Hippocrates: “First, do no harm.”

There’s been a fairly hot story in the news this week about a Shrewsbury, MA doctor who has publicly stated that she will not treat patients who are over 200 pounds.  Dr. Helen Carter claims that several of her medical staff were injured treating larger patients and that she doesn’t want to see anyone who weighs more.

The story broke after one patient, who had actually come in for her second appointment had been sent home.  Ida Davidson was very surprised when she came in for her follow-up appointment and was told, that she would no longer be accepted as a patient since she weighed over 200 lbs.  Dr. Carter said she did not feel equipped to deal with Ida’s needs.  She stated, “There’s an obesity center over at UMass that is much better staffed and has more resources than I do.”

Now first, let me state for the record, Dr. Carter’s decision is not illegal.  Doctors can choose to take on patients or not take on patients as they see fit.  But is it ethical?  Is her response even logical?  She refuses to provide any detail about the injuries to her staff workers from working with patients over 250 pounds.  And really, it seems the vast majority of medical offices out there routinely handle patients of that size and much larger without any injuries to medical staff.  One might question what these med techs were doing in a traditional doctor’s office to cause such problems.  And to be frank, me thinks the doc doth protest too much.  I’ve talked to a number of med techs who point out that the sort of routine care offered in a typical doctor’s office should not result in injuries to the staff of any kind, if the med techs were properly trained and following reasonable procedures.

While Dr. Carter may state that she is looking after her staff with this decision, I can’t help thinking that there are other motivations at work.  Maybe Dr. Carter just doesn’t like fat people.  Ida Davidson makes it clear that she felt outraged and humiliated about the way the whole thing was handled.  She felt the doctor had engaged neither tact nor compassion, and I quote, “She didn’t care about my health that day.  I think she just cared that I was a liability to her, maybe, and that I was too much work.”

But I also have to wonder if greed plays a part in Dr. Carter’s decision as well.  Increasingly, doctors are seeing financial bonuses from insurance companies and medical groups for keeping their patients within certain metrics.  In many cases, those metrics include BMI.  So I have to wonder, is this decision really about protecting her staff or filling her bank account?  And I also wonder, where will this end?  Will doctors ultimately decide we are too expensive to treat?  Will they stop seeing average-size or larger people at all?  Will they only agree to treat people who they deem healthy and avoid those with expensive problems?

But perhaps most alarming to me is the question of whether or not fat people will be so humiliated and stigmatized by their doctors that they will stop going altogether.  I’m far more frightened about the patients that Dr. Carter has turned away who are not brave enough to talk to CNN.  What about the patients who simply internalize the shame, and don’t go to see the doctor at all any more.  The Rudd Center has done a lot of work in documenting weight bias among medical professionals.  It is real, and it has a profound effect on the health and well being of people of size.  As the Rudd Center points out: people who are the victims of weight bias by medical professionals “are reluctant to seek medical care, cancel or delay medical appointments, and put off important preventative medical services.”

My dear Chicklettes.  I have experienced weight bias from doctors in the past, and I have allowed it to keep me from going to the doctor. I have allowed myself to feel sad and worthless by men and women in white coats.  I have suffered needlessly with medical conditions that would have been far less severe if I had gone to the doctor sooner.  So learn from my mistakes.  Make sure to find a doctor who treats you well.  You deserve to be treated with respect.  You deserve to receive competent, compassionate health care no matter what your size or shape or age or ability.   Please remember you are not a liability.  You are a unique and amazing person.


The Fat Chick

9 Comments. Leave new

  • Quite honestly, I smell publicity stunt. Whenever there is a new drug released from Pharma, media gimmicks abound, from health scare studies to PR tricks. Doctors have been refusing to treat fat folk for years. That this makes all the headlines has me a bit suspicious!

  • I am lucky to have incredibly good doctors who don’t pull the weight card any longer. My internist has been with me for nearly 20 years…I think it’s quite clear that being a thin person is not in the cards.

    I also was wondering what the doctor’s staff is doing to patients that resulted in injury! At my various doctors (an autoimmune disease means I see several. ugh.) the most they do is watch me get on the scale and take my BP. I get up and down on the table myself. I lift my arm for the BP. The lab does my quarterly blood draw in the regular manner. (I was quite pleased to see the chair they have for patients has an adjustable brace on the front to keep you from fainting and falling forward. I thought I was too big for it. Nope, it was pushed in really far! Relief…)

    I guess the patient was lucky she found out about the doctor’s bias. Who would want to financially support someone like that!?

  • Has the doctor opened her office to a CMS investigation with this excuse? Nurses and MAs using proper lifting techniques shouldn’t injure themselves or anyone else. Is she implying her office staff is incompetent?

  • A few years ago, I went to a yearly doctor appointment. The doctor spent the entire time shaming me, telling me that if I didn’t lose weight immediately I was going to die from a stroke (I was 28 at the time). I felt so awful and humiliated after leaving that I immediately began dieting and exercising to the extreme. I worked out 8 hours a day and at my worst was eating nothing more than a tomato and a cucumber a day. I had a stroke at age 29, weighing about 100 pounds (at 5’11”). It took years to get my hair to grow back, to get full function of my left side, to stop obsessing over every calorie. I went through hell and took my family with me.

    I think that doctor did more damage to me that day than anything else. I’m still struggling to be ok at a heavier weight (I’ve gained much of it back), and I try to avoid doctors at all costs. I’ve been to one once since my recovery and she told me to lose weight before she asked me any questions about my issue that day. I haven’t seen a doctor since.

  • Concerned citizen
    September 4, 2012 1:54 pm

    Being over weight is a medical condition. To me, Dr. Carter’s descion was the equivalent of a primary care doctor refusing to wait on patients who are in wheel chairs, have mental disorders, or are blind. Would anyone find that acceptable? I think not. Her claim that it is dangerous for her employees because they have to manually lift the exam table and put out the foot rest is ridiculous. If her equipment is that bad, maybe she should invest in some new equipment. There is nothing that has ever been done at my primary care physician’s office that couldn’t be done with someone over weight. It is the equivalent of saying she won’t wait on a someone using a wheel chair or crutches because she doesn’t want to provide an accessible office. If you feel this is unacceptable behavior on the part of a doctor and belong to a health plan in Massachusetts, then call your health provider and file a complaint. While it may not be illegal, she still has to follow policies given by the health plans she accepts. If you allow discrimination to happen at any level, you are just paving the way for another doctor to refuse to wait on some other minority.

    • HIPPA = Health Insurance Portability and Accountability Act
      Be sure to educate yourselfs on this. I am !!!
      A professional doctor is to only discuss patient health concerns between each other, not out in the lobby\ receptionist desk area in front of others to humiliate the patient.

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