January 11, 2012

Design Tips to Accommodate Obese Patients

With the country’s obesity rate rising, chances are a percentage of your patient base falls into the obese category. With that comes the very real consideration of how to accommodate these patients in your office.

“More than one third of the population is considered obese, and the number is rising rapidly,” says Kurt Forsthoefel, senior marketing manager of medical products & services for Midmark Corporation in Versailles, Ohio. “To accommodate these types of patients, it’s important that healthcare providers first rethink the concept of the clinical space with a patient-centered approach that ensures an accessible healthcare environment for everyone, including obese patients.”

To help your obese patients feel welcome and cared-for in your office, consider design problems such as narrow spaces, inappropriate seating, and medical equipment not designed for larger patients. For example, Dr. Carson Liu, a surgeon and specialist in bariatric surgery at Skylex Advanced Surgical in Santa Monica, Calif., designed his offices specifically for the comfort of his obese patients. To accomplish this, great care and consideration was given to the center’s physical plan, and every piece of furniture was comfort engineered.

In Liu’s practice, public areas, exam rooms and offices are decorated with inconspicuously and tastefully widened chairs, benches and sofas. A professional but serene feel was foremost in the designing of the clinic, as a patient of his once revealed that “it was an act of courage to pick up the phone and call Skylex for my obesity.”

Address seating matters

One of the most common items obese patients complain about regarding physicians’ offices is that they don’t have appropriate reception-area seating for their larger, heavier frames. Be sure to place at least one bariatric-quality seating element (sofa or chair) in your reception area – more if you treat a fair number of obese patients.

The furniture at Skylex is custom-designed and built to fit obese people, says Liu. Extra-deep, oversized couches and chairs are designed so that patients can sit and stand easily. In the reception area, chairs are 20 inches deep and 24 inches wide, and couches are designed without arms so patients don’t feel constricted. This seating can accommodate 600 lbs., as opposed to the stand manufacturer’s limit of 300 lbs.

If your practice has regular support-group meetings for obese people, consider placing seating along the walls and in the center of the reception room to create a comfortable conversation area.

Fix exam-room bugaboos

In your exam rooms, consider purchasing reinforced exam tables that feature assistance stools and raised backs for comfort and safety, Liu advises. “Our exam rooms offer privacy for physical examination and discussion. They are reinforced bariatric exam tables that are designed to hold up to 500 lbs. as opposed to the standard of 400 lbs.”

“Lifting and assisting patients through the use of accessible, barrier-free exam tables and scales helps minimize the risk of injury to healthcare providers,” says Forsthoefel, pointing out that the most important feature of a barrier-free table is that it is able to be lowered to a height of 17 to 19 inches so that patients are able to access it with little or no assistance. “This can increase a patient’s comfort, help the physician conduct a more thorough and accurate exam or procedure, and improve the overall patient experience.”

You may also wish to equip your exam room with bariatric chairs for a patient’s spouse or family member who is obese.

Deal with equipment issues

Healthcare providers run the increasing risk of not being equipped to provide care for a growing number of patients due to equipment limitations, Forsthoefel notes.

Consider maintaining higher-capacity weighing scales, such as the Midmark 625, which has a 650-lb. patient-weight capacity. Also, make sure that any equipment on which a patient places their full weight – such as an X-ray or MRI table – is built to accommodate obese people.

Larger blood pressure cuffs are another recommendation, say Karla Hamal, R.D. and Michael J. Nusbaum, M.D., medical director at The Obesity Treatment Centers of New Jersey. An added benefit to investing in the proper equipment is avoiding worker compensation claims which could occur if an accident takes place while an obese patient is on inappropriate equipment.

Examine your office layout

Obese patients should be able to navigate your office easily without bumping into walls, furniture or design elements. “The layout of the office [should accommodate] a larger person with having chairs easily accessible and not pushed tightly together, doors easy to access and walk through,” say Hamal and Nusbaum. “People are made to feel very uncomfortable and different if their physician is unable to accommodate their size.”

Make sure exam-room doorways and interior areas are wide enough for obese people to pass-through and maneuver around. The same goes for your restrooms, checkout areas and any other places in your office where patients may visit.

Think about emotional concerns

Just as typical-weight patients get nervous about doctor’s appointments, so do obese patients.

“Many [obese patients] fail to receive adequate care because of accessibility issues,” says Forsthoefel. “As this issue draws increased attention, physicians are starting to understand that they can accommodate the needs of their patients and provide them with accessibility, dignity, safety and comfort by creating a barrier-free practice.”

Forsthoefel recommends integrating higher-capacity elements into your standard waiting rooms, exam rooms and processes to prevent patients from feeling alienated by being taken to a “special” location away from the usual work areas.

Be especially sensitive to bias about weight from yourself and your staff, and don’t dismiss all physical complaints as related to the patient’s weight. “Many patients are very emotional about their weight,” say Hamal and Nusbaum.“Several patients have told me they have left practices because of callous and rude comments about their weight.”

In addition, make sure that obese patients are receiving proper nutritional advice from a registered dietitian equipped to handle their condition. “Most primary-care physicians do not have much, if any, education in nutrition and dietetics, which is why they should be working hand-in-hand with registered dietitians when counseling obese patients on weight loss,” says Manuel Villacorta, R.D., a spokesperson with the Academy of Nutrition and Dietetics (formerly the American Dietetic Association). “R.D.’s have the knowledge, training and expertise to counsel these patients and develop eating and exercise plans that are personalized and effective.”

Dr. Carson Liu

Original Article