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    Do doctors have the right to refuse to see fat patients?

    Since the whole gay "marriage" struggle session seems to be a running theme that benefits from lots of comparisons to other industries...

    ...and because someone (probably phank) made an offhand distinction between vocations who could be expected to refuse service to whomever they wish (hairdressers) and those who should never refuse service to anyone (clerks who sell hair products)...

    I decided to take things in a different direction, predictably medical given my history, with ER doctors who have to deal with morbidly obese patients. The experience should be biographical to at least a few of you, and while I have assisted in lifting and rolling people in the 250-400 pound range, this has to take the cake:

    The patient is large. Very large. At more than 600 pounds, he is a mountain of flesh.

    ďMy stomach hurts,Ē he says, his voice surprisingly high and childlike.
    Corpulence brings the only true gender equality-the shared androgyny that swallows up first secondary, then primary sexual characteristics. Only fat can bring victory over the oppression of the merely physical!

    The patient is in his 40s. He spends his days on the sofa at home, surviving on disability checks related to his back pain.
    Disability checks (of a certain type, of course,) are pure poison to the the left half of the bell curve, and build up the kind of disgustingly entitled mindset found on display shortly.

    Facing him, I feel momentarily put off. Iím not sure just where to start the examination, and when I begin, my hands look small and insignificant against the panorama of skin theyíre kneading.
    The feeling first felt by anyone who sees the pro-gay marriage arguments, I think.

    Itís hard to tell, exactly, but I think his pain is coming from somewhere around his stomach.

    I call the surgeon. When he finds out how much the patient weighs, he says that heíll be down to see him ďin a while.Ē

    Awaiting his arrival, we try to shoot some X-rays. When we roll him onto his side, though, he turns an unnatural shade of blue-gray and canít tolerate the position long enough for us to put the X-ray cassette behind his back.

    We try a chest X-ray, turning up the power to the maximum setting. All we see is white: The patientís body is just too thick to allow standard X-rays to penetrate to the bones; he is a walking lead shield.
    When the Washington Post starts calling the standard homosexual AIDS patient "a walking Petri dish", I will know the victory of the truth is in sight.

    We start an IV and get some blood work, all of which is normal. Our standard GI cocktail of shot-in-the-dark digestive tonics plinks into his stomach without any effect. Morphine at doses high enough to make me dance on tables merely makes him a bit drowsy.

    I talk to the patient between procedures, trying to get a sense of him as a person. He recites a litany of consultants heís seen for his back pain, his headaches, a chronic rash on his ankles, his shortness of breath, his weakness, his insomnia and his fatigue.

    ďAll of them have failed me
    he says, adding that the paramedics didnít have the proper ultra-wide, ultra-sturdy gurney to accommodate his body.

    ďThe Americans with Disabilities Act says that they should have the proper equipment to handle me, the same as they do for anyone else,Ē he says indignantly. ďIím entitled to that. Iíll probably have to sue to get the care I really need.Ē
    Behold the true master and operating expert of your inspiration, laws, and philosophy, liberals!

    Sadly, since this is the Washington Post, they couldn't end it there, and needed to add a liberal moral to the story.

    Finally, a slew of huffing, puffing, grunting attendants wheel him down the hall, leaving me to reflect on his plight.

    He lies at the very large center of his own world ó a world in which all the surgery mankind has to offer cannot heal the real pain he suffers.

    The patient lies trapped in his own body, like a prisoner in an enormous, fleshy castle. And though he must feel wounded by the ER personnelís remarks, he seems to find succor in knowing that thereís no comment so cutting that it canít be soothed by the balm of 8,000 calories per day.

    Later on in my shift, still feeling traces of the patientís presence, I sit and stare at my 700-calorie dinner, all appetite gone, wondering where empathy ends and compassion begins.
    Mine would have ended right around the time he said "they have failed me."

    I know why my colleagues and I are so glad to have this patient out of the ER and stowed away upstairs: heís an oversize mirror, reminding us of our own excesses. Itís easier to look away and joke at his expense than it is to peer into his eyes and see our own appetites staring back.
    Speak for yourself. There are such things as normal people with a normal disgust for taking every advantage the law offers you just because it may happen to be legal, and demanding time and attention away from people with actual problems, whom the profession was originally intended to serve.

    I push the food around on my plate, then give up and head back to the ER, ready to see more patients.
    Utterly the wrong response to an experience of the personification of Gluttony coming through your ward. If your authority to triage your own patients in your own hospital is being stolen by legal, personal, or institutional bullying, the correct response is to offer your resignation immediately and loudly, not wait several years after the fact to write a sanitized version of the story while ensuring that every other potential ER doc gets little public warning or sympathy due to institutional close-mindedness. While 8,000 calories is obviously too much, 700 calories is obviously way too little to maintain an attitude toward your professional space aggressive enough to resist leftist encroachment. The confrontation-avoiding get-along-to-go-along 150-pound foodie who can't intimidate his way out of a paper bag is the mirror image of the gluttonous bully. For everyone else, don't listen to "lessons" from either side, especially if published in a major newspaper.

    Though I have no way of knowing it, within a few months a crane will hoist the patientís body through a hole cut in the side of his house, a hole that allowed EMS personnel to lower the body onto their new ultra-wide, ultra-sturdy gurney.
    Ignore evil, and greater structures will fall to its demands.
    Last edited by Epoetker; 03-10-2014 at 02:08 AM.

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    tWebber Darth Xena's Avatar
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    So you think no help should have been given to the man?

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    Quote Originally Posted by Dee Dee Warren View Post
    So you think no help should have been given to the man?
    The only thing that can be done for the guy is surgery to remove all the excess fat (don't know the proper name for said surgery, or the details); but even then, I'm not sure it would do the man much good. The entitlement mentality appears to be firmly rooted in his head, and he doesn't seem to understand that his real medical issue is his sin of gluttony and his obesity. He'd probably complain about anyone who tried to "judge" him for his obesity, and even if he could be cured, would eventually return to his same old ways.

    Granted, I say if he can afford surgery to trim him down, might as well give him a shot. Maybe he will learn despite his present mentality. Although if he causes the same problem a second time (continues overeating), then I wouldn't judge any doctor who would refuse him service.

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    Quote Originally Posted by Dee Dee Warren View Post
    So you think no help should have been given to the man?
    I think he should have been treated openly and repeatedly the way you all think Anders Brevik should have been treated in prison. After a certain point past the Flabicon, someone else pretty much has to assist you in your daily tasks, and that someone has failed in their duty to microaggress against demanding and destructive gluttony wherever possible.

    But in actual reality, "one patient is equal to all other patients, more so if they're demanding." So, what will actually happen is a lot more qualified ER docs are going to be changing careers earlier, and those left behind will be a combination of the incompetent, the sociopathic, the AA hires, and the entry-level. I expect a lot more "accidental" sedation overdoses when fatties try that level of demanding on them, so it's possible this problem takes care of itself.

    Too bad for the non-demanding people who show up in such places for things that actually require competence, empathy, whiteness, or experience, but you just had to avoid confrontation, difficult decisions, and politically charged topics, didn't you?

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    tWebber Carrikature's Avatar
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    Quote Originally Posted by Dee Dee Warren View Post
    So you think no help should have been given to the man?
    Kidney transplants (and I'm sure others) require an assessment of health and likelihood of success based in part on patient mentality before one can be placed on the waiting list. People who can't or won't change their habits are out of luck. In such a case as the one presented, it would seem reasonable to base treatment on similar factors.

    From the author's comments (below the article), there are obviously other facets involved. The author cites an eating addiction specifically. To my knowledge, the transplant system deals with this sort of thing (addiction) as well. The social workers are equipped with information to direct relevant patients to experts that can help them deal with these issues. My wife, as a dietitian, already handles eating habits to the extent possible with her qualifications (she's not a counselor and so not able to help with actual addictions).

    There are ways to cut to the heart of the issue. Simply kowtowing and expecting any and all to cater to very unique needs is unrealistic (not to mention costly).
    I'm not here anymore.

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    tWebber Darth Executor's Avatar
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    700 calories sounds about right for a normal meal.
    "As for my people, children are their oppressors, and women rule over them. O my people, they which lead thee cause thee to err, and destroy the way of thy paths." Isaiah 3:12

    There is no such thing as innocence, only degrees of guilt.

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    I'd like to point out that:

    "Person P1 should help person P2 (with respect to X)."

    is not the same thing as

    "Person P1 should be punished (by men) for refraining from helping person P2."

    The latter does not follow from the former.
    One could consistently say that both P1 has the right to refrain, AND P1 should help P2.

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    tWebber Teallaura's Avatar
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    Forest, meet trees.


    Litany of complaints should set off bells - what is he taking for all this? What does he actually eat? Exercise? Who is his primary caregiver (he's not very mobile by this stage so someone is helping him - who is it?)?

    Take a decent history and figure out where to start. Drug interactions? Psychological issues (depression)? Nah, let's just treat the symptom and ship him home. ADA doesn't protect anyone from a doctor telling them the truth - you have to exercise and reduce your caloric intake (forget telling him to lose weight - that won't happen initially and it sets up another failure). Give him a regimen, not some vague suggestions and tell him to follow up with ONE primary doctor (too many cooks is REALLY bad in medicine). Don't pity him and don't humor him - give him the same care you would if you gave a darn about him.

    Don't assume non-compliance - make him actually have to chose to comply or not. Yes, you HAVE to or you won't get better - tell him the truth.

    And by law, ER docs don't get to refuse life saving tx of treatment when life or limb is at stake. An ER doc that ships him home with no exam given how difficult he is to examine commits malpractice in addition to breaking the law. Only once he poses a threat to staff or is actually non-compliant in clinic would an ER doc be justified in refusing care (since you can't know what's going on at the moment just by glancing at him).

    I tell patients all the time that abstinence followed by monogamy is better for them than condoms - because it's true. Do they listen? Sometimes - but they don't walk into my clinic re-infected with anyone to blame but themselves.

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    LOL...even if he DOES have a hormone problem (rarely happens) or an addiction (happens way too much), he doesn't rate ADA if he's not doing anything to help himself. And in this kind of situation, the whole family or whatever support system he has shares responsibility for his failure. Once they refuse to help him not take any responsibility for his caloric intake, he'll feel the pain quickly enough and look for solutions himself. Whether he does hit on the right solution, he doesn't rate ADA just because he says so.

    I had to provide proof of my handicap to get ADA assistance. He should too.

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    As for the OP: Wouldn't it be a pretty blatant violation of the Hippocratic oath? (Which of course isn't legally binding, else no doctors could help with executions, or abortions, for that matter...)
    "I am not angered that the Moral Majority boys campaign against abortion. I am angry when the same men who say, "Save OUR children" bellow "Build more and bigger bombers." That's right! Blast the children in other nations into eternity, or limbless misery as they lay crippled from "OUR" bombers! This does not jell." - Leonard Ravenhill

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