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Are Doctors’ Orders Less Likely To Be Followed If The Doctor Is Overweight?

A recent, 358-person survey conducted by researchers at Yale University (and published in the International Journal of Obesity) suggested that patients may be less likely to follow the medical advice of overweight and obese physicians. Survey respondents were 57% female, 70% Caucasian, 51% had BMIs in the normal or underweight category (31% overweight and 17% obese), and were an average age of 37 years old.

Respondents rated overweight and obese physicians as less credible than normal weight doctors, and stated that they would be less likely to follow advice (including guidance about diet, exercise, smoking cessation, preventive health screenings, and medication compliance) from such physicians. Although credibility and trust scores differed between the hypothetical overweight and obese providers and normal weight colleagues, the respondents predicted less of a difference between them in terms of empathy and bedside manner. Respondents said they’d be more likely to switch physicians based on their weight alone. There was no less bias against overweight and obese physicians found in respondents who were themselves overweight or obese.

The study authors note that this survey is the first of its kind – assessing potential weight bias against physicians by patients of different weights. Previous studies (by Puhl, Heuer, and others) have documented weight bias against patients by physicians.

While the study has some significant limitations (such as the respondents being disproportionately Caucasian, thin, and female), I think it raises some interesting questions about weight bias and physicians’ ability to influence patients to adopt healthier lifestyles.

Considering the expansion of pay-for-performance measures (where physicians receive higher compensation from Medicare/Medicaid when their patients achieve certain health goals -such as improved blood sugar levels), being overweight or obese could reduce practice profit margins. If patients are less likely to follow advice from overweight or obese doctors, then it stands to reason that patients’ health outcomes could suffer along with the doctors’ income.

I’m certainly not suggesting that CMS monitor physician waist circumferences in an attempt to improve patient compliance with healthy lifestyle choices (Oh no, did I just give the bureaucrats a new regulatory idea?), but rather that physicians redouble their efforts to practice what they preach as part of a commitment to being good clinicians.

Some will say that the problem here is not expanding provider waistlines, but bias against the overweight and obese. While I agree that weight has little to do with intellectual competence, it does have to do with disease risk. Normalizing and destigmatizing unhealthiness is not the way to solve the weight bias problem. We know instinctively that carrying around a lot of extra pounds is damaging to our health. It’s important to show grace and kindness to one another as we join together on the same health journey – a struggle to make good lifestyle choices in a challenging environment that tempts us to eat poorly and cease exercising.

To doctors I say, let’s fight the good fight and model healthy behaviors to our patients. To patients I say, show grace to your doctors who carry extra pounds – don’t assume that they are less competent or knowledgeable because of a weight problem. And to thin, female, 30-something, Caucasian survey respondents I say – Wait till you hit menopause before you judge people who are overweight! 😉

Trust Is Critical To Strong Doctor-Patient Relationships

Often the simplest solutions to problems are the best.  So it would seem when it comes to the impact that increasing patient trust in physicians could have on many of the intractable challenges that face the health care industry everyday like non-adherence, lack of involvement, poor health status, dissatisfaction and so on.

I explore the link between patient trust and outcomes in the following infographic I curated and designed.  What surprised me is how a patient’s level of  trust in their doctor, like so much of what I talk about in this blog, boils downs to the patient’s perception of the physician’s ability to communicate: Read more »

*This blog post was originally published at Mind The Gap*

No Forgetting To Take Your Meds

Normally, the patient calls the pharmacy for a prescription. Now, the prescription is doing that by itself. GlowCaps, a prescription bottle cap made by Vitality, has assumed control for medication compliance.

The bottle cap fits prescription bottles, but has uses cellphone technology to tap into wireless networks. Once connected, the pill bottle does everything imaginable to remind patients to take their pills.

There’s lights — plenty of them. The bottle cap really does glow and make noise to remind patients. Plug-in units wirelessly connected to the bottle cap can be placed anywhere there’s a wall socket. Oh, and it will call you, too, if you forget. The company calls this “Reminders Ramp from Subtle to Insistent.” (Add “relentless” to that.)

Ultimately, GlowCaps tallies compliance and sends reports to caregivers and physicians. Not surprisingly, studies show that constant nagging to take one’s medications works.

*This blog post was originally published at ACP Internist*

A Gene For Surviving Dialysis

As a hospitalist physician of seven years and taking care of dialysis patients, I’ve come to the conclusion that a dialysis survival gene exists. I talked with a nephrologist the other day about dialysis survival. Here’s what he said:

“If you take all dialysis comers, every year 25% of them will die.”

There is a broad range of dialysis survival. A 94-year-old with severe COPD, CHF, and dementia will not have the same survival statistics as a healthy 27-year-old with acute interstitial nephritis. The protoplasm from which you begin with often times determines the dialysis survival.

There are many factors that determine dialysis survival statistics. Some of them include, age, race, weight, and even the length of the dialysis treatments. But no where have I seen reported the association of dialysis survival with Happy’s presumed dialysis surivival gene. Read more »

*This blog post was originally published at The Happy Hospitalist*

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