you don't have to get on the scale

Agreed.

Lora

You're absolutely right here.  I think the issue really revolves around all the negativity and stigma associated with MO, and the fact that many, many people, including medical people, can be so extremely insensitive to our feelings, and the fact, as you said, that if we're MO, or SMO, we are very, very painfully aware of that fact.  We don't need to be constantly reminded.  It all depends on the doctor, I guess, in terms of whether or not there is some genuine caring behind any discussions about it, or if they're disdainful and downright mean, which some of them are.

Beth

It's absolutely about the stigma, and how emotionally damaging it can be.

Someone posted earlier today about how she cried for a long, long time after being weighed at her surgeon's office and being told she'd only last 49% of her excess weight and she should have lost 60% by then.  She was also informed that "usually" if a patient isn't losing the expected amount it's because she is not following the meal plan.  Now, I do think that your weight is pretty relevant when you visit your bariatric surgeon so it makes perfect sense to me that she got on that scale - but if I was in her shoes, I would not be too eager to get on it next time.

I don't see how that experience was helpful to her health.  It would not have helped me.

On the other hand, if the surgeon had handled it differently, it could have been very helpful instead of hurtful.  So hurtful that this person does not know if she wants to continue seeing her surgeon for follow ups, by the way.  That's a huge problem, if doctors are addressing patients about their weight in such a way that patients no longer feel comfortable seeing the doctor for care.

And no, of course not all doctors are like that.  I think my PCP mentioned my weight once.  She said something like "You know you're considered overweight, right?"  and I said, "yep."    And she said something like "So let us know if you want some information about nutrition and weight loss" and I said "I'll do that."  Which was all fine with me.  She figured I had noticed I was fat but checked to make sure just in case I hadn't, and offered assistance with weight loss if I wanted it.

You know, though, I think even when there is genuine caring behind it, doctors need to address the issue in a sensitive way.

Several years ago I stopped letting them bully me into getting weighed every danged visit. I tried to be sweet about it, but the medical asst. clearly thought I was noncompliant and weird. But I didn't believe they weighed every patient, just the ones they thought were overweight; since my doc wasn't treating me for weight-related matters, I declined on principle.

Then I was diagnosed with diabetes. Now there are no more confrontations--even quiet, polite ones--at the medical scale.

It's a political issue for me, a singling out of the minority. (insert freedom slogan here)

I think most docs do weigh everyone.  But I think being weighed is a very different experience, at least often, for overweight patients than for others.

I think it is a political issue, too.  You know, something you hear a lot in feminist circles is that "the personal is political."  And I think it really is.

I used to routinely refuse to get weighed at my PCPs office.  I would let them do it once a year (and they never gave me any grief about it).  Now I don't mind getting on the scale.  People may find, however, that the new electronic medical records software will force doctors to insist on weighing patients (and taking temp and BP) AT EVERY VISIT because the software requires those entries for each office visit (among other things like the diagnosis/treatment code).   That is the case with the software my PCP now uses (and hates).  Since the government has mandated electronic records, that may change a patient's ability to refuse to be weighed.

Lora

I didn't realize the government mandated electronic medical records.  Um... that's sort of scary.

However, my personal feeling is that the doctor's software is not my problem.  I can think of a bunch of ways a doctor might choose to deal with this problem.  The doctor could purchase software that does NOT require them to enter a weight at each visit (or did the government mandate that a weight be entered?  Because that is even scarier!).  The doctor could ask the patient what weight to enter.  The doctor could enter the last recorded weight for the patient, even if it's not accurate, just to satisfy the software.  Kind of like I sometimes enter Jan-1-1971 for my date of birth when I sign up for websites that insist I put in a date of birth, even though that is not my real date of birth.  Or doctors could make up a number, just to satisfy the software.

And I am assuming that not all medical records software does require the patient's weight, because neither my psychiatrist nor my back specialist have ever weighed me.  No, wait, my psychiatrist did once, when we were wondering if a particular drug was causing weight gain.  But that's it.  So if they use electronic records, which I actually know the back specialist does and assume the psychiatrist does if the government mandates it, then there must be software out there that does not require them to enter a weight.

Yep, it is a government mandate that ALL physicians utilize EMR software and eliminate their paper records by 2014.  As far as I know, the penalty for not doing so is only financial, not criminal (but, with PPO/HMO/Medicare/Medicaid all cutting reimbursement rates, the financial penalty is probably just as onerous as a criminal one).  Yes, the doctor has SOME choice over software, but many/most of the software products have similar features and basic requirements.  (I worked on a project to help a large family practice group evaluate and pick their software and identify customizations they wanted.) 

If a doctor just puts down an arbitrary weight or continues to use a previous weight,  they are opening themselves up to potential legal issues for falsifying records if for somne reason the patient (or a patient's family) would sue them for something, so I don't see them being willing to do that.

Lora

What will docs do if they do not have scales large enough to weigh some patients?  Like, in some offices, the scale cannot weigh patients above 350 lbs.  Or what about, say, a patient that is quadriplegic and cannot stand on a scale.  There are scales designed to weigh patients in chairs but I don't think most PCP's have those in their offices.  So they will have to deal with the software issue somehow, right?  Or will they just tell those patients, "Sorry, we can't see you because our software insists on a weight and we cannot weigh you."  I'm guessing they will deal with it in some manner, like choosing software that doesn't require a weight or just asking the patient what they weigh.  They might also make a note somewhere in the record about why they were unable to obtain an accurate weight for the patient.

In which case, couldn't docs do that for any patient that did not wish to get on the scale? 

I'm not an attorney, but would that really be considered falsifying records and open them up to legal issues? 

I am honestly not sure how they would do it for people that CANNOT be weighed.  Only one of the three major packages we looked at had any specific way to identify paraplegic or quadraplegic patients.

Yes, I suppose they could put a clearly bogus number down and make a clear notation that the patient refused to be weighed, but that is different than putting down an arbitrary weight, a previous weight, or -- worse -- taking the patients word for their weight (how many people really KNOW what they weigh and how many people who DO know lie about it (e.g. driver's license)?).  Those things would be questionable from an ethical standpoint as well as a legal one, IMO.

Of course, I think the government should butt the hell out of healthcare entirely...

Lora