Saturday, February 5, 2011

Bariatric Sensitivity Training

   Our hospital, in an effort to become a Bariatric Center of Excellence or some such nonsense, is requiring all staff, including physicians, to attend a bariatric sensitvity course. Now I will be the first to say that I could lose a few pounds. I have a "healthy" BMI, but am at the top end of normal, so three or four more pounds and I would be officially in overweight territory. So I am not some skinny girl hating on anyone heavier than me. I could definitely use more exercise and less sugar, no doubt about it. And of course everyone from Michelle Obama to Elmo is talking about America's obesity issue on television. However, I have to say that this class was by far not the most productive hour of my week.
   We spent the first half of the course covering points that hopefully those of us who are not complete a#%holes already knew. Obviously we should provide a larger bed for a larger patient, so they don't fall out.  Another example: when weighing an obese patient, we should not rudely holler out their weight so loudly that the entire unit can hear it. We also should not yell out "Hey Joe, we need to get the Big Boy wheelchair for this one", an actual example from the power point presentation.  We were also instructed to always provide an extra large gown for our bigger patients, which of course we would do anyway.
   Some of the other points, however, confused and disturbed me a little bit. We were instructed, in an effort to be sensitive, to not weigh a patient if they are uncomfortable about being weighed. Really? Many meds are weight based. An accurate weight is pretty helpful. A CHF patient often needs daily weights to determine if they are retaining fluids or not. This is a more complicated issue than it would seem.
   Another idea that seemed a little out of hand was to only discuss the patient's weight if the patient brought the subject up and wanted to talk about it. Apparently there have been a rash of patient complaints lately in which the patient was offended that a doctor or nurse had the temerity to advise that some weight loss might be a good idea if the patient wanted to live a few more years free of strokes, heart attacks and other not so pleasant things. This just flies in the face of common sense. Isn't prevention of health problems what we are going for (ideally) ? Are we not going to tell the chronic alcoholic with the cirrhotic liver that they should quit drinking? Do we not tell the diabetic who neglects their insulin that if they don't start taking care of themselves that little foot wound could result in an amputated leg? There are patients in our ICU right now who would not be there if not for their morbid obesity. That is a fact.
   We have extra large OR tables. We supposedly have "lift teams".  We have a special private preop area for bariatric surgery patients. We generally speaking are not jerks. We don't typically go around  making fun of anyone's weight. Sure, I know the patient probably aleady realizes they need to lose weight. Yes, I know many people would simply choose to ignore our advice. But damn...if we can't even talk about it in a sensitive manner, even raise the subject of possibly trying to lose some weight, how does that help anyone?


  1. I remember when bariatric sx was new and pts stayed for days and needed counseling to lose weight first, now it is routine and out pt or a one night stay.

    I still tell pts that their BMI is so and so which makes them obese or morbidly obese. We can't shy away from the truth that is how we charted it.

  2. Preach it TheDoctorStoleMyStethoscope!!
    I agree, how else do you take care of the patietns and their problems?

  3. Amen, yes, and yes again. Sensitive and compassionate? yep. Polite and professional? yep. Protect your privacy? Absolutely. Whitewash the truth in the name of being politically correct? not so much. I'd rather have a morbidly obese patient (or a noncompliant diabetic, or....) write an upset letter to admin because I lovingly and truthfully talked to them about disease management and prevention, than NOT tell them and have that result in more serious problems. In my mind, the latter should be actionable. Sadly, in today's healthcare environment, it's the former that so often is...

  4. One of the nurses I used to work with has a huge fat biased. I remember when she was picking up her patient assignments one morning and complaining quite loudly about how she had to get this huge patient and stated how some people need to "step away from the table". Unfortunately, people like her exists, and other than that particular aspect of her "personality" she appears to provide good care to her patients... but sensitivity training for her for bariatric patients would be merited.
    Its unfortunate that time has to be wasted to do a class when really most people have the common sense and are sensitive enough to realize what is and is not appropriate.
    We are taught cultural sensitivity in nursing school, the same rules apply.

  5. We are a bariatric center of excellence, so we are very sensitive. To the point where we designate our bari patients as "Bees" with little bumble bees, because "bari" or "bariatric" is insensitive.

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