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An Odd Complaint:

The AP reports (thanks to The New Editor for the pointer):

Dr. Terry Bennett says he tells obese patients their weight is bad for their health and their love lives, but the lecture drove one patient to complain to the state.

"I told a fat woman she was obese," Bennett says. "I tried to get her attention. I told her, 'You need to get on a program, join a group of like-minded people and peel off the weight that is going to kill you.'" . . .

[The woman's] complaint, filed about a year ago, was initially investigated by a panel of the New Hampshire Board of Medicine, which recommended that Bennett be sent a confidential letter of concern. The board rejected the suggestion in December and asked the attorney general's office to investigate. . . .

"Physicians have to be professional with patients and remember everyone is an individual. You should not be inflammatory or degrading to anyone," said board member Kevin Costin. . . .

It's hard from the article to figure out exactly what the woman is complaining about; it may well be that Dr. Bennett said something harsher than what he's quoted as saying. (The complaints and other materials are apparently confidential, though if anyone has any more data on this, I'd love to hear it.) Still, if the account is correct, it's pretty troubling. And, more broadly, do we really need government regulation to keep doctors from being mean to their patients? (For a sense of the First Amendment issues raised by such regulations, by the way, see this post.)

UPDATE: Another article reports that Bennett "has 'an obesity lecture for women' that is a stark litany designed to get the attention of obese female patients. He said he tells obese women they most likely will outlive an obese spouse and will have a difficult time establishing a new relationship because studies show most males are completely negative to obese women." I can see how that would get some people upset, though I also see why the doctor might figure that this is the one way to get to people who haven't listened to his other advice. And it still seems to me that this isn't something the state medical board needs to be regulating.

Clay Hellman (mail):
What was it Thomas Jefferson said about other peoples' religions... (their beliefs) "neither prick my finger, nor pick my pocket" or something like that...

Seems to apply here absent more information.
8.24.2005 4:19pm
goldsmith (mail):
I've never understood doctors who do this. It's certainly understandable to give patients advice/treatment/support regarding their weight, but it certainly doesn't require medical training to tell someone they are obese.

I have had several doctors tell me I was overweight. My response has always been "You are a brilliant diagnostician, aren't you? That was worth 150 dollars!"
8.24.2005 5:00pm
jasmindad (mail):
Goldsmith: I have had several doctors tell me I was overweight. My response has always been "You are a brilliant diagnostician, aren't you? That was worth 150 dollars!"

If that is all they said, yes, of course you are right. But what is a doctor supposed to say if he wanted the patient to start taking specific measures? He needs to start by saying that the patient is overweight, it has certain consequences, and she needs to do this and that. It is his responsibility, for Pete's sake. Of course, he needs to say it in as inoffensive a way as possible, but it is his job to say it. If you think all overweight people know they they are overweight and don't need to be told, you are wrong -- for years I denied my overweight status by coming up with cockamamie denials, but finally my doc told me, in response to my complaint about legs hurting, that I was overweight and should lose weight. I did, and the pain went away.
8.24.2005 5:10pm
goldsmith (mail):
Yes, my issue was that all the doctor said was "You're too fat, you need to do something about it." That seemed both callous and highly insufficient. Especially since the doctor was paunchy as well.
8.24.2005 5:17pm
akiva eisenberg (mail):
There is much critical information missing from the story, such as, exactly how overweight the patient was, how severe the language the doctor used was, what the remaining advice was, and how often mild comments had been ignored by the patient.

The way I imagine this playing out is as follows: patient dies of weight-related disease (certainly heart disease, diabetes, HBP; possibly cancer, many others). Family sues physician for not convincing patient into caring for herself and losing weight.

Alternatively, physician is stern with patient. Patient files complaint with medical association and local DA (oh, did that actually happen?), then sues for emotional distress. Note that by censuring the physician, the local medical board seems to have created a codicil to medical ethics that states, "The physician has an affirmative obligation not to inflict any emotional distress upon patients, regardless of his other medical responsibilities to the patient." Thus, the patient may now sue the physician for malpractice, with a major dollop of "punitive" damages tacked on to emotional distress.

By the way, responding to goldsmith: perhaps the doctor was waiting for you to ask, "OK, what should I do about it?" [Of course, this is pure speculation: I know nothing about you, the doctor in question, and the precise circumstances involved in your story.]
8.24.2005 5:38pm
cathyf:

Dr. Terry Bennett says he tells obese patients their weight is bad for their health and their love lives


That's a clue that Bennett may have said something that the patient interpreted as sexually offensive. Some people are just prudes. Even those of us who are not prudes get offended by people who assume that, as a matter of course, we simply must wish to have sex with more people more often.

cathy :-)
8.24.2005 6:12pm
Crane:
The full article went on to quote another (formerly) obese patient of the same doctor, and she said that she had also been extremely angry with him for bringing up the issue of her weight, but had then realized he was right. So, was the doctor acting like a jerk? Are fat women just overly sensitive? It would be nice to know what he actually said.
8.24.2005 7:36pm
Michelle Dulak Thomson (mail):
So you go to the doctor, and he points out that you're fat (which you already know), and that being fat is bad for you (which you also already know), and then he adds that fat women are really unattractive to men, and that fat men tend to die earlier even than fat women, so you had best slim yourself up before your husband dies, because if you don't, you won't be gettin' any ever again. Studies show that!

Not, I think, cause for legal action, but the sort of medical behaviour that would certainly cause me not to go to a doctor unless in mortal agony. Sheesh.
8.24.2005 9:05pm
Bruce Hayden (mail) (www):
I think that a lot of doctors really look at things differently than attorneys do. Some of them actually care about their patients and their health. Imagine the frustration of a doctor who knows the dangers of obesity, etc., and gets one obese patient after another who refuses to face her problem. So, he gets more and more graphic about the problems with their girth, trying to incite them to help themselves.

What I read into the article was that the doctor was extremely concerned about the health of his obese patients. He was trying to light a fire under them, and, apparently, went too far with this one woman.
8.24.2005 9:41pm
John Jenkins (mail):
Lawyers really care about their clients' legal well-being. Clients sometimes resist lawyers' recommendations because the lawyer tells the client something the client doesn't want to hear. The same principle is involved here. The woman heard something she didn't want to hear (you're fat and it will kill you). Even though she KNEW it (as most clients know what they want to do is or may be a bad idea when they bring it to you), she didn't want to believe it. I'm sure there are doctors actually endagnering patients' lives in New Hampshire and I wonder why this board is wasting time on this.
8.24.2005 9:53pm
Jim Rhoads (mail):
What this article illustrates is the extent to which nannification has invaded all facets of our lives. Now professionals are being chastized by their respective boards for giving what they are being paid for. Their honest (and correct) professional opinions.

Questions of tact and manner of communication have in my experience as an attorney with over 40 years of practice, been left to the professional's discretion. If a client doesn't like my manner he/she can choose not to hire me, to fire me or to let me know that they will do so if I don't change how I interact with them. Like doctors, lawyers are employed only so long as the patient/client allows that relationship to continue. Personal rapport is generally very important.

The Doctor in question was a psychiatrist. Without the general ability to establish rapport, a psychiatrist would starve, because most of their practices rely on frequent repeat visits. If they are not skilled at making a patient feel comfortable with them, one visit patients are the result.

The picture of this Doctor makes clear he is no youngster. He must have made a living in practice for quite a while. I have a hunch that this situation was an aberration that would not have made the news but for unwise chitchat from a board member or publicity from his plump patient.
8.24.2005 10:46pm
frank cross (mail):
To me, all this indicates is that if you read the answer, but not the complaint, the plaintiff's case will appear weak.
8.24.2005 10:49pm
chris (mail):

Doctor: You're overweight.

Patient: I want a second opinion.

Doctor: You're ugly too.
8.24.2005 11:20pm
Jim Rhoads (mail):
There is neither a complaint nor an answer, because there is no lawsuit. But what is there for the AG to investigate, frank?
8.24.2005 11:20pm
Assistant Village Idiot (mail):
There is no way of telling without context. The patient may have at some time indicated the importance of having a partner or a fear of lonliness, and the psychiatrist may have been attempting to use that as an entry point. On the other hand, the doctor may just have been especially tired of people denying the obvious that day and was rude to her. As I've worked in NH acute psychiatric services for 25 years, I may know this woman -- but I dare not speculate. It would be unethical to mislead others, and unethical to even obliquely identify the patient.

However, speaking in a general way, the problem is usually to find some new way to get the patient to hear. Would sharpness help? Or humor? Should I try something Socratic or Rogerian? Perhaps some paradoxical approach would help? Or should I even bother, as the patient has been told this a thousand times already? Is this my own value, and best dropped altogether?

In any event, the speech was at worst rude and insensitive. Do I get to sue all rude and insensitive people in my life?
8.24.2005 11:21pm
Jim Rhoads (mail):
In the last analysis, those of us who get paid for our advice generally get paid whether our clients/patients take our advice or not. Sometimes, we even get paid more if our clients/patients do not take our advice.

Still, we use all of our wiles to persuade those clients that our advice is correct and that they will be better off by following it than by not following it. Sometimes our advice requires our clients/patients to do unpleasant or difficult things. Often that advice is counterintuitive to the client/patient. Often it makes them angry. Still, we persist, because it is our professional duty to do so.

Enduring opposition and hostility to good advice is the somewhat like enduring a bout of chinese water torture. It feels so good when it stops. I have now earned the place in my practice where I make a simple deal with my clients: If you don't want to take my advice, find another lawyer. That simplifies my life.

I now have only six people in the world who regularly don't take my (valuable) advice without adverse consequence to them: my five adult daughters and my wife.
8.24.2005 11:44pm
Brian G (mail) (www):
Hey, why not? Next, let's sue the doctor who tells you that you have cancer. Is he not intentionally inflicting emotional distress on you? Surely it is eminently foreseeable that by telling a patient they are going to die will cause great emotional harm.
8.24.2005 11:47pm
speedwell (mail):
OK, did he lecture her before or after he found out what was making her obese? It is honestly not always a case of simple gluttony and laziness. There are diseases out there that tend to drain your energy and make you sluggish and depressed. Did the doctor know absolutely that the gal didn't have one of these diseases before he laid into her?
8.25.2005 1:40am
GG:
I knew someone who worked as a receptionist for a general practitioner. The doctor wrote on a chart that the patient was "grossly obese." The patient only saw the comment when she turned the chart over to the receptionist. Not understanding that "gross" was a medical term of art, the patient was insulted and proceded to respond in kind to the receptionist, doctor, and waiting room staff. Medical professionals may be non-judgmental in describing obesity as a medical problem but most lay people are judgmental and describe obesity as a character or aesthetic flaw.
8.25.2005 10:24am
cathyf:
I think that it is importmant to note that, according to the story, the patient didn't sue the doctor or go anywhere near the legal system. The patient made a complaint about unprofessional behavior though the procedure which the state medical board had set up to receive complaints about unprofessional behavior. It is the board that got the AG's office involved.

If this guy is a psychiatrist, and was prescribing medications for the patient which have weight gain as a listed side effect (as virtually every psychiatric drug does), then you have to wonder what other side-effects he thinks are effectively treated via haranguing his patients.

Has this doctor ever read an article in a peer-reviewed medical journal reporting on a double-blind, controlled study which shows the safety and efficacy of physician insults in treating obesity, anorexia, or any other condition? If not, what other unproven quackery does he practice? Leeches? Homeopathy? Ear candling?

cathy :-)
8.25.2005 11:19am
DK:
Um, I thought it was _normal_ for psychiatrists to discuss sex/love lives with patients, and, in some schools of psychiatry, to use confrontation as a treatment in some cases.

Note to Cathy: leeches _have_ been proven safe and effective for many conditions such as limb reattachment. And, I'd really like to see you or anyone conduct a "double-blind" study of any form of psychiatric analysis.
8.25.2005 12:28pm
NickM (mail) (www):
California used to have a section in its Business &Professions Code regulating lawyer practice that a lawyer was required to abstain from having "an offensive personality". It was eventually nullified by a court decision that it was unconstitutional as a First Amendment and Fifth Amendment due process violation (through incorporation). I would expect that any similar rule in New Hampshire that might be sought to be applied to the doctor's conduct would likewise be found unconstitutional.

Lawyers may need to cause offense to their own clients far more than doctors do. Doctors have a much easier time withdrawing from the professional representation than lawyers do if litigation has commenced, and lawyers often have their fee, or part of it, subject to successful recovery in the case.

Nick
8.25.2005 2:34pm
Amy Phillips (mail) (www):
Jim,
Where did you find information stating that the doctor was a psychiatrist? The articles I've read refer to him as a "family practice physician." A psychiatrist probably shouldn't be offering patients advice about their weight unless they're taking the time to keep up with the latest research in a specialty far removed from their practice area. If he were a psychiatrist, the comment about her love life would be more relevant (although still pretty idiotic), but I haven't been able to find any information other than your post here to say that he was anything other than her regular physician.
8.25.2005 4:01pm
Jim Rhoads (mail):
I saw an article with his picture in it, that I thought indicated that he had helped another of his patients lose weight through "therapy". From that, I inferred that he was a psychiatrist. My inference was probably unwarranted from the articles you cite. Nevertheless, I still think this is the type of stuff that should be left to the free marketplace to sort out.

Physician patient communications should not be monitored by government administrators, be they physicians or not.
8.25.2005 5:16pm