If you continue without changing your settings, we’ll assume you’re happy to receive all cookies from the BMA website. Find out more about cookies
When you visit any web site, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalised web experience.
Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.
These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms.
You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.
These cookies are required
These cookies allow us to know which pages are the most and least popular and see how visitors move around the site. All information we collect is anonymous unless you actively provide personal information to us.
If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.
These cookies allow a website to remember choices you make (such as your user name, language or the region you're in) and tailor the website to provide enhanced features and content for you.
For example, they can be used to remember certain log-in details, changes you've made to text size, font and other parts of pages that you can customise. They may also be used to provide services you've asked for such as watching a video or commenting on a blog. These cookies may be used to ensure that all our services and communications are relevant to you. The information these cookies collect cannot track your browsing activity on other websites.
Without these cookies, a website cannot remember choices you've previously made or personalise your browsing experience meaning you would have to reset these for every visit. In addition, some functionality may not be available if this category is switched off.
Our websites sometimes integrate with other companies’ sites. For example, we integrate with social networking sites such as Twitter and Facebook, to make it easier for you to share what you have read. These sites place their own cookies on your browser as a result of us including their icons and ‘like’ or ‘share’ buttons on our sites.
Recently I looked after a patient who, I’m afraid to say, was sometimes referred to by the ward staff simply as ‘the bariatric patient’.
He was certainly a man with a very significant body mass index, and it had left him with multiple problems. On top of his heart failure, joint pains and breathing difficulties, he was unfortunate enough to have developed infective diarrhoea.
As the bariatric bed wouldn’t fit in a side room, he had what was normally a six bed bay all to himself. Someone had put up a screen at the end to give some privacy. He was stranded in the middle of the emptied-out space, propped up awkwardly on the bed he couldn’t move from.
Almost every aspect of this patient’s care was complicated by his size. Getting intravenous access was a recurring battle. A prescription for therapeutic clexane necessitated a referral to haematology for specialist advice on the appropriate dose. He needed a CT scan, but the machine in the hospital wouldn’t support his weight. Over coffee there was a discussion about the veracity of reports that provision was sometimes made for scanning these patients at the zoo. The ignominy is unimaginable.
Unfortunately, a few days into his admission the patient’s condition took a turn for the worse, and he went into type two respiratory failure. A sequence of increasingly senior doctors attempted to get a blood gas sample. He needed an urgent chest x-ray and I was told to ensure the radiographers knew he was a bariatric patient. 'We can do a portable then, but it depends how many staff you have available,' was the response.
A multidisciplinary team of nurses, doctors and auxiliaries was duly assembled to manoeuvre him into the required position. Due to the extra high dose of radiation needed, half of the patients in the neighbouring bay had to be removed into the corridor.
Through all this the patient’s teenage daughter had been hovering around the bed, looking bewildered and upset. I found her a chair and a cup of tea, and tried to seem unfazed, as if all this was perfectly normal practice.
The patient was started on non-invasive ventilation, and against the odds he responded well. The next day he was more alert and able to start weaning off the machine. In the midst of everything that was happening to him, he noticed that one of the nurses had had her hair done, and complimented her on it. His humanity shone through in this potentially dehumanising situation. I only hope that ours did too.
Compassionate care is mostly about how you are treated by the human beings looking after you, but systems have a part to play too. At least in the hospital where I work, the lack of provision in the system for the particular needs of these patients makes it more difficult to care for them with the same respect and dignity afforded everyone else. With current population trends in obesity, it’s only going to be an increasing problem.
Have you found yourself in a similar situation? Use the comments section below
all too common - whilst trying to work around logistics, the fixes mean loss of dignity or personal care. I'm still dreading the day I have to use a commode behind a paper curtain, nevermind a succession of people trying to desperately get a blood gas from my groin....
There are at least a proportion of morbidly obese patients who have endured childhood abuse, and their over-eating is a psychological reaction to that. Unless we have lived through what they have, we should not be judgemental or feel superior.
Thanks for a thoughtful article.