

It is certainly not discrimination, denying a procedure or med until a pt looses weight for instance the borderline bp you mentioned serves the pt better overall. the same with the diabetic with the a1c of 13 high blood sugars complicate healing in patients who already take longer to heal. diabetes is a lifestyle and the pt has control over many factors that contribute to it. both the medical profession as well as the public side are lacking in many ways with issues like weight loss, addiction, mental health etc. too much give me a pill or procedure so I dont have to do the hard work.

 

[VentMedic]

The complications from doing a procedure such as surgery may be just one issue with obesity. The size both in weight and girth may prevent one from having diagnostic tests to determine exactly what the problem is once you do have a complication or even before doing the surgery by being unable to locate the exact cause.

If a patient weighing much over 300 pounds with stroke like symptoms goes to a hospital where the CT Scanner is not capable of that much weight, that patient may have to be transported to a center that is capable of doing the test. Many stroke centers do not have CT Scanners to accommodate the bariatric patient. Doing an abdominal scan on someone whose body girth is too large to fit in the scanner is also a problem and their weight may not necessarily be much over 300 pounds.

The other issue for complications is cardiac arrest. If the patient does experience ROSC, they may not be eligible to receive hypothermia due to complications and difficulty in cooling adipose tissue. The same goes for those with a cerebral event which could benefit from hypothermia. The additional risks may outweigh any potential benefit.

Of course there are many obese patients whose weight problem is not caused by over eating. Many of these patients are referred to hospitals that specialize in bariatric patients and have to equipment and resources to handle their medical situations and complications more effectively.

 

[MrBrown]

My friend David who is an anaesthesologist constantly *****es that he is not paid extra to deal with the obses patients he has to manage.

If anything, this "discrimination" may in fact be lifesaving

 

[Don Gwinn]

As a big fat guy who has lost large amounts of weight and gained smaller-but-still-large amounts back . . . I must sadly agree that there are kinds of this "discrimination" that are not only acceptable but represent better care than attempting to accommodate the weight.

The OP's example of a patient who may be able to control blood pressure either by losing weight or by taking medication is a good example. There is no negative side effect I can think of for a moderate weight loss in an overweight person, but I would imagine that the BP medication in question has side effects. Besides, if obesity is contributing to high BP, will the medication be enough to address the problem, or will the patient likely get worse and worse as time goes on? If that's the case, or if there are even mild side effects from the medication, then you're actually giving the patient worse care by giving him the pills instead of at least suggesting that weight loss would be better.

Now, if you're withholding the medication from a patient you know is not going to lose weight because it's extremely difficult (maybe he's quadriplegic?) you'd get into a thornier ethical area, but I don't think the OP was thinking of that situation. But if you've got a patient who should lose 20 pounds (I've got a LOT more than that to lose) and you tell him you will not prescribe the drug unless he loses the weight and his problem persists, you're on shakier ground. But even then, if the weight loss will do a better job of fixing the problem, it's hard to argue that it isn't the better patient care. Is it ethical to insist that you will only help the patient pursue the "best" solution, if the "best" solution requires more effort on the patient's part and they may not want to do it?

I've been a patient for a long time, but I have no experience as a medical professional. I'm three weeks into an EMT-B course and came here for a study guide. But I've always figured that my own obesity is my personal failing and my responsibility. The doctors will not suffer the health problems it causes; I will. But I pay them to give me the best advice from their training and experience.

Heinlein fans might remember Lazarus Long's rule on advice. He never gives it because people never take it.

 

[Aidey]

Do you guys think that an ambulance company could be sued for weight discrimination for not having a backboard large enough, or for something like not starting an IV because the Medic didn't think they would be successful?

With the way things are going, I could see someone or their family suing in Vent's stroke example. 550lb grandma has some general weakness and mild confusion, but doesn't meet criteria to go to the stroke center. Grandma goes to St. Whoever's hosptial, but their CT machine isn't rated at 550lbs. There is an hour and a 1/2 delay while transfer is arranged and the pt is transported to Holy Someone's hospital where there is a big enough CT machine. During that time grandma's symptoms worsen and she is found to have a stroke. Because of the delay we are outside of the window for TPA, so now grandma has permanent damage. Family sues stating the pt wouldn't have permanent damage if St. Whoever didn't discriminate against overweight people by not having a CT rated for 550lbs.

 

[MedicSqrl]

I am sure it will eventually happen when over half of the US population is over 300 lbs.