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With obesity being so prevalent in the United States, it’s important to know the risks that can be associated with treating obese patients appropriately and effectively.

In order to get the patients’ perspective, I recently interviewed two wheelchair-bound, middle-aged, obese people who regularly see their physicians and dentists. They shared some eye-opening information with me regarding the challenges they face during doctor and dental visits.

Overcoming the Obstacles

While their doctors’ offices do have ramps or ground-level access, both patients said they found that the offices are not built or retrofitted with automatic opening doors to accommodate the physically handicapped. Therefore, they face a major obstacle: how to get through the door at the main entrance. They have found the doors are wide enough for wheelchair access but difficult to negotiate from the sitting position in a wheelchair. Both explained that they would purposefully arrive early on the day of their appointment and wait for another patient to either arrive or leave using the main entrance. This provides an opportunity for them to enter the office without staff assistance. If they could not gain access to the office on their own, they would resort to knocking on the door, activating a doorbell or using a cell phone to request staff assistance. They explained that most disabled individuals strive to go through life as normally as possible, and only when faced with a significant physical barrier such as this, will they ask for help.

Once in the building, their next obstacle is communicating with the receptionist. If they have to complete forms, they sometimes need assistance. Because the receptionist counters do not always have an overhang or lower counter top to accommodate wheelchair patients, they are forced to speak loudly to the receptionist. Consequently, they feel as though everyone in the vicinity can overhear their confidential patient information.

Finding a spot in the waiting room that is comfortable is often a challenge as well, according to both patients. This is a potential problem for any obese patient, not just the wheelchair-bound. There often is no place for a wheelchair in the waiting room because of the location of the existing chairs and furniture. Both of the individuals interviewed said they have waited in the path of normal traffic because they did not fit into the existing waiting room furniture configuration. Additional problems arise for the obese patient in waiting rooms as the chairs are too narrow and the upholstery and supports are too soft, making the process of getting up a challenge.

Barriers to Effective Care

Once inside the examination room, the challenges continue for the obese patient. If the examination table is not wide or sturdy enough to support their weight, the examination might have to be performed while the patient remains seated in the wheelchair. 

One of the patients interviewed said she was scheduled by her doctor for a bone density scan but was turned away at the hospital at the last minute because they couldn’t handle a patient of her size and weight. She is still waiting to hear back from her primary care physician regarding a facility that can perform the test. Patient diagnostic equipment that cannot accommodate obese patients can also be a potential patient safety concern.

Plan Ahead

Whether it is larger examination gowns or blood-pressure cuffs, supplies and equipment should accommodate the larger patient. Also, be sure to consider the following:

• Sturdy, armless chairs and high, firm sofas in waiting rooms
• Sturdy, wide examination tables that are bolted to the floor to prevent tipping and are adjustable in height
• Front split-seat, floor-mounted toilets and specimen collectors with a handle
• Extra-long phlebotomy needles, tourniquets, and large vaginal speculate
• Weighted scales with adequate capacity for obese patients