There have been plenty of stories detailing how difficult it is to treat the morbidly obese.
Most of the time, the stories have centered on simply how difficult it is to transport these patients to the hospital.
Once there, however, emergency physician Shadowfax talks about other issues. For instance, obtaining IV access is near impossible, and 500+ pound patients present grave challenges to securing an airway, managing ventilation, or performing other procedures.
In addition to these issues, he also notes that, “there seems to be an association, not 100% but a strong association, between severe obesity and personality disorders and other psychiatric conditions that makes the interpersonal element of caring for them difficult on top of all the other technical challenges.”
As more Americans are crossing the threshold into morbid obesity, expect this phenomenon to only become prevelant in the hospital setting.
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- Imaging the obese
- Is racism a psychiatric disorder?
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{ 11 comments }
If you weighed 500 pounds for an extended period of time, unable to leave your home, hold down a job, have friends, and have hobbies, I bet you would develop a personality disorder, too.
We also have a lot of trouble treating these patients in radiation therapy. Our treatment couches are only rated for 450 pounds. Also, some patients are unable to physically fit through the bore of our CT scanners. Computer treatment planning systems often are only given data for patients less than 60 cm thick, and larger patients have their dose extrapolated.
Linda – by definition, personality disorders are present since at least adolescence and early adulthood and are ingrained in one’s being. Mood and anxiety orders can develop throughout one’s life.
This seems to be a pretty patently useless little blog post. What information does it convey? Either ‘I’m not equipped to handle all my patients’ or ‘fatties make my life hard’.
It may interest you to know that the obese and morbidly obese also find it hard to go to the doctor, because of prejudice, because they’re ignored, because fat is always blamed: http://fathealth.wordpress.com
Often times, the perceived difficulty in “the interpersonal element of caring” can be overcome by improving healthcare personnel skills. Diversity sensitivity training, with focus on diversity as related to obesity, can be extremely helpful. In the vast majority of cases, such a difficulty in interacting with the morbidly obese is really not an issue.
LJ – I think it is an incredibly useful post as it highlights why the challenge of obesity and morbid obesity are NOT simply cosmetic. This is not a concern about how one looks, this is life and death. And let’s be honest with ourselves, obesity IS the cause of many problems. And if it isn’t, it makes diagnosis very difficult. This is time and resources taken away from other patients. With all due respect, try giving an accurate assessment of lung sounds on someone who is 500+ pounds where the chest X-ray is useless. They are having trouble breathing – is that pneumonia, heart failure, obesity- hypoventilation? I am assuming you are not a care provider who understands these struggles and the limits it puts on your ability to care for these patients – but if you are, I would like to hear some suggestions and tools that you use to get around this problem.
to LJ: Dr. Kevin is not criticizing these patients. This is a segment of our patient population that has special needs. Flounder brings up an issue most of us haven’t thought about, drug dosing protocols. I think this post is meant to stimulate discussion on ways we can accommodate very large patients. For example, a waiting room should have a combination of chair types – chairs with arms for the elderly who need to push themselves up, and benches or four-footed chairs without arms for the heavier patients. By four-footed, I mean chairs that have four separate legs as opposed to the type with one connected loop at the bottom. I’m not explaining that very well but I hope you know what I mean. Beyond the physical issues like placement of the exam table and chairs in the room, etc, we need to be prepared with large sized blood pressure cuffs and speculums (specula?), longer injection needles, all types of durable medical equipment, ventillator and IV settings, etc. We are in our professions to treat all people, but a lot of times our ignorance gets in the way of making both logistical and medical accommodations for some our patients.
I appreciate one’s first reaction that any discussion of morbid obesity is going to be critical of the patient and suggest “weight-loss” (as if that were easy) as the only remedy to the problem. It’s not an unreasonable expectation given a person’s life experiences. However, that is not always the case. We in the medical profession cannot improve our treatment of these patients without acknowledging their needs first.
I think we will see more morbidly obese patients but those patients will be less personality disordered. When morbid obesity was rare, many of the morbidly obese had personality disorders but as more and more people become obese in general, more people without a personality disorder will become morbidly obese.
Don’t forget that health care providers themselves, especially nurses and aides, often suffer injuries doing routine care on these patients. Even if you have 6 or more people to help you, a simple boost up in bed can be a career-ending injury. If you have to do CPR, you’re guaranteed a wrist splint at a minimum.
You have to push them from the lobby to the room and you break your back and probably the wheelchair too. There have been times where a patient is so obese that I simply couldn’t push them even with leaning all my weight (which isn’t that much) into the wheelchair.
If they have a personality disorder, they may want staff to turn them and do all their stuff for them even if they can do it themselves or they may urinate/defecate on themselves as an excuse to have someone clean them up.
I had a fellow nurse in my ER the other day after boosting a morbidly obese patient with several other staff members. Huge disk herniation, shooting pain down both legs. She wasn’t even 25 years old yet.
Nurse k,
Yet one more thing you’ve found to complain about I’m sure.
This article was useless, tasteless and pathetic.
We need to be pro-active as part of the solutions and NOT part or the problem
I am a morbidly obese person. I’m not sure if you’ll find my perspective helpful. My doctor is very frustrated that I don’t just lose the weight, and I don’t know what to say to her. On the surface, it looks like it should be that simple. I take responsibility for my size, and I can appreciate that it’s an extra expense and risk for doctors/nurses to treat me. My solution is to no seek treatment if I can help it.
At age 20 I was in an accident that broke two vertebrae in my back. I was in the hospital for six weeks. At the time I weighed 160 lbs., but I could see how much the staff hated taking care of me because of my size. I did everything I could to keep from having to ask for help. Now I’m 50 years old and weigh 300 lbs. There is no way I would agree to be hospitalized for any reason. I’ve worn a do-not-resusitate bracelet for the past 10 years. My power of attorney for healthcare has instructions not to even give IV fluids if something should happen and I can’t refuse treatment myself. I reluctantly see the doctor twice a year. I have blood taken for lab tests and I take my medicine. I don’t have any exams/tests for cancer or heart disease because I would never seek treatment for these anyway. I agree that it’s a waste of resources and an unresaonable risk for health professionals to treat a person like me.
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