Recently I read a column in the Florida Sun Sentinel that there were some OB GYN doctors in South Florida who refused to treat Obese patients. Apparently 15 practices of the 105 polled so stated that the weight cut-off was 200 to 250 pounds. In the interests of transparency I must admit that I would have problems finding a doctor as I am 5’ 10.5” and over the weight limit for some of these doctors. As a woman of size I also attract possibly more than my share of large patients, and I have no regrets. Some of the respondents said that obese patients are high risk and have more complications. Multiple births have more complications, diabetics and women with seizures have more complications, underweight and very young or older women have more complications. OB GYN care is not elective or cosmetic. It is up to those of us who are educated and trained to care for women to care for all women, of any size, any shape, with any disability, or any co-morbidity. I am surprised that it isn’t illegal to discriminate on the basis of size. It was also stated in the article that the doctor did not want to have to get a consult if the patient developed a complication. Why not? I request consults whenever I am in a situation that requires expertise I do not possess. This is what doctors do. We take care of women until we find we are not capable of solving a problem and then we get help. If we have a patient with brittle diabetes, an unusual infection, a bowel obstruction, (I could go on and on but why…) denying access to a class of women (large women) is discriminatory and insulting and bad medicine.
There are many ways to easily accommodate larger women. In my office I have a variety of specula, some are extra long and narrow, some are extra long and wide and I can see what I need to without any problem. I have a couple of electrical tables and some mechanical tables all of which can accommodate most women. If someone is not ambulatory or over 400 or 500 pounds, this is a different story but up to 350 pounds is manageable in my office. We have extra long instruments for cervical biopsies and other office procedures. Sometimes I will have the patient lift her knees to her chest to give better access to the perineum. Our reception area has a very sturdy sofa without arms along three walls and several armchairs that are strong and can accommodate most sizes. They were purchased with this in mind.
No patient should ever be sent away from a medical office for their size. I find that our open attitude about this has encouraged many women to take better care of themselves, to start exercise programs to improve their fitness and to consider healthier eating patterns. They are certainly relieved that we are neither preachy nor judgmental. They follow up better and are very loyal patients. Doctors are here to treat all patients, not to cherry pick the “easy ones”. Let’s get back to why we took that oath and chose medicine as a profession, to care for those who need us.
This blog entry was cross-posted on OBGYN.NET