There is no guarantee that the first doctor a patient meets is right for them. For those with obesity, the challenge may be even more significant. According to Johns Hopkins, frustrations may mount for some patients. Researchers found that 37% of patients who had obesity switched providers up to three times a year, which impacted the continuity of their care.
“The practice of “doctor shopping” among overweight patients may be a result of negative experiences with the health care system, whether that be off-putting comments by office staff, unsolicited weight loss advice by providers, or improperly sized medical equipment and office furniture, says Kimberly A. Gudzune, M.D. M.P.H., an associate professor of medicine at Johns Hopkins School of Medicine, led the study.
In subsequent research, Gudzune noted that clinicians might avoid performing exams on patients with obesity, encounter technical difficulties, and feel unprepared when it comes to training to treat patients with obesity, and as a result, weight loss counseling became a lower priority when talking to their patients. These further impact patients who avoid screenings for cancers, from pap tests to mammograms to colonoscopies.
To find the right provider, patients might have to research before committing. The doctor-patient relationship is integral to the pursuit of their overall health. As a doctor, you should help foster a safe space to manage their healthcare concerns and your goals for them. This safe space must include all people, including those who have obesity.
Conduct a SWOT analysis to determine if your practice can be someone’s healthcare home. They are generally used to evaluate a business’ pitfalls and successes. However, this tool can be applied to any decision. In this case, it helps you approach the process methodically and dispassionately to consider what is most important to your patient.
Any patient-doctor relationship can be measured using it. This SWOT analysis will help you estimate your practice and its ability to treat different types of patients. Here’s what to consider in your SWOT analysis:
Strengths
Presenting yourself as an open slate is a strength. Please don’t make assumptions about your patient feelings or self-esteem.
- Black women have embraced their curves for years and feel more confident. Don’t detract from that. Focus on the facts instead. “Compared to women of other racial/ethnic groups, overweight and obese Black women exhibit acceptance of a larger body size,” according to Current Cardiovascular Risk Reports. Acknowledge that and use it to connect with them. Be congenial without being overly familiar.
- Learn how to market your empathy as a plus to potential patients.
- Your knowledge is a strength as well. Share the kinds of things you have learned in continuing education.
- Is there clinical equipment or a soothing environment that can make your space feel more comfortable and inviting for patients?
- Can you ensure that some chairs and robes fit them?
- Is your location convenient for the type of patients you treat?
- Do you have hours that will work with their schedule?
Start to think about the demographics of the people you treat and how you can show your support for them through consideration.
- Ask them what their communication style is. Learn how different styles work with your own.
- Work to ensure patients feel comfortable talking to you about everything, including their weight. A joint study by the Monash Business School and the Texas A&M University found that patients have difficulty asserting themselves due to a perceived “imbalance of power between the patient and medical staff.”
- Ask them if they feel like there are subjects they want to discuss. They want to tell you but can’t. Ask them if they would like someone else in the room, a friend or family member, or on FaceTime. Or offer one of your nurses. It will lead to more effective treatment.
Weaknesses
The use of the words obese and obesity can be triggering, and according to one study, it felt discriminatory to Black patients.
- Those who have obesity have seen how it leads to stigma when it comes to healthcare.
- Providers spend up to 28% less time with overweight patients, limiting patients’ ability to relay symptoms and seek solutions. That fact should inform your care.
- It’s important to know what you know and don’t know as a doctor, especially when treating someone facing stigmas. Before accepting a new patient, ask yourself if you are familiar with treating patients who share their lifestyle and concerns. Ask yourself if you give this advice to anyone in their circumstance or if you are jumping to conclusions based on looks.
- Ask your patient what their preferred language choices are and stick to them.
- Consider your language carefully. Familiarize yourself with the ways that terms and tools are evolving. This is particularly useful when discussing weight with patients.
- Before referring to the Body Mass Index, consider how it was created and who informed the research. Acknowledge its limitations so that you can establish trust. An Oxford University study found that “subtle aspects of communication, like word choice and tone of voice, influenced patient outcomes” in the weight loss arena. The AMSA has recommended physicians reconsider how they discuss weight. Exercise caution and consider your patient’s viewpoint.
How can you make this doctor-patient relationship benefit your patient’s life? Are you doing everything you need to ensure information flows two ways? How can you grow as a healthcare provider?
Dr. Courtney Whittle, MD, M.S.W. Diplomate of ABOM, acknowledges how patients react to doctors bluntly and rudely discussing their weight. Because culturally, our thickness might be celebrated in some circles while it may be deemed unhealthy in others, the shift can be jarring. “How many of us have gone to the doctor, heard someone bring up our weight, and been ready to take our earrings off,” she asked the audience during the Black Health Matters Winter 2024 Health Summit & Expo, who swiftly recognized the scenario.
“Weight is personal, and although you may be their physician, your questions can seem invasive,” the doctor continued. When listening to patient complaints about their ailments, do not dismiss them with a terse instruction to do more cardio or cut carbs. Listen closely and make sure you are doing so consistently and respectfully. The patient is not the enemy. You’re supposed to be working together.
If you sense your patient suspects bias, ask your patient if they are comfortable sharing their concerns with you and trusting that you will take them seriously. Most importantly, you must listen to them and take in any evidence they provide with an open mind. Please don’t belittle them.
Opportunities
Recent research reveals the importance of the 5A model (ask, assess, advise, agree, assist/arrange) in delivering meaningful consultations in weight management for patients with obesity. The study authors note patients with obesity often want to help set goals of losing 5 to 10% but have difficulty talking about their weight. “The 5A model also effectively improves physician-patient communication, patient motivation, and healthcare practitioner confidence in counseling patients.”
The 5A model is multifaceted and would require training if you want to incorporate it into your practice, but it is something to consider if you have a large percentage of patients who have obesity.
When audio tapes were analyzed in the University of Oxford study, they found it was not just the words that mattered but tone and delivery when talking to patients with obesity. When weight loss referrals were given with neutrality or highlighted health issues, only 50% of participants participated in a weight loss program offered. But when it was framed as good news, there was 83% program participation.
Threats
Ask yourself what issues arise from working with you as a healthcare provider.
Review your previous charts and highlight any notes you made that could be misconstrued. Patients have access to these notes. They are a helpful tool but “may also cause patients to feel judged or offended.”
- The New York Times reported that an analysis of outpatient clinic records published in JAMA Open Network on stigmatizing language with terms that used combative, argumentative, failed, and noncompliant on charts of diabetic patients, 3.15 percent of those terms were in charts of Black patients versus 2.6 of them of white patients.
- Revisit remarks you make that are taken out of context. Keep a file of comments and complaints and check them regularly. Learn how you can do better.
These can stem from complicated factors like a potential lack of cultural competency to more practical issues like their office’s distance from your home or workplace.
- Will they struggle with parking, filling them with dread every time they have to pop over for a follow-up?
- Are there unconscious biases you are unaware you and your staff need to uncover when it comes to obesity?
According to Gudzune, patients with obesity have a 68% greater incidence of emergency room visits, not because it leads to hospitalization, but because they don’t have the continuous care of a primary care physician.
The American College of Obstetricians and Gynecologists found that “weight bias often is implicit and beyond physicians’ immediate awareness, making it difficult to identify and remedy.
Current Psychology reports, “Empathy is crucial in healthcare required to develop healthy and effective patient communication.” This is more crucial in larger patients.
With the right perspective and environment, your obese patients will be more likely to view their unhealthy weight as a medical concern and work with you toward solutions.
