Doctor Won't Treat Anyone Over 200 lbs

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Alissa_Sal's picture
Joined: 06/29/06
Posts: 6427
Doctor Won't Treat Anyone Over 200 lbs

Doctor Turns Away Obese Patients - Weight Center - Everyday Health

A primary care physician in suburban Boston is feeling the backlash of her decision to turn away patients weighing more than 200 pounds.

Dr. Helen Carter of Shrewsbury, Mass., told patient Ida Davidson, she would have to weigh 200 pounds or less to be treated by her practice. Davidson, who is in her early 60s and lives in Shrewsbury, sought out Dr. Carter for a routine check-up, reported WCBV-TV, a Boston-based broadcast affiliate.

"I've never heard of anything like that," Davidson told the reporter at the television network. "She didn't care about my health that day. I think she just cared that I was a liability to her and too much work."

Dr. Carter says she didn't turn away Davidson, but will be happy to take her on as a patient once she's lost some weight.

"It's not that I forced her not to come back," says Dr. Carter.

The doctor, who has been in private practice for 11 years, says her office is not physically equipped to handle the care of above-average weight patients, and that examining obese patients places physical demands on her staff that puts them at high risk for personal injury.

Last spring, Dr. Carter says she decided to limit the obese patients she sees, after a staff member suffered a cervical neck strain while assisting on routine physicals of two obese patients, one of whom weighed 284 pounds. The injury occurred when the doctor attempted to pull out the foot rest on the exam table while the patient was lying down. Dr. Carter says the incident put the physician out of commission for 12 weeks and the injury required substantial physical therapy, and she will require a maintenance care program to cope with the injury the rest of her life. She says some time ago, another staff member herniated two lumbar spine disks performing a physical on a patient.

"People make a choice about what they eat and don't eat," says Dr. Carter. "Why should someone be personally injured by someone else's life choices?"

To accommodate heavier patients, Dr. Carter says she would need a special electric exam table that costs $7,000. She says that is unaffordable.

A less costly solution, says the 50-year-old doctor, might be to request obese patients pull out the foot rest on their own. But she says she isn't sure her patients would be willing to comply if she enforced the rule.

The Massachusetts doctor isn't the only health practitioner to place weight restrictions at her practice. A 2011 survey conducted by the South Florida Sentinel revealed that 14 out of 105 gynecologists in the area were refusing to see obese patients at their practice. Most cited inadequate medical equipment as a reason for this decision.

William Thompson, a medical malpractice attorney and partner at Lubin & Meyer in Boston, says he has yet to come across any resulting injuries from treating an obese patient. Thompson is not consulting either of the parties involved in this dispute, says it would be tricky to pin the negligence on either party involved in such an incident.

"You'd have to say someone is negligible," he says. "It's not the patient's fault. It's not the table's fault. It would be a freak accident."

Thompson speculates Dr. Carter's decision may mostly have to do with her bottom line. In July, Massachusetts lawmakers signed into law a health care bill that will force doctors to transition from fee-based pay per service to global payments, meaning insurance companies will pay a doctor an equal amount for each patient they treat at their practice. Dr. Carter insists the law did not influence her decision.

Obese patients can often require significantly more medical care which can be costly. A 2009 study by the CDC found that annually obese patients spend $1,429 more on medical care than other patients.

In its Medical Code of Ethics, the American Medical Association deems it permissible for a physician to refuse treatment for a patient. ?A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.?
But Thompson questions if Dr. Carter's actions might be a slippery slope. "What's next? Are doctors not going to treat patients with diabetes or HIV?"

Some healthcare practitioners insist that a patient's weight should not influence the quality of care they receive or restrict their access to doctors.

Dr. Deborah Johnson, a certified gynecologist in private practice in Salem, Ore., says she's never refused to treat a patient because of weight, and that the standard metal exam tables she has at her offices are sufficient and safe for patients who weigh over 200 pounds. Dr. Johnson, 64, says she safely performed a pap smear on a 400-pound patient using a standard electric exam table. She says she purchased the exam table used for approximately $2,500.

Dr. Johnson says she believes Dr. Carter's concerns for her employees' safety is merely a way to hide her prejudice against obese individuals.

"She may be within her rights legally, but ethically I would say she's on shaky ground."

Thoughts? Do you think this doctor makes a reasonable case about worrying about the safety of her staff, or is this weight based discrimination?

AlyssaEimers's picture
Joined: 08/22/06
Posts: 6560

I do not know if it is legal or not, and I guess I would have to say a doctor can see whom ever they want to, but boy, it is a rotten thing to do.

My doctor is my best motivator to loss weight. I see her every three months to be weighed, talk about how I can eat/exercises better and live healthier to loose weight. Since starting to see her earlier this summer I have lost 19lbs. We are also taking care of some medical problems including a recent diagnosis of PCOS. I have just 5 more lbs to get to that precious 200lb mark. I would be beyond hurt if the doctor had ridiculed me or made me feel like I could not go there because of my weight. I can tell you with certainty I would not have gone somewhere else, and I would not be loosing the weight.

GloriaInTX's picture
Joined: 07/29/08
Posts: 4116

I wouldn't be surprised if we don't see a lot more of this if Obamacare goes into effect. When doctors are getting less and less per patient why should they go out of their way to treat the more difficult ones.

Joined: 12/10/05
Posts: 1681

Since she is a private practitioner, she has the right to treat who ever she likes.

BUT, her excuses about safety and equipment are absolute bull$hit. No doubt about it. Standard medical equipment can handle well over 200lbs. And I seriously doubt that the injury described was the result of the patients weight, as opposed to just an awkward movement sort of thing. Plus, 200lbs is not that heavy. I mean it isn't as if mobility is affected or anything.... Lots of people weigh more than that.

Probably best she doesn't treat those patients anyways. I'm sure she would be awful to them.

AlyssaEimers's picture
Joined: 08/22/06
Posts: 6560

It is a good point to say that if someone feels that way toward over weight people, that they are probably not very supportive, and not the kind of doctor I want in the first place.

mom3girls's picture
Joined: 01/09/07
Posts: 1535

I wonder if 200 is her cut off or if they have to be considered overweight or obese? My DH is 6'3" and is around 205 (plus or minus some depending on the time of year)

I think it is her choice, she knows what her office and what her skill level is. I would think she would lose a lot of patients though so this may not be the best choice financially.

Joined: 08/17/04
Posts: 2226

"GloriaInTX" wrote:

I wouldn't be surprised if we don't see a lot more of this if Obamacare goes into effect. When doctors are getting less and less per patient why should they go out of their way to treat the more difficult ones.

I'd say it probably won't happen. This happened here in Mass. where we have had mandated health care for several years and this is the first time I've ever heard of this. Also, the global payment reason is also an incorrect reason. Doctors are not penalized for overweight patients.

Doctors have every right to decide who is a an acceptable patient at their office but I think this decision is terrible and her excuses are nauseating.

wlillie's picture
Joined: 09/17/07
Posts: 1796

It's her decision. If she gets paid the same for each patient no matter how much work or how much it costs, of course she's not going to want to deal with obese patients. That would be like asking a cell phone company to charge the same amount to a Grandma who uses her cell phone for less than 5 minutes a month as the teenager with text and internet and talk. I would choose the Grandma over the teen just as this doctor has chosen the healthier weight vs the unhealthier weight. I wonder if she also doesn't accept smokers and what the excuse for that would be.

Joined: 08/17/04
Posts: 2226

That's not how global payments work. You do get a set amount for all patients that you treat and when they have good outcomes you get paid more. Basically it's to help prevent things like unnecessary ER visits, unnecessary repeat inpatient stays, misuse of CT scan/MRI orders etc.

They will also tend to be grouped together. For example, with the hospital system so all the docs/specialists in that hospital system can easily share records so if you forget you have a new rx it pops up.

wlillie's picture
Joined: 09/17/07
Posts: 1796

In July, Massachusetts lawmakers signed into law a health care bill that will force doctors to transition from fee-based pay per service to global payments, meaning insurance companies will pay a doctor an equal amount for each patient they treat at their practice.

This was in the article. Nevertheless- even with your definition, an overweight individual is always going to have fewer good outcomes than someone at a healthy weight if other factors are the same.

eta-I just shared a birthboard with Audra. If a doctor had to choose between her with her healthy eating and exercising and 4 beautiful childbirths and me who fails often at the healthy eating and exercising (though I try) who also donated a kidney and had a previous c-section (and opted for a second) who do you think the doctor should choose if she's getting paid based on outcome?

Can I really claim discrimination if I know it's going to cost them profit to treat me?

Joined: 08/17/04
Posts: 2226

Yes but the article was wrong which is why I said that's not what global payments actually are. It's a bit simplified. Global payment systems are extremely complicated.

It's not costing them profit at all to treat you.

Alissa_Sal's picture
Joined: 06/29/06
Posts: 6427

I'm completely confused by the reason she gave about someone hurting themself putting out a foot rest for an obese patient. Was the patient sitting on the foot rest at the time? Otherwise, what the heck does their weight have to do with it?

I'm not sure if it's legal, but it sure is crappy. I also have a hard time believing that this is the future of health care. If doctors only treat healthy patients, they are going to lose most of their patients. Don't most people go to the dr because they're sick? LOL

MissyJ's picture
Joined: 01/31/02
Posts: 3212

"AlyssaEimers" wrote:

I do not know if it is legal or not, and I guess I would have to say a doctor can see whom ever they want to, but boy, it is a rotten thing to do.

My doctor is my best motivator to loss weight. I see her every three months to be weighed, talk about how I can eat/exercises better and live healthier to loose weight. Since starting to see her earlier this summer I have lost 19lbs. We are also taking care of some medical problems including a recent diagnosis of PCOS. I have just 5 more lbs to get to that precious 200lb mark. I would be beyond hurt if the doctor had ridiculed me or made me feel like I could not go there because of my weight. I can tell you with certainty I would not have gone somewhere else, and I would not be loosing the weight.

Agreed. I cannot imagine how this is likely to impact those overweight patients that probably are already reluctant to go in to be seen. This is an opportunity for a doctor to connect with their patient... reaching out to HELP them overcome challenges (preferably with compassion.) Those doctors that ridicule, demean, or worse... dismiss... are likely to have an extremely negative impact on these patients' lives (and on their families.) Rather than serving to encourage and inspire healthy lifestyle changes, the patient may instead opt to pull back and not subject themselves to such humiliation again.

While technically legal, it is such a rotten thing to do.

Joined: 03/14/09
Posts: 624

If I found out my doctor had a policy like this, whether it affected me or not, I would stop going to that doctor. It would make me question whether the doctor was able to read the latest research, or whether their phobias were more important than their ability to make scientific judgements.

Minx_Kristi's picture
Joined: 01/02/09
Posts: 1261

What a crock of sh*t.

I'm sorry but she is a DOCTOR and should not be able to pick and choose who she cares for. If she is private and someone on the heavier side can afford her services she should treat them! Can you imagine if firemen started saying they wouldn't rescue you from a fire if you weighed over a certain weight?! These people (I thought anyways) go into these professions to help people, not discriminate them!!

xx

wlillie's picture
Joined: 09/17/07
Posts: 1796

"Jessica80" wrote:

Yes but the article was wrong which is why I said that's not what global payments actually are. It's a bit simplified. Global payment systems are extremely complicated.

It's not costing them profit at all to treat you.

You said they were paid on outcome. If you start off with someone who isn't healthy (don't care what anyone says, obesity means you are not healthy), you are going to have fewer good outcomes (no matter how much work you put into it) than you do if you start off with someone who is at a healthy weight (even if their habits aren't healthy).

Joined: 03/14/09
Posts: 624

"Minx_Kristi" wrote:

Can you imagine if firemen started saying they wouldn't rescue you from a fire if you weighed over a certain weight?!

Frightening, isn't it?

Joined: 08/17/04
Posts: 2226

"wlillie" wrote:

You said they were paid on outcome. If you start off with someone who isn't healthy (don't care what anyone says, obesity means you are not healthy), you are going to have fewer good outcomes (no matter how much work you put into it) than you do if you start off with someone who is at a healthy weight (even if their habits aren't healthy).

No it is more like....you have obese patient. You encourage them to lose weight. Things like nutrition therapy (which ins. covers), weight watchers (my company reimburses for membership) etc. That is a good outcome.

It doesn't mean oh all your patients are 24-29 and healthy. Not at all

Rivergallery's picture
Joined: 05/23/03
Posts: 1301

200 is hardly anything IMO, I am 5'4 1/2 and in healthy weight.. but when pregnant got to 178.. that is so close to 200 I imagine someone in my situation easily needing an exam table that can support 200 lbs I think she is full of it and why not ask the client to help out? sounds stupid.

ClairesMommy's picture
Joined: 08/15/06
Posts: 2299

"Rivergallery" wrote:

200 is hardly anything IMO, I am 5'4 1/2 and in healthy weight.. but when pregnant got to 178.. that is so close to 200 I imagine someone in my situation easily needing an exam table that can support 200 lbs I think she is full of it and why not ask the client to help out? sounds stupid.

Exactly. At 5'8" I'm healthy at 150 pounds. The day I had DD I was 195.

My brother is 6'1" and over 200 pounds. He's a firefighter and is built like a Mack truck. Is he obese or even unhealthy? No way.

I believe this is discriminatory.