Patients lose if physicians are expected to practice perfect medicine

I discussed whether or not ambulances should be required to add equipment costing $12,000 in order to be able to transport 850 pound patients recently, so I won’t belabor the point here. Providing medical care to morbidly obese patients presents multiple challenges.

Then I read an article in the Florida Sun Sentinel about how some obstetrician-gynecologists in South Florida are refusing to provide medical care to obese women. Fifteen out of 105 Ob/Gyns refuse to treat patients based upon either weight or BMI. Some won’t take any patients who weigh more than 200 lbs.

In the article, other obstetricians without such a policy state that “no doctor should be unable to treat patients just because they are heavy.”

The “ability” to treat patients is only one of the issues involved, though.

Morbidly obese patients are more likely to develop surgical and post-op complications.  One of the physicians in the article mentioned that ultrasounds are more difficult to perform and interpret in obese patients. If a physician misses a critical finding on ultrasound due to a patient’s obesity, a plaintiff’s attorney will argue that the patient should have been referred to someone with more experience under those circumstances.

Malpractice insurance costs in Florida are some of the highest in the country. In fact, the costs are so high that the article states that half of Florida obstetricians go without malpractice insurance.

If physicians want to decrease their risk in managing patients by excluding patients who are at higher risk for complications, shouldn’t they be able to do so?

Many commenters to the article have harsh words for doctors who are unwilling to treat obese patients. The article itself cites physician groups, medical ethics experts and advocates for the obese, all of whom said that refusing to treat patients based on obesity would “violate the spirit of the medical profession.”

Insurers can refuse to provide insurance based upon pre-existing conditions (at least for a few more years) or can jack up premiums so high that the insurance is unaffordable. Good luck getting life insurance or disability insurance if you have a history of cancer. Airlines can refuse to transport people that are deemed an excessive “risk.” Banks can put limitations on those who enter their premises. Try walking inside a bank wearing a ski mask some day. Lawyers can reject any potential client for any reason. I don’t understand why people find it morally reprehensible if some doctors want to try to limit their liability by refusing to care for patients who are a higher risk for adverse outcomes.

This whole situation is a perfect example of the “perfect care” or “available care” paradigm.

The more that physicians who care for higher-risk patients are sued for less than perfect outcomes, the less that those physicians will be willing to treat higher-risk patients.

“WhiteCoat” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly.

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