TUESDAY, April 6 (HealthDay News) — Countering concerns that obese Americans get second-rate health care, a new study has found no difference in the quality of medical attention they receive versus that of normal-weight patients.

In fact, the quality of care for the obese may actually be higher and more aggressive than that given to normal-weight people, the study authors said.

“Contrary to our expectations, we found that in certain measures overweight patients were actually slightly more likely to get recommend care,” said lead researcher Dr. Virginia W. Chang, an assistant professor of medicine and sociology at the University of Pennsylvania.

The study findings are published in the April 7 issue of the Journal of the American Medical Association.

Chang said the study was motivated by surveys that found many doctors and health-care professionals “openly admit having negative attitudes towards obese patients. They say they are dissatisfied in caring for obese patients. They find it uncomfortable, unpleasant and not professionally rewarding.”

Obese patients are sensitive to this, she added. “A lot of obese patients will say they experience weight-related stigma from a doctor or they will name doctors as the primary source of weight-related bias,” Chang said.

These attitudes left Chang wondering if stigma might somehow lower the quality of care obese patients receive.

To find out, her team tracked eight common measures of quality of medical care, including diabetes care, pneumococcal vaccination, influenza vaccination, and screenings for breast, colorectal and cervical cancers.

The researchers evaluated these quality measures for more than 36,000 Medicare patients and 33,550 Veterans Administration patients.

Across all the quality measures in both groups of patients there was no indication that obese or overweight patients had lower odds of getting the recommended care, compared with normal-weight patients, Chang’s team found.

In many cases, obese and overweight patients had better chances of getting optimal care compared to normal-weight patients, the researchers found.

More aggressive treatment for obese patients was seen most among the Medicare group, where many more overweight and obese patients had their cholesterol levels and blood sugar screened.

In addition, a slightly higher number of obese and overweight patients in both groups received vaccinations against the flu and pneumococcal viruses. In the Medicare population there were also slightly higher rates of breast cancer screening, and among VA patients a higher rate of colorectal and cervical cancer screening versus that experienced by normal-weight patients.

“While it may be true that physicians and other health-care providers harbor negative attitudes towards obesity is does not seem to be borne out in lower quality of care. They are actually doing a good job,” Chang said.

Another expert agreed.

“I think our obese patients sometimes get better care than the people who are not because of their known risk factors,” said Dr. Robert Schwartz, professor and chair of the department of family medicine and community health at the University of Miami Miller School of Medicine. “So when an obese patient comes into the office we are probably hyper-vigilant rather than less vigilant.”

Schwartz noted that obese patients may feel they have more difficulty with the health-care system because the usual recommendation from doctors is often to diet and lose weight.

“Many obese patients are sensitive about their conditions,” he noted. But health problems associated with obesity, such as diabetes and heart disease, mean these patients will need more medical attention.

Obese patients also need a lot of support to optimize their care, Schwartz said.

“They need a team approach. They need to see a nutritionist. They need to get into a physical therapy program. They need to make sure they don’t have diabetes and if they do that needs to be taken care of,” he said. “It’s a much more complex problem than the way we used to look at obesity.”

More information

For more information on obesity, visit the U.S. National Library of Medicine.

By Steven Reinberg
HealthDay Reporter

SOURCES: Virginia W. Chang, M.D., Ph.D., assistant professor, medicine and sociology, University of Pennsylvania School of Medicine, Philadelphia; Robert Schwartz, M.D., professor and chair, department of family medicine and community health, University of Miami Miller School of Medicine; April 7, 2010, Journal of the American Medical Association

Last Updated: April 06, 2010

Copyright Š 2010 HealthDay. All rights reserved.

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Public Citizen report slams Minnesota Medical Board

Is the Minnesota Board of Medical Practice too lax on discipline or are Minnesota doctors just that good?

Public Citizen, the consumer watchdog group founded by Ralph Nader, released a stinging report Monday that calls Minnesota the worst state in the nation in punishing wayward docs. From 2007 to 2009, Minnesota issued only 1.07 serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 physicians, the fewest in the United States, according to the report.

Of course, the lack of disciplinary action does not necessarily mean there’s something to discipline. But 1.07 per 1,000 does seem kind of low, considering problem docs have become a growing issue in recent years.

According to a 2003 survey of 2,000 nurses, pharmacists and other staff by the Institute for Safe Medication Practices, nearly half of the respondents reported intimidating behavior, mostly from doctors, such as strong verbal abuse and threatening body language. Four percent even reported physical abuse. Experts say burned out doctors, if unchecked, often resort to substance abuse and even criminal behavior that could harm patient safety.

In 2008, The Joint Commission, an independent, nonprofit organization that accredits and certifies more than 17,000 health care organizations, established new standards that require hospitals to develop a code of conduct that defines acceptable and disruptive and inappropriate behaviors and create and implement a process for managing such behaviors.

The presence of intimidating and disruptive behaviors in an organization erodes professional behavior and creates an unhealthy or even hostile work environment one that is readily recognized by patients and their families, The Joint Commission said. Health care organizations that ignore these behaviors also expose themselves to litigation from both employees and patients.

Perhaps hospitals are heeding the Joint Committee’s call and dealing with doctors before the Minnesota Medical Board intervenes. Some even say discipline is not best way to correct bad behavior.

“What I can tell you is that in the past, the Board has said that the results of the Public Citizen survey are skewed because [the group] doesnt take into account that Minnesota issues far more Agreements for Corrective Action (which are considered non-disciplinary, and are not reported to the Federation of State Medical Boards) than it does disciplinary actions,” Karolyn Smith, a lawyer for the Minnesota Medical Association, wrote to MedCity News in an e-mail.

“It does this because Agreements for Corrective Action are remedial and work better than disciplinary actions,” Smith continued. Most other states dont have Agreements for Corrective Action.”

Smith also noted Minnesota receives far fewer complaints than most states. Yes, but the number of complaints has been rising. According to its most recent report, the Minnesota Medical Board reported 832 complaints in 2007, a 8.4 percent jump over the previous year, and 868 complaints in 2008, a 4.2 percent rise from the previous year. The vast majority of them involved unprofessional/unethical conduct.

The board took action on 8.1 percent of those cases. Of the 139 discipline orders issued over those two years, the board only once revoked a doctor’s license.

Thomas Lee

Thomas Lee is the Minnesota Bureau Chief for MedCityNews.