Should a hospital be allowed to deny employment to doctors and healthcare providers who are significantly overweight? Bioethicist Arthur Caplan, PhD, discussed this in a Medscape video, and it set off a firestorm on Medscape's Physician Connect. There was much outrage, but also a great deal of support.
Caplan's video was inspired by the decision of a Texas-based hospital, Citizens Medical Center, to refuse employment to obese healthcare providers (> 35 kg/m2). Caplan discussed the ethical implications of their ruling, and his analysis set off a firestorm of responses by readers.
Can an Obese Doctor Promote Healthy Lifestyle Choices?
A central rationale for this policy is the belief that an obese physician isn't an appropriate role model to teach patients about healthy behaviors, such as good nutrition and exercise.
Readers who agreed with the hospital's decision stated that, in the words of one physician, "It would be dishonest of me to counsel patients if I myself have issues." Another noted, "The reason why the American population is fat and unhealthy is because American physicians are fat and unhealthy. Physicians are supposed to be the role models for healthcare. Who is going to take their physician seriously if he weighs 300 pounds and eats Lays potato chips?" A third argued, "All studies [that have been] done show that people sometimes do as you do. They rarely do as you say."
Proponents of this position also said that obesity is regarded as "normal" in our society and that obese physicians are implicitly condoning -- thus normalizing--obesity.
But other readers vehemently disagreed. "As an overweight nurse, I can honestly tell you that people respond better to me than to thinner nurses when we talk about weight and diet." A healthcare provider, also overweight, said that "being advised by larger nurses or doctors helped me because I felt they truly understood the battle I have with my weight."
Another questioned the alienating message given to obese patients. "Patients often avoid health care out of fear that they'll be judged for poor health habits and this policy would likely only further perpetuate that concern."
Does a trim physician really serve as an inspiration to patients to improve their diet and lose weight? No, said some readers. "Just because I don't drink alcohol or smoke doesn't make my patients quit smoking or drinking. How ridiculous!" said one. Another concurred: "I don't believe that patients look to the healthcare staff as 'role models.'"
Do Patients Choose Doctors Based on Weight?
Doctors who agreed with the hospital's decision suggested that trim, healthy clinicians will be more sought out by patients. Opponents disagreed. "I'm more concerned with the competency and knowledge of those caring for me and my loved ones, rather than physical appearance," said one reader.
Another said, "My own primary care provider is huge and I'm slender. I don't care that she's overweight; that's her business. She's a great doc as far as I'm concerned." One reader summed up this position: "Weight does not matter in the least to patients selecting a healthcare practitioner. Excellence in practice and compassion are much preferred."
Medscape Business of Medicine © 2012
Cite this: Only Hire Thin Physicians? Medscape Readers Fuel a Fiery Debate - Medscape - May 31, 2012.