Doctors treat thinner patients better

[johnthomasmacdonald]

Are doctors nicer to patients who aren’t fat?

A provocative new study suggests that they are — that thin patients are treated with more warmth and empathy than those who are overweight or obese.

For the study, published in the medical journal Obesity, researchers at Johns Hopkins obtained permission to record discussions between 39 primary care doctors and more than 200 patients who had high blood pressure.

Although patients were there to talk about blood pressure, not weight, most fell into the overweight or obese category.

Only 28 were of normal weight, meaning they had a body mass index below 25. Of the remaining patients, 120 were obese (B.M.I. of 30 or greater) and 60 were classified as overweight (index of 25 to 30).

For the most part, all of the patients were treated about the same; there were no meaningful differences in the amount of time doctors spent with them or the topics discussed.

But when researchers analyzed transcripts of the visits, there was one striking difference. Doctors seemed just a bit nicer to their normal-weight patients, showing more empathy and warmth in their conversations. Although the study was relatively small, the findings are statistically significant.

“It’s not like the physicians were being overtly negative or harsh,” said the lead author, Dr. Kimberly A. Gudzune, an assistant professor of general internal medicine at the Johns Hopkins School of Medicine.

“They were just not engaging patients in that rapport-building or making that emotional connection with the patient.”

In conversations with patients of normal weight, the doctors offered simple comments to show concern — for example, “I’m glad you’re feeling better” to a woman who had experienced hot flashes.

When a normal-weight patient had trouble getting an appointment with a specialist, her doctor shared her concerns. “I agree with you,” the doctor said. “That gets extremely frustrating when that happens.”

Another patient lamented a scar on her leg after surgery and the ugly shoes she was forced to wear. “You went through a lot,” the doctor told her, adding compliments to lift her spirits.

“You still got great legs. Chunky shoes are still in. Get something pretty, something for spring. That always makes you feel good.”

While such expressions of concern and empathy are not remarkable on their own, what was surprising was how absent they were in conversations with overweight and obese patients.

And statements like these are no small thing. Studies show that patients are far more likely to follow a doctor’s advice and to have a better health outcome when they believe their doctor empathizes with their plight.

“When there is increased empathy by the doctor, patients are more likely to report they are satisfied with their care, and they are more likely to adhere to recommendations of physicians,” Dr. Gudzune said.

“There is evidence to show that after visits with more empathy, patients have improved clinical outcomes, so patients with diabetes have better blood sugar control or cholesterol is better controlled.”

Dr. David L. Katz, director of the Yale-Griffin University Prevention Research Center, says that overweight patients often complain to him that doctors appear judgmental about their weight, at the expense of other health concerns.

“You come in with a headache, and the doctors say, ‘You really need to lose weight.’ You have a sore throat, and the doctor says, ‘You really need to lose weight,’ ” he said. “These patients feel like the doctor doesn’t help them and they insult them, and so they stop going.”

In dealing with patients who are overweight, Dr. Katz added, doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.

“When we can’t fix what is broken we tend to behave badly,” he said.

Dr. Katz said his grandmother, who was obese, was so tired of physicians’ negative comments about her weight that she stopped going to the doctor altogether, even when she developed a breast tumor. When she finally sought treatment, she had advanced-stage breast cancer and died in her 50s.

“Every time she went to the doctor for any reason, they wagged a finger at her and talked about her weight,” Dr. Katz said. “We need to understand that the stakes are very high.”

The solution, he said, is better training so that medical students and doctors understand the complex nature of obesity as well as their own (perhaps subconscious) biases. Yale, for one, offers a continuing education program for doctors on compassionate and effective lifestyle counseling for patients.

“I think a lot of them are compassionate and don’t realize this is going on,” Dr. Katz said. “The antipathy for obesity is really rooted in our culture. We should expect better from doctors and train them better.”http://well.blogs.nytimes.com/2013/04/2 ... ref=health

[John from Brookston]

Doctors think that since we're overweight (OK, *OBESE*. Happy now?) that we don't give a shit about our health, and if we're not going to put forth the effort, neither are they.
I "fired" a doctor once because he had me on a medication who's number one side effect was weight gain, and instead of connecting the dots, he looked at my chart and said "Hmmm... Need to do more 'push-aways' from the dinner table, I see...".

And Dieticians, either still pushing Ancel Keye's low-fat, high carb fad diet, or the ADA "Eat all of whatever you want and cover it in Insulin" diet.

[BlackSpinner]

And here is the doctors view point
http://www.themonthly.com.au/issue/2013 ... k/fat-city

This year I started work as the physician in an obesity clinic with a group of bariatric surgeons. No one else really wanted to do it. The attempt to help people lose weight is generally seen as one of the most futile acts we as doctors of internal medicine can perform: pretty much all we can do is make you feel crappier about yourself than you already do. But the surgeons can do something: they can clamp a band at the top of your stomach, cut half your stomach out or bypass part of your small intestine so food is not absorbed. The waiting list for our clinic is long. One of my patients gained 60 kilos between referral and consultation. Some of our patients have become so fat they can walk only five steps without needing a rest. Many are only in their 30s. My role at the clinic is to tighten up their diabetes control, make sure they don’t have a catastrophic hormonal condition that has made them fat (no one ever does), treat their high blood pressure and discuss eating and exercise habits

[SleepingUgly]

Another patient lamented a scar on her leg after surgery and the ugly shoes she was forced to wear. “You went through a lot,” the doctor told her, adding compliments to lift her spirits.

“You still got great legs. Chunky shoes are still in. Get something pretty, something for spring. That always makes you feel good.”

While such expressions of concern and empathy...

Helllooo??? Am I the only one here who would NOT be happy if my doctor told me I had "great legs"?! Unless my doctor was gay, I'd really appreciate it if he would NOT tell me that I have "great legs" and advise me to get "something pretty, something for spring". If he's gay, I'm OK with it, and in fact, he can go shopping with me to buy that something pretty for spring.

I know this is off the point, but I couldn't refrain.

[pikov22]

Are doctors nicer to patients who aren’t fat?

Everyone is nicer to people who are not fat!

[Lugus]

I have the opposite experience. I went through 3 doctors before one said I should lose some weight and that was after I pushed by asking why none of my other doctors would tell me I was overweight.

[Kate M]

Helllooo??? Am I the only one here who would NOT be happy if my doctor told me I had "great legs"?! Unless my doctor was gay, I'd really appreciate it if he would NOT tell me that I have "great legs" and advise me to get "something pretty, something for spring". If he's gay, I'm OK with it, and in fact, he can go shopping with me to buy that something pretty for spring.

I know this is off the point, but I couldn't refrain.

I was assuming this was a female doctor. It IS a very female type compliment, and suggesting shopping therapy -- has to be either female or gay!