American Medical News (amednews.com)
June 6, 2013
The study author says they end up in emergency deparments for medical issues that could have been treated in a primary care office.
Negative health care experiences could lead obese patients to switch primary care doctors repeatedly in search of a practice where they feel accepted, said Baltimore internist Kimberly A. Gudzune, MD, MPH.
Such encounters may include off-putting comments, unsolicited weight loss advice and offices with blood pressure cuffs, chairs and exam tables that are not large enough to accommodate obese patients, Dr. Gudzune said.
She led a study on doctor-shopping among overweight and obese adults after years of hearing from such patients about their difficulties finding a physician who is sensitive to their needs. The findings were posted online May 13 in the journal Obesity.
"I was spurred on by the [question] of whether this is a pervasive issue," said Dr. Gudzune, assistant professor of medicine in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine in Baltimore.
The study found that 28% of obese adults visited at least three primary care physicians during a two-year period compared with 21% of normal-weight patients.
"There's something going wrong in these doctor-patient relationships that makes these switches so frequent for this group of people," Dr. Gudzune said.
As a result, the health of overweight and obese patients who doctor-shop is being compromised. "Because they do not remain with their doctors for very long, they are ending up in the emergency room, likely for things that could have been taken care of in a primary care office," she said.
Steps to make patients comfortable
Dr. Gudzune suggests that physicians ensure that their offices can accommodate obese patients. She also said doctors should take time to think about how they could be more sensitive to that patient population's needs.
One way to accomplish this is by "addressing weight with patients in a way that's engaging and constructive and positive rather than negative or stigmatizing or condescending," said Adam G. Tsai, MD, MSCE, a Denver internist and chair of the Obesity Society Public Affairs Committee.
For instance, physicians should use respectful terms such as "excess weight," ask patients about their eating habits and encourage them to replace unhealthy foods with nutritious alternatives, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
The institute suggests that physicians consider starting weight-loss conversations by saying, "Your BMI is above the healthy range. Excess weight could increase your risk for some health problems. Would you mind if we talked about it?"
The Obesity study researchers examined BlueCross BlueShield claims data from 2002-05 for 20,726 adults age 20 to 64. All participants lived in the same state and had at least one year of continuous coverage. Researchers didn't identify the state because of an agreement with the insurer to keep it private.
They also examined information on patients' height and body weight, which was part of the health risk assessments that occurred during the same study period.
Excluded from the study were pregnant women, people with a diagnosed malignancy and those with a substance abuse problem, because those conditions can cause significant weight changes. Underweight adults, those with a body mass index less than 18.5 kg/m2, also were excluded due to the relatively small sample size.
Normal weight was defined as a BMI of 18.5-24.9 kg/m2; overweight, a BMI between 25 and 29.9 kg/m2; and obese, a level of 30 kg/m2 or higher.
Researchers found the odds of seeking a new doctor increased by 19% for overweight patients and 37% for obese individuals compared with those who were a normal weight. Doctor-shopping was defined as visiting at least three primary care physicians in the past two years.
Overweight and obese doctor-shoppers were 85% more likely to visit the emergency department than normal-weight individuals who have regular doctors. They were not, however, more likely to be hospitalized, which suggests that their health issues probably could have been addressed by a primary care physician, Dr. Gudzune said.
"We need to strive to create a safe, judgment-free environment where all patients can receive satisfying medical care," she said.