I know Kaiser Permanente HMO is not perfect; but overall I have had less problems with them on the fat issue than under any other medical plan. What I really like is that before choosing a doctor you can go to their bio page and see what kind of person they are, what are their interests, etc. For example, I don’t think I would be a good match with a doctor who is into running marathons. Just saying. So you can dodge some bullets that way.
Recently I had to undergo some outpatient surgery (female plumbing – argh) and ran into a problem. I was scheduled to have the procedure done in their outpatient clinic. I’m about halfway through the telephone pre-op interview when the fact that I’m fat comes up.
Now, I don’t make it a secret I’m fat (like I could); I let Kaiser weigh me pretty much every time I walk in the door (they are fairly discreet about it) and I would have assumed they wrote that down somewhere. They also ask me how tall I am, and I also assumed they wrote that down. With those two magic numbers they should be able to calculate that almighty not useful number my BMI. And I must admit that I usually remind people that I am fat before a procedure (i.e., when I had a CAT scan I asked if my size would be an issue); but this time I didn’t.
The doctor I was speaking with had my records in front of her (everything is computerized at my Kaiser), and yet she was shocked (SHOCKED I tell you) that I was FAT! Holy crap!!! She pitched a fit and fell right into it. Up to that point we were having a pleasant conversation, suddenly she is telling me that I can’t have the procedure done in the outpatient clinic, that it has to be done in the hospital because I must have sleep apnea or hypertension or some other problem because, you see, I’m fat.
Things that make me go grrrrrrr.
Well I was caught totally flat footed. I should have laid into her, but I was feeling humiliated, distressed and totally vulnerable.
HOWEVER, by the next day, when I had an appointment with my OB/GYN I had recovered and was pissed. Very pissed. When I am pissed, people can tell.
Turns out if your BMI is over a certain point, Kaiser has a rule that procedures must be done in surgery. That’s it. That’s the rule. I don’t have a problem with this rule. I understand that statistically there are certain issues that may arise when operating on a fat person and Kaiser is just covering its ass. It’s not arbitrary (any more than using the BMI for anything is arbitrary). You are not being accused of being unhealthy, it’s just the rule.
My problem is two-fold.
First, if that is the rule, I should never have been scheduled for the outpatient clinic. They have the numbers, they have computers, just trying to schedule it should have been impossible. Change the protocol.
Second, the doctor who conducted the pre-op interview should have simply said, “Kaiser has a rule that if your BMI is over (whatever it is), you cannot have the procedure in the outpatient clinic. We’ll have to reschedule this.” Instead of going off like a hen trying to pass an extraordinarily painful egg –WHA— WHA—- WHA— WHA — THAT MEANS YOUR BMI IS 55!
I filed a complaint online with Kaiser, and since then have received a letter assuring me the issues are being addressed, plus I received a telephone call from Kaiser investigating the matter and again assuring me that the matter would be reported and dealt with. And I made sure they understood this is not just a “me” issue, this is a “fat” issue – that some fat patients will simply walk away from necessary treatment rather than deal with the abuse.
My OB/GYN was so apologetic. The thing is many people never even think about size and the problems we face —- which in a way is a good thing; that size is not always an issue with a healthcare provider; but obviously that can lead to another set of problems.
Now, I don’t know if they will actually fix anything; but at least I wasn’t ignored. And it feels good to stand up for yourself (and other fatties). So if you have a problem like this, I urge you to investigate to see if there is a protocol in place for reporting same and if there is, use it!
And by the way, the procedure went fine and I’m fine (sooooo fine!).