Living with obesity comes with many challenges, from the impact on health to social or environmental limitations. These challenges are hard enough on their own without being made unnecessarily worse from the people and systems that are supposed to help, however weight bias and discrimination is so prevalent, especially in healthcare. Today’s blog post comes from our friend Healther who wanted to share an experience she had when seeking care, in hopes that it will help others realize that they deserve better and they can advocate for themselves.
I recently had a horrible experience with a hospital here in Ontario as I was trying to get help for severe pain and limited mobility with my knees. My quality of life has been impacted and I was desperate to get some relief. I was referred to an Orthopedic surgery program to explore the possibility of surgery.
The first doctor I saw was one who I had previously seen several years ago, back in 2013 he suggested that while my knees were getting bad and imaging showed the deterioration of the joint, it was not yet at a point of intervention beyond physiotherapy but that surgery might be a possibility down the road if they got worse.
I managed with physiotherapy and supplementation, at a followup in 2014, the doctor said that while still not great, given I was 57 years old at the the time, if he did surgery then, I would likely need to have surgery again later on in life again for the same issue and that he would like to hold off on the surgery for now. So instead of getting pain relief and improved quality of life now, I had to wait until that pain and mobility was worse.. I said, “I would rather be active while I am in my 50s and 60s. I don’t care if I can’t walk when I am 80” but the doctor refused. By 2020 both knees had deteriorated to the point that I was in much more pain and had much more mobility issues. I was so uncomfortable that I was having issues sleeping because of the pain in my knee. I told my family doctor that something was getting stuck, the pain was unbearable and my mobility was hindered. My family doctor got me a referral back to the same surgeon.
After reviewing the new imagery on my joints he said “Your knees are bad, your hips are worse, and your back is just a mess!” He said there was calcium buildup in both knees. However, he said he wasn’t prepared to do surgery to repair my knees and instead asked if I ever considered bariatric surgery, making it clear that he was refusing to proceed with treatment for my immediate needs, because of my weight.
As someone who has lived with obesity for a long time, and have taken steps over the years to manage my health behaviours to be able to avoid any additional weight gain even given my mobility issues. I was in this appointment with the expectation that my immediate pain and mobility issues would be addressed in order to improve my quality of life. I was NOT there to discuss my weight. Furthermore, given my age and existing wait times (years from point of referral to point of surgery) for bariatric surgery in Ontario, I honestly question why this was presented as a serious option for treatment for my knee issues. He is suggesting that I continue with pain and mobility issues for YEARS without any intervention in order to have another unrelated procedure that does not address the structural issues my knees have.
Frustrated that I was not interested in this option,the surgeon said he could arrange for a cortisone shot but would not offer any other course of treatment.
About two weeks after that appointment, I called an ambulance because the knee locked up, I could not put any weight on it, and the pain did not subside on sitting. The emergency room doctor sent me for x-rays, and said there was a meniscus tear along with calcium build up and that I would need to get surgery.
Another appointment was booked with the surgeon following the ER Doctor’s direction. After questioning why I was back there He said, “We discussed this at the last visit. I am not prepared to operate.”
He said “Your knees are wrecked. However, surgery is risky because you have Atrial Fibrillation Arrhythmia”. I told him I had major rotator cuff surgery and that I could get a note from the Heart Surgeon okaying surgery. I had the same BMI in 2013 when I had a totally severed supraspinatus in the right shoulder repaired during a 4 hour surgery, and there was no heart complication. I had the same BMI in 2016 when I had a totally severed supraspinatus repaired, along with a bicep tear on the left shoulder and there were no complications. My Cardiologist said he was happy to send a note approving me for surgery and that my A-Fib should not be an issue.
The surgeon then shifted his opposition to treating my knees to my weight. His justification was that “Still, the risk of surgery is greatly increased due to the extra weight”. When pressed on this he stated “It’s because they are cutting through more layers of tissue and thus the risk of infection is very high”. He added, “Knee infections are very serious and painful. Sometimes the infection is so bad that amputation is necessary.” and even added, “Some people die of infection and you wouldn’t want that would you?”.
I explained that I am aware that all surgeries carry a risk, but given my recent history of orthopedic surgery and my current quality of life, effectively resolving my knee issues was certainly worth the risk. This is when he again asked if I thought about getting Bariatric Surgery. When he couldn’t answer how much weight I needed to lose in order for him to do the knee surgery, he stated “Look, I took an oath to do no harm and I will not operate on you because it could do more harm.”
Given the amount of pain and lack of mobility, I would argue that doing nothing is directly causing more harm than the potential risk of harm with treatment. I also believe his rationale is not evidence-based and might even be considered malpractice. He deliberately attempted to use scare tactics, “serious risk of infection and death”. What exactly is the increased risk of infection for someone with obesity? According to this doctor, cutting through additional layers of tissue on my knee is too risky, yet his clinical suggestion is a procedure that is far more risky, not to mention one that I would not qualify for based on my age. His rationale is flawed and based solely in his bias, not in any justifiable clinical decision making process.
I was given what was supposed to be an independent second opinion from another doctor in the clinic, however that experience did not go any better and in fact the fat shaming and weight bias was even more obvious.
This new doctor entered the room with my file and asked me bluntly, “Why are you here?” I explained I was there to get a second opinion about my knees. Without asking for any additional information, or even examining the knees, she said she would not operate on the knees. Without asking me anything, she said, “What disturbs me most is that you refuse Cortisone shots”. She never asked me why. I don’t know how she knew I refused the Cortisone unless she read the first doctor’s comments (so much for an independent second opinion). I started to tear up, as her demeanor since she entered the room was hostile and combative. She asked me what I thought would happen at this visit and I told her I thought there would be a treatment plan whereby we could discuss which knee should be done first or at the very least what steps could be taken to prepare to have the knee joint replaced. She said, “Your knees are wrecked. But so are your hips and back and you will still have pain. I will not do surgery”. I can live with pain. I cannot accept that the pain is due to something that can be treated with surgery, so I started to cry and said I don’t want to end up in a wheelchair and packing on weight due to a lack of mobility which is the eventuality when one has “wrecked/shot knees”.
She saw me crying as she headed for the door and said, “We’re done here, unless you want cortisone shots.” In my grief, I meekly said, “ok”. At that point, she stopped in the open doorway and turned around to say, as she looked me up and down, “By the way, I didn’t do THIS to you.” referring to my weight. It is unprofessional and inhumane treatment like this that causes such trauma. I was shattered that a licensed physician in whom I had an inherent trust and vulnerability with, would speak to me in such an insensitive way. I was left feeling bullied, body-shamed, and unworthy of basic health care.
This is something that fundamentally violates my rights as both a patient and as a human being. To have a doctor (literally) turn their back on you and also hurl insults as they walk out the door. Is entirely unprofessional. I felt hopeless.
As health professionals, I would expect that both doctors are at the very least aware that obesity is a complex chronic disease and not something I chose or did to myself. I would also expect that they believe that all of their patients deserve dignified and respectful treatment. I would expect that doctors would be aware and refer to Clinical Practice Guidelines in making clinical recommendations. Finally, I expect that they would recognize that their interactions with patients can be very impactful and for someone so concerned about “doing no harm”, these doctors caused immeasurably more harm.
I have since filed a complaint with the hospital regarding this treatment and have advocated for myself to get a referral to another hospital, where I was seen and heard by another doctor. In fact this final doctor suggested that my condition in my knee was so severe that I was booked for surgery only 3 ½ weeks after that initial consult. I am now recovering well but still bothered by the treatment from the first hospital.
During Obesity Canada’s most recent webinar, Dr. Chaudhry explained the justification to deny surgery based on infection rates for individuals with a higher BMI. While the evidence does suggest that there is elevated risk compared to “normal BMI” individuals, that actual risk is still exceedingly low and certainly not something that would justify denial of care. It is clear that the system and many doctors who work in it have a great deal of weight bias. This is hurting people everyday and it needs to stop. More people need to ask questions, push back and make these health professionals justify their decisions using evidence, anything less is inappropriate. Make them uncomfortable as they have to acknowledge and address their bias and their errors. If we keep letting them get away with it and take their word as gospel, nothing will change.