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Controversy over Dr.s remarks about patient's weight

Posted: Nov 21, 2009

My husband told me he read somewhere on the Internet about an ophthalmologist telling an extremely obese patient that he was refusing to do her eye exam since she was going to lose her sight anyway because of her uncontrolled (apparently she's been noncompliant with her diabetic care) diabetes and obesity. He told her she was obese and had better ose some weight

What are your thoughts?

He's just a jerk.

He cares about his patients and knows her obesity is going to kill her.

H was having a bad day?

Maybe he actually did her a favor and gave her a wake up call, stressing that she iis GOING TO GO BLIND if she doesn't lose the weight and control her diabtes.

;

controversy - anotheranon

[ In Reply To ..]
wow! this is tuff! I am leaning towards "he is a jerk", but then again, he probably did have the patient's health in mind. He just has a very poor bedside manner. Some patient's however, sometimes need a kick in the pants to do what is best for themselves, but this was a poor way of doing it. It probably hurt the patient more than anything else.

I have a quick question though, after taking the hypocratic oath, is it not "illegal" for a doctor to refuse care to a patient??? Just a thought.

No, a doctor can refuse to see a patient - L

[ In Reply To ..]
If a person already that particular doctor's the patient can be told they will need to find another doctor. Usually the doctor gives a time frame but a physician absolutely can say he is discontinuing his care for you.

well, ... - anotheranon

[ In Reply To ..]
Wouldn't a doctor's refusal to see a patient be for something like non payment? but to tell a person he will not treat them because they are too fat, to me, is ridiculous. Sometime's being over weight is NOT the patient's fault. I just think this is totally wrong. Not every one who is over weight has a problem with pushing themselves away from the table, or is over weight because they "choose" to be, or are just plain lazy. Often times there is a medical reason why they are overweight and I thought this doctor was just plain crass!

My former boss didn't "fire" patients for nonpayment... - CrankyOldBroadOnTheBeach

[ In Reply To ..]
... the ones he got rid of were ones who were abusing their prescriptions.

There was a period of time when he had gone through some serious financial difficulties so he was more or less accepting any patient who walked through the door, regardless of whether their ailments came under his specialty or not. Word got around town, as it often does, that he was not stingy about prescribing pain medications, and so they started coming out of the woodwork. Some of the patients had legitimate chronic pain syndromes, and he was happy to give them what they needed. Others, not so much.

One patient who got "fired" was actually a long-time patient who did fall under the doctor's specialty and did have a legitimate pain condition, but he was selling his prescription meds on the street.

Another woman always paid her bill on time, every time--but she became very abusive to the staff when she couldn't get her "fix" and so she too was "fired."

Then, of course, there were the stories about pill bottles falling into the toilet, pills being stolen out of purses, you name it, we heard it. Those patients didn't last long either. Most of them just quietly disappeared and we didn't even have to "fire" them.

A doctor does not have to have a reason, for example - L

[ In Reply To ..]
a doctor told my deceased husband if he continued to smoke he would not be his doctor and sure enough, the hubby got turned over to the PA, who by the way had less sense than me when it came to most things. I told the husband basically he did not have an intern and we got him another so like I said, a physician does not have to see you period.

If the patient is not willing to help themselves, the doctor - has every right to dismiss them as a patient. NM

[ In Reply To ..]
x

I would discontinue care on the basis of noncompliance. s/m - RoadRunnerMT

[ In Reply To ..]
It doesn't appear by the story that she is struggling medical wise but is uncompliant, which in turn can put the doctor and the care he/she provides under much scrutiny and is a very high risk patient.

Noncompliance - gourdpainter

[ In Reply To ..]
So am I to understand that just because someone is obese they should not receive medical care? What would you suggest doing with them?

Another Point of View - anon

[ In Reply To ..]
Also, may I bring up another point for consideration. Everybody is talking about a patient being refused treatment for "noncompliance" with doctor's "orders." Which makes me ask, since when does a patient HAVE to do what the doctor suggests???!!! What happened to our personal freedom of "Choice?"

If some MTs have not noticed, let me interject that a patient may see several different physicians for second and third opinions on any given diagnosis and receive two or three different diagnoses for the same symptoms, as well as two or three different sets of "recommendations" by the different doctors. These "doctors" are not GOD, and we do NOT HAVE to do what they say or even ACCEPT what they say! I have noticed while doing transcription that the variation in different doctor's opinions about any given ailment suggests to me that not one of them is absolutely SURE of what may be wrong with a patient. It is all a "guessing game" and I, for one, do not feel that I should have to put my body and life at risk just because a "doctor" "suggests" I do, and for them to "refuse treatment" simply because I choose not to agree with their diagnoses and treatment goes against my personal freedom of "choice." No person absolutely HAS to do everything a doctor says they should!! If a doctor refused to treat me for "noncompliance" to his "suggestions" of treatment, then I would say good riddance, and find someone else that has less of a GOD complex and is more focused on true patient care, which includes "allowing" the patient to be interactive with what one does or does not want to do in regards to that care. The same goes for insurance companies and pharmaceuticals, as well. Nobody should be "forced" to accept any sort of treatment they do not want, whether it is considered "noncompliance" or not!! JMO--flame away.

And still my point of view - L

[ In Reply To ..]
Which is about the same as yours but you have people going to physicians who think whatever they say goes. I had an older aunt who suffers from familial tremors, doctor had her on 3 medications each month, not working and when I asked my aunt to please ask if something else she could try (because I knew there was) she never asked the physician because "the doctor might think I donâ��t trust her." I have no problem speaking my mind, speaking up for both myself and husband as he tends to be shy and I tend to be out there for him as well. A person has a choice in going to the physician they want to or not going but I can speak up and do.

I agree with you. Nobody can be forced to follow..sm - omg

[ In Reply To ..]
a doctor's orders, especially if you have doubts about the right diagnosis or the way he wants to treat you.

But this has the logical consequence that YOU stop going to this particular doctor, because you do not think that his way of treating you is the right one.

I had this problem once with a doctor who wanted to force me to take antidepressants. I hate antidepressants because they mess with your brain and your 'soul.' I started with them, but after I felt miserable, I just stopped them and stopped going to this doctor. The pure thought of being dependent on these little pills to feel 'good,' made me sick and feel worse.

I beat depression on my own through brain- and willpower, without antidepressants and now I feel fine.

I hear ya - gourdpainter

[ In Reply To ..]
When we moved to Arkansas and I had to find a new doc, I was fired by a couple because I refused to be "compliant." I wouldn't trade the one I finally found for anything. For one thing, he obviously LIKES me or he would have fired me a long time ago. Better yet, he respects me as being a person with a MIND. I argue with him all the time and I refuse to do anything I don't want to do. He has told me for example that I "should" quit smoking but he said that I know that and there is no need for him to rail about it to me. As I tell him, I'm going to die one day and I know that. He agrees with me and says it is his "job" to tell me these things. I understand that and I have no problem with it. If, however, he chose to fire me, fine. It's my body and my life and I'm sick and tired of some people thinking they have to "pay" for my care. No one has to pay for anything for me, we all pay for people on Medicaid, some of whom are obviously as healthy as horses but they sure go to the doctor for every snotty nose that comes down the pike.

Doctors - vikefan

[ In Reply To ..]
That's the way I feel. She probably needed a reality check. I worked for a great internist for six years while living in CT. He was never a jerk to his patients but did stress weight loss, quitting smoking, etc. When I became an alcoholic and ended up in the hospital, he bluntly told me if I kept it up, I'd be dead in a year. That was a good reality check. I'd rather they lecture and be honest with me. I can't get an honest answer about why the foot I broke on August 1 still hurts so bad at times. All I was told is that hindfoot fractures take longer to heal. I've been in that cam boot for 3.5 months now and it's hurting my back. I can't wait to see the orthopedist on Monday. The pod doc also said I have a peroneal tear. I wonder if that's the delay in healing. Regardless, I'm sick to death of walking into that office every two weeks, him walking in, asking about the foot, me telling him it still hurts and him saying 2 more weeks of the Cam boot and walking out the door. The pod doc has just been pussy footing around the issue and I'm sick of it. Pain months after a fracture can also be a sign of avascular necrosis.

First do no harm - Alice

[ In Reply To ..]
I'm not sure about it being illegal to refuse to care for a patient. It happens all the time with doctors' offices refusing a patient simply due to the type of insurance.

However, it seems to me that the FIRST DO NO HARM portion of the hypocratic oath should include the emotional wellbeing of the patient as well as the physical.

I hate the word 'obese' and find it very insulting, hate typing it in reports. I informed my doctor that I interpret that word as being synonymous with the word 'trash', at which point he gave me a look that indicated he had no idea what I was talking about.

Those doctors who have never experienced firsthand what it is like to be overweight are simply clueless as to what it is like. I know a few that became 'obese' in later life and got a spoonful of their own medicine.

Huh? - sm

[ In Reply To ..]
You think the word "obese" is insulting? So, do you think the doctor should just completely ignore that fact when seeing patients? What else are they supposed to call it? You and I both know that being obese causes all kinds of health problems.

I don't know any such thing - gourdpainter

[ In Reply To ..]
I happen to know a lot of people who are obese who are quite fit, can work circles around you and me both. I think the doctors have no business refusing care to obese patients any more than they have any business refusing care to people who have diabetes. Do you think that obese people want to be obese? No. Do you think they don't know they are obese? Of course they do. Especiallly as you get older it gets harder and harder to shed extra pounds. I know, I need to shed about 20. I am diabetic and have been since before I gained that extra weight. Do you think it is because I am "obese" or might it possibly be that as far back as is known my family, maternal and paternal, all were diabetic and had hypertension and not a single one of them was overweight. Quite the contrary, they were all farmers so got plenty of exercise. I am sick and tired of people ridiculing people for the way God made them. Now I admit that when I go to a restaurant buffet and see someone loading up 3 plates at a time, scarfing that down and loading up 3 more all the while with their belly hanging down to their knees between shirt and pants it makes me want to barf. That is GREED for food which is just like any other greed in my most humble opinion. Not all people are greedy but most are in one way or another.

it's called gluttony - n/m

[ In Reply To ..]
n/m

If the patient has been repeatedly told to do something - ht

[ In Reply To ..]
for her medical conditions and refuses the doctor has the right to not see the patient for medical noncompliance. Our doctors will send a certified/registered letter to the patient that they will no longer be seen by them after xxx date, and will be glad to forward their records to their new physician.

I would say 'He is a jerk.' It is not always..sm - omg

[ In Reply To ..]
the diabetic patient's fault if his/her sugar level is 'uncontrolled.' Doctors automatically assume that the patient is not following their instructions regarding food intake etc.., but this is not always the case. Some diabetics have very fluctuating sugar levels inspite of the fact that they are very careful and savvy about what they are allowed to eat and what not and adhere to it.
This often happens when they suffer of insulin intolerance, that means that he body cells cannot absorb the insulin.

Not always is it the patient's fault if they cannot lose weight, it might be due to an illness.

The doctor should first look into these possibilities before declining to treat her eyesight.

So, I say 'jerk' to the ophthalmologist.
He has NO right to decline his treatment concerning her eyesight, maybe the doctor who treats her diabetes or obesity could decline further treatment, if it is not caused by an illness and she is not following his instructions.

You don't know the history behind this patient, so - JG

[ In Reply To ..]
who really knows. Could be that she has been told over and over again to lose the weight, whether she tried and it didn't work or didn't care to try; apparently she is noncompliant with her diabetes which in and of itself is a reason to dismiss her. My cousin was dismissed by several doctors before she died because of that fact--she ate what she wanted, drank alcohol, and would not take her medication. A doctor can only do so much and if the patient won't cooperate, why waste your time. A doctor at the hospital I used to work at dismissed a patient because he repeatedly was admitted to the hospital and left AMA. His thought was - if he doesn't want to do anything to help himself, why should I keep treating him and then end up on the end of a law suit??

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