It's widely known that obesity translates to a higher risk of heart disease, diabetes, cancer, hospitalization, and early death. So why don't more doctors discuss it with their patients?
The Mayo Clinic recently conducted a study to evaluate whether primary care physicians diagnose their obese patients (body mass index greater than or equal to 30) with obesity and, if so, subsequently formulate a weight-management plan with them.
Researchers found that the charts of only 1 in 5 obese patients listed them as obese. As for formulating a weight-management plan: If it isn't in the chart, it's probably not discussed between doctor and patient.
Those in the study who were diagnosed as obese were more than twice as likely to develop a weight-management plan with their doctor.
The study seems to show that it is easier to discuss a diagnosis of obesity once the patient develops symptoms of an associated illness.
So why should a doctor discuss obesity with at-risk patients? The liability for preventive medicine is remote, but it may occur if the patient is later diagnosed with a disease for which obesity is a risk factor, or if the patient resorts to the high-risk option of bariatric medicine.
And damages can be great if the patient dies young with dependents and/or incurs many hospital bills.
The analogy for liability in failure to diagnose would be a patient who gets lung cancer and sues the doctor for failure to warn about smoking.
If an obese patient suffers a heart attack, questions may arise about whether treatment could have prevented the incident. Proximate cause between a failure to diagnose and any later illnesses would be tangential.
However, a note in the chart that obesity and a weight-management plan were discussed with the patient would put the doctor in a very defensible position.
Certainly, doctors should discuss a weight-management plan with their patients when the situation is so severe that they are considering bariatric surgery. The high rate of recidivism and the high mortality rate of patients with extreme risk factors make bariatric surgery a high liability area. Referring doctors may be included in any lawsuit, with potential questions of informed consent, preventive diagnosis, and negligent referral.
In an ideal world, patients would step forward and ask their doctors about weight management, thus taking the burden off of the doctor. One way doctors could encourage patients to talk about weight is by listing potential preventive medicine issues on the intake history.
It may also become cost efficient if the doctor has material on the topic ready to disseminate to interested patients and if he can bill for the incidental diagnosis. All conversations must be documented, including a record of all materials provided.
The author is a health-care attorney in Mt. Kisco, New York, specializing in risk-management issues. She can be reached at firstname.lastname@example.org
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