Medical school’s new goal: doctors who do not discriminate against patients

When Melissa Botan complained to her OB / GYN about pelvic pain, the doctor responded by asking about her diet and exercise habits.

At the time, Botan thought the question seemed irrelevant, considering the kind of pain he was feeling. But it was not uncommon for this to come from a doctor. “Whenever he went, he talked about diet and exercise,” said Button, 34, of Durham, North Carolina.

On this occasion, three years ago, Dr. Bouton was told that weight loss would probably solve his pelvic pain. He mentioned diet and exercise at least twice more during the appointment. And he said he would order an ultrasound to calm her down.

Ultrasound revealed the source of her pain: a 7-centimeter fluid-filled tumor in her left ovary.

“I hate that doctor the way he treated me, like my pain wasn’t a big deal,” Botan said. “It simply came to our notice then.

Research has long shown that doctors are less likely to respect overweight or obese patients, although about three-quarters of adults in the United States now fall into this category.

Obesity, when the body mass index (BMI) is 30 or higher, is widespread in the south and midwest, according to the Centers for Disease Control and Prevention (CDC). The highest-rated state is Mississippi, where 4 out of 10 adults qualify as obese.

Obesity is a common and treatable condition that is associated with a long list of health risks, including type 2 diabetes, heart disease and some cancers. Despite the prevalence of obesity, it carries a unique stigma.

Physicians often go to drug practice with anti-fat bias and do not find it easy to communicate with patients who are overweight. Some obesity experts blame the lack of attention in medical schools. Others blame the lack of empathy.

To address both, the Association of American Medical Colleges plans to implement new diversity, equity and inclusion standards in June aimed at educating physicians, among other things, to treat people identified as overweight or obese with respect.

Director of Obesity Medicine at the Cleveland Clinic Metabolic and Bariatric Institute. This does not happen in many patients, says Scott Batsch. “It’s almost like a bad habit … The stereotypes and misconceptions surrounding this disease enter clinical practice.”

The problem, Boots argued, is that little attention is paid to obesity in college. When he trained and taught at Harvard Medical School for several years, Bush said students did not receive more than nine hours of obesity education in three days out of four years.

Melissa Bouton said her OB / GYN told her about diet and exercise when she told her she had pain in her pelvis. It was a tumor. (Melissa Button)

In 2013, the American Medical Association voted to recognize obesity as a disease. But, Butts says, doctors often go for it with a one-size-fits-all approach. “Eat less, move more” doesn’t work for everyone, he said.

“There are many different forms of obesity, but we are treating them as if we were giving the same chemotherapy to all types of cancer,” Bush said.

All but four of the 128 medical schools covered topics related to obesity and bariatric medicine in the 2020-21 academic year, according to data provided to KHN by the Association of American Medical Colleges, which does not represent osteopathic schools.

Nevertheless, research suggests that many doctors around the world are not trained enough to deal with weight problems. A survey conducted by leaders of 40 US medical schools found that only 10% felt that their students were “too ready” to handle obesity patients. Expanding education in this area is not a priority, they wrote in the 2020 article about the survey.

Butch wants Congress to pass a resolution emphasizing that medical schools should include substantial training on nutrition, diet and obesity.

Dr. David Cole, president of the Medical University of South Carolina, said many issues in medical school should be covered more fully. “There’s a huge tom here, it’s so big,” Cole said, raising his hand. “The point is: what I didn’t learn in medical school.”

The Association of American Medical Colleges is trying to address the problem in two ways.

First, it created a career preparation test for aspiring medical school students, called Preview, designed to assess applicants’ cultural skills, hearing and social skills, and their ability to analyze situations at hand. Can be found in medical school and clinical settings.

“We call them soft skills, but they are actually the hardest to learn,” said Lisa Howley, an educational psychologist and senior director of the association’s strategic initiative. More than a dozen schools now recommend or submit applicants their preview scores along with their entrance exam scores.

Second, in June, the association will apply new competency standards for medical students, residents and existing practitioners related to diversity, equity and inclusion. These values ​​will address racism, inherent bias and gender inequality, and will aim to teach doctors how to communicate with overweight people.

After discovering the source of Melissa Bouton’s pelvic pain, the same doctor acted as if the tumor was “no big deal.”

Bouton sought a second opinion from a doctor who advertised his practice as “healthy for all sizes”. The doctor referred her to a surgical oncologist, who removed the tumor, her left ovary, and part of a fallopian tube. The tumor was large, but it was not cancerous. And since the removal surgery was considered successful, Button has had problems conceiving and is undergoing fertility treatment.

“It’s an emotional roller coaster,” he said. “I feel very young at 34 to go through this.”

Bouton, who described himself as “not fitting the BMI box”, said experience had taught him to choose his doctors differently. If the doctor asks if you’re dieting and exercising, I’ll just “start looking for another one.”

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