Patients weighing 204 kg or more face barriers and discrimination when scheduling or attending appointments with specialist physicians, according to a new study by Northwestern Medicine.
Using a secret shopper method, the scientists attempted to schedule appointments for a hypothetical patient weighing 220 kilograms in practices of five specialties (dermatology, endocrinology, obstetrics and gynecology, orthopedic surgery, and otolaryngology) in four metropolitan areas (Boston, Cleveland, Ohio, Houston, and Portland, Oregon). Each hypothetical patient was able to walk and did not require assistance getting on and off the examination table.
The researchers wanted to find out if the clinics met the basic standards for the care of bariatric patients. In their view, these include an examination table or chair with a sufficiently high weight limit, seating in the waiting room, sufficiently wide hallways and doors, and sufficiently large gowns.
Breakdown of results:
Of the 300 clinics studied, 52% lacked basic care standards, and 41% refused to schedule an appointment. Otolaryngologists (ear, nose, and throat doctors) were the least likely to schedule an appointment with the patient (only 48.3% scheduled appointments, compared to 59% overall). This was despite the researchers providing information during the appointment scheduling that strongly suggested the patient had cancer.
According to the study, only 117 practices (39%) were fully accessible, with endocrinology practices being the most likely to agree to appointments and meet basic care standards.
An additional 16% of practices in the study that were willing to schedule the patient had a treatment plan that did not meet the standard and provided workarounds for limited accessibility. For example, patients were told they could come to the clinic but would have to stand during the examination or cover themselves with a sheet because there were no gowns that fit.
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