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Doc Biases Hinder Patient-Provider Communication, Outcomes

Research suggests that doctor biases, or "medical fat shaming," can impair patient-provider communications, patient access, and thus clinical outcomes.

Doctor bias impairs patient-provider communication and clinical outcomes.

Source: Thinkstock

By Sara Heath

- Physician biases and disrespectful patient-provider communications have been linked to tangible, negative clinical outcomes, according to new research.

Presented at the 125th Annual Convention of the American Psychological Association (APA), researchers examined the effects of patient-provider encounters during which the provider was disrespectful or overly judgmental about the patient’s weight.

Dubbing the practice “medical fat shaming,” Connecticut College researcher Joan Chrisler, PhD, said that some providers offer harsh judgments toward patients in an effort to drive patient motivation. Although potentially good-intentioned, this strategy usually does more harm than good.

“Disrespectful treatment and medical fat shaming, in an attempt to motivate people to change their behavior, is stressful and can cause patients to delay health care seeking or avoid interacting with providers,” Chrisler said during her presentation, according to an announcement from the APA.

Providers may be acting on implicit biases about patients who are overweight or obese, Chrisler added. These biases can cause an undue strain on the patient-provider relationship and lead to more patient stress, ultimately hindering the patient’s journey to better health.

READ MORE: Patient EHR Note Input Boosts Patient-Provider Communication

“Implicit attitudes might be experienced by patients as microaggressions — for example, a provider’s apparent reluctance to touch a fat patient, or a headshake, wince or ‘tsk’ while noting the patient’s weight in the chart,” Chrisler said. “Microaggressions are stressful over time and can contribute to the felt experience of stigmatization.”

However, this issue moves beyond patient perceptions of the doctor-patient relationship – although not to discredit the importance of physician respect. Rather, Chrisler’s findings show that physician biases about patients who are overweight or obese can get in the way of a quality clinical diagnosis.

Chrisler conducted a literature review of the clinical impacts that physicians’ viewpoints about overweight or obese patients may have. These impacts run the gamut of prescribing incorrect medication dosages for patients to misdiagnoses due to preconceived notions about health and nutrition.

Many drug clinical trials exclude overweight or obese patients from participating because researchers have prejudices about what a patient’s weight says about her overall health and wellness. This leads to an implicit bias in medication dosages. Because the drug was tested on a population of patients within a certain average weight, standard dosages may be too weak for a patient, Chrisler found.

In other studies, Chrisler observed physicians misdiagnosing patients due to their weight. Many clinicians will assume that the patient’s weight is the root cause of all medical issues and not perform necessary tests that other patients would otherwise undergo.

READ MORE: Patient-Provider Communication Key to Wellness Improvement

“Recommending different treatments for patients with the same condition based on their weight is unethical and a form of malpractice,” Chrisler said. “Research has shown that doctors repeatedly advise weight loss for fat patients while recommending CAT scans, blood work or physical therapy for other, average weight patients.”

In one study Chrisler consulted, researchers found that overweight or obese patients were 1.65 times as likely to have an underlying, major illness. In many cases, these illnesses were overlooked because clinicians acted upon an implicit bias about overall patient health and wellness.

Maureen McHugh, PhD, echoed Chrisler’s sentiments during her own presentation at the APA conference. “Medical fat shaming” is not an effective strategy for driving patient behavior change and is an ill-suited tool for patient motivation, she argued.

“Rather, stigmatization of obese individuals poses serious risks to their psychological health,” McHugh said. “Research demonstrates that weight stigma leads to psychological stress, which can lead to poor physical and psychological health outcomes for obese people.”

Chrisler and McHugh both concluded their presentations by calling on the medical profession to continue to address the potential effects that negative attitudes about wellness and weight may have on clinical outcomes.

READ MORE: Patient Satisfaction and HCAHPS: What It Means for Providers

Patient motivation for health behavior change is admittedly a careful art that is difficult to develop. Some research has dabbled in the area and found a handful of potential strategies for patient motivation.

A HealthMine survey from 2016 found that wellness programs run by health plans or employers can be effective in driving patient motivation. These wellness programs usually offer rewards for patients who meet health benchmarks, such as exercising for a certain amount of time each day or following a smoking cessation program.

The rewards aspect of these programs helps maintain patient enrollment and participation.

Another 2017 study published in the Journal of Medical Internet Research showed that tailored and personalized behavior change plans are better at driving patient motivation than more generic programs. Understanding the patient’s health needs, history, preferences, and personality can help providers understand how they can motivate that singular individual, driving more success.

However, as McHugh and Chrisler found, it is important for providers to embed all patient encounters with respect. Clinicians can ensure that they are treating the correct disease by implicitly respecting their patients’ needs and by ridding themselves of any biases.

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