What is the common factor in these five cases?
The common factor in these five cases is evident: obesity-related complications in otherwise routine clinical settings.
Our population is growing—not only in numbers, but also in size. The World Health Organization (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that may impair health. Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his or her height in meters (kg/m2).
Obesity is not restricted to adults; children are at risk as well. According to the National Institutes of Health, in the past 30 years, obesity has tripled among school-aged children and teens.
The Doctors Company continues to see an alarming increase in lawsuits that involve obese patients. The following loss analysis focuses on obesity-related claims from 2007 through 2012. The total number of patients in this study was 415. The analysis showed a 64 percent increase in claims during a six-year period, compared to a previous study that encompassed 10 years. Twenty-five percent of the patients died. The patients ranged in age from 10 to 89; a breakdown of the claims by age and specialty follows.
In this recent review, it is interesting that an increased number of claims involved orthopedics and plastic surgery.
The chart below outlines the top 10 injuries in claims involving obesity as a comorbidity. Because more than one comorbidity can affect each patient, the numbers and percentages that appear in the chart are greater than the total number of claims.
The patient safety risk managers of The Doctors Company survey hundreds of office practices each year. We can recognize the practices that meet the needs of obese patients: They have appropriately sized furniture in the waiting areas and exam rooms. They also have equipment, such as blood pressure cuffs, needles, and wheelchairs, designed for obese patients. Weight assessment tools are handy, and these practices provide weight education to patients. They understand the importance of talking about weight with their patients—and that the conversation should take place early for better prevention and treatment.
Many factors can arise that inhibit a practitioner from speaking frankly about weight with a patient. As obesity rates continue to increase, it is worthwhile for practitioners to recognize that they might have their own barriers to such communications. The American Medical Association has resources available to help you talk about weight with your patients.
Caring for an overweight or obese patient in the office proactively may reverse a weight gain trend that could ultimately lead to surgical intervention. While bariatric surgery is a viable option, most patients would prefer weight reduction instead of surgery.
Sensitive treatment of obese patients involves attending to their needs for comfort, safety, and respect. Obesity can be viewed as one of the many chronic health conditions afflicting patients. The person, not the obesity, should be the focus of treatment. As with any patient with a chronic health condition, a relationship with respectful caring forms the bedrock of medical care.
By Paul Nagle, ARM, CPHRM, Director, Physician Patient Safety, The Doctors Company.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.