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Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

nytimes.com

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Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#21

Post by nugget »

fjjrxcbdhx wrote: post #8
ZanyProgrammer wrote: post #4

Earlier quoted context omitted.

Or doctors could learn to be more humane when dealing with patients? Calling for automation in this case seems to be a very software engineering centric solution to the issue.

I don't even work in software, but it just makes sense considering most of what they do is looking up factoids in a textbook. They frequently misdiagnose or let things slip by because there's just no way for humans to memorize that many books.

That's a little like saying software developers spend all day googling for syntax. The "factoids" aren't very useful unless you know how to put them together and what to do with them.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#22

Post by ivraatiems »

I'm disappointed by the lack of empathy in these comments.

While I agree that yes, an obese person needs to lose weight, telling them that and offering no other help is like telling someone with depression "why don't you just cheer up?" It's totally unuseful advice that incorporate all sorts of gross value judgments about the person. It doesn't solve problems.

I've been overweight - not obese, but close at times - all my life. I'm now on a weight loss program and seeing significant success. It took years of mental and physical issues to get me to that point and it is a struggle every day. It's hard work. That's why people are proud of losing weight: it's an achievement. It represents a permanent change to lifestyle and behavior that takes weeks, months, even years to effect.

Please don't discount people's experiences by saying things like "oh, just lose weight." Consider the human being in there, and how to reach them. Don't assume that because it's easy for you to be fit and skinny, it's easy for everyone.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#23

Post by csours »

There is something similar in IT operations/support. Many companies refuse to investigate an issue until you are on the latest versions of software and firmware.

There are good reasons for each of these checkpoints: there may be a real issue not caused by obesity/old firmware, but it is really hard to tell until you get past that.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#24

Post by nugget »

whamlastxmas wrote: post #5

Let me save you the time: it's an article pandering to fat people without any substance and really dishonest arguments. The complaint is that doctors tell fat people to lose weight when they come in with symptoms that match the symptoms of being very overweight. If you go to the doctor with knee pain and you are drastically overweight, the most likely answer is that the knee pain is from being overweight. The doctor…

One interesting point they touch upon is medicare's move to bundled payments creating an incentive for physicians (and hospitals) not to operate on anyone they believe more likely to suffer complications, including the obese. Fair or not, people respond to incentives, especially financial incentives. We will start to hear a lot more about this in the future.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#25

Post by __jal »

fjjrxcbdhx wrote: post #8
ZanyProgrammer wrote: post #4

Earlier quoted context omitted.

Or doctors could learn to be more humane when dealing with patients? Calling for automation in this case seems to be a very software engineering centric solution to the issue.

I don't even work in software, but it just makes sense considering most of what they do is looking up factoids in a textbook. They frequently misdiagnose or let things slip by because there's just no way for humans to memorize that many books.

Wow.

Who knew that medicine and library science were the same thing? Come to think of it, I bet librarians could replace lawyers, too. Just need to teach them to shout "objection" and be jerks in the coffee room, right?

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#26

Post by dclowd9901 »

lsy wrote: post #20
whamlastxmas wrote: post #5

Let me save you the time: it's an article pandering to fat people without any substance and really dishonest arguments. The complaint is that doctors tell fat people to lose weight when they come in with symptoms that match the symptoms of being very overweight. If you go to the doctor with knee pain and you are drastically overweight, the most likely answer is that the knee pain is from being overweight. The doctor…

This seems like an unfair characterization of the article. Denial of care, or dangerously mismeasured care, is not acceptable simply based on BMI (a non-scientific measure invented in the early 1800s). If you look at the statistics on weight loss success rates, asking a 500lbs person to lose 200+lbs before you're willing to treat their disease with actual evidence-based medicine—looking at symptoms, pathology, etc—is…

But therein lies the problem: being overweight is so _unbelievably_ unhealthy that most problems would be resolved simply by losing the weight. And conversely, I don't think any doctor out there is refusing to treat a sinus infection because a patient is overweight.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#27

Post by bkor »

lsy wrote: post #20
whamlastxmas wrote: post #5

Let me save you the time: it's an article pandering to fat people without any substance and really dishonest arguments. The complaint is that doctors tell fat people to lose weight when they come in with symptoms that match the symptoms of being very overweight. If you go to the doctor with knee pain and you are drastically overweight, the most likely answer is that the knee pain is from being overweight. The doctor…

This seems like an unfair characterization of the article. Denial of care, or dangerously mismeasured care, is not acceptable simply based on BMI (a non-scientific measure invented in the early 1800s). If you look at the statistics on weight loss success rates, asking a 500lbs person to lose 200+lbs before you're willing to treat their disease with actual evidence-based medicine—looking at symptoms, pathology, etc—is…

BMI works just fine for someone weighing so much that they need to go and find a special scale to measure them.

Already before you're obese it'll be difficult to give someone CPR. If someone is obese that's dangerous already. It's completely normal and logical response to tell them to lose weight.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#28

Post by imagist »

whamlastxmas wrote: post #5

Let me save you the time: it's an article pandering to fat people without any substance and really dishonest arguments. The complaint is that doctors tell fat people to lose weight when they come in with symptoms that match the symptoms of being very overweight. If you go to the doctor with knee pain and you are drastically overweight, the most likely answer is that the knee pain is from being overweight. The doctor…

So, I'm in strong agreement that it's reasonable to have weight cutoffs as requirements for surgery, but let's make that argument based on facts, please. You said:

> This survey doesn't confirm that surgeries are refused for the fear of lower ratings.

The articles says:

> And 42 percent who picked a body mass index cutoff said they had done so because they were worried about their performance score or that of their hospital.

The problem with this story isn't that it's facts are wrong or misrepresented, it's that they're only reporting one side of the debate in a situation which is very much not one-sided.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#30

Post by hart_russell »

csours wrote: post #23

There is something similar in IT operations/support. Many companies refuse to investigate an issue until you are on the latest versions of software and firmware. There are good reasons for each of these checkpoints: there may be a real issue not caused by obesity/old firmware, but it is really hard to tell until you get past that.

Great analogy
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