Thursday Born

The everyday life of a psychiatry resident (who was born on a Thursday).

Archive for November 14th, 2009

Doctors and Obese Patients

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Dissecting Frank’s limbs was not as fun as his abdomen and thorax. Never a sports person, and apparently just generally very oblivious to a lot of things about the body, I had very little base knowledge about the limb muscles. Sure I knew the terms quads and hamstrings, but did I have any idea which set of muscles did which action? No.

To add insult to injury, Franks moderate layer of fat seemed particularly annoying during the leg dissection. Frank was probably not obese, but he was definitely overweight to a significant degree, and this means there’s fat stored all over. After taking the rear approach to the pelvic area, maybe I should’ve been used to digging through fat to find small, delicate structures, but I think it’s one thing when you’re expecting it, and another when you’re trying to dissect the thighs and legs and Why is there fat inbetween all these muscles? Why are his arteries and veins and nerves covered in fat? The painstaking removal of little pockets of fat with tweezers and dull scissors from delicate, stringy structures got old quickly.

But it made me think a lot. I felt bad, being so frustrated because of his fat. I’m still quite fond of Frank (whose face I have finally seen; we started the head and neck last week) and I still treat him with the same respect I always did. I think I managed to keep the line between being annoyed at the fat and not being annoyed at him. I’m hoping I will always maintain this distinction, but I am already aware of classmates who don’t, and I have certainly met many doctors who don’t.

Medical professionals, much like the general public, are constantly being told that obesity is the #1 healthcare problem in the US. Medical students are not exempt from this. I did a public health pre-orientation program and obesity (in and of itself, and in the sub topics of racial health disparities, nutritional issues, diabetes and heart problems) came up often. During our general orientation, one faculty member began his little speech by talking about the obesity epidemic and how it is probably going to become a more serious problem and is going to concretely affect the way we will practice medicine (and the medicine itself).

Then there’s another side to it. The general public might be less familiar with thinking about this beyond hoping that the person they’re sitting next to on the airplane is relatively thin. The larger size of overweight people has all sorts of more practical implications. As I am intimately aware of, their cadavers have more fat for us to dissect through, and their live bodies are also more difficult to operate on.

This also comes up in radiology (a component of our anatomy lab). It’s harder to get an accurate x-ray in a bigger person; more fat equals more tissue between the film and the target organ or bone equals less accurate results. Some people may simply be too big for certain measures. Have you seen an fMRI machine before? There is a limit on how big of a person can fit inside one. And then there’s physicals. It is simply, dare I say it?, more cumbersome to examine a significantly larger person.

So here we have doctors, and here we have fat patients. Fat patients are apparently prone to all sorts of medical complications (that may be caused by the fat or may cause the fat; it can go both ways) and on top of that, they are somewhat more difficult to examine and operate on and diagnostic tools may not work as well on them. And then you add on society’s general “You did this to yourself!” attitude, and you have the doctor’s disdain for fat patients.

And it is still inexcusable.

I think there’s no excuse for showing a judgmental attitude toward your patients. It is not our place. First do no harm, right? Well, being rude to your patients is harmful. It certainly isn’t helping them. Even if they eat ten cheeseburgers a day and avoid physical exertion like it’s their duty, you are their doctor, and being rude or showing contempt helps neither of you, especially not them. I know it can be hard sometimes, to show even a neutral face when you disagree so strongly with some aspect of a person, but we have to try.

Written by Aba

November 14, 2009 at 9:39 am

Posted in Uncategorized

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