— OAC Community Perspectives: by Sarah Bramblette, MSHL
Oftentimes, access to healthcare is associated with whether or not a person has health insurance. However, you should know that access to care involves a lot more than an insurance card.
Thankfully, I’ve had some type of healthcare coverage for most of my adult life. However, I encounter barriers to care at nearly every health appointment I attend! To help educate others about the serious lack of healthcare existing out there for patients with obesity, I wanted to give an overview of one of my medical appointments in particular. This is one of many appointments that exemplifies the multiple barriers (and potential barriers) that are realities for other patients with similar experiences as mine.
An Appointment for a Heart Defect
The appointment was for a congenital defect which requires periodic follow-up care with a cardiologist. It’s not an issue directly related to my weight. When speaking up about a lack of accommodations in healthcare, I often get replies that bariatric doctors and surgeons DO provide appropriate accommodations. And this is true, because many do, but definitely not all. However, patients have needs beyond those addressed and treated by bariatric specialists. We should have access to care for ALL types of providers — primary care physicians, specialists, dentists, etc.
Issue #1: Travel
My cardiologist was located in another city that required a four hour round-trip drive. So, one appointment takes up an entire day. I have a car, I’m able to drive, and I have money for gas and parking. But some patients don’t and wouldn’t be able to make this trip. I also travel by myself, as it’s not always possible to have someone who can also take an entire day away from their regular schedule.
Traveling this distance wasn’t new for me. I was going to the same hospital where I had my bariatric surgery in 2003. It’s probably the closest facility that accepts high-risk patients, just as it was back then. I was able to travel up for all my needed appointments, and the program allowed me to complete some required appointments with my local providers. However, the distance did impact my ability to participate in post-op support groups.
Issue #2: Parking
Once at the hospital, parking options are either a garage that requires walking to get to the building or valet service which costs more but allows me to get out at the main entrance. More often than not, there is a fee for parking — even in a garage, and even with a disability placard.
Issue #3: Seating
As I entered the lobby, I noticed there was ample seating options: a mix of couches and regular chairs, but no obvious designation of “special” seating. When I was called back to the registration area, there was a wider width chair placed at the desk for me. I noticed staff pulling the regular-sized chair back into the corner as they held the door open for me. I thought this was good staff training. Unfortunately, as is often the case, the accommodations present in the lobby and registration areas didn’t extend into the treatment areas.
Issue #4: Pre-appointment Vitals
Starting with the basics, there was no scale that could weigh me and the blood pressure cuff was not large enough to fit my upper arm. The nurse tried to take my blood pressure on my lower arm but the machine couldn’t get a reading. It inflated twice to a painful pressure just to read “error.” She then took me to another area where there was a scale with a higher capacity to weigh me. I’m not sure why that wasn’t the first scale used. I was not a new patient. My previous weight was in my record, so why attempt to weigh me on a scale that you know doesn’t have a high enough capacity?
Issue #5: The Exam Room
Once in the room, the exam table was too high and there was no stool. The table had a step, but that isn’t adequate for someone of my size as the table often tips and there is nothing to hold on so I can steady myself. A different nurse came in with a manual blood pressure cuff, which was again too small for my upper harm. She also attempted to measure it on my lower arm but was not able to get a reading. There was no large cuff or staff trained in how to take manual blood pressure on the lower arm. Isn’t blood pressure an important vital sign? Especially in cardiology?
Issue #6: The Exam
This was my first time seeing this cardiologist, as I had recently moved from another state. In reviewing my chart, my cardiologist asked me about my diet and what a typical day looked like for me — including my consumption of food and drinks. When I told her I drink diet soda, her eyes lit up and she said, “Ah ha! I bet the diet soda is causing you to snack more than you realize.”
I thought she was trying to find a reason for my excess weight and made assumptions about my habits. I explained to her that I have other conditions which contribute to my weight. She only understood once she did her physical exam. “Are those surgical scars on your arms?” I answered, “Yes. I’ve had surgery twice to remove excess skin and try to reduce the size of my arms, but it keeps coming back due to my lipedema and lymphedema.” She offered to refer me to vascular doctors, which I did in fact need because I had to establish more providers since I moved.
Issue #7: Follow-up Care
She also ordered an echo-cardiogram. To her credit, she asked that it be done while I was there so I wouldn’t have to make the drive another day. When I was called back for the echo, the technician handed me a gown to put on “open in the front.” It didn’t fit, so I just laid down and draped it over my upper body. Surely there were larger gowns available. Anyone who sees me should know that a regular size gown would not fit, but little care is taken — and if I asked about one, it would take time for someone to go search for a larger gown. I’ve experienced this before.
My day illustrated these access to care issues:
- Lack of providers in my area
- Lack of equipment
- Lack of staff and medical training
- Lack of compassion
If people with obesity are at higher risk for cardiovascular disease, why is the cardiology department so ill equipped to care for patients with obesity?