I’m guessing that’s under the US health system, where doctors are incentivised to only perform surgeries with a low risk of complications
Comment on doctors
Irelephant@lemm.ee 11 months agoThe meme isn’t about that, I’ve read stories of some doctors refusing to perform surguries to overweight people, but other doctors doing the surgery anyway.
The same way a lot of women get told stuff is just from their period by doctors…
Cypher@lemmy.world 11 months ago
Lv_InSaNe_vL@lemmy.world 11 months ago
What countries medical system encourages risky surgeries? As far as I’m aware “reducing risk” is most of the game in medicine
medgremlin@midwest.social 11 months ago
For a lot of doctors, the incentive to not do risky procedures is the fact that you have to live with the guilt of your patient’s death, even if you did everything perfectly. Or, you do everything perfectly, but they still have a poor outcome because they weren’t healthy enough to go through the procedure and the recovery, and you get sued for millions of dollars because you didn’t spend 4 hours going through the informed consent with the patient to ensure that every single possible complication was adequately discussed.
I’ve worked in emergency medicine and I’ve had patients die in my care that we had absolutely no way of saving. The screams of their families still haunt me and I will carry those cries of anguish and loss to my grave. I would not perform a procedure that was not 1000000% necessary if the risks are too high because I have enough blood on my hands already, and I haven’t even finished medical school.
andros_rex@lemmy.world 11 months ago
Similarly - if you are trans and on HRT, every problem is due to your hormones.
medgremlin@midwest.social 11 months ago
I’m a medical student and I have some direct experience with this. Sometimes, the difference between the surgeon who will do the procedure versus the surgeon that won’t do the procedure is the availability of specialized facilities and equipment that they have access to. An elective surgery (i.e. not an emergency surgery) can go from routine to very high risk depending on the amount of adipose tissue the patient has.
And it’s not just a matter of the fat tissue overlying the surgical site. Morbidly obese patients are much more likely to have things like sleep apnea which can make anesthesia more risky and might require more specialized equipment than a particular surgeon/hospital/anesthesiologist might have access to. The “morbid” part of “morbid obesity” also refers to the fact that people above a certain threshold of weight are much more likely to have other health conditions like heart disease that make anesthesia more risky.
Irelephant@lemm.ee 11 months ago
Would a surgeon unable to do it refer the patient to one who is capable?
medgremlin@midwest.social 11 months ago
Sometimes. It depends why the first surgeon would be unable to do the procedure. If the problem is that the patient might not wake up from anesthesia because of problems with heart disease, lung problems, or other metabolic issues, then it doesn’t really matter what the surgeon has to say about actually doing the procedure because the anesthesiologist is the one saying “no”. If it’s an issue of too much adipose, sometimes it would mean that the surgery would take longer than it’s safe for the patient to be under anesthesia.
Another possibility is that the first surgeon operates at a facility that doesn’t have access to more advanced technologies or other medical specialists in the event that something goes wrong. And there are some surgeons that are just more willing to accept the risk of a bad outcome, and I would argue that that’s rarely in the patient’s best interest. There are alternative options that the surgeon should discuss with the patient as part of the informed consent process, and sometimes, the alternatives to surgery are just safer than the risk of the surgery itself, even if they aren’t as effective or are a long term treatment (ongoing) as opposed to a definitive treatment (cure). If the patient has a high risk of serious complications, up to and including death, then attempting the curative procedure might be more risk than it’s worth compared to a long term medication that mitigates the disease.
You’ll see this with pregnant patients too. For elective procedures that have safer alternatives or temporizing measures (a holdover treatment until surgery is safe), those are generally preferred to putting a pregnant patient under anesthesia because of all the cardiovascular, immunologic, and other physiologic changes that happen during pregnancy alongside potential risks to the fetus.
uselessRN@lemm.ee 11 months ago
This is what I came to say but wasn’t smart enough to put into words. There’s a lot more factors than just being overweight of why a surgery can’t be performed. For a while an issue at my hospital was we were one of the few in the area that could do MRIs on larger patients. So bigger hospitals would transfer these patients to us just for an MRI because their MRI machine was too small or couldn’t handle the weight.
medgremlin@midwest.social 11 months ago
There’s a reason you have to get a pre-op physical exam for any non-emergent surgery. Figuring out if you’ll wake up from the anesthesia at all is part of the calculus that determines whether the benefits of the procedure outweigh the risks.
HollowNaught@lemmy.world 11 months ago
When talking about obese insividuals, the fat very easily gets in the way of surgery. Compared to a healthy patient the risk of complications during surgery is much greater and really not worth chancing it (most if the time)
ChairmanMeow@programming.dev 11 months ago
The reason for that is that surgeons are rated based on their success percentages meaning they’ll recommend against risky surgeries.
The upside of this is that surgeons aren’t operating willy-nilly on people and will make a proper risk assessment. The downside is that overweight people have an inherently higher risk of complications from surgery, so some surgeons will pass.
It’s not because they think these people don’t need it, it’s because they think it’s too risky. They’re usually not wrong about that, you just need to find a surgeon willing to take the risk or, if possible, reduce the risk by losing weight.
Fogle@lemmy.ca 11 months ago
There’s also no point to surgeries if the people aren’t committed and are just going to eat even more and put the weight back on. It’s like consolidating debt to make one payment easier but keeping all the credit cards and building up the debt again. It just makes you worse off
albert180@piefed.social 11 months ago
That's why where I am from you usually need a clearance from a psychiatrist that there are no psychological issues in eating habits that would render that surgery useless, before the surgeon is allowed to do it
kkj@lemmy.dbzer0.com 11 months ago
That depends on the surgery. Gastric bypass notoriously has weight requirements, but a gallbladder removal can still kill you if you’re too fat.
gaja@lemm.ee 11 months ago
Look. Shitty doctors exist, but when 1/3 of the US is overweight, there are underlying issues that need addressing. I only hear horror stories when an addict, alcoholic, or overweight individual in my life is feeling insecure or defensive about a prognosis. Too many people deflect and it’s enabling a much larger issues. Our basic instincts are being exploited.
geekgrrl0@lemmy.ca 11 months ago
I have some horror stories about being a normal weight woman seeking medical care. What’s that about then?
Lv_InSaNe_vL@lemmy.world 11 months ago
Different issues have different causes.
geekgrrl0@lemmy.ca 11 months ago
I don’t know, the medical community ignoring fat people’s health concerns (beyond obesity) and ignoring women’s health concerns, seem to be the same issue and I posit they are the same cause too (hubris, arrogance, and just simply not living up to their oath)
msprout@lemmy.world 11 months ago
America’s obesity epidemic is a function of our car culture. This is the only country on God’s green Earth that feels putting in sidewalks is a moral failure.
prettybunnys@sh.itjust.works 11 months ago
Obesity is a food issue, our reliance on cars and increasingly sedentary lifestyle may exacerbate the issue but it’s not the cause
Nalivai@lemmy.world 11 months ago
You can’t really know it. I suspect it’s a combination of the two. If you drive everywhere and sit around the rest of the time, you can’t be healthy no matter your diet.
grrgyle@slrpnk.net 11 months ago
Look. Shitty doctors exist …
Yes. They’re in the meme.
Irelephant@lemm.ee 11 months ago
I know, I’m not arguing for obesity, that would be stupid.
prettybunnys@sh.itjust.works 11 months ago
Well someone’s gonna have to
ZeffSyde@lemmy.world 11 months ago
My mother had a doctor that refused to move forward with knee surgery because she was so depressed and refused to do therapy because it hurt her knee so much to move around.
I guess I understand, why go through the trouble of surgery if she’s just going to be a bummer couch potato afterwards and never change her ways?
But at least she’d be a bummer couch potato whose knee didn’t threaten to give out on her whenever she tried to do laundry in the basement.
If I take my car in for new brake pads, don’t refuse me service because the transmission is on its way out.
Kornblumenratte@feddit.org 11 months ago
People are more complicated than cars, and surgeons are no magicians. I think your idea of the reason of your mother’s surgeon for refusal might be a bit off:
Without adequate pre- and post-op physiotherapy, a joint will likely be worse after surgery.
If simple physiotherapy is already too painful, cutting into this overexcited tissue risks inducing a complex regional pain syndrome.
If someone suffers from both depression and from too much pain to do physiotherapy, they need a multimodal pain therapy to prepare for surgery.
So, based on the bit of info you provided, refusing surgery was very likely the right thing to do to avoid worsening your mother’s situation. What I di hate is when doctors don’t explain themselves and just say “I can’t help you”, but do not point patients to someone who can.