<p>Other doctors have examining tables which must support the patient’s weight. Other doctors palpate for tumors. Seems odd to me that only OBGYNs are turning away obese patients.</p>
<p>Not talking gyn, but ob carries more risk, among other things, because they have the longest period of liability. Until the baby is 18.</p>
<p>I see a couple of different facets to this.</p>
<p>One is economic. The insurance companies would have to do an analysis to quantify exactly what the added risk is, and one solution might be to allow the doctor to price his services based in part on the cost of the risk - i.o.w., fat people pay more. (As would unhealthily skinny people and other high risk groups). </p>
<p>There are areas where we (as a society) have accepted price discrimination based on risk - car insurance and life insurance for example. There are areas where we have largely rejected it - pre-existing conditions for health insurance have been eliminated in many cases, genetic testing for setting health insurance rates (or denying coverage) has been rejected pretty much everywhere AFAIK. No one dies from not getting car insurance though.</p>
<p>Another facet is ethical. I would hope “do no harm” would be the foundation of every doctor’s practice, yet how can refusing to treat a patient because they are fat not be a violation of this? IMO, anyway. Cherry-picking your patients in order to maximize your profits is reprehensible.</p>
<p>Having to buy new equipment able to support heavy people? Using this as a reason is total BS. It’s a one-time investment, recovered over years of practice.</p>
<p>“yet how can refusing to treat a patient because they are fat not be a violation of this? IMO, anyway. Cherry-picking your patients in order to maximize your profits is reprehensible”</p>
<p>One way to look at it, but how about picking patients you feel confident you can care for, and minimizing risk to the patient?.</p>
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<p>Where can I get health insurance that doesn’t discriminate against preexisting conditions?</p>
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<p>From the article:</p>
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It’s one thing to decline patients that are beyond your competency, but that doesn’t seem to be the case here. I don’t see anything taking about what benefits the patient.</p>
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When you switch jobs, if you were previously covered by insurance, your new insurance company cannot exclude coverage of existing conditions. This didn’t used to be the case. </p>
<p>I have personally delayed care because of this (a number of years ago), and I knew more than one person who was trapped in a job because they would lose insurance coverage for an existing condition if they had left their job.</p>
<p>Many physicians think that not having something go wrong benefits the patient. And yes, benefits the doctor too. </p>
<p>Aren’t there other fields where people who run their own business can say “no, I won’t do that job; there is too much risk.” Yeah, I know; medicine is different. Isn’t that accountability without authority?</p>
<p>I’m no ob, but I can relate to trying to avoid very risky situations that will put me in a situation I have no control over. In my business, the example that comes to mind is the issue of how difficult it is to find a psychiatric hospital bed, especially for someone with no insurance. And then there is the whole issue of it being almost impossible to psychiatrically hospitalize someone against their will.</p>
<p>But I digress. Peace out!</p>
<p>Shrinkrap: Yes, I think medicine is different. Do people honestly become doctors with the idea that they won’t treat people who are likely to have serious medical problems?</p>
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<p>If the new insurance is a group policy at the new job, employers must offer it to everyone, without underwriting, and that’s been the case for a long time. Group policies follow Rule #1 of insurance: The more people in the risk pool, the wider the risk is spread; the cost of pre-existing conditions is spread throughout the group.</p>
<p>Of course, things are very different in the world of individual policies, which is the world I live in. There, the insurance company has all the power and can refuse you for pretty much any reason they want – or jack up the premium to such a level that you can’t possibly pay it. My DH pays almost twice the going rate because he has a diagnosis of high blood pressure and high cholesterol. Doesn’t matter that both conditions are now well-controlled. The diagnosis is what kills you in the individual insurance market. And I’ve been told that my D is uninsurable on her own; we must keep her on our policy until hopefully one day she gets a job which offers medical benefits. Her crime: she saw a counsellor when she was a junior in high school.</p>
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<p>Perhaps the threat and expense of litigation is too hard to ignore. A once-idealistic medical student, after finishing medical school and residency, entering practice, and seeing others get sued, or being sued, may no longer have as much idealism.</p>
<p><a href=“http://www.hsph.harvard.edu/faculty/michelle-mello/files/litigation.pdf[/url]”>http://www.hsph.harvard.edu/faculty/michelle-mello/files/litigation.pdf</a> suggests that the 28% of claims not associated with medical errors resulted in compensation, while 27% of claims associated with medical errors did not result in compensation, and the legal and administrative expenses cost 54% as much as the total compensation.</p>
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<p>It is my understanding that by definition, a woman with diabetes is considered high risk. That doesn’t mean that she will have complications, but by virtue of her diabetes, her pregnancy is automatically considered to be high risk. Same with mothers of a certain age or with other health problems.</p>
<p>I would imagine that malpractice insurance for OB/GYN’s taking care of a high risk population would be high. Perhaps prohibitively high for certain individuals.</p>
<p>Somewhat OT, but - </p>
<p>In the autism community it is not uncommon for those of us with a child on the more severe end of the spectrum to find it nearly impossible to get medical (or behavioral) treatment for issues related to autism, even from so-called autism (NOT Asperger’s) specialists, and even from several who maintain a high pubic profile as specialists in the entire spectrum. It is not an insurance matter as many of our children are covered by both Medical Assistance and a parent’s policy. (I have also heard that many Asperger’s specialists also turn away individuals who are more difficult to treat.)</p>
<p>In the end I believe this hurts even those individuals whose “autism” is less incapacitating, since in my own experience it is those who have experience treating the most difficult cases who are able to work most effectively with milder cases.</p>
<p>Even though this prejudice against the most involved individuals seems to extend to other professionals (special education teachers, ST’s, OT’s, behavioral therapists), I do have to wonder how many physicians learned to avoid difficult and challenging cases when they sandbagged their way through pre-med courses.</p>
<p>Doctors can and should refuse high risk patients and refer them to a different doctor/specialist who specializes in them. It is one thing to refuse emergency care because of liability but it is entirely different when a doctor has to take someone on for repeated visits and may be a lifelong doctor/patient relationship. Liability is a huge factor for treating someone and you are talking about the doctor’s livelihood here. Texas went after the liability issue a few years ago and capped them. Since then doctors have been happy to treat anyone.</p>
<p>In the not too distant future, we will all be on medicare. Has anyone looked at how many doctors are turning down medicare patients lately because they are claiming the cost of treatment is higher than the reimbursements? This is going to be a much bigger problem for all us. This is a cost issue and so there are lots of stories even in Texas about doctors not taking on any new medicare patients.</p>
<p>Connecticut just failed in its latest effort to create a lower-cost health care plan. Physician groups (few sole practitioners here anymore) agreed to reduced rates in exchange for some protection from lawsuits. Everything was a “go” until the legislature decided to accept the offer of lower rates but eliminate the protections from litigation … at which point the physician groups withdrew their support for the program.</p>
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<p>That is the cut off weight of the doctors in the article.</p>
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<p>No. But many Ob/gyn’s in Illinois simply stop practicing the Ob part because the insurance is so high they actually can’t make a living with it. You practically have to go to another state to get an OB anymore. </p>
<p>This is probably just another way of managing that issue. </p>
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<p>Until we start to provide doctors with some protection from lawsuits, particularly in the case of high risk patients, I suspect we will see more and more limits on who will and will not get treatment, as well as who will and will not go into medicine.</p>
<p>I don’t see any problem and, in fact, encourage doctors to refuse to take on patients who have conditions and possibilities that said doctors do not know enough to treat well. Anyone who has certain high risk conditions should be referred to someone who has the experience in dealing with those conditions. I have sadly seen many good intentioned doctors give bad advice, poor care and not get the leading edge treatments for patients because those doctors just were not set up to deal with the issues of those patients. I don’t even fool around with certain health issues with my internist. He needs the info that the specialist sends to him. In many cases, one needs the internist for the specialist referral, but I have no intention of having a generalist treat a special problem that requires trial and error and research even on part of the specialists.</p>
<p>As far as the weight issue goes, if the high risk factors that come with women who are of that weight and more, is the reason these doctors are not taking women over 200lbs that is one thing. That can be categorized as having bp of a certain number, blood sugar issues, health history that the doctors feel need to be under the care of a specialist. It is a fact that those who weigh over a certain threshhold have a greater chance of health complications. In fact, obesity is a major high risk factor for many things. And like with many things, the line is drawn by that striking feature rather than trying to pick out those who are the exceptions. Certainly someone who is 6’ tall and weighs 200 is not going to be obese as would the person who is 5’ tall. But by drawing a line at the weight, it makes it simple and saves having to pick out the outlier. </p>
<p>When you get private insurance there are very pragmatic lines as to who gets favored rates or covered at all, and though there may be mitigating factors that can be appealed, the basic rule is laid down. </p>
<p>As an aside, I am appalled at how some doctors do make their cuts on who they see. I know a doctor who refuses to see anyone who can’t get on the table him/herself. Doesn’t want to have to help the person on the examining table. There was a scene where a parent had a handicapped child who needed to be lifted on the table for examination and was told to go elsewhere. Some place that has orderlies that can lift or a hoyer lift available. When you are a doctor, you are going to have patients who at times may not be in condition to be able to get on the table. So you then dismiss them? If the patient has medical issues that you are not competent to address the best way, that’s one thing, but any doctors office should have accessibility and the ability to deal with patients who can’t get up, need help physically, etc. Something is wrong if that cannot be accommodated. I, for one, do not want have a family doctor that will refuse to see me if I get some condition that makes me immobile for simple examination.</p>
<p>* I know a doctor who refuses to see anyone who can’t get on the table him/herself. *
That is just rude. What if they are elderly or injured or in pain?Are they judge and jury of who gets treatment?</p>
<p>I had to see a high risk ob when I was pregnant with my 2nd child.
However, I live in the city & we not only had several to choose from, but two different hospitals with level iii nurseries.
Although my family dr. was willing to take me, I had a previous pre-term birth & the neighborhood hospital turned me down.</p>
<p>I expect they thought that my next baby would also have to be born early by section, after tying three true knots in the umbilicus.
Cause ya know how siblings like to imitate. ( I went term VBAC)
I can understand people of a certain fat:ratio being " high risk" & they are going to require more skill but I would worry about a section of the population being shut out of medical care. ( however- I do acknowledge that for the baby & the moms sake, getting to a healthy weight * before* pregnancy , is preferable- even critical)</p>