What field is going to benefit most from the rising obesity rates?

[TheRealCookieMonster]

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Dude just quit while youre behind. Stop ruining threads with garbage

 

[TheRealCookieMonster]

/end

 

[Angus Avagadro]

Just because you shadowed someone doesnt mean you completely understand the entire thought process behind the decision to operate or not. On my med school year book page, I thanked the doctors who taught me how to do things correctly,and a I gave a bigger thanks to those who showed me how NOT to do things. Just because you got away with operating on a poor candidate with reversible risk factors, doesnt mean you did the right thing. It just means you got away with it this time. Do you want to practice medicine doing the right thing, or hoping to just get away with what you did? Which doctor do you want to be?

 

[RNthenDoc]

Don’t feed the trolls.

...Because overfeeding can lead to a high BMI!

Mods, did you see how expertly I swung the thread back onto topic? Oil of Olivier, I swear.

 

[dpmd]

How come no one has mentioned how surgeons get to deal with all the extra complications and difficulty associated with obese patients but don't get reimbursed any differently. Not exactly benefitting from increased rates of obesity.

 

[TheRealCookieMonster]

Just because you shadowed someone doesnt mean you completely understand the entire thought process behind the decision to operate or not. On my med school year book page, I thanked the doctors who taught me how to do things correctly,and a I gave a bigger thanks to those who showed me how NOT to do things. Just because you got away with operating on a poor candidate with reversible risk factors, doesnt mean you did the right thing. It just means you got away with it this time. Do you want to practice medicine doing the right thing, or hoping to just get away with what you did? Which doctor do you want to be?

I’m sure this was rhetorical. But I’m already running against the grain. Your point is well taken and genuine. I have a feeling my practice will be mostly dictated by the system/environment I’m in. My point in the shadowing comment was simply to illustrate that the claim that a surgeon absolutely can’t (or don’t) do joint replacements on bariatric patients is just false. The post was an over generalizion. I pointed that out, albeit sarcastically and with contempt. But we all have thick skin in here.

 

[NeuroticButCute]

I’m sure this was rhetorical. But I’m already running against the grain. Your point is well taken and genuine. I have a feeling my practice will be mostly dictated by the system/environment I’m in. My point in the shadowing comment was simply to illustrate that the claim that a surgeon absolutely can’t (or don’t) do joint replacements on bariatric patients is just false. The post was an over generalizion. I pointed that out, albeit sarcastically and with contempt. But we all have thick skin in here.

I think the point that they can't do it over a certain BMI may have less to do with the doctor's own personal restrictions and maybe more to do with billing insurance. If a patient is in a category that their insurance deems too high-risk then the claim can get rejected, and if the claim is rejected and the patient absolutely cannot afford the surgery out of pocket, then the surgeon most likely literally cannot do anything.
And maybe some people in some places deal with insurance companies that will just approve whatever, and if the surgeon is comfortable operating on a pt that's morbidly obese then it all goes ahead. But some people in some places have insurance that is stingy and will not cover a surgery that they think is likely to lead to more complications (read: more money that insurance has to pay for other doctor visits later). There are probably also cases where the insurance would pay for it, but the surgeon is not comfortable doing a procedure that has such high risk, which is equally valid. Nothing in medicine is completely the same across the board for anyone ever.
So I'd bet on money that the Ortho attending who has seen dozens of patients and dealt with paperwork from dozens of insurance companies knows best about what surgeons literally cannot do AND what they just prefer not to do.

tl;dr: you're wrong

 

[dpmd]

I think the point that they can't do it over a certain BMI may have less to do with the doctor's own personal restrictions and maybe more to do with billing insurance. If a patient is in a category that their insurance deems too high-risk then the claim can get rejected, and if the claim is rejected and the patient absolutely cannot afford the surgery out of pocket, then the surgeon most likely literally cannot do anything.
And maybe some people in some places deal with insurance companies that will just approve whatever, and if the surgeon is comfortable operating on a pt that's morbidly obese then it all goes ahead. But some people in some places have insurance that is stingy and will not cover a surgery that they think is likely to lead to more complications (read: more money that insurance has to pay for other doctor visits later). There are probably also cases where the insurance would pay for it, but the surgeon is not comfortable doing a procedure that has such high risk, which is equally valid. Nothing in medicine is completely the same across the board for anyone ever.
So I'd bet on money that the Ortho attending who has seen dozens of patients and dealt with paperwork from dozens of insurance companies knows best about what surgeons literally cannot do AND what they just prefer not to do.

tl;dr: you're wrong

Doing it at a center of excellence also likely impacts things as they have to adhere to certain guidelines intended to maximize good outcomes. Perhaps the use of "literally" was overselling the case as it isn't like the patient will explode if you try, but assuming it is similar to hernia repair in the very obese, it isn't as mild as preferring not to so much as it is the chance of successfully accomplishing the goal of treatment is low enough that people shouldn't even if some less scrupulous docs do it anyway.

 

[TheRealCookieMonster]

I think the point that they can't do it over a certain BMI may have less to do with the doctor's own personal restrictions and maybe more to do with billing insurance. If a patient is in a category that their insurance deems too high-risk then the claim can get rejected, and if the claim is rejected and the patient absolutely cannot afford the surgery out of pocket, then the surgeon most likely literally cannot do anything.
And maybe some people in some places deal with insurance companies that will just approve whatever, and if the surgeon is comfortable operating on a pt that's morbidly obese then it all goes ahead. But some people in some places have insurance that is stingy and will not cover a surgery that they think is likely to lead to more complications (read: more money that insurance has to pay for other doctor visits later). There are probably also cases where the insurance would pay for it, but the surgeon is not comfortable doing a procedure that has such high risk, which is equally valid. Nothing in medicine is completely the same across the board for anyone ever.
So I'd bet on money that the Ortho attending who has seen dozens of patients and dealt with paperwork from dozens of insurance companies knows best about what surgeons literally cannot do AND what they just prefer not to do.

tl;dr: you're wrong

😴

 

[Angus Avagadro]

I do know that insurance companies monitor your complication rate. If you are consistently above threshold for complications, you risk being dropped from the insurance company's panel, meaning you cant take care of their patients. This makes some surgeons more discriminating in their patient selection. Also, if complications arise, you are more likely to be sued. Some malpractice Carriers will drop you if you have 3 successful lawsuits against you. That includes settling the suit. Another reason to be picky about who you operate on.

 

[esob]

A friendly reminder to stay friendly when discussing hot button topics. Cordial discussion is mandatory, regardless of one's opinion. Disciplinary action has been dispensed for inappropriate comments in this thread. The staff, along with the vast majority of the community at SDN continues to work toward an environment where topics can be discussed without becoming toxic just because everyone doesn't agree. Also, as a side note, please show some respect to those physicians that have taken the time to become verified physician members here; they are an invaluable resource to premeds, med students, and residents that are still completing the journey.

 

[mc29012]

I do know that insurance companies monitor your complication rate. If you are consistently above threshold for complications, you risk being dropped from the insurance company's panel, meaning you cant take care of their patients. This makes some surgeons more discriminating in their patient selection. Also, if complications arise, you are more likely to be sued. Some malpractice Carriers will drop you if you have 3 successful lawsuits against you. That includes settling the suit. Another reason to be picky about who you operate on.

In addition to this, institutions/administration monitor complication rate. The hospital I work at will not allow anyone over 35 BMI have elective joint replacement because the complication rate is so astronomical. They have to lose weight or deal with it.

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[Cognovi]

There's a saying in radiology: fat is your friend. The hardest abdominal CTs to read are in skinny people where there is not any separation between organs, vessels, lymph nodes.

 

[Angus Avagadro]

There's a saying in radiology: fat is your friend. The hardest abdominal CTs to read are in skinny people where there is not any separation between organs, vessels, lymph nodes.

Very true.
And there are people who dont fit on the gantry, usually around 400 lbs weight limit.

 

[OrthoTraumaMD]

Very true.
And there are people who dont fit on the gantry, usually around 400 lbs weight limit.

Yep. We have had to send some patients over to another hospital because they had CT scanners meant for horses.


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[TheRealCookieMonster]

CT scanners meant for horses.

Lol 🤣ruthless. Crushing the fatties

 

[Black Coffee 24/7]

Serious quest:

What do you guys do with 400+ lbs O or D lineman coming in with acute injuries?

 

[OrthoTraumaMD]

Serious quest:

What do you guys do with 400+ lbs O or D lineman coming in with acute injuries?

Depends on the injury. If it’s operative we fix it. We have put 2 OR tables together for some very big people. Obviously outcomes are questionable.... but trauma is different. It’s not elective. Sometimes you have no choice. You work with what you got, and do the best you can. That’s part of the beauty and the suffering of being a traumatologist.


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[dpmd]

Serious quest:

What do you guys do with 400+ lbs O or D lineman coming in with acute injuries?

The really tall folks that weigh a lot might be able to fit in the regular ct scanner (part of the problem is the size of the opening in the donut not just weight limit for the table). The shorter wider ones not so much. Same goes for the or tables (which while rated for some hefty weights are not all that wide). If the weight is compact muscle distributed throughout it may not make a surgery as difficult as fat especially fat that is concentrated where you are going to be working.

 

[Foot Fetish]

Derm. More surface area.

 

[resiroth]

Serious quest:

What do you guys do with 400+ lbs O or D lineman coming in with acute injuries?

The reason for the BMI limit is mostly because of the increase in fat. If someone is taller, their BMI is overly high (relative to how these guidelines are made). If you have like Ronnie Coleman coming in his knee shouldn’t have really much fat around it and be pretty accessible.

Again, not an ortho attending but I had the same question and that’s what an attending said.

I’m sure plenty of people would refuse regardless (as there are standards for a reason) but you’ll have a much easier time finding a surgeon to do a knee if you’re a bmi of 41 and 6 foot 6” tall + muscular vs 5 foot and well...not muscular.