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From the article: "But there should not be blanket refusals to operate on fat people, the committee wrote. Those with a body mass index over 40 — like a 5-foot

by lsy 10y ago

From the article: "But there should not be blanket refusals to operate on fat people, the committee wrote. Those with a body mass index over 40 — like a 5-foot-5-inch woman weighing 250 pounds or a 6-foot man weighing 300 — and who cannot lose weight should be informed that their risks are greater, but they should not be categorically dismissed, the group concluded." It's really simple. You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. The article here is not saying that doctors should ignore weight as a factor, but that they shouldn't make decisions to deny or provide care based solely on BMI.

asynchronous13 10y ago
"But there should not be blanket refusals to operate on fat people" I don't know anyone who would disagree with this sentiment. And the article doesn't present any evidence that there are blanket refusals. Sure, the article presents a few anecdotes, but that's not enough to show that blanket refusals are happening on a larger scale. > You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. It's really not that simple. A medical doctor's mission is to help people and very specifically to "do no harm". When the data suggests that they are more likely to do harm by operating, then the doctor is following their oath by not performing a surgery.
- lsy 10y ago
  From the article: "A recent survey of more than 700 hip and knee surgeons confirmed Dr. Yates’s impressions. Sixty-two percent said they used body mass index scores as cutoffs for requiring weight loss before offering surgery." It sounds to me like "cutoffs" and "requiring" would indicate a blanket refusal, and 62% seems like a fairly large scale to me. What evidence are you looking for? Other common conditions can also increase risks of complications, and patients are routinely given opportunities to weigh those risks before deciding on surgeries. My suggestion isn't that the doctor throw his duties out the window, but that with high-BMI patients, those duties should not suddenly become more dictatorial than with other patients.
  - vonmoltke 10y ago
    Some aren't. Patients with severe hypertension, for instance, are often categorically denied non-critical surgeries as well.
  - asynchronous13 10y ago
    There's a difference between saying "You're fat, so we won't operate on you." versus "The pain that you hope to fix will become worse if we perform surgery on you." Surgeries that involve weight-bearing joints and bones are particularly sensitive to the mass of the patient (like the hip and knee surgeons surveyed). For heavier patients, the healing time is longer and the risk of additional pain after surgery is much much higher.
whamlastxmas 10y ago
Doctors have to use their best judgment in providing care to patients. An ethical doctor will not provide care to a patient that he or she believes is more likely to cause harm than good. Letting patients "make their own decisions" to this extent doesn't happen in any part of medicine. If you go to the doctor and say "Hey I have really bad anxiety and I've had success with Xanax in the past to manage it" you'll get denied 95% of the time. Are doctors discriminating against people with anxiety because they don't allow them carte-blanche over the medical care provided? The answer is no - doctors know that drug dependency is a huge issue, and in most cases of anxiety, the risk of that dependency doesn't outweigh the quality of life reduction from anxiety. They will have a lot of alternative options to someone with anxiety, just like they have a lot of alternative options to someone severely overweight: lose the weight (in itself it will relief symptoms), mild exercise, steroid shots, physical rehab, anti-inflammatories, the list goes on.
drzaiusapelord 10y ago
>let them make their own decisions Why would a doctor let his patient take on a risk that he isn't willing to perform? Patients should not get 100% say in their treatments. If there's a high mortality rate for something as trivial as knee pain, then the compassionate thing would be to refuse that operation and look at alternatives like pills or physical therapy. Having that person's family deal with 'suicide by doctor' is a non-starter here. This is like saying mechanics should respect the wishes of people who want to output their exhaust into the cabin. Afterall, the customer is always right! Also, people in pain aren't terribly rational and don't make good decisions. Doctors should be the gatekeepers here on a certain level. I shouldn't be able to demand surgery willy-nilly and expect doctors and surgeons to act like a concierge service. Surgery is a serious risk and no one is going to casually perform malpractice here. Worse, knee repair is a tricky thing. If your knee can't support 300+lbs then a repair is only going to be a temporary solution until you damage it again, which will probably be soon after. We're not engineered to handle these kinds of loads, thus the weight loss recommendation.
adrr 10y ago
Article doesn't mention who pays for the increased cost to serve the morbidly obese. Replacing all the MRIs, Xray machines etc would be very expensive. Also added malpractice insurance as morbidly obese have more complications especially when it comes to anesthesiology as dosing is extremely hard to to get correct.
- dragonwriter 10y ago
  Reducing the malpractice currently occurring in the treatment of the morbidly obese should reduce the needed malpractice insurance. (The problem may be that the malpractice that the article documents isn't being prosecuted sufficiently by its victims; if it was, the behavior would probably change.)

by lsy 10y ago

asynchronous13 10y ago

"But there should not be blanket refusals to operate on fat people" I don't know anyone who would disagree with this sentiment. And the article doesn't present any evidence that there are blanket refusals. Sure, the article presents a few anecdotes, but that's not enough to show that blanket refusals are happening on a larger scale. > You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. It's really not that simple. A medical doctor's mission is to help people and very specifically to "do no harm". When the data suggests that they are more likely to do harm by operating, then the doctor is following their oath by not performing a surgery.

lsy 10y ago
From the article: "A recent survey of more than 700 hip and knee surgeons confirmed Dr. Yates’s impressions. Sixty-two percent said they used body mass index scores as cutoffs for requiring weight loss before offering surgery." It sounds to me like "cutoffs" and "requiring" would indicate a blanket refusal, and 62% seems like a fairly large scale to me. What evidence are you looking for? Other common conditions can also increase risks of complications, and patients are routinely given opportunities to weigh those risks before deciding on surgeries. My suggestion isn't that the doctor throw his duties out the window, but that with high-BMI patients, those duties should not suddenly become more dictatorial than with other patients.
- vonmoltke 10y ago
  Some aren't. Patients with severe hypertension, for instance, are often categorically denied non-critical surgeries as well.
- asynchronous13 10y ago
  There's a difference between saying "You're fat, so we won't operate on you." versus "The pain that you hope to fix will become worse if we perform surgery on you." Surgeries that involve weight-bearing joints and bones are particularly sensitive to the mass of the patient (like the hip and knee surgeons surveyed). For heavier patients, the healing time is longer and the risk of additional pain after surgery is much much higher.

whamlastxmas 10y ago

Doctors have to use their best judgment in providing care to patients. An ethical doctor will not provide care to a patient that he or she believes is more likely to cause harm than good. Letting patients "make their own decisions" to this extent doesn't happen in any part of medicine. If you go to the doctor and say "Hey I have really bad anxiety and I've had success with Xanax in the past to manage it" you'll get denied 95% of the time. Are doctors discriminating against people with anxiety because they don't allow them carte-blanche over the medical care provided? The answer is no - doctors know that drug dependency is a huge issue, and in most cases of anxiety, the risk of that dependency doesn't outweigh the quality of life reduction from anxiety. They will have a lot of alternative options to someone with anxiety, just like they have a lot of alternative options to someone severely overweight: lose the weight (in itself it will relief symptoms), mild exercise, steroid shots, physical rehab, anti-inflammatories, the list goes on.

drzaiusapelord 10y ago

>let them make their own decisions Why would a doctor let his patient take on a risk that he isn't willing to perform? Patients should not get 100% say in their treatments. If there's a high mortality rate for something as trivial as knee pain, then the compassionate thing would be to refuse that operation and look at alternatives like pills or physical therapy. Having that person's family deal with 'suicide by doctor' is a non-starter here. This is like saying mechanics should respect the wishes of people who want to output their exhaust into the cabin. Afterall, the customer is always right! Also, people in pain aren't terribly rational and don't make good decisions. Doctors should be the gatekeepers here on a certain level. I shouldn't be able to demand surgery willy-nilly and expect doctors and surgeons to act like a concierge service. Surgery is a serious risk and no one is going to casually perform malpractice here. Worse, knee repair is a tricky thing. If your knee can't support 300+lbs then a repair is only going to be a temporary solution until you damage it again, which will probably be soon after. We're not engineered to handle these kinds of loads, thus the weight loss recommendation.

adrr 10y ago

Article doesn't mention who pays for the increased cost to serve the morbidly obese. Replacing all the MRIs, Xray machines etc would be very expensive. Also added malpractice insurance as morbidly obese have more complications especially when it comes to anesthesiology as dosing is extremely hard to to get correct.

dragonwriter 10y ago
Reducing the malpractice currently occurring in the treatment of the morbidly obese should reduce the needed malpractice insurance. (The problem may be that the malpractice that the article documents isn't being prosecuted sufficiently by its victims; if it was, the behavior would probably change.)