Over 600 bariatric patients were asked, “In thinking about how doctors treat their weight loss surgery patients, what do you wish your doctor would have done differently?” Their responses reveal that we have many opportunities for improvement, and little details make all the difference.

Physician Sensitivity is Critical to Patient Satisfaction

The bariatric population is a special one; after years of being exposed to stigma and discrimination, many patients are emotionally raw and sensitive. As a physician, if your goal is to achieve the best outcome for your patients and your practice, try implementing these small steps to make sure your patients feel comfortable.

Choose your words carefully.

Bariatric clients are especially sensitive to language. After enduring years of jokes and jabs, they critically analyze conversations for hints of negativity or judgment. Therefore, how you word a statement may make the difference between bonding with a patient or pushing them away. Choose descriptors and adjectives that have a more positive connotation; avoid anything that has a negative thrust. For example, describe something as “oversized” or “extended” as opposed to “giant” or “huge.”

Select credible and approachable staff.

A young, attractive, super-slim nutritionist who has never had a weight problem will be viewed as less credible than an experienced staff member who can share real life experience and advice for dealing with the challenges of weight loss. Most bariatric patients report feeling comfortable when there is at least one person who works in the office who is also overweight.

Communicate clearly.

Meet new patients in your office first, then take them to the exam room. Look your patients in the eye. Talk carefully about their health history and ask questions empathetically. Offer to answer any questions and ask if there is anything they do not understand. Often, a little encouragement will give your patients the confidence they need to ask questions they have. One WLS patient explained, “My surgeon sketched a picture for me of what exactly he was going to do. I know I had previously seen diagrams of the pouch, etc. … but it really helped me to understand visually as he was explaining things.”

Have appropriate and comfortable equipment.

Furniture for bariatric patients should be solid, sturdy, comfortably-sized, and safe. Select equipment and office tools that are appropriate for this population for every area of your office your patients will go. One bariatric patient wrote: “Did you know that I purchased my own weight extender for the standard bar slide scale that most doctors use. The cost? Around $60. Even if I’m your only ‘oversized’ patient, isn’t my health and well-being worth $60 to you?”

Develop scale sensitivity.

Invest in a bariatric scale or equipment that allows your scale to accommodate overweight patients, weigh the patients in a private area, and never, ever yell out a patient’s weight to other office staff members. A recent WLS post-op wrote: “Scale sensitivity would be a plus not just for bariatric offices but for all offices. Last week I got on the scale and the nurse yelled out, ‘225 pounds.’ I teach in a small town and one of my students was in the waiting room, so now all my students know how much I weigh. Just weigh me and write it down in the chart, thank you.”

Don’t send mixed messages.

You can’t get away with saying “I really care about your difficulties with weight and I know how hard it is for you” when you have posters of nearly-perfect models all over the place. Make sure your staff, office décor, and imagery reflect caring and consideration. Case in point: a bariatric client went to a physician’s office and reported the following: “When I went to my doctor’s office I already felt like a cow. I looked around and saw all California beach blonde types. This made me know they had no clue; they had no idea what I had experienced, and I felt fatter and more uncomfortable.”

Train your staff to do the same.

As you are not likely to be the first person your patients encounter, your entire office needs to be trained to be sensitive in the ways described. Most patients report that their first impression of a physician came from his or her receptionist. Therefore, we must make sure everyone in our offices understands that every patient is our concern, that no patient should be ridiculed or treated as unimportant.

I remember clearly the day that one of my office staff members told me about Warren Kushnick. He had already obtained his insurance authorization for gastric bypass surgery at another facility. He was continuing to research where to have his surgery since he was told that he was high-risk and he felt the other facility was “taking their time” with scheduling his surgery.

After talking with my staff and attending a lecture, Warren had decided to have his surgery with us.  While reviewing his health questionnaire, I learned that Warren was 63-years-old, weighed 365 pounds, had severe sleep apnea, hypertension, and chronic heart rhythm problems secondary to coronary artery disease for which he had open heart surgery and bypass grafting. Wow! I had to admit, to undertake a laparoscopic gastric bypass on a patient who brings all this to the table (literally), was more than a little concerning to me.

After meeting Warren and his wife in consult, there was nothing, within my best medical judgement, that was going to prevent me from performing his surgery. Why? Simple – Warren reminded me so much of my own father who had struggled with obesity for years.

Growing Up With Obesity

My Father, Jack Nease

My father was a Judo Instructor in the military and in relatively good physical condition. I remember him lifting weights routinely. Five years after he was discharged from the Army, he began to gain weight quite rapidly. This is where genetics, lack of exercise and good home cooking come into play. At the age of 36, he developed Rheumatoid Arthritis, and was placed on steroids, another weight gain factor, along with many other types of medications for two years. All this weight gain made the joint pain even worse. My dad missed many of my ballgames, which was such a big part of my life growing up. I was involved with several organized sports, but my father rarely was able to toss a football or throw a baseball to help me practice. It was even difficult for him to be a spectator at my games, because he gained so much weight he avoided being in crowds.

Me, in my younger times.

When I was 12 years old, my mom and dad brought lawn chairs to one of my games because it had become too difficult for him to climb the bleachers. He weighed 300 pounds at that time. As luck would have it, he exceeded the weight limit of the lawn chair and it collapsed beneath him. My mother tried to help him up from this terrible and embarrassing position, but she could not do it on her own and enlisted the help of two men in the crowd. Despite the laughs of some of the people, my dad pretended that it did not bother him but I knew differently. I was very protective of him and couldn’t do much about the adults who were laughing, but I could do something about the one kid on the opposing team whose laughter seemed to never end. Let’s just say it ended quite abruptly after being introduced to his first black-eye. (Here’s one for you Dad!)

I Can Do It On My Own

As I grew up, I found myself drawn to medicine for many reasons. As a third year medical student at Ohio State University, I had heard about the disease of obesity during my surgery rotation. I talked to my dad about considering gastric bypass surgery. He was now 350 pounds and had developed sleep apnea, hypertension, diabetes and severe problems with degenerative joint disease of his knees. His response to me was, “Once I get my knees replaced, I’ll get around much better and lose this weight.” Well, he had both knees replaced shortly thereafter and you probably can guess – he did not lose any weight. In fact, he gained more weight and four years later he needed one of his knees replaced again. By this time, I was at the University of South Florida for my surgical residency, where bariatric surgery was an integral part of my training. My dad was now 400 pounds. I tried to convince him that the operation he really needed was a gastric bypass and not another knee replacement. But dad said this time he could do it on his own. If only his knees would hang in there long enough for him to lose the weight.

Dad, in his heavier times.

Over the next few years, he continued to battle the weight and related health problems, and I began to see a dramatic decrease in the quality of his life. His highest weight was just under 500 pounds. He had become oxygen dependent, and required assistance of a ventilator at night. He never complained and rarely asked for anything. My dad was truly one of those rare people who gave more than he received or expected back in life.

Bitter Sweet

Early in 2000, my wife, Sheila, and I were expecting our second child, but since it was early in the pregnancy, we did not announce it to anyone and told our 2-year-old son Garrett, to keep it a special secret. Well, as you can imagine, it was not a secret for very long and on Easter Sunday, Garrett informed my parents of our own bit of Easter “Good News.”  My dad, who was a “kid magnet,” was so thrilled to be a “Paw-Paw” again and couldn’t wait for the day to arrive.

Sadly, the day never arrived for my dad. Two days after Easter on April 25, 2000 he was defeated by the devastating diseases process called morbid obesity. I no longer could call or go visit him. He would never know my children who are now forever deprived of his unconditional love as I had growing up. I was angry and hurt to be robbed of such a wonderful friend and father, but much as I knew he silently suffered, I also knew he was now at peace.

To Be or Not To Be

Even though I saw what bariatric surgery could do to help achieve long-term weight loss surgery in my training, I had no plans of making it part of my medical practice. There was no immediate gratification knowing that the surgery went well. In general, most surgeons are of the mentality of, “Have surgery and fix the problem.”  If someone has a bad appendix, you remove it and it takes care of the problem. If it’s a tumor, remove it and your job is done. Albeit, there may be further treatment necessary, but the surgeon’s job is generally complete and there is satisfaction knowing you are aiding in the recovery.

However, bariatric surgery is just not that way. There is nothing immediate that tells you whether the risk was worth it because results are not instant (this is where a surgeon has trouble dealing with delayed gratification).

And since you get to know the patient on a more personal level than with other types of surgery, you worry even more so and really feel it when there is a complication. This factor, along with an overall higher risk groups of patients, continued insurance coverage and reimbursement problems, high malpractice costs for this specialty and a new baby on the way — I just wasn’t sure. Not to mention, my anger at such a disease that took my fathers’ life. I didn’t think I could deal with it on a daily basis.

The road leading to bariatric surgery as my specialty was not as simple or a clear path from the beginning. I’m not sure I actually chose this field or whether it chose me. Dealing with obesity was certainly not new in my life, but to dedicate my whole practice to it was not an immediate or easy decision. Over time, however, the pain and anger of my father’s death seemed to have lessened and after a few years of advanced laparoscopic general surgery, I decided to consider adding bariatric surgery to my practice. I first implemented a program that would provide proper support, and after the first few cases I was hooked. I got such a unique satisfaction that I could help those who undoubtedly faced similar health problems and social situations as my father. And it wasn’t hard to get used to that delayed gratification after the first few “success stories.”

Back to Warren

Dr. Nease talks with Warren about his progress.

I was determined to not allow my father’s fate with obesity to be that of Warren and his family. Despite the high risk involved, Warren went on to have a laparoscopic gastric bypass in October of 2003. To date, he is proud to tell anyone who will listen that he has lost over 100 pounds and his health has dramatically improved.

For all the Warrens out there and in memory of my dad, Jack Nease, this is how and why I have chosen to fight the battle against obesity. I am truly blessed to be a part of this specialty and am thankful to all those who have had the courage to make a difference for themselves, their family and friends.

For the Love of My Father originally appeared in ObesityHelp Magazine Summer 2004. To see the full pdf version, please check out Dr. Nease’s website.

Dr. Blaine NeaseBariatric Surgeonhttp://www.yourwls.com/ – Center for Surgical Weight Control