Should OB's be able to turn away obese patients?

64 posts / 0 new
Last post
AlyssaEimers's picture
Offline
Last seen: 3 months 1 week ago
Joined: 08/22/06
Posts: 6803
Should OB's be able to turn away obese patients?

I am not sure how to post this but I was floored when I read this.

http://abcnews.go.com/Health/poll-finds-florida-ob-gyns-turn-obese-patients/story?id=13622579

Obese pregnant women, already at higher risk for health complications, have had another setback: a survey conducted this week by South Florida's Sun Sentinel revealed that several ob-gyns there refuse to treat overweight and obese women.

Some doctors who admitted they refused obese patients in the survey said that they did not have adequate equipment to treat women over a certain weight. Others said they refuse obese patients because they are too high-risk to treat, and need doctors with special skills.

"I think this is unconscionable," said Dr. Robert Kushner, professor of medicine at Northwestern University's Feinberg School of Medicine. "This is a form of discrimination in the worst way."

Drs. Jeffrey Solomon and Isabel Otero-Echandi, private practice ob-gyns in Plantation, Fla., were among the 15 who admitted they reject new patients who weigh more than 250 lbs, according to the Sun Sentinel.

The office manager said the doctors had no further comment.

Obese pregnant women are at an increased risk of gestational diabetes, preeclampsia and postpartum infection, among other complications.

Turning down obese patients is not illegal. Doctors are allowed to drop or refuse patients if they feel a patient's condition is outside of their skill set, and it is not based on race, sexual orientation or gender.

But Dr. F. Ralph Dauterive, chair of obstetrics and gynecology at the Ochsner Clinical Foundation in Baton Rouge, said that he not only disagrees with doctors who exclude overweight patients from an obstetrics practice, but he rejected the excuse that physicians' medical training would make them unable to care for obese patients.

"The medical risk to the pregnancy is greater, but the obstetrical trained M.D. should be capable of management," said Dauterive. "We have an obligation to care for patients based upon our training. We really do owe that to the community in which we live."

And that community is growing. According to the Centers of Disease Control and Prevention, 26.1 percent of U.S. adults were obese in 2008, up from 25.6 percent in 2007.

Many experts say that's too large a population simply to deny, especially because complicated pregnancies are the ones that require the most preventive and vigilant care.

James Zervios, director of communications for the Obesity Action Coalition, said that this likely happens a lot more than people think.

"We've heard this going on with other doctors in the past," said Zervios. "I find it hard to believe that doctors don't have tables and equipment to accommodate overweight patients with 93 million Americans affected by obesity."

"This goes against the basic principles of health care," continued Zervios. "They're there to improve the quality of life for those they serve."

Because of fear of discrimination and belittling, Zervios said many obese people avoid the doctor altogether, even though a trusting relationship between a doctor and patient would offer a perfect time to discuss necessary lifestyle changes. It's a missed opportunity that could address issues that are affecting one quarter of Americans, said Zervios.

Obese Pregnant Women: Refusal to Treat Could Affect Public Health

"From a public health point of view, what if every specialty trained M.D. chose to only take care of low-risk patients?" said Dauterive. "We would not have enough providers caring for the segment of the population that needs the specialized care the most. Of note, if an obstetrician will only see low-risk patients, then they are basically doing the job of a midwife at a much higher cost, with outcomes that are statistically not better."

But Dr. Brad Imler, president of the American Pregnancy Association, said doctors avoid overweight patients more out of fear of getting sued than because they discriminate.

"Everybody needs an investment in their pregnancy to increase the probability of a healthy baby," said Imler. "But I understand the challenge and concern. Women who are overweight are looking at a greater chance of complications. With our society being prone to litigation that puts doctors in a liable situation, or a position of concern. Either way, neither situation is good for the health of the baby."

"A woman can do everything right during her pregnancy and still have complications," said Imler. "When that happens, most people want someone to be held accountable. That affects public health."

Obstetric experts have been "falling off the map" for years because of high cost and the fear of lawsuits, said Imler. "It is one of the main concerns of ACOG (the American Congress of Obstetrics and Gynecologists)," said Imler. "It's cheaper and they make more money to do straight gynecology."

"I think doctors gladly seek to care for a woman whom he knows needs the care and would seek to provide her with proper education and foster healthy pregnancy in spite of challenges faced with whatever lifestyle factors," said Imler. "That is, as long as, if complications arise, he or she is not going to be sued."

AlyssaEimers's picture
Offline
Last seen: 3 months 1 week ago
Joined: 08/22/06
Posts: 6803

Sorry if I posted it wrong.

Alissa_Sal's picture
Offline
Last seen: 2 years 9 months ago
Joined: 06/29/06
Posts: 6427

You did fine. Smile

I think that if a doctor truly feels that a patient's condition is outside of their skill set, they should definitely refer the patient to another doctor that specializes more in that condition rather than give them inadequate care. But at least according to the article

Obese pregnant women are at an increased risk of gestational diabetes, preeclampsia and postpartum infection, among other complications.

That says to me that all women are capable of experiencing these complications, so presumably most OBs must be competent at handling them if they do arise. I can say for a fact that I got GD with T and I was no where close to obese, and they are assuming that I will have it again this time (still not obese.) What's next, refusing to treat people of certain races that are at a higher risk for things (for example, GD in the hispanic population.) It strikes me as an excuse, not a good reason.

Also, I can say from having GD myself, my OB didn't really treat me for it - he refered me to a nutritionist, and I worked directly with her, and she sent reports to him. So yeah, again, that seems like something you could do whether the patient was obese or not.

Offline
Last seen: 4 years 4 months ago
Joined: 08/05/06
Posts: 441

I read about this elsewhere (I can't remember where) a few days ago and I was under the impression that they weren't declining these patients due to increased risk for health problems but due to a lack of appropriate technology to give these patients the standard of care (exam tables that will hold higher weights, lengthened speculums, etc). I'm not really sure how I feel about this, so I'll be interested to follow the debate.

Offline
Last seen: 4 years 2 months ago
Joined: 12/10/05
Posts: 1681

That is ridiculous.

Referring patients to a specialist for high level care is one thing, but ob/gyn ARE the specialists. There isn't anyone else to refer those women too. I think working with the women regarding healthy eating, monitoring weight gain, etc are all reasonable (and important) but to refuse care .period. is wrong.

The ONLY exception to that would be if truly there wasn't equipment to meet the women's needs BUT I know for a fact that isn't a problem unless a person is 400lb or so. At that weight bariatric stretchers, beds, etc would be needed and that could potentially cause a problem. But, the birth is likely to be in hospital and hospitals have all those things. I find it really hard to believe any office visit type equipment would be a problem.

AlyssaEimers's picture
Offline
Last seen: 3 months 1 week ago
Joined: 08/22/06
Posts: 6803

I am overweight myself (less then the article is talking about) and can not imagine a doctor not being willing to see me due to my weight. I am working hard at loosing weight and I can not see how refusing to see a patient due to their weight helps a the situation.

Offline
Last seen: 4 years 6 months ago
Joined: 01/01/06
Posts: 262

I think any business should be allowed to choose who they want to do stuff for--whether it's selling stuff or doing medical work.

That said I don't obesity as being a reason not to see someone, unless you don't have the proper equipment. And yes, that means in your office, not just the hospital. OBs see more people than just for pregnancy....

RebeccaA'07's picture
Offline
Last seen: 4 years 3 months ago
Joined: 11/19/07
Posts: 1628

As a business, I think they have the right to turn away patients if they are not equipped to handle their situation. If the doctor does not have the right equipment or is not skilled in obese pregnancies, I would much rather them turn the patient away or over to another OB then risk mis-handling of the patient's health.

wlillie's picture
Offline
Last seen: 3 weeks 5 days ago
Joined: 09/17/07
Posts: 1796

If that many obese women are pregnant, why aren't the states requiring OBs to be able to handle the extra heavy women before giving out licenses?

Offline
Last seen: 3 years 3 months ago
Joined: 05/31/06
Posts: 4780

Sounds like a great business opportunity for an OB who has some background of or knowledge or specialization in obesity.

I don't see it as being all that different from a midwife or other provider "risking someone out". Is it? Maybe I'm just not looking at it right?

Also, Kate, I'm a little freaked out at the images coming to my mind ~ do obese people really need lengthened speculums? Why?

Offline
Last seen: 4 years 2 months ago
Joined: 12/10/05
Posts: 1681

"Potter75" wrote:

Sounds like a great business opportunity for an OB who has some background of or knowledge or specialization in obesity.

I don't see it as being all that different from a midwife or other provider "risking someone out". Is it? Maybe I'm just not looking at it right?

Also, Kate, I'm a little freaked out at the images coming to my mind ~ do obese people really need lengthened speculums? Why?

A midwife or GP is technically trained in low-risk pregnancy/birth, but a ob/gyn IS the specialist. Who would they risk them out to?

If medical programs today aren't covering medical care for people over 250lbs, then there needs to be a serious overhaul of doctors education.

These GP's are just cherry picking the "easier" patients who are less likely to have complications so they can see more patients. Doctors and midwives (here at least) get paid per pregnancy/delivery. So regardless of whether they see you twice the whole pregnancy or every week for 40 weeks, they get paid the same.

Offline
Last seen: 4 years 5 months ago
Joined: 06/04/07
Posts: 1368

Some doctors who admitted they refused obese patients in the survey said that they did not have adequate equipment to treat women over a certain weight. Others said they refuse obese patients because they are too high-risk to treat, and need doctors with special skills.

"From a public health point of view, what if every specialty trained M.D. chose to only take care of low-risk patients?" said Dauterive. "We would not have enough providers caring for the segment of the population that needs the specialized care the most. Of note, if an obstetrician will only see low-risk patients, then they are basically doing the job of a midwife at a much higher cost, with outcomes that are statistically not better."

OB's are specialty trained for high risk patients, so I think it's ridiculous that they state they are not equipped to handle this group of patients who would also be considered high risk. I had no choice but to go with an OB doctor after my first one because they're the only ones who deal with high risk pregnancies (due to an e-c-section). To say they lack equipment or need "special" skills for overweight women is a complete cop-out. Discrimination at it's best, imo.

Spacers's picture
Offline
Last seen: 10 months 3 weeks ago
Joined: 12/29/03
Posts: 4104

This is ridiculous. Just because a woman is obese doesn't mean she'll have any problems. If problems develop in any pregnancy, the OB either deals with them as they are trained to, or refers the mother to a high-risk specialist. It shouldn't matter what you weigh, it should matter how your pregnancy goes. I was about 250 pounds when I got pregnant with Weston, and there was nothing about my pregnancy that was high risk or required any additional equipment. They needed to use the larger BP cuff but that was it. I was healthy enough to not be risked out for a homebirth.

Offline
Last seen: 4 years 4 months ago
Joined: 08/05/06
Posts: 441

"Potter75" wrote:

Sounds like a great business opportunity for an OB who has some background of or knowledge or specialization in obesity.

I don't see it as being all that different from a midwife or other provider "risking someone out". Is it? Maybe I'm just not looking at it right?

Also, Kate, I'm a little freaked out at the images coming to my mind ~ do obese people really need lengthened speculums? Why?

My understanding is that a very obese woman may require a different sort of speculum than what is standard if there is a lot of adipose tissue present. This certainly is not my area of specialty, though, so your mileage may vary.

lovelymomma's picture
Offline
Last seen: 3 years 5 months ago
Joined: 11/04/05
Posts: 88

leave it to be my city...

i guess they should be able to turn away patients, if they truly believe its a risk to their license. I had a dr turn me away as a VBA2C, its their right to do that. I dont think that its "right" or fair though, any patient can turn high risk at any time. Obese or not. if its a mater of not having proper equipment what are they supposed to do? as for ob's being for high risk, they would get sent to peri... i did.

daniellevmt's picture
Offline
Last seen: 4 years 10 months ago
Joined: 07/25/06
Posts: 213

Hold up. I realize that an OB *is* a specialist, but I had high BP issues and my OB stated from the get-go that if it turned into pre-e, he would require me to start seeing an OB in the nearest metro area because they would be better equipped to treat me and the baby. I'm not overweight.

Do I think there are OB's out there that refuse to take on obese patients because it's more work/less money for them? Sure. But there are obviously OB's out there that *truly* just want to do what is best for the patients. I can see being upset by this, but I also think too much is being read into the article. I have quite a few obese friends, and I have to say, they ALL had pregnancy issues directly related to their being overweight (or so their Dr. said). But then again, I had pretty nasty BP issues and I'm not overweight...how do they even know for sure that these things ARE directly related to weight? Statistics, I'm sure, but overall, that's a tough call.

culturedmom's picture
Offline
Last seen: 4 years 4 months ago
Joined: 09/30/06
Posts: 1131

"lovelymomma" wrote:

leave it to be my city...

i guess they should be able to turn away patients, if they truly believe its a risk to their license. I had a dr turn me away as a VBA2C, its their right to do that. I dont think that its "right" or fair though, any patient can turn high risk at any time. Obese or not. if its a mater of not having proper equipment what are they supposed to do? as for ob's being for high risk, they would get sent to peri... i did.

I just don't think it is the same. The dr. I assume turned you away because he/she was against that procedure and felt it was not a safe practice. Unless these drs. are turning away fat women because they are against fat women, then I don't see their reasoning. They are drs. for christ sake and they are turning away patients because they might get sicker? That just seems f'ed up to me. Obese women may be at higher risk, but so are short women with tall husbands, women who have had previous c-sections, women with small pelvises, women who are having multiple births, etc. Any dr. who says they only want to see completely healthy patients is an idiot and I don't know why any woman would want to go to a dr. like that.

BTW, I think it is simply a malpractice reason. Today I heard on NPR that malpractice lawsuits against OB's have risen.

daniellevmt's picture
Offline
Last seen: 4 years 10 months ago
Joined: 07/25/06
Posts: 213

"culturedmom" wrote:

I just don't think it is the same. The dr. I assume turned you away because he/she was against that procedure and felt it was not a safe practice. Unless these drs. are turning away fat women because they are against fat women, then I don't see their reasoning. They are drs. for christ sake and they are turning away patients because they might get sicker? That just seems f'ed up to me. Obese women may be at higher risk, but so are short women with tall husbands, women who have had previous c-sections, women with small pelvises, women who are having multiple births, etc. Any dr. who says they only want to see completely healthy patients is an idiot and I don't know why any woman would want to go to a dr. like that.

BTW, I think it is simply a malpractice reason. Today I heard on NPR that malpractice lawsuits against OB's have risen.

Yes, that's exactly the reason why a lot of OB's turn women away who want a VBAC. Our society has created this problem by choosing to and being allowed to sue for every tiny little thing. It sucks.

culturedmom's picture
Offline
Last seen: 4 years 4 months ago
Joined: 09/30/06
Posts: 1131

"daniellevmt" wrote:

Yes, that's exactly the reason why a lot of OB's turn women away who want a VBAC. Our society has created this problem by choosing to and being allowed to sue for every tiny little thing. It sucks.

I agree. But I see a big difference between a dr. who won't do a VBAC and a dr. who won't see overweight patients. The dr. who doesn't do VBAC's isn't saying they won't see patients with c-sections. They aren't discriminating against one women over a another. They are simply saying, right or wrong, I don't feel comfortable with this procedure. Ashley's dr. would see her if she didn't want the VBAC. The drs. refusal was not towards her but to the procedure she wanted. That happens all the time. Just like you might not choose a dr. who prefers holistic measures or one who allows BF'ing while giving your baby a shot. Those are procedural differences. A dr. who refuses to see a fat patient is discriminating against the patient.

AlyssaEimers's picture
Offline
Last seen: 3 months 1 week ago
Joined: 08/22/06
Posts: 6803

"lovelymomma" wrote:

leave it to be my city...

i guess they should be able to turn away patients, if they truly believe its a risk to their license. I had a dr turn me away as a VBA2C, its their right to do that. I dont think that its "right" or fair though, any patient can turn high risk at any time. Obese or not. if its a mater of not having proper equipment what are they supposed to do? as for ob's being for high risk, they would get sent to peri... i did.

Perinatologist. For the life of me I could not remember what they were called.

Offline
Last seen: 4 years 2 months ago
Joined: 12/10/05
Posts: 1681

"daniellevmt" wrote:

Hold up. I realize that an OB *is* a specialist, but I had high BP issues and my OB stated from the get-go that if it turned into pre-e, he would require me to start seeing an OB in the nearest metro area because they would be better equipped to treat me and the baby. I'm not overweight.

Referring a patient to a larger center is entirely different. Your OB was likely trained to deal with pre-e but the local hospital supports don't allow for it. I work on a mat unit in a small community hospital. Our OB's are totally competent in treating pre-e, but patients will get referred to a higher level of care usually due to NICU constraints.

Perinatology is a subspecialty. They are OB's who only deal with maternity vs. one who also does gyne.

daniellevmt's picture
Offline
Last seen: 4 years 10 months ago
Joined: 07/25/06
Posts: 213

"culturedmom" wrote:

I agree. But I see a big difference between a dr. who won't do a VBAC and a dr. who won't see overweight patients. The dr. who doesn't do VBAC's isn't saying they won't see patients with c-sections. They aren't discriminating against one women over a another. They are simply saying, right or wrong, I don't feel comfortable with this procedure. Ashley's dr. would see her if she didn't want the VBAC. The drs. refusal was not towards her but to the procedure she wanted. That happens all the time. Just like you might not choose a dr. who prefers holistic measures or one who allows BF'ing while giving your baby a shot. Those are procedural differences. A dr. who refuses to see a fat patient is discriminating against the patient.

I don't disagree with you completely, but just to throw this out there: If a doc can say, right or wrong, they don't feel comfortable performing a VBAC, why shouldn't they be able to say, right or wrong, they don't feel comfortable treating an obese patient due to the increased risk of multiple pregnancy induced conditions? KWIM? Try to look beyond taking this personally. I don't think it has as much to do with "you" (general you) as you think here. An obese woman is a patient, and obesity is legit medical condition. Would you feel the same if a doctor turned away any other woman with a specific medical condition because he/she didn't feel comfortable treating them? I mean sure, there is an "increased risk" of an obese woman having complications, so you could argue that there may never be a complication so the OB should have to see her. However, isn't obesity in and of itself a poorly medical condition?

I guess I just don't think it's fair that people think doctors shouldn't be allowed to choose their patients based on what THEY feel comfortable treating. I mean, we can all sit here and say they were specialty trained in this and that, but that doesn't mean that ALL OB's are comfortable with every facet of obstetrics. The basics, sure, they have to be. But when things get serious, I don't think they should be stripped of the right to refuse to take on a patient if they don't feel comfortable with treating the medical condition they bring with them.

Who knows. Maybe if this turns into an epidemic (well, obesity really IS an epidemic already), there will be a need to create a subspecialty that turns out doctors who only take obese patients. My friends who are obese had completely different visits than I did the whole 9 months. And we all had the same OB! And the reason was directly related to their obesity. They were screened for a lot more things (or screened more often, kept a close on) at their appt's than I was as a healthy, normal weight woman. So yeah, I could totally see there being a need for a subspecialty to create available and proper care for obese pregnant women.

Or maybe they need to be referred to a high risk doc?? IDK...

daniellevmt's picture
Offline
Last seen: 4 years 10 months ago
Joined: 07/25/06
Posts: 213

"kris_w" wrote:

Referring a patient to a larger center is entirely different. Your OB was likely trained to deal with pre-e but the local hospital supports don't allow for it. I work on a mat unit in a small community hospital. Our OB's are totally competent in treating pre-e, but patients will get referred to a higher level of care usually due to NICU constraints.

Perinatology is a subspecialty. They are OB's who only deal with maternity vs. one who also does gyne.

Perinatololgy is a subspecialty of obstetrics? I guess I always thought it was a subspecialty of pediatrics, but medical terminology tells me I was wrong, LOL.

As to the bolded, do you think some of the cases discussed in the article fit in here? Maybe that's why the OB's didn't feel comfortable taking the cases, because they weren't equipped to deal with the complications?

keky's picture
Offline
Last seen: 4 years 3 weeks ago
Joined: 12/23/07
Posts: 163

Funny because I work in OB and I would say obese vs. not I see the complications equally. I personally am considered obese and had 2 pregnancies, no complications, quick vaginal deliveries.

culturedmom's picture
Offline
Last seen: 4 years 4 months ago
Joined: 09/30/06
Posts: 1131

"daniellevmt" wrote:

I don't disagree with you completely, but just to throw this out there: If a doc can say, right or wrong, they don't feel comfortable performing a VBAC, why shouldn't they be able to say, right or wrong, they don't feel comfortable treating an obese patient due to the increased risk of multiple pregnancy induced conditions? KWIM? Try to look beyond taking this personally. I don't think it has as much to do with "you" (general you) as you think here. An obese woman is a patient, and obesity is legit medical condition. Would you feel the same if a doctor turned away any other woman with a specific medical condition because he/she didn't feel comfortable treating them? I mean sure, there is an "increased risk" of an obese woman having complications, so you could argue that there may never be a complication so the OB should have to see her. However, isn't obesity in and of itself a poorly medical condition?

I guess I just don't think it's fair that people think doctors shouldn't be allowed to choose their patients based on what THEY feel comfortable treating. I mean, we can all sit here and say they were specialty trained in this and that, but that doesn't mean that ALL OB's are comfortable with every facet of obstetrics. The basics, sure, they have to be. But when things get serious, I don't think they should be stripped of the right to refuse to take on a patient if they don't feel comfortable with treating the medical condition they bring with them.

Who knows. Maybe if this turns into an epidemic (well, obesity really IS an epidemic already), there will be a need to create a subspecialty that turns out doctors who only take obese patients. My friends who are obese had completely different visits than I did the whole 9 months. And we all had the same OB! And the reason was directly related to their obesity. They were screened for a lot more things (or screened more often, kept a close on) at their appt's than I was as a healthy, normal weight woman. So yeah, I could totally see there being a need for a subspecialty to create available and proper care for obese pregnant women.

Or maybe they need to be referred to a high risk doc?? IDK...

First, what do you mean by the bolded Danielle? Just because I disagree with you and think it's complete discrimination, does not mean I am thinking about it emotionally or with any less logic then you.

And no, I don't think it is the same and no I don't know what you mean. If a patient wants a VBAC, that is a specific procedure they are asking a dr. to perform. It's a given. If an obese patient came in with GD or already had complications, then yes I can see a dr. sending them to a specialist. But to assume because they are fat that they might have problmes and so you refuse to see them? No, Danielle, that's just wrong.

Again, refusing to do a VBAC has nothing to do with the patient. The Ob isn;t saying I refuse to see patients who have had c-sections just in case they change their mind and want a VBAC. It's not some twisted pre-emptive thing.

Offline
Last seen: 4 years 2 months ago
Joined: 12/10/05
Posts: 1681

"daniellevmt" wrote:

Perinatololgy is a subspecialty of obstetrics? I guess I always thought it was a subspecialty of pediatrics, but medical terminology tells me I was wrong, LOL.

As to the bolded, do you think some of the cases discussed in the article fit in here? Maybe that's why the OB's didn't feel comfortable taking the cases, because they weren't equipped to deal with the complications?

I wasn't 100% sure, so I looked it up Smile

I sort of doubt that hospital contraints are the issues in these cases (with these specific docs). If it were they should just say so, it is perfectly reasonable to refer out a patient who needs care beyond what your local hospital can provide.

An example of this was my SIL, she developed PIH and was hospitalized at 28 weeks. Our local OB's treated her initially, but when it became apparent how severe her condition was (borderline eclamptic) she was transfered to another hospital, in another city, that would be able to care for a baby of that gestation. She ended up having an emergency c/s at 29 weeks. Our doctors were skilled enough to treat her, but our facility was not able to care for her baby.

I just don't buy it that being over 250lb automatically creates sooooo many complications that these doctors are unable to treat. Sure there are some higher risks (GD, PIH, c/s) but is certainly isn't a given. I really think it is discrimination.

fudd8963's picture
Offline
Last seen: 3 years 9 months ago
Joined: 12/27/07
Posts: 1630

"RebeccaA'07" wrote:

As a business, I think they have the right to turn away patients if they are not equipped to handle their situation. If the doctor does not have the right equipment or is not skilled in obese pregnancies, I would much rather them turn the patient away or over to another OB then risk mis-handling of the patient's health.

I agree. People keep saying the OBs are the specialist. There are even further specialist in that field, that are trained in the truly high risk pregnancies. I can't remember the title of it, but I had to see one when I was pregnant. So while OBs are specialist, there is still a more specialized doctor above your general OB.

b525's picture
Offline
Last seen: 3 years 6 months ago
Joined: 06/06/07
Posts: 298

"kris_w" wrote:

I wasn't 100% sure, so I looked it up Smile

I sort of doubt that hospital contraints are the issues in these cases (with these specific docs). If it were they should just say so, it is perfectly reasonable to refer out a patient who needs care beyond what your local hospital can provide.

An example of this was my SIL, she developed PIH and was hospitalized at 28 weeks. Our local OB's treated her initially, but when it became apparent how severe her condition was (borderline eclamptic) she was transfered to another hospital, in another city, that would be able to care for a baby of that gestation. She ended up having an emergency c/s at 29 weeks. Our doctors were skilled enough to treat her, but our facility was not able to care for her baby.

I just don't buy it that being over 250lb automatically creates sooooo many complications that these doctors are unable to treat. Sure there are some higher risks (GD, PIH, c/s) but is certainly isn't a given. I really think it is discrimination.

Yes! Some really skinny people are genetically predisposed to things, too, but they're not being ruled out. I don't see any reason why the doctors couldn't start treating someone, unless they truly don't have appropriate equipment, and then handle referrals as needed. They absolutely should have strong enough tables to hold 250 lbs and much more! And, how hard is it to keep an extra long speculum around? These sound like poor excuses to me.

culturedmom's picture
Offline
Last seen: 4 years 4 months ago
Joined: 09/30/06
Posts: 1131

"fudd8963" wrote:

I agree. People keep saying the OBs are the specialist. There are even further specialist in that field, that are trained in the truly high risk pregnancies. I can't remember the title of it, but I had to see one when I was pregnant. So while OBs are specialist, there is still a more specialized doctor above your general OB.

According to an article in the Biological Research of Nursing...

Predictors for fetal distress included race (Whites) and pregnancy-induced hypertension (p

So it seems white women have a higher rate of fetal distress and Black women are at higher risks then other races for infant mortality. Maybe they should be turned away to "specialists" too. Seriously, what's next? if drs. can turn away patients for being potentially "higher risks" and not for what they actually have, then what is to stop them from cherry picking patients who are best for them and not who need their care. I mean when did medicine become a feild of only dealing with the well and the easiest?

I don;t buy the whole specialist reasoning anyway. If that were the case then they would take the patient and if they showed signs of actually startign to have compications then they would send them to a specialist. I mean your General Dr. doesn't automatically refuse to see you and send you to a Oncologist because you have a family history of cancer and thus it makes you a higher risk factor?

Offline
Last seen: 4 years 2 months ago
Joined: 12/10/05
Posts: 1681

"fudd8963" wrote:

I agree. People keep saying the OBs are the specialist. There are even further specialist in that field, that are trained in the truly high risk pregnancies. I can't remember the title of it, but I had to see one when I was pregnant. So while OBs are specialist, there is still a more specialized doctor above your general OB.

Sure, there are all sorts of subspecialties. But, a generally trained OB absolutely has the skills to manage complications such as GD or hyper tension. Those are "common" complications. Referring to a higher level of care is entirely different than saying, "you're fat. I won't treat you".

Offline
Last seen: 4 years 2 months ago
Joined: 12/10/05
Posts: 1681

"culturedmom" wrote:

I don;t buy the whole specialist reasoning anyway. If that were the case then they would take the patient and if they showed signs of actually startign to have compications then they would send them to a specialist. I mean your General Dr. doesn't automatically refuse to see you and send you to a Oncologist because you have a family history of cancer and thus it makes you a higher risk factor?

Exactly.

daniellevmt's picture
Offline
Last seen: 4 years 10 months ago
Joined: 07/25/06
Posts: 213

"culturedmom" wrote:

First, what do you mean by the bolded Danielle? Just because I disagree with you and think it's complete discrimination, does not mean I am thinking about it emotionally or with any less logic then you.

And no, I don't think it is the same and no I don't know what you mean. If a patient wants a VBAC, that is a specific procedure they are asking a dr. to perform. It's a given. If an obese patient came in with GD or already had complications, then yes I can see a dr. sending them to a specialist. But to assume because they are fat that they might have problmes and so you refuse to see them? No, Danielle, that's just wrong.

Again, refusing to do a VBAC has nothing to do with the patient. The Ob isn;t saying I refuse to see patients who have had c-sections just in case they change their mind and want a VBAC. It's not some twisted pre-emptive thing.

I should've moved my (general you) one sentence up...I didn't mean you personally, I just meant in general, referring to the article.

I still think that obesity is a "medical condition". I'm not saying I agree with doctors who turn away patinets "because they are fat". I just don't agree that it's as simple as you make it sound, as if it's just some aversion to overweight women.

Alissa_Sal's picture
Offline
Last seen: 2 years 9 months ago
Joined: 06/29/06
Posts: 6427

"kris_w" wrote:

I just don't buy it that being over 250lb automatically creates sooooo many complications that these doctors are unable to treat. Sure there are some higher risks (GD, PIH, c/s) but is certainly isn't a given. I really think it is discrimination.

Yep. And again, you don't even have to be obese to get those things, and you would assume that most ob would know how to either treat those things or do a referal if they DO arise.

My doctor already assumes that I will have GD since I had such a big reaction last time, so I'm guessing that (at least in his mind) my chances of having GD this time are HIGHER than an obese woman coming in off the street, because he seems to be putting me at about 99.999%. But he isn't refusing to treat me just because I have a higher risk.

daniellevmt's picture
Offline
Last seen: 4 years 10 months ago
Joined: 07/25/06
Posts: 213

"Alissa_Sal" wrote:

Yep. And again, you don't even have to be obese to get those things, and you would assume that most ob would know how to either treat those things or do a referal if they DO arise.

My doctor already assumes that I will have GD since I had such a big reaction last time, so I'm guessing that (at least in his mind) my chances of having GD this time are HIGHER than an obese woman coming in off the street, because he seems to be putting me at about 99.999%. But he isn't refusing to treat me just because I have a higher risk.

But do you think doctors shouldn't have a choice as to what they are and are not comfortable treating? Even if it's techinically within their scope of practice?

Offline
Last seen: 4 years 2 months ago
Joined: 12/10/05
Posts: 1681

"daniellevmt" wrote:

But do you think doctors shouldn't have a choice as to what they are and are not comfortable treating? Even if it's techinically within their scope of practice?

If it is technically within their scope of practice then it is their professional responsibility to be comfortable with it.

There are lots of thing I don't like doing at work or maybe don't do often, but if it falls within my scope of practice, it is my responsibility to figure out how to do it and then do it.

Alissa_Sal's picture
Offline
Last seen: 2 years 9 months ago
Joined: 06/29/06
Posts: 6427

"daniellevmt" wrote:

But do you think doctors shouldn't have a choice as to what they are and are not comfortable treating? Even if it's techinically within their scope of practice?

I think that if it is something that is a well known risk in their area of specialty (like GD or high blood pressure in the area of obstetrics) then they should be be prepared to treat it in everyone or go into a different specialty. To my understanding, obese women aren't at risk for different complications than non-obese women, they are just at a higher risk for the same complications as everyone else. Therefore, presumably, a competent OB would know how to handle these complications IF they did arise in an obese woman, just as s/he would if they did arise (quite possible) in a non-obese woman.

That would be like a vet that simply refused to treat labs because they might develop hip dysplasia. (I hope I'm remembering correctly that labs commonly get hip dysplasia - I was trying to tailor my example to you, since you're a vet tech, but the danger in that is if my example is wrong, you'll know. :lol:) Other dogs get hip dysplasia too, and I assume that all vets are fairly prepared to treat it in any dog that gets it, right?

And as I said before, I find the GD example particularly suspect, because really my OB didn't treat me for my GD - he sent me to a nutritionist who I worked with directly, and who sent him reports. So not being comfortable treating someone for GD shouldn't even be an issue.

Offline
Last seen: 3 years 3 months ago
Joined: 05/31/06
Posts: 4780

This debate boils down to whether the obese should be a protected class like minorities or the disabled or homosexuals are, doesn't it? Because regardless of what OB's "should" do, if they don't have to treat these clients by law, they don't have to. Should they have to, is the question, right?

culturedmom's picture
Offline
Last seen: 4 years 4 months ago
Joined: 09/30/06
Posts: 1131

"Potter75" wrote:

This debate boils down to whether the obese should be a protected class like minorities or the disabled or homosexuals are, doesn't it? Because regardless of what OB's "should" do, if they don't have to treat these clients by law, they don't have to. Should they have to, is the question, right?

Oh, should they have to? No they shouldn't. Mainly because why would anyone want to go to such an a$$hole of a dr. to begin with. I kind of would rather know up front that the dr. was a d!ck. But I also would hope no one else would go to them either.

b525's picture
Offline
Last seen: 3 years 6 months ago
Joined: 06/06/07
Posts: 298

Should they HAVE to? No, because of personal freedoms and all that jazz.

But, SHOULD they? Absolutely. Their reasoning just doesn't ring true. The problems that obese people have are similar to things they already treat with non-obese people. I wonder why they drew the line at 250 lbs. People can be obese at under 200 lbs. If they really don't want to treat obese people, they should lower their number. That's what makes it clear to me that they're just giving excuses for their behavior.

Offline
Last seen: 4 years 2 months ago
Joined: 12/10/05
Posts: 1681

"Potter75" wrote:

This debate boils down to whether the obese should be a protected class like minorities or the disabled or homosexuals are, doesn't it? Because regardless of what OB's "should" do, if they don't have to treat these clients by law, they don't have to. Should they have to, is the question, right?

If these doctor were saying, "I don't accept fat patients because I think they are gross and I don't want to", I would think he is a jerk, but I do respect their right to decline patients. What bugs me is that they are trying to make it into a issue of care and it really isn't. Maybe they should hang a sign their waiting area stating "I don't know how to look after people who are overweight". It is a lame excuse and if they honestly can't figure out what to do with an overweight person, they should have their license revoked.

I work in obstetrics. There is no doubt that an obese woman is more work than one of average size. It is typically more difficult to start an IV, get an epidural in, if her needs a c/s moving/repositioning her is heavy, supporting her legs while she pushes might leave me with a sore back, breastfeeding can be a challenge, it can be really hard to find a fetal heart.... BUT those women deserve care and I think it is awful to deny them that. Even worse, to lie about it and say it is for their benefit.

Offline
Last seen: 3 years 3 months ago
Joined: 05/31/06
Posts: 4780

"b525" wrote:

Should they HAVE to? No, because of personal freedoms and all that jazz.

But they HAVE to treat patients regardless of their religion, ethnicity, or sexual preference.....they don't have the personal freedom to refuse to treat anyone on those basis. If obesity was a protected class it would be the same way.

Dr's can't say "I refuse to treat these patients because I think that they are gross" about black people, right? Why is this different to some of you?

b525's picture
Offline
Last seen: 3 years 6 months ago
Joined: 06/06/07
Posts: 298

"Potter75" wrote:

But they HAVE to treat patients regardless of their religion, ethnicity, or sexual preference.....they don't have the personal freedom to refuse to treat anyone on those basis. If obesity was a protected class it would be the same way.

Dr's can't say "I refuse to treat these patients because I think that they are gross" about black people, right? Why is this different to some of you?

I haven't really thought before about whether obesity should be a protected class. I'm inclined to say it shouldn't because it's something that can be changed. That's not to say it's easy to change, but it CAN be changed, unlike race, gender, etc. (...although, I guess religion could be changed, but the religious folk wouldn't agree that it's changeable)

b525's picture
Offline
Last seen: 3 years 6 months ago
Joined: 06/06/07
Posts: 298

BTW, I'm totally stuck on this number of 250. It's so arbitrary! For someone of my height to be morbidly obese, I'd have to weigh about 300 lbs. That's so very much more than 250. And, 250 lbs for someone who is 5 feet is very different than 250 lbs for a woman who is 5'7" or above. Do they make women weigh in and, if they are 249, they're okay? Do they ask the woman's weight first and then not allow them to schedule an appointment? If not, then they are judging the woman by how she looks when she walks in and that's not right (not illegal, just not right!).

b525's picture
Offline
Last seen: 3 years 6 months ago
Joined: 06/06/07
Posts: 298

"kris_w" wrote:

[...] BUT those women deserve care and I think it is awful to deny them that. Even worse, to lie about it and say it is for their benefit.

Hear hear!

Offline
Last seen: 4 years 4 months ago
Joined: 08/05/06
Posts: 441

"b525" wrote:

BTW, I'm totally stuck on this number of 250. It's so arbitrary! For someone of my height to be morbidly obese, I'd have to weigh about 300 lbs. That's so very much more than 250. And, 250 lbs for someone who is 5 feet is very different than 250 lbs for a woman who is 5'7" or above. Do they make women weigh in and, if they are 249, they're okay? Do they ask the woman's weight first and then not allow them to schedule an appointment? If not, then they are judging the woman by how she looks when she walks in and that's not right (not illegal, just not right!).

The only reason for that particular cutoff that I can imagine is that is the weight limit on their existing exam tables.

Alissa_Sal's picture
Offline
Last seen: 2 years 9 months ago
Joined: 06/29/06
Posts: 6427

"CalBearInBoston" wrote:

The only reason for that particular cutoff that I can imagine is that is the weight limit on their existing exam tables.

That seems like it would be a low number for an exam table. I mean, presumably OB tables are the same exam tables (or fairly similar to the same exam tables) that all of the other doctors use (with the possible exception of peds), and I have never heard of a GP or any other doctor turning anyone away because they weighed over 250 lbs. And if you think about it, I bet there are even more men than women out there that weigh 250+ pounds (just because they tend to be physically bigger anyway.) I know that wouldn't matter to an OB/GYN, but again, I think that the tables must be at least fairly similar.

Also, if that were the case, what would happen if a woman was under the weight limit when she began her pregnancy (let's say 230) and then gained enough weight to be over the limit by the end of her pregnancy? Would they stop seeing her, or make her lay on the floor?

I just can't imagine that 250 is the cut off weight for the table. I'm thinking of my OB's table, and it seems extremely sturdy. It's not some little rickity thing - it's a heavy peice of furniture. I think my couch could probably handle a 250+ person laying on it, and I'd be willing to wager that my OB's table is at least as sturdy as my couch. Smile

Offline
Last seen: 4 years 5 months ago
Joined: 06/04/07
Posts: 1368

"daniellevmt" wrote:

But do you think doctors shouldn't have a choice as to what they are and are not comfortable treating? Even if it's techinically within their scope of practice?

Should they turn away treating patients who are prisoners just because they know they killed someone else and aren't comfortable with being around them? They took an oath to treat to the best of their ability. OB's are fully capable of adequately caring for obese pregnant patients. I still see this as simple discrimination be it because their own insurance company lowers their premium rates if they choose this or choose to not invest in "proper" equipment, whatever blanket reason they automatically turn away a patient for the sole reason being weight.

AlyssaEimers's picture
Offline
Last seen: 3 months 1 week ago
Joined: 08/22/06
Posts: 6803

On one side of this, I think we need to be careful telling doctors what they HAVE to do. They still have rights. For example if a doctor is morally against preforming an abortion they should not be forced to. However I think they SHOULD see over weight patients unless there is a medical reason not to. I appreciated the person that posted real reasons why it would be harder to see an overweight person. Maybe the better plan of action would be to work with the patient and give them the tools they need to become healthier. A healthy eating plan, showing what exercise is ok during pg...

Offline
Last seen: 4 years 4 months ago
Joined: 08/05/06
Posts: 441

"AlyssaEimers" wrote:

On one side of this, I think we need to be careful telling doctors what they HAVE to do. They still have rights. For example if a doctor is morally against preforming an abortion they should not be forced to. However I think they SHOULD see over weight patients unless there is a medical reason not to. I appreciated the person that posted real reasons why it would be harder to see an overweight person. Maybe the better plan of action would be to work with the patient and give them the tools they need to become healthier. A healthy eating plan, showing what exercise is ok during pg...

What if a doctor thinks that treating obese people is enabling them and therefore morally wrong? Why should they be allowed to not perform abortions for moral reasons but be forced to treat obese people?

Offline
Last seen: 4 years 2 months ago
Joined: 12/10/05
Posts: 1681

"CalBearInBoston" wrote:

What if a doctor thinks that treating obese people is enabling them and therefore morally wrong? Why should they be allowed to not perform abortions for moral reasons but be forced to treat obese people?

I realize you may be playing devil advocate with this question, but I hardly see treating an overweight pregnant person as "enabling". It isn't as if they are handing them a bag of chips or something. It is a perfect chance for making healthy changes and many women do successfully with the extra motivation of trying to grow a healthy baby. You may object to their lifestyle choices, but no one is asking you to approve them or participate in them, unlike forcing someone to provide an abortion.

Offline
Last seen: 4 years 4 months ago
Joined: 08/05/06
Posts: 441

"kris_w" wrote:

I realize you may be playing devil advocate with this question, but I hardly see treating an overweight pregnant person as "enabling". It isn't as if they are handing them a bag of chips or something. It is a perfect chance for making healthy changes and many women do successfully with the extra motivation of trying to grow a healthy baby. You may object to their lifestyle choices, but no one is asking you to approve them or participate in them, unlike forcing someone to provide an abortion.

I am playing devil's advocate and curious where the line is drawn. My example was probably a poor one, how about comparing treating an obese person to referring someone for an abortion. I just think claiming that someone can withhold treatment for moral issues in some spheres but not others is really problematic.

Pages