Another Malpractice Angle

Many physicians receive periodic newsletters, usually from their professional liability insurance company, alerting them to the details of various types of malpractice risks, and also regarding how to stay out of trouble.

I received my most recent newsletter last week.  The cover story caught my attention.

The article pointed out the an issue has arisen regarding whether McDonald's restaurants should be held liable in the courts when obese plaintiffs sue to recover damages because of medical complications of obesity.  It was suggested that the medical risks faced by the obese might also be blamed on the treating physician in the courtroom.

Law professor John Banzhaf, III at George Washington University Law School suggests that obesity suits against physicians are on the horizon.  The article states, "He claims that if physicians don't counsel obese patients about the risks of carrying additional weight, and help them lose weight, they may be the next targets."

The article suggests, however,  the implications of physicians routinely taking this approach to protect themselves medicolegally.   "Obese patients tend to be emotional about this issue.  They can be reluctant to seek or follow through on medical care, perhaps feeling mistreated or misunderstood."

Initiating discussion on this topic, uninvited, is a surefire way to alienate a significant slice of obese patients.  But this warning from the law professor illustrates the divide between a legal community, and its cheerleaders, who want to notch the expectation level ever higher-- sometimes to a marginally attainable ideal-- and the real world of medical practice, which has been likened to a "hamster wheel".   

Never mind the issue of whether payors are willing to provide reimbursement for all the interventions that are expected under best-practice medicolegal guidelines.

We-- all of us-- live in an imperfect world, and need to strive to remember all for which we should be grateful.

Comments

[greedytriallawyer]

If you are fearful about offending your obese patients how about the smokers, the drinkers, the illicit drug users, the prescription abusers....? When a professional decides to avoid an issue related to the service he is providing because it may offend he is really saying he likes the money too much to open his mouth.

[Joe Guarino]

Greedy-- I appreciate your insight.

In fact, you are correct that this type of issue is one with which practicing physicians have to struggle on a daily basis-- the difference between what a patient wants to hear, and what he or she needs to hear. And this is a more difficult minefield to traverse with the consumeristic/entitlement mentality regarding medical care that sometimes prevails, the legal environment and the production/customer service demands faced by physicians-- many of whom are employed.

In general, many patients are more ready to hear messages of this type when they have established a trusting relationship with a single physician over a period of time; if they have specifically sought preventive care; or if they are developing complications related to their health behaviors.

[Roch101]

I want, expect, my doctor to be completely forthright with me -- to give me his best medical advice not only for treatment of illnesses but for keeping healthy, even if he thinks it might hurts my feelings.

[Joe Guarino]

I would like for that to be a universal desire, but alas...

[Bubba]

".....the difference between what a patient wants to hear, and what he or she needs to hear."

Perhaps more importantly, you could substitute the words "act upon" in place of "hear" in that sentence.

What are the medical ethics and implications of telling a patient that you know longer want to be the patient's doctor?

[Joe Guarino]

Bubba-- good question. A physician in private practice is under no obligation to remain the treating physician for a given patient indefinitely. The physician can terminate the relationship, but the patient would need to be given a reasonable period of time to plug in with another physician.

The dilemma is that one cannot terminate every patient who is non-compliant or who has unreasonable expectations. This is a prerogative that I, for instance, have used only on very rare occasions, under extreme circumstances. But the reality is that the patient is a client, and if you are not giving them what they want or expect, you are often effectively terminating yourself. I am not aware of physicians terminating patients to protect themselves medicolegally, but I suppose it may happen.

[Brenda Bowers]

Joe, People know when they have a weight problem and really don't need to be told. And, they won't do anything about it until they are ready. I personally have had an eating disorder all my life that doctors are just now recognizing as a legitimate problem. My disorder is Chronic Hunger. I have spent a lifetime of dieting and as a result really messed up my metabolism. I mentioned my problem to a doctor two years ago and she prescribed Wellbutrin XL. For the first time in my long life I am not hungry. You can not imagine how GOOD it feels. Perhaps this could help some of your patients and you could prescribe it for some other reason if you feel you don't want to talk to them about weight.

[Joe Guarino]

Brenda, I agree that folks will not commit to lose weight until they reach a certain level of readiness. And I empathize with the chronic hunger situation-- I feel I have some of that myself. It is intriguing that Welbutrin worked in that situation-- I did not know about its use for that purpose.