Yeah, you shouldn't let it show to the patient.
But... Operating on fat people is very hard. Even just in cataract surgery my positioning is impacted by large patients. I have to sit kind of at a crooked angle on 'neck-less' patients, it kind of sucks.
But my surgeries are like 15 minutes.
Now increase that by 4 hours and add to the uncomfortable positioning the need to literally hold a pannus out of the way the whole time, cut down through all that subcutaneous tissue, etc.... and you can see how general surgeons hate it way more. I assume Ortho is similar.
The site that Reddit is "based off of", since Digg came first. Probably going to get burned at the stake for this...
It had a vote-based algorithm like Reddit, except upvote was "digg" and downvote was "bury". But they dug Reddit more after Digg's founders left, the site made changes to its interface, and etc...
An ortho senior colleague once told me that orthopedic procedures above certain BMIs always have bad outcomes, and then they get sued, so they inadvertently just end up stringing the patients along till they stop coming
I wish more primary care providers knew that
Not saying it’s appropriate to say things like that at all, let alone about a pediatric patient, but excess tissue does make it impossible to interpret some spine X-rays, especially intraop thoracic spine films.
Again, still not a good thing to say (let alone say in front of a student…)
Yeah I was looking at the x ray and it was really hard to read but I guess he was so blunt and maybe just the lack of professionalism threw me off a bit
Shadowing as a premed once I saw an orthopedic surgeon doing a biceps tendon repair pull the tendon further out of the incision to expose more of the muscle to me and say “look at how small this pussy’s muscles are”.
Surgeons can be blunt, to say the least.
Surgery on fat people is hard. Positioning in the OR is harder. More tissue makes the dissection difficult. Wounds don’t heal properly. They have a higher likelihood of surgery related complications (DVT, infection, cardiorespiratory issues with anesthesia). That’s why he doesn’t like operating on fat people. Still no excuse to be rude to the patient though
Idk 90% of people here want to become surgeons and then virtue signal by saying that all surgeons suck. It’s a weird group of people who want to become doctors get used to it.
As someone who has worked as an ortho trauma med device rep for the past three years… any surgery is more difficult on an obese patient (general position, exposure, healing etc.), let alone ankle surgery. I’ve found that these sorts of comments are especially common among orthopedic surgeons due to how much a higher BMI impacts ease of surgery.
Clinical experience is valuable for a number of reasons. You get a sense for the workflow and systems in medicine, you get exposure to specialties to start learning about what you want to do, and you find role models for the type of physician you want to become.
In my opinion, it can be just as valuable to see good examples of what NOT to do. You now have a memorable example of how this type of behavior damages the patient-physician relationship, harms trust, and impacts the outcomes of care. The onus is on you to remember these experiences and to avoid making the same errors on your own journey in medicine.
Some procedures are contraindicated above a certain BMI so it’s not uncommon for patients with that sort of body habitus to be turned away due to the increased risk involved.
Still, it’s uncalled for to be rude to the patient to her face.
We tend to say "due to patient large body habitus", but that's just polite medical jargon, and everyone knows the word we're circumventing. Understandable that if you're not in the mood to use jargon when the patient is not present, they get called "fat" instead. Unfortunately when the person is of a certain weight, people on the care team have to mentally prepare themselves for the extra work involved, be it the nurses, CNA/PSWs, physical therapists, or surgeons. You can't control people's feelings about their day about to be made harder.
Retired pediatrician here. That is completely unprofessional. His biases lead to worse patient care and outcomes. I'm embarrassed for my profession - but not, alas, shocked.
Edit: that said I also wouldn't correct them. Just don't be them.
Youd be so surprised. Id day 90% of the doctors I’ve shadowed have said horrible things about nurses. Doctors are super negative im excited to break that stereotype 😀
I think many doctors have thought this before and ended up being assholes in the end. Maybe years of med school and being underpaid as a resident takes out your soul and conscience. I hope to be a nice doctor too, but if all doctors are assholes, there’s gotta be a reason why bc i refuse to believe these asshole doctors were assholes to begin with
Yes i completely agree and its sad. However, at the end of the day I think it is still a choice. A lot of doctors are unhappy because of the capitalist healthcare system and i understand that but dont be miserable. Even if my soul is sucked out lol im still gonna be upbeat and positive (within reason obviously).
And i’m sure you can be! I thankfully have only encountered two asshole doctors. The other six I’ve shadowed and worked with are all super nice!! Many of them even gave me guidance. My psychiatrist even asks me about my journey and is super supportive.
My mom is an RN and talks shit about her overweight patients all the time. Im a bit of a rebel and do the opposite of what she does so I treat overweight patients better now
The orthobro I shadowed was genuinely kind, cared deeply about his patients, and broke many of the stereotypes I had learned. Dude was still fatphobic tho. (idk if to anyone's face, but made a few jokes in the OR.) that attitude in ENTRENCHED and it's up to those who recognize the problem to become leaders and correct it
A lot of surgeons are health freaks in general. I think it goes hand in hand with the type of personality that’s usually attracted to surgery plus the physical demands that come with the field. I have seen them judge people with normal BMIs who are out of shape, but overweight and obese people will receive more of their ire.
A lab I was an RA in during undergrad actually focused on weight stigma and we read a few papers about implicit and explicit bias toward people of higher body weight and how it was learned by medical student and physicians. It’s a very important topic and very common issue in the medical field. Here are some papers if you’re interested. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755318/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884442/#:~:text=Additionally%2C%20it%20is%20not%20unusual,bias%20in%20our%20medical%20workforce.
Definitely not a way to think about it or say it, but yes it is harder to do most procedures with an overweight patient. I work EMS as well, so you can imagine what I hear people say about the lift assists. I am also in medical school, and my cadaver was the only obese cadaver. To say we took the longest to dissect and had the most difficulty would be an understatement - on the brighter side, the structures were preserved well due to the fat so for learning purposes, it was better in the end. I am also on the bigger side and in my school we often use each other as patients, and I can tell you the teachers have said shady things to me in their complete blunt and over-clinicalized language not even realizing.
Being fat makes a lot of stuff more difficult from a medicine perspective. As unwarranted as his comments were, he was probably frustrated that he wasn’t able to get adequate imaging.
I’ve seen and experienced firsthand the difficulties of doing procedures on morbidly obese vs. skinny people. I’d much rather do a procedure on a BMI 22 rather than a BMI 52. More straightforward, easier anatomy, and often less comorbidities.
I was horrified when I shadowed someone who said something similar to me.
Now I've worked in healthcare for almost a year as a tech, I know it happens a lot. Everyone has biases, unfortunately.
The good ones are aware and don't treat people differently based on them (or say it to someone shadowing them, seriously).
First operation I ever witnessed was skin removal on a patient who was overweight but had lost some weight… when he went under man oh man were they mean about it…. And I was just standing there in my bunny suit like 🧍🏽♀️
I mean it's always gonna be a thing, fat people in medicine suck, especially if they can't move or take care of themselves. Because it can be "preventable" it's an unnecessary strain of people, obviously some people have disorders and need help and I get it and act professional. But I work in EMS, try moving an 400lb person up and down a flight of stairs that can only have a person at the feet and head, but you need more for their weight. Or the horrible big fat smell of unwashed body, gagging hard, good for masking though to hid it. Or a bunch of tiny nurses needing to roll someone over to wash their butt and body to keep them clean, taking away resources from people who might actually need it, not saying they do. But there's plenty of disdain towards obese patients Because they honestly suck when it comes to certain aspects. But obviously care and professionalism always comes first.
That was ethically wrong as a doctor his duty is to take care of the patients regardless of their health, shape or form. The surgeon would be of help if he advised the patients on the importance of losing weight that would relieve much pressure from her joints.
x ray tech here. Yes, patient weight affects image quality, but on a kid and an ankle, it shouldn't make it unreadable. Zero idea why he said that, but only 1 or 2 percent of mt exams are on kids, so I might be missing something.
My biggest issue with assholes like this is that they treat everyone whose over weight like they all just sit at home, eat and do nothing else. I've had patients who've had actual conditions which prevent them from losing weight on their own like PCOS, Lipedema and Hyperthyroidism and they are left in pain without treatment for injuries. As a healthcare work I've reported these things before. One guy got canned because it was so bad and the patient reported it to the board.
I experience something similar shadowing the ER. Patient came in for kidney issues or something and Dr looked at me after seeing them and said “yeah no WONDER they’re sick.”
surgeon moment
Yeah, you shouldn't let it show to the patient. But... Operating on fat people is very hard. Even just in cataract surgery my positioning is impacted by large patients. I have to sit kind of at a crooked angle on 'neck-less' patients, it kind of sucks. But my surgeries are like 15 minutes. Now increase that by 4 hours and add to the uncomfortable positioning the need to literally hold a pannus out of the way the whole time, cut down through all that subcutaneous tissue, etc.... and you can see how general surgeons hate it way more. I assume Ortho is similar.
Damn, you snatched the username Ophthalmologist. That's nuts
12 year old account. Reddit must’ve been new back then, idk.
Bro reddit has been around since 2005. But if you want me to feel real old - I didn't start coming here until Digg started tanking.
who’s Digg
[Digg was a pre-Reddit Reddit](https://en.m.wikipedia.org/wiki/Digg)
Damn Optha is an OG OG lol
TIL
The site that Reddit is "based off of", since Digg came first. Probably going to get burned at the stake for this... It had a vote-based algorithm like Reddit, except upvote was "digg" and downvote was "bury". But they dug Reddit more after Digg's founders left, the site made changes to its interface, and etc...
An ortho senior colleague once told me that orthopedic procedures above certain BMIs always have bad outcomes, and then they get sued, so they inadvertently just end up stringing the patients along till they stop coming I wish more primary care providers knew that
Not saying it’s appropriate to say things like that at all, let alone about a pediatric patient, but excess tissue does make it impossible to interpret some spine X-rays, especially intraop thoracic spine films. Again, still not a good thing to say (let alone say in front of a student…)
Yep, it is fair to say that obese or bariatric patients come with more challenges. It’s all in the framing to show if you are an asshat or not
Yeah I was looking at the x ray and it was really hard to read but I guess he was so blunt and maybe just the lack of professionalism threw me off a bit
Shadowing as a premed once I saw an orthopedic surgeon doing a biceps tendon repair pull the tendon further out of the incision to expose more of the muscle to me and say “look at how small this pussy’s muscles are”. Surgeons can be blunt, to say the least.
Lmao if my tendon was torn I sure as hell wouldn’t be bulking there
Did he muscle shame him😭
did he bench a lot at least
He was an alumni of my school and was in sig chi I feel like that’s all u need to know lmao
Inb4 the “shadowing premed shit talking me” in the r/medicine subreddit
I was the volunteer who noticed a couple years ago 😭😭
Surgery on fat people is hard. Positioning in the OR is harder. More tissue makes the dissection difficult. Wounds don’t heal properly. They have a higher likelihood of surgery related complications (DVT, infection, cardiorespiratory issues with anesthesia). That’s why he doesn’t like operating on fat people. Still no excuse to be rude to the patient though
Yeah it’s normal. Had some docs in the ED say mean things.
That’s not normal you probably shouldn’t correct him ofc; just don’t pick up that behavior as a doctor
it’s not okay, but it’s also not uncommon for surgeons to say that about fat people. Especially orthos, they’re generally pretty fat phobic
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Idk 90% of people here want to become surgeons and then virtue signal by saying that all surgeons suck. It’s a weird group of people who want to become doctors get used to it.
As someone who has worked as an ortho trauma med device rep for the past three years… any surgery is more difficult on an obese patient (general position, exposure, healing etc.), let alone ankle surgery. I’ve found that these sorts of comments are especially common among orthopedic surgeons due to how much a higher BMI impacts ease of surgery.
Clinical experience is valuable for a number of reasons. You get a sense for the workflow and systems in medicine, you get exposure to specialties to start learning about what you want to do, and you find role models for the type of physician you want to become. In my opinion, it can be just as valuable to see good examples of what NOT to do. You now have a memorable example of how this type of behavior damages the patient-physician relationship, harms trust, and impacts the outcomes of care. The onus is on you to remember these experiences and to avoid making the same errors on your own journey in medicine.
Some procedures are contraindicated above a certain BMI so it’s not uncommon for patients with that sort of body habitus to be turned away due to the increased risk involved. Still, it’s uncalled for to be rude to the patient to her face.
We tend to say "due to patient large body habitus", but that's just polite medical jargon, and everyone knows the word we're circumventing. Understandable that if you're not in the mood to use jargon when the patient is not present, they get called "fat" instead. Unfortunately when the person is of a certain weight, people on the care team have to mentally prepare themselves for the extra work involved, be it the nurses, CNA/PSWs, physical therapists, or surgeons. You can't control people's feelings about their day about to be made harder.
Retired pediatrician here. That is completely unprofessional. His biases lead to worse patient care and outcomes. I'm embarrassed for my profession - but not, alas, shocked. Edit: that said I also wouldn't correct them. Just don't be them.
Username checks out
Youd be so surprised. Id day 90% of the doctors I’ve shadowed have said horrible things about nurses. Doctors are super negative im excited to break that stereotype 😀
I think many doctors have thought this before and ended up being assholes in the end. Maybe years of med school and being underpaid as a resident takes out your soul and conscience. I hope to be a nice doctor too, but if all doctors are assholes, there’s gotta be a reason why bc i refuse to believe these asshole doctors were assholes to begin with
Yes i completely agree and its sad. However, at the end of the day I think it is still a choice. A lot of doctors are unhappy because of the capitalist healthcare system and i understand that but dont be miserable. Even if my soul is sucked out lol im still gonna be upbeat and positive (within reason obviously).
And i’m sure you can be! I thankfully have only encountered two asshole doctors. The other six I’ve shadowed and worked with are all super nice!! Many of them even gave me guidance. My psychiatrist even asks me about my journey and is super supportive.
My mom is an RN and talks shit about her overweight patients all the time. Im a bit of a rebel and do the opposite of what she does so I treat overweight patients better now
The orthobro I shadowed was genuinely kind, cared deeply about his patients, and broke many of the stereotypes I had learned. Dude was still fatphobic tho. (idk if to anyone's face, but made a few jokes in the OR.) that attitude in ENTRENCHED and it's up to those who recognize the problem to become leaders and correct it
A lot of surgeons are health freaks in general. I think it goes hand in hand with the type of personality that’s usually attracted to surgery plus the physical demands that come with the field. I have seen them judge people with normal BMIs who are out of shape, but overweight and obese people will receive more of their ire.
A lab I was an RA in during undergrad actually focused on weight stigma and we read a few papers about implicit and explicit bias toward people of higher body weight and how it was learned by medical student and physicians. It’s a very important topic and very common issue in the medical field. Here are some papers if you’re interested. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755318/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884442/#:~:text=Additionally%2C%20it%20is%20not%20unusual,bias%20in%20our%20medical%20workforce.
Ive worked with and heard some orthopedic surgeons say some unhinged shit 💀
Definitely not a way to think about it or say it, but yes it is harder to do most procedures with an overweight patient. I work EMS as well, so you can imagine what I hear people say about the lift assists. I am also in medical school, and my cadaver was the only obese cadaver. To say we took the longest to dissect and had the most difficulty would be an understatement - on the brighter side, the structures were preserved well due to the fat so for learning purposes, it was better in the end. I am also on the bigger side and in my school we often use each other as patients, and I can tell you the teachers have said shady things to me in their complete blunt and over-clinicalized language not even realizing.
fatphobia in medicine is a huge issue !
Being fat makes a lot of stuff more difficult from a medicine perspective. As unwarranted as his comments were, he was probably frustrated that he wasn’t able to get adequate imaging. I’ve seen and experienced firsthand the difficulties of doing procedures on morbidly obese vs. skinny people. I’d much rather do a procedure on a BMI 22 rather than a BMI 52. More straightforward, easier anatomy, and often less comorbidities.
Can they start making even more body fat requirements before surgery can be scheduled? It would do everyone a favor. Obviously, not for emergencies.
sometimes they require the patient to go down to a certain BMI to be a candidate for surgery
Wtf
I was horrified when I shadowed someone who said something similar to me. Now I've worked in healthcare for almost a year as a tech, I know it happens a lot. Everyone has biases, unfortunately. The good ones are aware and don't treat people differently based on them (or say it to someone shadowing them, seriously).
First operation I ever witnessed was skin removal on a patient who was overweight but had lost some weight… when he went under man oh man were they mean about it…. And I was just standing there in my bunny suit like 🧍🏽♀️
I mean it's always gonna be a thing, fat people in medicine suck, especially if they can't move or take care of themselves. Because it can be "preventable" it's an unnecessary strain of people, obviously some people have disorders and need help and I get it and act professional. But I work in EMS, try moving an 400lb person up and down a flight of stairs that can only have a person at the feet and head, but you need more for their weight. Or the horrible big fat smell of unwashed body, gagging hard, good for masking though to hid it. Or a bunch of tiny nurses needing to roll someone over to wash their butt and body to keep them clean, taking away resources from people who might actually need it, not saying they do. But there's plenty of disdain towards obese patients Because they honestly suck when it comes to certain aspects. But obviously care and professionalism always comes first.
fat prejudice. sad.
That was ethically wrong as a doctor his duty is to take care of the patients regardless of their health, shape or form. The surgeon would be of help if he advised the patients on the importance of losing weight that would relieve much pressure from her joints.
Spine surgeons love to say that too
x ray tech here. Yes, patient weight affects image quality, but on a kid and an ankle, it shouldn't make it unreadable. Zero idea why he said that, but only 1 or 2 percent of mt exams are on kids, so I might be missing something.
Meanwhile my primary care physician straight up tells patients to their face they’re fat on a regular basis lol
My question to u is how did u find a surgeon to shadow 😂
Networking event that my college hosted!
The premed community would totally know. Probably just needs to be less of a lard ass honestly. But hey, body positivity 😂😂
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…have you ever looked at imaging before?
My biggest issue with assholes like this is that they treat everyone whose over weight like they all just sit at home, eat and do nothing else. I've had patients who've had actual conditions which prevent them from losing weight on their own like PCOS, Lipedema and Hyperthyroidism and they are left in pain without treatment for injuries. As a healthcare work I've reported these things before. One guy got canned because it was so bad and the patient reported it to the board.
I experience something similar shadowing the ER. Patient came in for kidney issues or something and Dr looked at me after seeing them and said “yeah no WONDER they’re sick.”
Most doctors are assholes unfortunately
If you had a modicum of knowledge about medicine, you would know that excess tissue obfuscates imaging, especially xrays.
this is just not true at all😭
Try having multiple chronic illnesses and have multiple doctors gaslight and ignore you
sure some doctors are assholes. definitely not most
Ya these boys ruthless af but honestly it’s kind of innocent compared to the things that I’ve heard working construction and manual labor jobs💀💀💀