Chances are good that in your practice, you treat obese patients. Obesity continues to be a national crisis. Current research has found that 35% of men and 40.4% of women in the United States are obese. The obesity crisis not only contributes to growing health costs but also raises serious patient safety risks.
Patients who have experienced an adverse medical event leading to a medical malpractice claim are frequently noted to be obese (based on documented height and weight). A review of 7,065 claims from 2011 to 2013 by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, revealed that 28% were identified as having one or more comorbidities, and obesity was the most common (8.3% of total claims and 19.2% of total claims with a comorbidity). When closed claims were analyzed, 26% of claims that resulted in indemnity payments listed obesity as a comorbidity.
Increased risks: Complications and access issues
Obese patients commonly have a variety of comorbidities. Many are associated with a metabolic syndrome (i.e., hypertension, dyslipidemia, and hyperglycemia) which increases the risk of stroke, ischemic heart disease, and diabetes mellitus. These patients also have increased risk of obstructive sleep apnea (which often contributes to opioid-induced respiratory depression), susceptibility to nosocomial and postoperative infections, and weight-associated wear and tear on joints that can lead to osteoarthritis. Additionally, bariatric surgery can be associated with both surgical and metabolic complications.
In addition to the risks of comorbidities, healthcare facilities also face risks if they are unprepared to accommodate obese patients. An inability to fit a morbidly obese patient into a conventional MRI machine or CT scanner is a unique problem necessitating use of an open MRI or CT. Healthcare facilities that are unable to accommodate morbidly obese patients in their MRI machine or CT scanner, or if their MRI or CT isn’t available at night or on weekends, should have transfer agreements with open facilities in place so there are no delays in urgent MRIs or CT scans. The failure to transfer an obese patient to a facility with an open MRI machine or CT scanner in a timely fashion may result in a delay of diagnosis and/or surgical treatment—and, ultimately, in a malpractice claim.
Steps to accommodate patients of all sizes
Practices should have appropriately sized furniture in the waiting areas and exam rooms to meet the needs of obese patients. They should also have equipment—such as blood pressure cuffs, needles, and wheelchairs—designed for obese patients.
Weight assessment tools are handy, and practices may want to consider providing weight education to patients. It is key to understanding the importance of talking about weight with patients—the conversation should take place early for better prevention and treatment. Many factors can arise that inhibit a practitioner from speaking frankly about weight with a patient. As obesity rates continue to increase, it is worthwhile for doctors and other healthcare professionals to recognize that they might have their own barriers to such communications as this case study illustrates:
A 44-year-old morbidly obese woman (body mass index [BMI] 65.8) had a sleep apnea test that was monitored by a technician on a recording system.
The technician observed that the patient had fallen out of the bed and was unable to get up. Instead of responding, the technician assisted another patient. The patient struggled for almost 10 minutes before she was able to get up by herself.
The patient went back to sleep but awoke later with a prolonged episode of coughing. Again, the technician failed to assist in a timely manner and did not help the patient remove the CPAP mask. When the patient coughed some phlegm onto the floor, the technician chastised her. The patient left after that incident, saying that the staff at the healthcare facility had not treated her with respect.
These episodes were captured on DVD as part of the sleep apnea workup. The technician was fired for his inattention and his unacceptable response to the patient.
This case illustrates an employee’s inappropriate behavior toward a patient and may also indicate a negative attitude toward obese patients. This necessitates a closer examination of attitudes. The Obesity Society offers advice to doctors and other healthcare providers to help address this issue. The first step is to become aware of any personal bias against obese people by asking these questions:
- Do I make assumptions based only on weight regarding a person’s character, intelligence, professional success, health status, or lifestyle behaviors?
- Am I comfortable working with people of all shapes and sizes?
- Do I give appropriate feedback to encourage healthful behavior change?
- Am I sensitive to the needs and concerns of obese individuals?
- Do I treat the individual or only the condition?
Answering these questions can assist doctors in developing empathy and meeting the needs of obese patients. It can also help them create a positive health experience for obese patients. Here are some specific strategies to use:
- Consider that patients may have had negative experiences with other health professionals regarding their weight, and approach patients with sensitivity.
- Recognize the complex etiology of obesity, and communicate this to colleagues and patients to avoid stereotypes that obesity is attributable to personal willpower.
- Explore all causes of presenting problems, not just weight.
- Recognize that many patients have tried to lose weight repeatedly.
- Emphasize behavior changes rather than just the number on the scale.
- Offer concrete advice (e.g., start an exercise program, eat at home, etc).
- Acknowledge the difficulty of lifestyle changes.
- Recognize that small weight losses can result in significant health gains.
Sensitive treatment of obese patients involves attending to their needs for comfort, safety, and respect. Obesity can be viewed as one of the many chronic health conditions afflicting patients. The person, not the obesity, should be the focus of treatment. As with any patient with a chronic health condition, a relationship with respectful caring forms the bedrock of medical care.
This post was sponsored by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer.