by David B. Troxel, MD, Medical Director, The Doctors Company
Obesity continues to be a national crisis: Current research has found that 35 percent of men and 40.4 percent of women in the United States are obese.1 The obesity crisis not only contributes to growing health costs but also raises serious patient safety risks.
Patients who have experienced an adverse medical event leading to a medical malpractice claim are frequently noted to be obese (based on documented height and weight). A review of 7,065 claims from 2011 to 2013 by The Doctors Company, the nation's largest physician-owned medical malpractice insurer, revealed that 28 percent were identified as having one or more comorbidities, and obesity was the most common (8.3 percent of total claims and 19.2 percent of total claims with a comorbidity). When closed claims were analyzed, 26 percent of claims that resulted in indemnity payments listed obesity as a comorbidity.
Increased Risks: Complications and Access Issues
Obese patients commonly have a variety of comorbidities. Many are associated with a metabolic syndrome, such as hypertension, dyslipidemia, and hyperglycemia, which increases the risk of stroke, ischemic heart disease, and diabetes mellitus. These patients also have increased risk of obstructive sleep apnea (which often contributes to opioid-induced respiratory depression), susceptibility to nosocomial and postoperative infections, and weight-associated wear and tear on joints that can lead to osteoarthritis. Additionally, bariatric surgery can be associated with both surgical and metabolic complications.
In addition to the risks of comorbidities, healthcare facilities also face risks if they are unprepared to accommodate obese patients. An inability to fit a morbidly obese patient into a conventional MRI machine or CT scanner is a unique problem necessitating use of an open MRI or CT. Healthcare facilities that are unable to accommodate morbidly obese patients in their MRI machine or CT scanner or if their MRI or CT isn't available at night or on weekends should have transfer agreements with open facilities in place so there are no delays in urgent MRIs or CT scans. The failure to transfer an obese patient to a facility with an open MRI machine or CT scanner in a timely fashion may result in a delay of diagnosis and/or surgical treatment -- and, ultimately, in a malpractice claim.
Practices should have appropriately sized furniture in the waiting areas and exam rooms to meet the needs of obese patients. They should also have equipment -- such as blood pressure cuffs, needles, and wheelchairs -- designed for obese patients.
It's key to understand the importance of talking about weight with patients -- the conversation should take place early for better prevention and treatment. Many factors can arise that inhibit a practitioner from speaking frankly about weight with a patient. As obesity rates continue to increase, it is worthwhile for doctors and other healthcare professionals to recognize that they might have their own barriers to such communications.
Sensitive treatment of obese patients involves attending to their needs for comfort, safety, and respect. Obesity can be viewed as one of the many chronic health conditions afflicting patients. The person, not the obesity, should be the focus of treatment. As with any patient with a chronic health condition, a relationship with respectful caring forms the bedrock of medical care.
- Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284-2291. doi:10.1001/jama.2016.6458. http://jama.jamanetwork.com/article.aspx?articleid=2526639. Accessed June 9, 2016.
Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.