Tall and Skinny, No Whip

The Empire State Building

“Your patient is on social media Tweeting about it.”

“Tweeting about what?”

“The weight thing that prints out on the after visit summary for the patients.”

Come to find out she had also called and spoken to my office manager and my practice administrator. 

Good for her.

When we first moved to this electronic health record last fall one of the most annoying things was that on everyone that the program deemed “overweight” or “obese” got a large bright yellow box on the screen that alerted to me to the fact that I needed to add weight loss to their goals. 

I always hit the ignore button but it annoyed me that now I had to click an extra button because it stood between me and each patient’s active problem list. Not everyone needs to have “obesity” on their problem list and I would argue that NO ONE should have “overweight” as an official diagnosis. People who are “overweight” and  “obese” know good and well where they fall. They certainly do not need a computer “diagnosing” them with it, too.

I growled inside each time I saw that yellow box.

Then sometime in March I noticed that all of my “overweight” and “obese” patients were getting detailed weight loss instructions printed on their end of visit paperwork. It was going so far as to tell them exactly how much weight they needed to lose to reach a BMI of 25.

WHAT? I didn’t tell it to do that!

It was autopropagating. Someone flipped a switch somewhere which meant a good many other someones approved the change.

What were they thinking?

Shouldn’t I have control over that? Shouldn’t I be the one to decide? I am the doctor. I know the patient. 

I complained.

Nothing happened.

I mentioned it again.

Still nothing happened.

Some of my patients have eating disorders. A number of my patients have serious emotional issues wrapped up in their obesity. These people for sure should not end up with that kind of stuff on their handouts.

I messed around with the program for a while and discovered that I could manually remove it from the print outs if I clicked an obscure “X” box on the wrap up page at the end of the visit. I have to scroll down to the bottom of the screen to find it. That meant that on every patient I see every day I would have to scroll down to that area and click a box to remove weight from their goals.

I should not have to do that. There are literally 30 million other clicks I have to remember on each patient at each visit. Give me a busy day and things will slip through the cracks. This is something where the cost of human error is too great in my opinion.

For this patient, I was running 30 minutes behind. On hers I forgot to click the button. The print out told her she needed to loose over 30 pounds and detailed the diet and exercise changes she needed to make to get that accomplished. So she went to social media with it.

Suddenly, everyone downtown started scrambling. There will be a meeting now to discuss this.

And I am so very angry.

But not at her.

What does it say about a system that responds to social media pressure before it listens to its own physicians? And why would you ever pick a BMI of 25 and set it as the automatic weight loss goal for every single patient? What about the studies that show that people who are in “normal” BMI range do not live as long as those in the overweight range? That a decrease in life expectancy does not occur in obesity except for the extreme morbid obesity range?

Obesity isn’t killing people. Diabetes is. Cardiovascular disease is. We have put such a focus on weight that we have sabotaged the patients who are most vulnerable and as far as I am concerned we are killing them.

“I can’t lose weight so what’s the point of exercising and eating healthy?” 

I hear this every day.

Weight is not the point. It should not be the point. Healthy lifestyle is. But rather than use those things as the goals they made weight loss THE goal.

Fine.

Maybe I cannot change their mind. Maybe I cannot change yours. But do NOT force me to participate in a game that I do not want to play.

Next time I see that woman I am going to give her a great big hug and a high five.

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123 thoughts on “Tall and Skinny, No Whip

  1. A friend of mine suffered from abuse-induced eating disorders. She was overweight and dare not seek help because of the guilt she believed she carried ( she was two when the abuse started). She binge-ate constantly,,,then had periods of starvation when we could not even persuade her to drink water….

    It took years, and the trauma of getting her rapist sent to prison before she became stable and happy enough to eat sensibly.

    I can only imagine what that print out would do to people in her position….

    You must be tearing your hair out….

    Liked by 9 people

      • I’m wondering about that too. Sad to say, it’s probably true in some sense. The tail wags the dog all too often. On the other hand, it is mildly encouraging that a doctor in this system can modify a computer-programed printout. Maybe someone will design a “voice app” for that, Dr. V., so you don’t have to go hunting for the little box to check. Or you could tell your patients which parts of the printout to attend to (and which are simply standard health care talk).

        Liked by 1 person

  2. Ah, the weight issue. Know it well! Finally this past year I’ve found something that works, and it meant changes to my eating habits. I cannot seem to lose those last few pounds to reach target, but you know, I’ve maintained the same weight (give or take a pound or two) for over six months which ahs to account for something PLUS it is almost six stones lighter than I was 15 years ago. I’m happy enough with that, even though I am still classed as being overweight.

    Liked by 1 person

  3. This was an awesome post. No one cares about health, only if your obesity is offensive to their eyes or sensibilities. Health isn’t about losing weight but survival and prolonging life. I’m so happy that you’re a doctor who gets that.

    Liked by 4 people

  4. Oh Doc, this is a good post. You are an amazing Doctor. We have print outs but they do not have that yet on them. its coming I am sure. I did however, hit the roof about an IDC code that printed out on mine that said obese due to excess calories. HOW DO THEY CODE SOMETHING LIKE THAT. and if my doctor put that code in, shame on him. I want a code that says excess weight gain due to incorrectly prescribed medication or due to side effect of medication, or acute mobility issues or….due to childhood trauma, or domestic violence or substance abuse or….. well you get my point.
    I had a MA call me once and launched into a lecture on what I should be eating because my A1C was up. It was totally due to the medication I was on….but she was reporting my results and decided it was her job. I told the Doc and she was admonished, but I was pissed.

    Liked by 1 person

  5. I recently messed with my blog theme. I deleted the “Mobile View” for readers using their phone. One reader asked me in a comment if I could turn it back on. I FELT SO BAD and this is a person reading my blog. I can’t imagine realizing that this stuff was going out to your patients. I also wish my doctor would read your blog. Maybe I can attach a note to the end of all my correspondence with them – Lack of human interest noted – treatment plan: doctorly.wordpress,,, It might work.

    Liked by 1 person

  6. Hannah was in the dead center of her healthy BMI range when she was a walking skeleton before she died. If she hadn’t have been, maybe I wouldn’t have fallen for her excuse about the weight loss and known something much worse was occurring earlier. Maybe not, but that arbitrary BMI number is something that has no business in medicine, in my opinion.

    Liked by 1 person

  7. Victo, this is so well stated I want to crow it to some of my friends (if they’d listen and change their attitudes). This is especially so to the fat-phobics in particular; otherwise good people who who consciously discriminate against overweight and especially obese people without considering many are great people living the best they can with some serious odds stacked against them. Grrr… Despite our advances, technology is evolving so rapidly it sometimes seems to defeat itself and I believe it especially true in the health care industry. Never stop shouting!

    Liked by 1 person

  8. I would be beyond upset and angry if this happened with my EHR system because I am now more acutely aware of how many people are just defensive about their size and weight.. A while back, I made a suggestion on one of my running forums that if a woman weighs more than 150 pounds, they might find a men’s running shoe a better option than a women’s shoe. The nasty responses were amazing. I didn’t say that one HAD to wear a men’s shoe, I suggested that they might find better support in a men’s shoe since many men’s shoe designs are made for heavier weights.. As I read the responses, I became acutely aware of how sensitive many woman (and some men) are about their weight. As a person who formerly weighed more than 300 pounds, even at my heaviest, I wasn’t defensive about my weight but more acutely aware of how my health was affected by being obese. I lost 175 pounds and am now on the low end of the BMI/weight scale for my 5’8″ height (have to be thinner for my long-distance running). While the numbers are what they are, weight is a very individual matter and it’s loss or gain is something that I discuss with my patients as individuals. BMIs are the bane of any physicians existence these days but I am always aware that BMI/weight is something that I want to discuss with my individual patients within the context of their health goals rather than a generic print out that I didn’t request or wasn’t aware of from an EHR. This would make me livid as a physician or as a patient.

    Liked by 2 people

  9. Really shows how much it affected her, considering all the fat-shaming that happens on social media, for her to risk it and go on there anyway. Good for her. I left the doc a little while ago and cringed at the obesity thing yet again, funny to read this shortly thereafter.

    Liked by 1 person

  10. Good for you for considering the whole patient and not just treating them as another “statistic”!

    Quite frankly, this kind of impersonal, “we know what’s good for you” Big Pharma/scientific system looks like it’s found yet another way to focus on the negative and add to a patient’s stress. And for that, they certainly do have a fix…psychiatry and all kinds of drugs!

    Katching! Katching!

    They’re laughing all the way to the bank…

    Now Holistic medicine is something I can get behind. Isn’t it interesting how so many holistic medical practitioners are either ridiculed or wind up falling in front of buses these days?

    Oy!

    Love Always,

    Stargazer

    Liked by 1 person

  11. What a strange amalgam of contradiction. One one hand you have a country that is known world wide for its civil freedoms, its constitutional rights etc and then you have a 1984 Big Brother sneaky computer driven invasion of privacy. I can quite imagine you being just a tiny little bit not happy. Keep punching.

    Liked by 1 person

    • It is impossible to know ahead of time all of the possible permutations and repercussions of decisions sometimes but it sure out to take more than a few months to respond to physician concerns when they are brought up.

      Liked by 1 person

  12. Ugh. As you know, I’m quite fluffy. I figure at some point in the doctor/patient relationship the topic of obesity has to be mentioned, because if a doctor is doing her/his job it kinda has to be. At which point I will quip something, because as you said above, it isn’t like I went to sleep last night a size two and woke up this morning “holy cow!” huge. Yeah, I know. If the doctor does the due diligence thing, that’s fine. What I can’t stand (and will not stay with a practice if this happens) is regardless of what I go in for it is always because of my weight. Hangnail? “Lose weight.” Um, expletive and finger gesture. I also get told I “should” have diabetes. (Seriously, the word “should” is used.) I should have high cholesterol. I should not be able to touch my toes. Should I apologize? It often seems like it. I love, love, love what you said about how “we” have put our single-minded focus on weight, and only weight. I hate, hate, hate walking into a practice and that is all they see. I chuckled, in a black humor sort of way, that your complaints were ignored until Twitter was involved. Oy. Honestly, if I got that print out about obesity and that was NOT why I came to visit you (like the real reason was that pesky hangnail)? I would not stay with your practice past the first visit, unless it was for insurance or some sort of financial reason. And that would be a horrible thing to happen because of course you are a fabulous doctor. I blame it on :::rolls out a huge parchment roll list:::

    Liked by 1 person

    • That is the thing. I know you are not the only one who feels this way. I am certain that I have lost patients because of it. And all because some nameless person flipped a switch somewhere and will not flip it back….

      Liked by 1 person

  13. I once asked a nurse who was weighing me for a visit to doc about something that my weight would have no bearing on, if they got paid “by the pound” since I was made to step on the scale everytime I went in. Yes, I am morbidly obese but a sore throat isn’t weight-related!
    I love having a female doctor who is overweight as she never tells me I need to lose weight. I am 62 and not stupid, so ya, I know my risks. But until it becomes important to me to get thinner, it ain’t gonna happen no matter how many times they weigh me….I never even bother anymore to take off my coat or shoes…what is a few pounds when you are 100 pounds too short!!! LOL

    Liked by 1 person

  14. Nothing makes me more angry than instructions on the patient instruction sheet I didn’t include. I get no less than 1 phone call every few days about confusing D.C. Instructions that are only included so we don’t fail to meet “core measures.”
    It’s maddening.

    Liked by 1 person

    • OMG. Core measures and Patient Centered Medical Home and Medicare government mandates are the source of so much stupidity. Why can’t these things translate into something helpful for patients? Why does it have to be stupidity?

      Liked by 1 person

      • I have no idea- every time I think I know a better way to do things- I am horribly wrong.
        I just want to take care of my patients. I want to do things that make sense for them. I frequently feel backed into a corner. It sucks.

        Liked by 1 person

  15. What is their goal when they establish these auto-doc procedures? Surely they mean well? First do no harm.

    But it can be argued that diabetes and cardiovascular disease is hastened by obesity. They are not mutually exclusive. So there’s that to consider.

    Liked by 1 person

  16. Weight loss is such a sensitive topic. Checked boxes and computer-generated paperwork are such a lame approach. Your sensitivity and fortitude on the topic is admirable, Doc, and I wish you well on this fight.

    Liked by 1 person

  17. You. Are. Awesome. I’m having one of those job-related screenings next week and am already breaking out in a cold sweat and wondering if I can lose an extra 10 lbs in that time. Maybe those awful diuretic pills. But I SHOULD NOT HAVE TO.

    Liked by 1 person

  18. This focus on thinness now THAT is a disease! Everyone is different and to clump all together mandating you need to be a certain BMI is BS. I’m angry right along with you that stupid FB has a louder voice then a physician. Now I’m really glad I closed my FB page! Medicine has gotten highjacked by greed and stupidity! MY opinion. HUGS!!

    Liked by 1 person

  19. I’ve wondered why my own doctor seems to have gotten a little strange over the last few years. He probably wouldn’t have notice that (sigh) I have gained a fair amount of weight were it not for that darn computer program. I think it actually upset him to have to admit that except for the extra weight (and the colitis), I am just fine. At this point in my life, as long as I feel good and am able to do most of the things I want, and as long as I haven’t developed diabetes or cardiac disease, I’m not going to lose sleep over how much more of the bed my body covers. The next time I have a flare-up, I’ll lose 10 lbs. anyway.

    Liked by 1 person

  20. Wow. What a weighty comment section today!

    Seriously, as a pudgy person, I appreciate it. Would you take any comfort in knowing that I, personally, never read the damn print outs? I listen to the doc and take notes. And the printout often has pictures of the state of my rectum. Sooooo….

    You are a good person in that white coat. And your blog should be required in med school.

    Liked by 1 person

    • Aw, thank you! 🙂 I am always surprised at who reads those things. Used to be the actual physician instructions were the first thing you saw. Now it is buried somewhere near the end of page 2 or 3. What is the point of me writing anything important if it is going to be buried? “We can’t fix it, sorry!” Grrrrrr.

      Liked by 1 person

  21. The clicking…..I say it at least once a day at work “I’m just a clicker” There are so many unnecessary button to click and I’m not even in the EHR part, I’m in the front office stuff. It’s crazy about the weight bullying! I agree with you…good for that woman. It’s a sad reality that you aren’t being listened to….your opinion should hold some weight. It’s all big business these days and patients should be treated as patients not “customers” or “guests”. I could go on but you already know this and more.

    Liked by 1 person

  22. I have all my medical records from Scotland. The doctor’s notes quite regularly mentioned that I was overweight. None of it made any difference to my core problem – mental illness. I am slim now, obsessively watch my weight, and yet am still mentally ill with arthritis and sciatica. When I moved to the US, I was perplexed by having to be weighed each visit and I am still so anxious that I never look at the scale. I certainly don’t need a receipt!

    Liked by 1 person

  23. “Obesity isn’t killing people. Diabetes is. Cardiovascular disease is. We have put such a focus on weight that we have sabotaged the patients who are most vulnerable and as far as I am concerned we are killing them.” I want this to be on repeat forever. I know this is anecdotal, but I’ve heard stories about people who nearly died from cancer because their doctor ignored the symptoms they were complaining of and told them to lose weight.

    I had to go through so many doctors and two endocrinologists before I found one that would listen to what I was saying instead of assuming I was lazy and lying because of my size (oh, let’s not even talk about the first endo told me that the cutting scars on my arm were not life threatening and I’d only done it for attention…you know after my mother died when I was 14 *fumes*). I’m currently still struggling with health issues, but at the very least I have doctors who are willing to work with me and not assume I just need to lose weight. I’m overjoyed that you’re one of them. It can be so difficult for fat people to find decent healthcare and/or be treated at all. There are physicians who refuse to see fat patients, and while I’m no doctor, I’m pretty sure “do no harm” is part of the oath, and it seems to me that would do a hell of a lot of harm.

    Liked by 1 person

  24. Pingback: Writing Links 7/17/17 – Where Genres Collide

  25. Wow! I share your anger. What a dangerous thing to just switch on automatically. As you say, you are the doctor, you know your patients and their particular issues, and whether having this sort of information handed to them may be detrimental to them physically or mentally. Things like that drive me crazy, when people think it is appropriate to automate human interactions with no clear thought about the consequences.

    Liked by 1 person

  26. I haven’t had to deal with this, but I have a complaint about the scales that always weigh me at least five lbs. heavier. I have weighed myself with my cat and without, and it always weighs me 13.5 lbs. heavier with the cat, which is how I know they’re accurate. Then I go to the doctor’s office and I’m suddenly five lbs. more! Please explain that to me. 🙂

    Liked by 1 person

    • EVERYONE complains of that! The truth you cannot compare numbers from two different scales. They are not calibrated the same. Second, depending on how you weigh (before or after eating/drinking, before/after peeing or pooping) there is a considerable amount of variation.

      Like

  27. Everytime I read posts like this, I wonder where you live and if you’ll be my doctor. I’ve been toying with a post on what patients with trauma histories and mental health challenges *should* be getting in trauma-sensitive care. I’ll definitely be linking back to your posts as a form of “see, it can be done.”

    Liked by 1 person

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