<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 …It is not an insurance matter as many of our children are covered by both Medical Assistance and a parent’s policy. …
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>There’s the “rub” with the whole “spectrum” thing; it is indeed OT, but in my experience, there is often little to nothing in common between two patients, in spite of the fact they carry the same diagnosis. What is the point of diagnosis then? </p>
<p>And with regard to degree of impairment, where do YOU fall with regard to your opinion on allocating the most medical/social resources to the most needy? That may be what it comes down to, especially in the context of “mental health”, and I believe that’s why the “spectrum” issue has evolved.</p>
<p>With regard to insurance average, if it’s “not an insurance issue” than I have not seen the coverage you have. There are some diagnosis and treatments that are meant to be covered by regional centers and schools, but just aren’t. Even if you misrepresent why you are seeing a patient so it is covered by medical/ mental health coverage, it is strongly in favor of medication, and discouraging of what most “spectrum” patients would benefit from, IF you believe in evidence based medicine.</p>
<p>"I am sure 200 pounds is not the issue.
That is the cut off weight of the doctors in the article. "</p>
<p>For the articles sake yes, but wasn’t that 14 ob’s out of who knows how many, in Florida if not the US?</p>
<p>There is a team of cardiac surgeons in our area that has a stellar success record, but is notorious for bouncing the highest-risk patients to the surgeons at the local public hospital instead. Each year, success rates for certain cardiac procedures at each hospital are published in the newspaper; each year this team looks as if they walk on water. The medical community is well aware that they’re cherry-picking the lowest-risk cases.</p>
<p>It’s a disillusioning aspect of medicine, to say the least. My dh is an MD who treats obese children fairly often. He doesn’t think these physicians will be able to get away with refusing to accept obese patients into their practices for long; says it’s clearly discriminatory, higher-risk or not. Also says most examining tables will hold folks well over 200 pounds.</p>
<p>I wonder if these guys in FL are worried about any PR problems? They’ve made themselves look self-serving, unprofessional, and greedy.</p>
<p>I don’t know. I think, in some ways, this is the way health care will trend. For a long time a certain group of patients couldn’t get care because they couldn’t afford it. Now, a certain group of patients won’t get care because the doctor’s can’t afford it. The real problem is too few doctors and too many patients. I don’t actually think they are going to be able to “force” doctors to practice medicine for very little money with uncapped risk and malpractice insurance premiums.</p>
<p>So, the solution is going to be to shift the people who don’t get care. You can already hear it in the language of the media and the rest of the country. People talk about unhealthy eating or lack of excercise as if it is a crime against humanity. Soon, they will have public opinion that they don’t “deserve” care. </p>
<p>It’s the new “outre” group. there’s always one.</p>
<p>I only know S FL area, but malpractice and rise of suits breed caution among the docs. Once a patient has sued a doc, the next is leery to take them on.</p>
<p>I read some online reviews of one doctor that I was seeing. Several patients said that this doctor treats minor illnesses and the minute someone might have a more serious condition, this doctor refers them to another physician INSTEAD of continuing to see them after they are seen by a specialist. In other words, this doctor escorts that patient out of their practice permanently. It sounded sort of strange to me, but perhaps this is becoming more common.</p>
<p>“I was imagining it would be GOOD PR for their desired clientele. “Elite”. Like an Ivy.”</p>
<p>You may be right. Passing the test to come to this doctor may be an article of pride for some patients, reassurance that they’re one of the smart ones with good self-control.</p>
<p>Some of this is a reflection of a general contempt for overweight people in our culture, especially the educated and well-off section of our culture. But it may also be an expression of frustration on the part of doctors toward people they perceive as undermining their own health. It’s like the doctor is fighting to preserve the patient’s health, and the patient is ruining the doctor’s work. Most doctors despise dealing with addicts.</p>
<p>I’ve experienced this on the legal-services side, and it’s absolutely infuriating when the client does more to hurt her case than the opposing counsel could ever do. It feels like you care more about this person’s future than they do, which makes it very hard to stay motivated. I’m not saying that it’s admirable to solve the problem by refusing to treat people who don’t assist the professional in helping themselves. I just get where the doctors are coming from.</p>
<p>I agree with those who have said this is “cherry picking”.</p>
<p>I am an md (surgical speciality) though not an ob/gyn. </p>
<p>I feel this comes close to unethical. An obgyn should have at least the skills to take care of heavy or moderately obese patients. If the weight limit had been 300 or 350 I might feel differently as then there might be some legitimate concerns about equipment. </p>
<p>These physicians are dumping on colleagues who are willing to treat more patients. The article does not refer to just ob patients so this is not a case of refusing high risk ob (which would be legitimate if an ob is not a high risk ob). I think the real reason in not ever letting these patients in the door is that if one of them needs gyn surgery these md’s will have to pick up the phone and call another md and explain why they are unable to operate on someone who weighs 210 lbs. I have a hard time seeing that. Hazy ethics. </p>
<p>The telling detail in this article is the note at the beginning about one of the md’s doing an about face. </p>
<p>These kinds of doctors have been around for a while. They are sort of medical cowards - preferring to treat patients who don’t need much if any treatment and leave the challenging cases to others. But what sort of doctor is it who abandons his/her patients as soon as they really need help?</p>
<p>There has been a growing trend where MD’s farm out their patient to others when they won’t or can’t handle a medical problem. MD’s send pts to ER for something that normally was handled via an office visit. As nurses we tend to look at these physicians as “dumpers” and would never recommend these docs to anybody. We have lost a lot of respect for these guys.</p>
<p>This is just another example of women not getting the care that they need. Obese or not, they are less likely to be treated appropriately than men. More likely to have worse outcomes from MI’s, less likely to go to MD’s when I’ll. Just add more insult. I would not even go to these MD’s on ethics alone. This will come back to bite them eventually.</p>
<p>An interesting side note : most specialty MDs have to take call for the ER for a case that may require their specialty. Pt are also referred to see them if their services are required outside of the ER, so now they can refuse?</p>
<p>This is One of the reasons why medicine is in the state that it is in.</p>
<p>“This is One of the reasons why medicine is in the state that it is in”</p>
<p>I don’t understand. One of the reasons medicine is in the state that it is because specialty MD’s have to take call in the ER? Because patients from primary care doctors are referred to the ER? </p>
<p>I am curious about your opinion as a nurse. Do you have any solutions in mind?</p>
<p>Do you have an opinion on “physician extenders”? H and I are MD’s, but I think we think that’s the place to be.</p>
<p>Accountability without authority seems like a recipe for corruption.</p>
<p>I have been told that the opposite is true – that men are less likely than women to regularly visit doctors, and that this is a factor in women’s longer life spans.</p>
<p>Currently insurance companies are using “incentive programs” for people with chronic health conditions. Patients can get a monetary payment (or price break on premiums) if they sign up to be case managed. As I understand it, the case manager urges the person to lose weight, exercise, comply with medical advice, etc.</p>
<p>My Prediction: This incentive plan is designed to morph into a tiered premium structure where people who have a high-risk or chronic condition will pay a higher premium if they do not consent to be hounded (my word) by a case manager. I predict fat people will be included in this group.</p>
<p>I worked for our state board of health for a decade, and watched cases of massive malpractice make their way to the state medical board. Maybe 3-4 doctors a year out of 20,000+ would lose their licenses to practice because of some of the most egregious and outrageous actions. Dumping patients doesn’t even begin to cover it.</p>
<p>The ONLY protection that consumers have in the medical world is the courts, and lawyers who will take on cases (most of which they will lose) on their behalf. Until state medical boards take their responsibilities seriously, I say God bless the lawyers.</p>
<p>Having said that, insurance companies are including or choosing not to include physicians in their plans based on “quality”, meaning fewer adverse consequences. ObamaCare will encourage this still further through the creation of “Accountable Care Organizations”. Until health insurance companies no longer have an incentive to cherrypick, we’ll have more of the same. (And the health insurance lobby is far more powerful than either docs or lawyers.)</p>
<p>The companies are also doing their own thing to combat costs by offering similar wellness incentives with rewards for losing weight, exercising, opening their own clinics inhouse, doing annual bloodworks, etc. They are trying figure out how to manage costs based on the new healthcare law.</p>
<p>It’s not about the ethics or about the hippocratic oath, it’s about the lawyers, pure and simple. Obese patient = likely risk of complications = lawsuit. So, docs won’t see them.</p>