Jeremy Brown: “It has taken me a while to pluck up the courage to speak frankly with obese patients about this problem. For 15 years I have broached virtually every delicate subject “” from sexual histories to the cough that is really cancer “” in the noisy, impersonal setting of a busy ER. It is expected of me. It is my job.
So why has it been so hard to talk about this? With an epidemic of obesity in the United States, why are so many doctors skittish about discussing obesity with its sufferers?
The truth is, I don’t know.”
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One strong deterrent to weight discussions is the absence of any solution with demonstrated efficacy. It’s possible that for some things, like the knee pain in the article, that the patients are actually not making the connection between weight and knee pain. People can be amazingly unaware.
But what is the gain (aside from increasing guilt, stress, public hostility, prejudices, etc.) from bringing up something that the patient already knows far too well. It’s like saying to an amputee that they really ought to do something about that missing limb. Do you really think they haven’t noticed it’s missing? You don’t bring it up without having a treatment approach.
If you have an reasonable chance of effective treatment the situation is different. The common issues like blood pressure, immunizations, etc. do have effective treatments. You might not reach 100%, but it is appropriate to bring up something when you have some effective treatment alternatives.
Until there are some demonstrated effective treatments available there will be reluctance to bring up issues like this, especially in an ED environment.
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