Should ANY health care agency or institution have a mass lay off based upon morpholog

[surgblumm]

This issue came up on Clinician1 yesterday and I thought it was worth sharing with this astute group and give you a new area of focused debate and perhaps get some solid feedback.

 

[h=1]Medscape: Hospital Bars Obese Providers-Ethical?[/h] Posted 16 hours, 16 minutes ago by Dave Mittman in Adolescent Care , Adult Health, Cardiology, Emergency Medicine, Family Medicine, Geriatric Medicine, Internal Medicine, Military Healthcare, Plastic Surgery and Women's Health

WOW. I am torn. I think we need to set an example. And the BMI noted for hospital action is pretty high. The military also tells people they can not be obese, even HCPs.

Seems kind of big brother though.

I would vote yes.

Dave

-------------------------------------------------

Can a Hospital Say, “Only Thin Doctors Can Work Here”?

Arthur L. Caplan, PhD

Hi. I am Art Caplan, and I am speaking to you today from the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

Today’s topic is one that I think will get everybody’s attention. To put it bluntly, should hospitals hire employees who are overweight?

A hospital in Texas, Citizens Medical Center, has said that it is not going to hire anybody—doctors, health staff, nurses—who is overweight. For them, that means a body mass index of over 35 kg/m2; or in other words, for a 5’10” man, if you weigh more than about 250 lb, you wouldn’t get hired at this particular Texas facility.

So, just like people are talking about not hiring employees who smoke at hospitals or nursing homes or clinics, this institution is the first that I know of to say, “We are not going to hire overweight people.”

Now, you might think this is illegal, but it isn’t. It turns out that there are no laws against discrimination against overweight people except in Michigan, and a few cities have passed these laws.

Maybe overweight can be treated as a disability, but you would have to go to court and fight that, and I’m not sure how it would turn out. So, if the hospital wants to try this in Texas, it probably can without violating any civil rights statutes.

What is the argument that they have for doing this? They say, “Look, if you are going to come in and counsel people about health, you need to have a staff that is slim and fit.” It is certainly the case that it is hard to have people say, “Follow what I say, don’t do what I do,” and I think they are worried that it might not be as attractive to patients to have someone tell them to lose weight who is overweight themselves.

It is also the case that overweight staff sometimes require their own special equipment and furniture, so there can be costs there, and it turns out that overweight people may be absent more just because of health-related problems. There is probably some argument that it raises healthcare insurance costs because of the problems associated with being overweight.

So, maybe there is a case here, but let’s look at the pros and cons. On the side of doing this, it may be good for patients and encourage them, maybe it will cut down the costs for the hospital, maybe it will send a message that we expect our staff to maintain good health habits themselves as part of trying to encourage it in others.

What’s on the negative side? I can think of a major problem, and that’s treating healthcare risks equally. If you want to go after overweight, then who is going to sit in the hospital parking lot and see who is speeding when they come in? Who is going to make sure that someone arriving on a motorcycle or a bicycle is wearing a helmet? Who is going to make sure that they are wearing their seatbelts when they come to work? And to take this a bit further, in Texas, who is going to make sure that they are not riding horses at home because it is dangerous; or own a gun, which turns out to be a big health risk? There are a lot of other equally risky things besides weight that doctors or nurses or healthcare staff might do, and the question is, are we going to control that?

Look, I’m all for trying to set a good example and I think there are plenty of businesses where being thin and being in shape really do matter. I guess if you run a modeling agency it is very important. But I’m not convinced, really, that putting in weight restrictions is the best idea in terms of sending out the right message or a necessary message to patients. Patients, I think, can work with their doctors to try to overcome common problems. Doctors see all kinds of patients with all kinds of habits and all kinds of lifestyles. I think patients can deal with seeing all kinds of healthcare workers with all kinds of habits and all kinds of lifestyles. If they want a thin one, they should be able to pick one, but I don’t think the hospital necessarily should have to say that only the thin ones can work here.

Thanks for watching. This is Art Caplan, and I’m at the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

 

 

Posted in:

• Ethics
  

 

 

Specialties

• Adolescent Care
  
• Adult Health
  
• Cardiology
  
• Emergency Medicine
  
• Family Medicine
  
• Geriatric Medicine
  
• Internal Medicine
  
• Military Healthcare
  
• Plastic Surgery
  
• Women's Health
  

 

 

Keywords

 

[h=2]Discussion[/h]

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1. bblumm9 hours, 13 minutes ago Wow, I think this is a big error. Yes, I fit into the obese category but am in my early sixties. If you were to discharge all of your obese physicians, anesthesiologist, surgeons, professors, Nurses, Nurses Aides or assistants, medical Assistant, Physician Assistants, Administrators and Dieticians, all of your professional technologists such as pulmonary, lab personnel, runners, security officers, etc. Who the hell would be out there providing the care. We make up the statistic of one third obese, one third overweight and one third normal. Sorry folks, it wouldn’t work. You can have a group of skinny personnel but what is the extent of their past experience? We became fat from doing double shifts in the ER and all over the place where our only food was in the machines that served chips, candy and soda. They created or at least helped create our disability.
   Bob
    
   
2. bezoar4 hours, 15 minutes ago How can I say this in the most respectably. Bull****!
    
   
3. bblumm12 minutes ago Opinions, any opinions are what thhis forum is for. Somewhere between my exegesis of thhis statement and your “bull****”, lie a correct response or solution. This just cannot be an issue concerning weight with no concern for good clinical judgement , experience and skills. How would you feel if you recieved a telegram saying;” Hey Chubby, we are getting rid of the fat and you are no longer needed?”
    
   
4. bblumm3 minutes ago Leading the News
   IOM Calls For Changes Throughout American Life To Combat Obesity.
   NBC Nightly News (5/8, story 8, 2:20, Williams) reported, “Back now with our reporting on what’s being called The Weight Of The Nation. Last night we told you about a stunning prediction that by the year 2030, health experts are telling us 42% of Americans will be obese. Today at a conference in Washington, some sweeping strategies for fighting this epidemic.”
   The AP (5/9, Neergaard) reports in a story appearing on at least 180 news sites that the Institute of Medicine released a “major new report” yesterday finding that “fighting obesity will require changes everywhere Americans live, work, play and learn.”
   USA Today (5/9, Hellmich) reports, “The goals and some of the strategies were presented...at the Centers for Disease Control and Prevention’s ‘Weight of the Nation’ meeting, where experts are discussing ideas for the prevention and control of obesity.” While “the report says there is no one answer to this problem...it’s going to require bringing all the pieces together—the schools, the workplace, health care providers, says Dan Glickman, chairman of the institute committee and former secretary of the US Department of Agriculture.”
   The Wall Street Journal (5/9, McKay, Subscription Publication) quotes Glickman as saying, “If you believe this is a massive national problem, you have to deal with it in a systems way.” He added, “This problem is incapable of being solved with a magic bullet.”
   The Boston Globe (5/9, Kotz) “Daily Dose” blog reports, “The panel of 16 experts—a mixture of lawyers, health policy makers, health care executives and obesity researchers—sorted through 800 previously published recommendations for obesity prevention, examining the latest evidence for each of them and whether it was strong enough to fold into...five main goals.”
   The Los Angeles Times (5/9, Healy) “Booster Shots” blog reports, “The panel recommended that schools position themselves as gateways to obesity prevention, ensuring that children get at least an hour of physical activity daily, barring access to foods and beverages high in calories, and offering all students healthful, nutritious foods and instruction in the fundamentals of healthful eating and living.” Additionally, “workplaces and health insurers should ‘increase the support structure’ for obesity prevention, diagnosis and treatment and for encouraging healthful behaviors such as regular exercise, healthful eating and breast-feeding for new mothers.” Meanwhile, “Congress should support the Obama administration’s proposed funding increase for the school lunch program and join with federal officials in setting aside ‘substantial funding’ for a ‘sustained and robust social marketing program on physical activity and nutrition,’ the report said.”
   The Hill (5/9, Viebeck) “Healthwatch” blog reports, “The changes are aimed at a complete overhaul of the United States’ ‘obesogenic’ environment, the panel wrote.”
   Reuters (5/9, Begley) reports in a story appearing on at least 50 news sites that the IOM found that obesity is not the result of individual choice or lack of willpower, and that societal change is necessary to reduce it. One member of the IOM is quoted saying that the environment promotes obesity. Also covering the story are WebMD (5/9, DeNoon), Medscape (5/9, MacReady), MedPage Today (5/9, Fiore), and HealthDay (5/9, Preidt). :;DD:
    
    
   

[marilynpac]

It's a clear cut case of discrimination.....weight gain can be due to many reasons....

[surgblumm]

Great answer and I am surprised that those that support thhis new rule have not come to this decision.

weight gain can be from many medications including insulin. Inability to exercise mat come from Cardio-pulmonary causes as well as from musculuar skelatal problems. Endocrine problems such as those that relate to hypothroidism can be causitive and pelvic floor adhesions in females who have had GYN surgeries or endometriosis can be a part of this almost never ending differential diagnosis. What ever happened to the fact that obesity is also a medical problem and a psychological problem and needs to be approached by a two tong measure. People eat when stress just as they drink ETOH, take designer or street drugs or decide and going out to live their fantasies such as shooting their administrators. We are health care professionals and are pledged to care for those in our sphere of influence, not fire them.

 

bob

[mdebord]

A few quick thoughts:

I am from Victoria and so have a peripheral knowledge of Citizens, although I don't work there.

I do not agree with this decision, mostly because I see it as discrimination.

Interestingly enough, they are consistently a top-rated hospital. It's one thing to go public with this now, but when push comes to shove, I'm wondering if they would really pass up a more highly-qualified specialist over something like BMI.

Also, for clarity sake, there is no layoff. Current employees are to be grandfathered in.

[JoelleK]

Total discrimination.... but I also have a question maybe one of y'all can answer - couldn't someone have a BMI 35 or greater and still be healthy as in a case of someone who is not very tall but has large muscle mass (i.e. a 5'4" body builder)?

[EMEDPA]

the issue at hand aside it's hard to be "healthy" at a bmi of 35. that's almost morbidly obese.

I'm athletic and on the thin side but I could gain 100 lbs and still meet their requirements although at that weight there is no way I would consider myself healthy.

in the example above 5'4" bmi 35 = 205. no way that guy is healthy. he would be a square.

[mackjacks]

he would be a square.

 

He might not be "in" shape, but he'd be a shape!

[EMEDPA]

He might not be "in" shape, but he'd be a shape!

EXACTLY, round is a shape....

[kargiver]

Interesting... Texas is tied for 5th as most obese state in the country. Its neighbors aren't much better. From where will they draw their application pool?

 

Also, its only a matter of time before this becomes a law case for discrimination. We have made obesity into a medical condition. Ask anyone who has had a gastric bypass. Agree with the previous poster... the lawyers are drooling.

 

G

[physasst]

Depends, if it's a private, for profit healthcare institution, than they should be able to hire whoever they want.

 

For example, I am aware of many hospitals who do not hire smokers, including Cleveland Clinic. In fact, they test your urine to make sure you are not a smoker....

 

We discussed this not long ago on here. This has nothing to do with setting an example for patients. It's money. It's all about money. Obese employees be they physicians or nurses or janitors or whoever, cost the hospital more in health insurance, absenteeism, lost wages, lost productivity, and disability.

 

I predict that this will eventually spread to other companies and industries too.

 

As long as the hospital is private, I have no issues with them hiring who they want.

 

There was just a thread about this topic on here a few weeks ago.