Last year, the State Volunteer Mutual Insurance Company highlighted the increased risk of litigation against physicians caring for overweight or obese adults, children and adolescents. The epidemic of overweight and obesity will significantly impact the healthcare industry in the next few decades. Potential complications of obesity affect nearly every system of the body and common complications include hypertension, type 2 diabetes, obstructive sleep apnea, depression and polycystic ovarian disease. While complications may not manifest until adulthood, they can begin in childhood.

Whether children or adults, if the primary care physician has not dealt with obesity issues in a patient and the patient has an adverse outcome due to known complications, the physician might be liable.

Steps physicians can take to help the patient and protect the doctor:

• Obtain the patient’s BMI (or percentile BMI for pediatric patients).

• Document that an elevated BMI was interpreted (obesity vs. muscularity) and health risks discussed.

• Document that the patient (or patient’s family) was approached about their readiness to make a change. If not ready, emphasize the risks associated with high BMI and schedule a return visit for future discussions.

• Advice a program of exercise, diet and lifestyle change. Document and arrange follow up for program.

• If complications are identified or likely, document the steps taken to deal with the complications including referrals to specialists.

• Document the referral appointments were made and establish that patient went to referral.

• Establish a list of resources including dieticians, exercise programs, lifestyle counselors, or clinics and physicians specializing in obesity or the complications of obesity.

• Have educational handouts and directions for locations of reliable information including Web sites that deal with the various aspects of obesity and document giving this information to the patient.

• Obese surgical candidates need detailed information consent, and attention to anesthesia, post-operative recovery and wound healing.

Source: Thombs, D. Risk Points, 2006; Volume 5, Issue 3, 2-3




November 2007

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