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  • Posted by Unknown Member on June 29, 2023 at 8:33 am

    Should we mention obesity in the impression?
     
    Recommend weight loss….
     
    Why do we admit anorexics and literally force feed them? But not admit morbidly obese people and force fast them? Seems like a lot in healthcare would be fixed if we really tried to get America back to normal weight (aren’t like 2/3 of obese at this point). 
     
    Just sad at this point. To make me nervous I have heard the term obesity is now offensive and wouldn’t want to get sued for body shaming. But still as physicians don’t we have some responsibility to promote health?

    sarah.r.huntington replied 10 months, 3 weeks ago 13 Members · 14 Replies
  • 14 Replies
  • kstepanovs_485

    Member
    June 29, 2023 at 8:55 am

    I wish we could, but like you said, we would probably be attacked for hurting people’s feelings. Also big Pharma/insurance/hospital systems want to keep people fat and sick to line their pockets. This is what happens when doctors aren’t in charge of healthcare and putting patients first. 

    • Unknown Member

      Deleted User
      June 29, 2023 at 8:58 am

      Theres no reason for you to think youd be sued. Patient might complain but its correct. If you feel strongly about it, then just put it in the report including impression, and youve done your job.

      • satyanar

        Member
        June 29, 2023 at 9:10 am

        Sued is a stretch for sure. I did hear of a patient that complained to their PCP that it was in the report. It makes one think about how the patient feels about it if you are human. I honestly dont know what is right. I do know that I have stopped mentioning it unless it affects the diagnosis. Do we think they dont know? What real value did mentioning it add?

      • xavivillagran_893

        Member
        June 29, 2023 at 9:14 am

        Often “Exam limited by large body habitus.” lets referrer know the test isn’t optimal without sounding judgy.

        • S0m3Guy

          Member
          June 29, 2023 at 9:38 am

          Why do you feel compelled to describe it? It’s patently obvious from across the room. Not a radiology diagnosis. You’re adding no value. Move on.

        • Unknown Member

          Deleted User
          June 29, 2023 at 9:38 am

          In my opinion, its obvious and just not in the realm of radiology. Yes we can see it they can too, and they know weight loss is the general goal of treatment. But how to achieve that is complex, and beyond the scope of rads. I dont comment on it because its not worth the time to even dictate it, it should be apparent to all providers caring for the patient.

          I wouldnt be afraid of being sued for it. If its accurate, there was no misdiagnosis. Proving harm would also be difficult.

          BUT just be careful because it may not be accurate. Sure the person with subq fat occupying the entire gantry is obese, but what if there is a lot of subq fat and a big belly. Do you call it? Whats your cutoff? No way to assess on an online forum. But, if your cutoff is too low, they may just be overweight, in which case your imaging diagnosis is incorrect. I do not know how someones subjective perception of excess adipose tissue correlates with their BMI. Im sure there are indices/ ways to calculate it more accurately, but aint nobody got time for that.

          • Unknown Member

            Deleted User
            June 29, 2023 at 9:53 am

            This is not the intent of a radiology study. Dont waste your time plus youd be wandering out of the conventions of normal radiology practice which isnt necessarily a bad thing but in this case could be viewed poorly particularly since there is little added value, no definable cutoff, and a chance you could offend someone.

            • bezalel72_205

              Member
              June 29, 2023 at 11:30 am

              Had an old school attending in residency that would put in, whenever appropriate: “The patient [i]remains [/i]morbidly obese.”
               
              I feel like the passive aggressive rad-nerd way of saying it is just: “Hepatic steatosis”

              • elikot

                Member
                June 29, 2023 at 1:41 pm

                Of course it is a relevant diagnosis, and in some cases the most important one.. It is in every one of these patients H and P’s . it is the cause of significant morbidity and mortality. It is relevant in the patient with hepatic steatosis. During the height of Covid, 95% of the intubated Chest xrays were on morbidly obese patients. I could go on and on.

                • amyelizabethbarrett28_711

                  Member
                  June 29, 2023 at 1:49 pm

                  I only mention it if it degrades image quality.

                  Like someone said above, its obvious to everyone that the person is obese and its obvious to everyone what should be done about it.

                  If I have a lung cancer screening CT, I dont put in my impression Emphysema. Recommend patient stop smoking.

                  Or a patient with suspected PID I dont say no TOA. Recommend safe sex.

                  • skysdad

                    Member
                    June 30, 2023 at 4:02 pm

                    This just isn’t our fight man. Besides, those plump abdoment CT’s are fun to read when everything is several centimeters apart from everything else. 
                    Appendicitis on a skinny 19 BMI child sucks.

                    • tdetlie_105

                      Member
                      June 30, 2023 at 4:15 pm

                      Quote from Teedevil

                      This just isn’t our fight man. Besides, those plump abdoment CT’s are fun to read when everything is several centimeters apart from everything else. 
                      Appendicitis on a skinny 19 BMI child sucks.

                       
                      True!…On a similar but separate theme, the standard obese, unhealthy pt with fatty liver etc has become the norm.  These pts seems to always have borderline/mildly enlarged lymph nodes from their inflammatory life-style.  Also splenomegaly seems common, even after taking stature into account.  

                    • Unknown Member

                      Deleted User
                      June 30, 2023 at 9:19 pm

                      Judgy. Adds barely any value – if you look on the EMR front page the BMI is right there in red so why bother? If it limits the exam I state exam is limited by body habitus.

                      I see this sort of thing on reports sometimes – unnecessary poke in the eye of the patient without much value.

                    • sarah.r.huntington

                      Member
                      July 1, 2023 at 7:03 am

                      I’m the same as everyone else.
                       
                      I mention if there is artifact from it, but otherwise don’t bother. It’s something their doctor already certainly knows. The biggest EMRs already autocalculate the BMI.
                       
                      I wouldn’t worried about being sued. The patient has their elevated BMI highlighted in the chart and usually multiple physician/NP notes documenting “Obesity” somewhere in their notes.