Overweight and obese patients are significantly more likely than their normal-weight counterparts to repeatedly switch primary care doctors, a practice that disrupts continuity of care and leads to more emergency room visits, new Johns Hopkins research suggests.
The practice of "doctor shopping" among overweight patients may be a result of negative experiences with the health care system, whether that be off-putting comments by office staff, unsolicited weight loss advice by providers, or improperly sized medical equipment and office furniture, says Kimberly A. Gudzune, M.D., M.P.H., an assistant professor in the division of general internal medicine at the Johns Hopkins University School of Medicine. Gudzune led the research described online in the journal Obesity.
Gudzune, who has conducted other research on challenges faced by overweight patients in their interactions with the health care system, and her colleagues define doctor shopping as seeing three or more different primary care physicians over the course of 24 months. In their study of more than 20,700 patients in a BlueCross BlueShield claims database, the researchers found that 23 percent met the definition. The odds of doctor shopping increased by 19 percent for overweight patients and 37 percent for obese patients, as compared with normal-weight patients in the database. Four percent of patients saw five or more primary care doctors over two years, a practice more likely in obese and overweight patients as well.
Gudzune cautions that not all doctor shopping is counterproductive or ill-considered. "If you are dissatisfied with your care or feel judged because of your weight, then you may be better served by finding a provider who can meet your needs," she says. The concerning issue, she adds, is that some patients may not find a provider that they connect with and are then driven to keep searching for new ones.
"There's something going wrong in these doctor-patient relationships that make these switches so frequent for this group of people," Gudzune says. "The real problem here is that the health of overweight and obese patients who doctor shop is being compromised. Because they do not remain with their doctors for very long, they are ending up in the emergency room, likely for things that could have been taken care of in a primary care office."
The researchers found that compared with normal-weight non-shoppers, overweight and obese doctor shoppers were 85 percent more likely than these normal-weight individuals to visit the ER. Even when compared to non-shoppers of their own weight, the overweight and obese doctor shoppers were still significantly more likely to visit the ER.
Moreover, this group was not more likely to be hospitalized, Gudzune notes, suggesting that their problems likely could have been solved by a primary care doctor in an office setting.
Gudzune says that other studies have shown that care continuity is associated with decreased hospitalizations and ER visits, improved use of preventive services and reduced health care costs.
Gudzune emphasizes that although her study did not determine the exact reasons why overweight and obese patients were switching doctors so often, the results affirm observations from a focus group study of obese women who discussed switching from doctor to doctor until they located a physician who met their needs.
Gudzune says more study is needed to tease out the reasons behind this phenomenon and to look for ways to ensure delivery of more compassionate care to overweight and obese patients.
"If they feel judged or hear offhanded comments about their weight, if the blood pressure cuff won't fit properly or they are afraid the examination table will not support their weight, it reinforces negative stereotypes obese patients encounter elsewhere," she says. "We need to strive to create a safe, judgment-free environment where all patients can receive satisfying medical care."
Other Johns Hopkins researchers involved in the study include Sara N. Bleich, Ph.D.; Thomas M. Richards, M.S.; Jonathan P. Weiner, Dr.P.H.; and Jeanne M. Clark, M.D., M.P.H.
The research was supported by grants from the Health Resources and Service Administration (T32HP10025-16-00) and the National Institutes of Health's National Heart, Lung, and Blood Institute (1K01HL096409).
For more information: http://www.hopkinsmedicine.org/awomansjourney/baltimore/2012_conference/2012_speaker_profiles/kimberly.gudzune.html
Johns Hopkins Medicine
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