Doctors Refuse To Treat Fat Women. WTF?

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Doctors Refuse To Treat Fat Women. WTF?

Lissa Rankin, May 17, 2011

Doctors refuse to treat fat women

Yes. You read that title right. It’s heartbreakingly true. According to this article, 15 OB/GYN practices in South Florida have set a weight limit and will not accept obstetrics or gynecology patients who weigh more.

"People don't realize the risk we're taking by taking care of these patients," the South Florida Sun-Sentinel quoted Dr. Albert Triana of South Miami as saying. "There's more risk of something going wrong and more risk of getting sued. Everything is more complicated with an obese patient in GYN surgeries and in [pregnancies]."

Why You Should Be Pissed At These Docs

My tweeps are already all a-Twitter about this news, and I’m livid right along with them. Who are these doctors to determine who can and can’t get care? And how dare they discriminate against a woman just because she’s overweight? You can guarantee that the overweight woman probably beats herself enough for her obesity, and the last thing she needs is to be rejected by her doctor when she’s pregnant or in need of gynecologic care. Way to kick a girl when she’s down.

It’s easy to get your blood boiling if you imagine that these misogynistic docs are sitting around the doctor’s lounge, making fat jokes and scheming up ways to discriminate against overweight women. You can just see them fighting over the weight limit and getting their jollies on by trying to define “fat.” You can imagine that these gynecologists only want pretty patients to do Pap smears on and they’d prefer not to deliver babies amidst rolls of vulva.

And if you feel that way and it pisses you off, you have every reason to feel that way. I certainly would, if I wasn’t an OB/GYN myself.

Why You The Problem Goes Deeper Than These Docs

I’d be tempted to unleash one of my signature rants on the doctors in these 15 practices if I wasn’t a doctor myself. But let me go out on a limb for a minute and play devil’s advocate, just to shine a light on the other side so you can have a balanced understanding of this issue and choose how you feel with both sides illuminated.

Overweight women are at significantly greater risk of complications, especially in pregnancy and during surgery. Pregnant women are more likely to hemorrhage, have birth traumas, get C-sections, suffer from preeclampsia and gestational diabetes, and wind up with infected surgical wounds. They’re more likely to have emergencies that put their babies at risk and land the baby in the neonatal ICU. Overweight women who undergo gynecologic surgery are more likely to wind up getting their bowel injured, getting their ureter accidentally cut, hemorrhaging, or getting a wound infection. They’re all at greater risk of suffering rare complications like pulmonary embolism and maternal or infant death.

Blame Our Legal System

And the reality in our litigious society is that when bad things happen, people sue. And Florida gets hit harder than almost anyone these days. My father was a doctor in Florida and lost a lawsuit that led to the demise of his career. He also spent his entire career paying big bucks of his salary into what they call the “bad baby” fund. In other words, lawsuits against obstetricians in Florida wind up with such HUGE payouts to those who have bad outcomes that all doctors must help cover the malpractice insurance of Florida obstetricians. Otherwise, Florida would have no obstetricians.

Why is Florida in such bad shape when it comes to malpractice? Unlike California, they have no tort reform. A runaway jury can decide to payout 100 million dollars if they feel sorry for someone who suffered a bad outcome, even if nobody was really at fault (because sometimes, in hospitals and doctor’s offices, bad things just happen and nobody’s to blame).

So although I think what these doctors are doing is despicable, I understand it. Most likely, they’re not total misogynists plotting against overweight women. Most likely, they’ve been sued and they’re looking at their statistics, and they’re realizing that most of their lawsuits come from overweight women, and they’re scared into doing the wrong thing.

I get why they’re scared. And I see the rationale behind their decision. And it’s not illegal to discriminate in this way (although I think it should be).

So yes, we should be implementing malpractice reform if we’re going to vilify these doctors.

They Should Be Ashamed

But that’s all I’m going to say to defend these doctors because I think the whole thing is disgusting, and it makes me sick to my stomach. Even if I understand it, I still think it’s just plain wrong. When you sign up to be a doctor, you sign up to serve whoever walks in your door. Or, sadly, at least whoever’s insurance you accept. It’s a violation of civil rights to pick and choose which patients you prefer to help, in my opinion.

What if all doctors in South Florida were to ban obese women from their practices? Would those women have to move? And what if other doctors did the same thing? What if overweight women couldn’t find a surgeon when they have breast cancer or a primary care doctor to help with their diabetes or a gastroenterologist when they have ulcers?

It’s horrible. And even though I get it, those doctors should be ashamed of themselves. Although what they’re doing may be legal, it’s clearly unethical. Those doctors all swore by the Hippocratic Oath, which clearly states, “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.”

Discriminating against women because of their weight does immeasurable harm and fails to do good.

Shame on you, doctors. Shame on you.

What do you think of this nonsense? What should we do about it? How does this make you feel?

Feeling sad about how broken my profession is,

Lissa

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Comments

I do not understand

By Brittany (not verified) on Thursday, 05/26/2011 at 11:41 PM

I am a little overweight, but I think I would still be able to meet their "requirements". If there is a greater risks, are there not Dr. who specialize or are better prepared to handle difficulties that may arise. Hey, if my Dr is not confident, that is a problem. I do understand why some people may be offended, but if I was a Dr. and I felt that trying to help someone with a difficulty outside of my confort zone, I would have to say so. And recommend a Dr. who would be better. But I refuse to jump up and be offended. These Dr. are just trying to protect themselves from a society the refuses to accept that in Medicine there are risks, and you shouldn't look at them as a easy target to line your pockets.

Former obese Floridian woman.

By Anonymous (not verified) on Thursday, 05/19/2011 at 4:58 PM

I am a born and bred Miami, FL girl and I was morbidly obese most of my life. I chose to have gastric bypass surgery 3 years ago. I have had the most difficult time finding a caring and compassionate ob\gyn. I finally found one who I trust but it's been difficult, even now. This article infuriates me and hurts me deeply. I had horrible experiences with doctors in the past. Examinations leaving me ashamed and humilated by my weight. I have lost a lot of faith in doctors as a result and it takes a lot of work (tears and consults) to gain my trust. I have learned though, as with all things in life...as a fat person and as a person with ongoing mental health issues, that you don't want to be treated by someone who doesn't respect or want to treat you. Don't give them your time or business. Tell others about them. Stand up for yourselves. We all deserve better. We all deserve to be respected and treated like human beings. It's our responsibility to fight for that and we should contact our state representatives and call upon them to represent us. I believe it's the only way. I will not be a victim anymore and I will never allow someone to mistreat me again. My body, my soul...and any child I may have are way too precious.

I agree!

By Anonymous (not verified) on Thursday, 05/19/2011 at 5:55 PM

WELL SAID!!!

you don't want to be treated by someone who doesn't respect or want to treat you. Don't give them your time or business. Tell others about them. Stand up for yourselves. We all deserve better.

I'm disgusted and sickened

By Michelle Medina (not verified) on Wednesday, 05/18/2011 at 1:44 PM

I'm disgusted and sickened but not surprised. I weight 214 currently and am working on losing the weight despite having practically everyone in my family being overweight. My Dad's family is overweight, but most of them aren't obese, and on my mother's side she had gastric bypass and my grandmother had her stomach stappled back in the 80's. So it's one hell of a legacy to try and break! My friend is overweight and so are some people in her family, my sister is overweight, pretty much everyone I hang or used to hang out with was overweight. It's interesting looking back on it as I'm typing this now, but I never really had tons of skinny friends or new skinny people, nor did we have them in our families.

In Mexico, this would never

By Anonymous (not verified) on Wednesday, 05/18/2011 at 9:59 AM

In Mexico, this would never happen. One benefit of the Mexican healthcare system is there is next to zero outrageous litigation for things gone wrong. It benefits doctors and patients. Doctors don't have the pressure to be perfect all the time, and they don't have malpractice insurance. This keeps costs down CONSIDERABLY for patients. But, when things go wrong, be ready to accept it. Unless it is gross neglect or intentional harm, you can't sue. Not saying the whole healthcare system is better or worse, but this is one aspect that I prefer.

I find the attitude of self-preservation ironic in a traditionally altruistic profession, but tort reform really needs to keep it in check. Otherwise, where does the slippery slope stop? Will folks with other medical conditions be denied care? Could my OB/GYN in the US refuse to see me because my blood clotting disorder would predispose me to complications? Do we all have to be perfectly healthy in order to see health professionals??!?

Mara, that's horrible

By Lissa Rankin on Wednesday, 05/18/2011 at 7:12 AM

Your story brought tears to my eyes. That's just horrible. I'm so sorry. I'm glad you at least found one doctor who would care for you.

As a surgeon myself, I just can't imagine refusing to help a woman who was overweight. I'm so sorry you had to go through that and hope your knees are getting you out and about in the world.

With love
Lissa

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Thanks for this article and a question about complications

By Golda (not verified) on Tuesday, 05/17/2011 at 7:53 PM

Hi Lissa,

Thanks for this article. Unfortunately, I'm not shocked about this at all. As a member of the fat activist community, I hear stories like this all too often.

Here's a link to a really sad study about bias against fat people among medical professionals: http://www.naafaonline.com/dev2/the_issues/health.html.

I was wondering, in your opinion, are the problems that you noted partially caused not by fatness but by the ill-treatment of fat people? Are some of these problems avoidable with a little extra thought on the part of the doctor? I'm really curious as to what you think.

Thanks!

Golda

Hi! I just wanted to post a

By Anonymous (not verified) on Wednesday, 05/25/2011 at 10:01 AM

Hi! I just wanted to post a response to that survey because I felt like it left a lot of room for interpretation. First off, physicians should respond to obesity negatively, because from a healthcare perspective, it isn't healthy. I don't understand why that is seen as a problem in the survey. Also, in general, obese patients legitimately have a worse prognosis than their thinner counterparts, so I don't see why that's listed as a problem. And finally, because I have a lot of friends who are nurses, I just wanted to say that they have to lift and clean these patients, and after an hour of trying to roll a 300 lb person on their side so they can then lift fat folds to clean dirty bottoms, nobody would want to take care of an obese patient. It doesn't mean they're hateful, it's just that obese patients' body weight makes nurses' jobs a thousand times more difficult. Anyone would chose a thin patient because a thin patient won't cause them to pull a muscle. I'm not defending prejudices against the obese, I'm just saying that sometimes it's not blind hatred that drives these prejudices as much as legitimate hardships.

Overweight women denied health care

By Kate (not verified) on Tuesday, 06/28/2011 at 7:23 PM

First off, if it takes a nurse an hour to roll a 300lb person then they are poorly trained or just plain stupid. Where are these nurses working? I have several friends that are nurses and my sister is also a nurse, none of them work where they are expected to turn someone of that size by themselves. Why do you assume that a 300lb person can't turn themselves? Do overweight people face more health issues? Yes, they do. Do overweight people have the right to health care? Yes, they do. Nurses and doctors chose their profession, the fact that the may have to treat fat people is not kept a secret during their training. This is just another form of legal discrimination that overweight people face.

Again I want to point out

By Anonymous (not verified) on Wednesday, 05/25/2011 at 3:04 PM

Again I want to point out that obesity is not the fault of the obese person! Obesity is a medical condition that is caused by medical issues not over eating or lack of exercise. Do you really think that anyone would chose to be obese? There is so much that is not yet understood about the role of nano bacteria in the human body. I suspect that before long this will become the cure for obesity. Deal with the chronic infections and the chronic obesity disappears without diet and exercise.

There are risks for everyone, not just overweight people

By Cassandra (not verified) on Tuesday, 05/17/2011 at 5:49 PM

I could not believe that I was reading this story today!
Of course there are risks for overweight clients, but there are also risks for "skinny" clients too. This is implying that there will be less chance of medical problems occuring for thinner women which is utter bullshit.
I am an Acupuncture practitioner and I am overweight, but I have never let it be an issue for me and stop me from doing what I wanted to do or pursuing my dreams.
My weight does not effect my ability to care for others.
yes, I will get the occasional "you're in healthcare?" look or comment but I would never discriminate in this way agaisnt a client or turn someone away becuase they are overweight.
I am so tired of the judgements and assumptions that are made about overweight people, that we are lazy, that we overindulge etc, etc. We have enough discrimination to deal with already and now we are being denied medical attention! I am completely outraged.

When doctors discriminate (long story and rant)

By Mara (not verified) on Tuesday, 05/17/2011 at 4:47 PM

This is a great subject for discussion. I am, as Gaby put it, "grossly overweight", although I prefer to say that I'm fat, or very fat. I don't assume that there's one preferable weight that everyone should be. Wouldn't that be boring?

I've needed knee replacement surgery in the past and asked my doctors who they would recommend locally. I called their offices and told their staff what I was looking for and how much I weigh. I didn't want to go through the cost, time or disappointment when a doctor refused me service based on my weight. One doctor allowed me to make an appointment. I had Xrays done at his clinic, in a hospital, just before my appointment.

When the surgeon entered the room, he looked scared to death. I've made an impression on my doctors in the past, but not in this way. Without consulting my Xrays, he told me "I wouldn't touch you with a ten foot pole." Yeah, how's that for friendliness? He told me that he was afraid I'd have a blood clot on the table and die. I *made* him look at my Xrays and he said that I needed replacement, but not by his hand.

Fortunately, a woman who was my doppelganger as far as weight, age, commitment to exercise and diabetes goes gave me the name of her orthopedic surgeon (in Florida yet!) at the Mayo Clinic. I called the hospital after sending him my medical file, and he told me "It's my belief that everyone, 80 pounds or 800 pounds, deserves to have this surgery if they need it."

I could have kissed the phone. Instead I asked him if he knew anyone at the Arizona Mayo Clinic (I live in Portland Oregon - it's closer than Florida) who would do my surgery. He did, and I made an appointment and arrangements to fly down to AZ with my husband (who took off work) for a consultation.

Instead of talking to me about knee replacements, he tried to talk me into weight loss surgery - five times. Each time I told him I would never do that to myself, that I had 14 friends die of it over the years, and I would NEVER EVER have that surgery, get it? When I asked him if my weight were a dealbreaker, he said no, he would do the surgery. I'd have knocked his block off if he said anything else - he could have rejected me over the phone and saved us a bunch of money, hassle and grief.

So I had my left knee replaced. The surgeon wanted me to stay in rehab there where he could watch me for six weeks. I agreed. However, there were no complications and I worked my butt off with my PT so I went home two and a half weeks later. Seven months later I had the other knee replaced. No complications from my body - however one of the antibiotics they gave me put me in acute renal failure and I had to undergo dialysis for a couple of days.

I *still* went home two and a half weeks after surgery. And I had no problems at home. My knees were doing great.

But I know quite a few fat women whose surgeons have told them they have to lose X amount of weight before they can be operated on. And I have no where to advise them to go - the Arizona Mayo Clinic surgeon told me not to refer any fat friends to him. Asshole.
The first Mayo doc in FL isn't working there anymore - he was probably too liberal for them in choosing patients.

What's a fat person with damaged knees to do?

Oh, and I'm a Licensed Massage Therapist with over 35 years' experience. I welcome fat women into my massage room because often they've been treated poorly by former massage therapists. They've been lectured about dieting, only the center third of their body was touched and no folds or creases, or they've been hurt by massage therapists who decided that since there was extra "stuff" on their client, they had to use lots of pressure.

Since I welcome fat clients (or did, I'm not practicing right now), why aren't there doctors who welcome them too? Shouldn't the medical schools be teaching how to take care of their fat and supersized patients? If there's such an "obesity epidemic" (ooh get away from me - your fat might jump on me) why aren't the med schools teaching bariatric studies? And they'd have *tons* of patients.

obesity and bacteria

By Anonymous (not verified) on Tuesday, 05/17/2011 at 3:48 PM

The saddest part about this story is that obesity is not something someone chooses to live with. It is a medical condition that should be treated by a medical doctor. Obesity is not a calorie or exercise thing! Don't let them fool you into thinking it is your fault if you are over weight.

There is sufficient information out there to show that food additives, factory produced meals, for profit nutrition and bacterial infections are responsible for obesity.

Yes if you are just a few pounds over weight some extra exercise and skipping dessert will help you drop those pounds BUT obesity is so much different! It is a medical condition and should be treated as such.

VBAC

By Lissa Rankin on Tuesday, 05/17/2011 at 12:47 PM

Yeah Katie-
Most hospitals now which have-as a policy- no VBACs unless the doc agrees to be on property 24/7, which you can't do if you're running a practice and need to be in the office. Why? Because if you do VBACs, you're more likely to get sued. It's not that most OB/GYNs are anti-VBAC. It's that they have businesses to run and lives to live and can't camp out at the hospital.

Again, blame the legal system. Patients want VBACs. Docs want to offer them. Get the lawyers out of the way!

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Jessie, I feel you sister

By Lissa Rankin on Tuesday, 05/17/2011 at 12:44 PM

You are SO right. There are so many biases in our culture. We discriminate against overweight people and celebrate skinnyness so much that our children wind up with eating disorders.

I so wish I could wave my magic wand and change it. I'm sorry for what you've experienced, love. It's not right.

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I live in S. FL.

By Katie (not verified) on Tuesday, 05/17/2011 at 12:36 PM

I live in S. Fl. and while I am not overweight nor have personally experienced this bias, the choice of doctors in the area is not the greatest. Doctors are recommended among groups of women solely based on their willingness to perform VBACs, which is almost unheard of in a area where some hospitals are at 60% C-section rates. My experience with some of the better OB/GYN practices are those that clearly state that they do not carry malpractice insurance, as allowed by FL statute, and that by accepting care from this provider you realize that they do not carry this insurance and would not be able to collect in the case of an issue. Because they are not bound by this insurance, they tend to provide better, more holistic care. But even they are not the best, and I am seeking well-woman mid-wife care (supervised by an OB/GYN in case of need for surgery, etc.) as the best alternate to the poor options we have here in S. FL. It's certainly a sad state of affairs in all of the US that this is even an issue, that those in most need of care are those being specifically excluded because they need the extra care! What a vicious cycle!

"No Fat Chicks"

By Jessie Matthews (not verified) on Tuesday, 05/17/2011 at 11:11 AM

They might as well hang that sign on their door. All sorts of places do anymore, even if it isn't an actual sign. It's the dirty looks they give you at the gym, the way the waitress snears down at you when you order food in a restaurant (it doesn't matter what you order - if it's the cheeseburger, they get to blame you for not fitting the slender ideal - and if you order the salad, they get to roll their eyes and think "who is SHE kidding??"), it's at the doctor's office where they WILL see you, but where they humiliate you by "misplacing" the standard BP cuff or by forcing you to weigh in so the nurse can sigh and shake her head at you - because, clearly, you have no idea how huge and unhealthy you are, even if you are healthy, it's in the insurance companies who tell you that you're uninsurable because of your BMI - and now, it's in doctors refusing to see you at all in a society where many, many large people choose not to seek medical care when they really, truly need it because they are afraid of being shamed and humiliated. This whole thing is so sad and makes me so angry. :(

Amen, Gaby!

By Lissa Rankin on Tuesday, 05/17/2011 at 11:06 AM

I wrote a whole yet unpublished book called BROKEN: One doctor's search for the lost heart of medicine, and it's all about how our system needs a MASSIVE overhaul!

And yes, I do see both sides. I know how hard it is to operate on an obese patient, and yet, I feel like it's the job I signed up to do and it's not right to discriminate, even if it is a malpractice liability.

Tough issue!

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I know :o( I remember you

By Gaby (not verified) on Tuesday, 05/17/2011 at 11:14 AM

I know :o( I remember you polled us on FB about whether you should publish it or another one. I would've loved to have read it! Have you considered selling it as an ebook or .pdf file? I'm sure tons of us would buy it right off the bat!

It is sad...

By Gaby (not verified) on Tuesday, 05/17/2011 at 11:01 AM

but I can't help but agree with you on both points.

Mind you: I, myself, am overweight. According to my doc, I should weigh 115lbs (not happening... I once went down to 130 and you could count my ribs and vertebrae), and yet I weigh 153. So it hurts to know that some people would rather not deal with me because I carry an extra pound or twenty around with me.

However, at the same time... I'm a Licensed Massage Therapist. And I've had grossly overweight patients on my table. My practice is not invasive at all. I don't have to worry about someone hemorrhaging to death, or some such terrible thing, at least not as a direct result of my work. But it's still worrisome and a little frightening when one of my patients has a hard time reaching their shoes to untie them, or spends ten or fifteen minutes on my table trying to regain their breath from the effort it took to undress or turn face down. It's worrisome knowing that part of their pain and tension is from sleep apnea secondary to excessive weight, to lumbar problems because of a belly, etc.

And I can't help but feel bad for some doctors who would love to treat anyone and everyone, and yet can't even begin to cover their malpractice insurance, so they can't take the chance.

But I've worked with many, many doctors in the past, beneath their direction... and so very many of them are just plain assholes (can I say that here?). They've been nasty, spiteful people that enjoyed their feeling of superiority (one infamous doctor was popular for screaming at his front desk staff in front of patients that they were useless idiots, and that front desk work wasn't rocket science. These poor girls were some of the hardest working people I've ever had the pleasure of dealing with!), and a lot of them discriminated shamelessly on race, age, gender and social status. And those just make me steam...

So what can we do about this? One one hand, it's not good for any of us to be overweight. But on the other, it's not fair to decline treatment because we're not Kate Moss. I think this calls for an overhaul of the medical practice! A more holistic (whole-istic!!) view of medicine would serve us (helping us to live healthier) and them (by decreasing chances of lawsuits due to decreased risk and increased accuracy of treatment!) and be such a blessing!

Is that really so much to ask?

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