Roni K. Devlin, MD

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

Upon finishing medical school, many of us recited this passage from a modernized version of the Hippocratic Oath. Though there has been controversy regarding the current relevancy of this oath, it can still serve as a reminder of the promises we made on behalf of our patients: To treat them ethically, with empathy and respect, and without pretension. Though I hadn’t thought about the Hippocratic Oath in ages, it came to mind recently after I read an article about weight trends in adults during the COVID pandemic.

No surprise – we gained weight during the initial surge at a rate of roughly a pound and a half per month following the initial shelter-in-place period. For some of us, that trend in weight gain worsened as the pandemic persisted. A survey conducted in February 2021 suggested that over 40% of adults who experienced undesired weight changes since the start of the pandemic gained an average of 29 pounds (significantly more than the typical gain of 15 pounds, often referred to as the “Quarantine 15” or “COVID-15”).

Updated data, obtained via a review of electronic health records for over 15 million patients, shows that 39% of patients gained weight during the pandemic (10% of them gained more than 12.5 pounds, while 2% gained over 27.5 pounds). Though these recent numbers may be lower than previously reported, they still aren’t reassuring. As our bodies have changed, so has the concern for worsening weight stigma (bias against individuals because of their body size).

Research has already confirmed that sizeism has a negative impact on both a patient’s physical health and psychological well-being, and as medical providers, we’re part of the problem. We cause distress in our patients through disrespectful treatment and medical fat shaming, which can lead to cycles of disordered eating, reduced physical activity, and more weight gain. We discriminate based on weight, causing our patients to delay health care visits and other provider interactions, resulting in increased risks for morbidity and even mortality. We make assumptions that a patient’s presenting complaints are due to weight rather than other causes, resulting in missed diagnoses. And we recommend different treatments for obese patients with the same condition as nonobese patients simply because of their weight.

One study has suggested that over 40% of adults in the United States have suffered from weight stigma, and physicians and coworkers are listed as some of the most common sources. Another study suggests that nearly 70% of overweight or obese patients report feeling stigmatized by physicians, whether through expressed biases or purposeful avoidance (patients have previously reported that their providers addressed weight loss in fewer than 20% of their examinations).

As health care providers, we need to do better. We should all be willing to consider our own biases about body size, and there are self-assessments to help with this, including the Implicit Associations Test: Weight Bias. By becoming more self-aware, hopefully we can change the doctor-patient conversation about weight management.

Studies have shown that meaningful conversations with physicians can have a significant impact on patients’ attempts to change behaviors related to weight. Yet, many medical providers are not trained in how to counsel patients on nutrition, weight loss, and physical activity (if we bring it up at all). We need to better educate ourselves about weight science and treatments.

In the meantime, we can work on how we interact with our patients:

• Make sure that your practice space is accommodating and nondiscriminatory, with appropriately sized furniture in the waiting and exam rooms, large blood pressure cuffs and gowns, and size-inclusive reading materials.
• Ensure that your workplace has an antiharassment policy that includes sizeism.
• Be an ally and speak up against weight discrimination.
• Educate your office staff about weight stigma and ensure that they avoid commenting on the weight or body size of others (being recognized only for losing weight isn’t a compliment, and sharing “fat jokes” isn’t funny).
• Remember that a person’s body size tells you nothing about that person’s health behaviors. Stop assuming that larger body sizes are related to laziness, overeating, or a lack of motivation.
• Ask your overweight or obese patients if they are willing to talk about their weight before jumping into the topic.
• Practice (patients are more likely to report changing their exercise routine and attempting to lose weight with these techniques).
• Be mindful of your word choices; for example, it can be more helpful to focus on comorbidities (such as high blood pressure or prediabetes) rather than body weight, nutrition rather than dieting, and physical activity rather than specific exercises.

Regardless of how you feel about reciting the Hippocratic Oath, our patients, no matter their body size, deserve to be treated with respect and dignity, as others have said in more eloquent ways than I. Let’s stop playing the fat shame game and help fight weight bias in medicine.

Dr. Devlin is president, Locum Infectious Disease Services, and an independent contractor for Weatherby Healthcare. She reported no relevant conflicts of interest. A version of this article first appeared on Medscape.com.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

Upon finishing medical school, many of us recited this passage from a modernized version of the Hippocratic Oath. Though there has been controversy regarding the current relevancy of this oath, it can still serve as a reminder of the promises we made on behalf of our patients: To treat them ethically, with empathy and respect, and without pretension. Though I hadn’t thought about the Hippocratic Oath in ages, it came to mind recently after I read an article about weight trends in adults during the COVID pandemic.

No surprise – we gained weight during the initial surge at a rate of roughly a pound and a half per month following the initial shelter-in-place period. For some of us, that trend in weight gain worsened as the pandemic persisted. A survey conducted in February 2021 suggested that over 40% of adults who experienced undesired weight changes since the start of the pandemic gained an average of 29 pounds (significantly more than the typical gain of 15 pounds, often referred to as the “Quarantine 15” or “COVID-15”).

Updated data, obtained via a review of electronic health records for over 15 million patients, shows that 39% of patients gained weight during the pandemic (10% of them gained more than 12.5 pounds, while 2% gained over 27.5 pounds). Though these recent numbers may be lower than previously reported, they still aren’t reassuring. As our bodies have changed, so has the concern for worsening weight stigma (bias against individuals because of their body size).

Research has already confirmed that sizeism has a negative impact on both a patient’s physical health and psychological well-being, and as medical providers, we’re part of the problem. We cause distress in our patients through disrespectful treatment and medical fat shaming, which can lead to cycles of disordered eating, reduced physical activity, and more weight gain. We discriminate based on weight, causing our patients to delay health care visits and other provider interactions, resulting in increased risks for morbidity and even mortality. We make assumptions that a patient’s presenting complaints are due to weight rather than other causes, resulting in missed diagnoses. And we recommend different treatments for obese patients with the same condition as nonobese patients simply because of their weight.

One study has suggested that over 40% of adults in the United States have suffered from weight stigma, and physicians and coworkers are listed as some of the most common sources. Another study suggests that nearly 70% of overweight or obese patients report feeling stigmatized by physicians, whether through expressed biases or purposeful avoidance (patients have previously reported that their providers addressed weight loss in fewer than 20% of their examinations).

As health care providers, we need to do better. We should all be willing to consider our own biases about body size, and there are self-assessments to help with this, including the Implicit Associations Test: Weight Bias. By becoming more self-aware, hopefully we can change the doctor-patient conversation about weight management.

Studies have shown that meaningful conversations with physicians can have a significant impact on patients’ attempts to change behaviors related to weight. Yet, many medical providers are not trained in how to counsel patients on nutrition, weight loss, and physical activity (if we bring it up at all). We need to better educate ourselves about weight science and treatments.

In the meantime, we can work on how we interact with our patients:

• Make sure that your practice space is accommodating and nondiscriminatory, with appropriately sized furniture in the waiting and exam rooms, large blood pressure cuffs and gowns, and size-inclusive reading materials.
• Ensure that your workplace has an antiharassment policy that includes sizeism.
• Be an ally and speak up against weight discrimination.
• Educate your office staff about weight stigma and ensure that they avoid commenting on the weight or body size of others (being recognized only for losing weight isn’t a compliment, and sharing “fat jokes” isn’t funny).
• Remember that a person’s body size tells you nothing about that person’s health behaviors. Stop assuming that larger body sizes are related to laziness, overeating, or a lack of motivation.
• Ask your overweight or obese patients if they are willing to talk about their weight before jumping into the topic.
• Practice (patients are more likely to report changing their exercise routine and attempting to lose weight with these techniques).
• Be mindful of your word choices; for example, it can be more helpful to focus on comorbidities (such as high blood pressure or prediabetes) rather than body weight, nutrition rather than dieting, and physical activity rather than specific exercises.

Regardless of how you feel about reciting the Hippocratic Oath, our patients, no matter their body size, deserve to be treated with respect and dignity, as others have said in more eloquent ways than I. Let’s stop playing the fat shame game and help fight weight bias in medicine.

Dr. Devlin is president, Locum Infectious Disease Services, and an independent contractor for Weatherby Healthcare. She reported no relevant conflicts of interest. A version of this article first appeared on Medscape.com.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

Upon finishing medical school, many of us recited this passage from a modernized version of the Hippocratic Oath. Though there has been controversy regarding the current relevancy of this oath, it can still serve as a reminder of the promises we made on behalf of our patients: To treat them ethically, with empathy and respect, and without pretension. Though I hadn’t thought about the Hippocratic Oath in ages, it came to mind recently after I read an article about weight trends in adults during the COVID pandemic.

No surprise – we gained weight during the initial surge at a rate of roughly a pound and a half per month following the initial shelter-in-place period. For some of us, that trend in weight gain worsened as the pandemic persisted. A survey conducted in February 2021 suggested that over 40% of adults who experienced undesired weight changes since the start of the pandemic gained an average of 29 pounds (significantly more than the typical gain of 15 pounds, often referred to as the “Quarantine 15” or “COVID-15”).

Updated data, obtained via a review of electronic health records for over 15 million patients, shows that 39% of patients gained weight during the pandemic (10% of them gained more than 12.5 pounds, while 2% gained over 27.5 pounds). Though these recent numbers may be lower than previously reported, they still aren’t reassuring. As our bodies have changed, so has the concern for worsening weight stigma (bias against individuals because of their body size).

Research has already confirmed that sizeism has a negative impact on both a patient’s physical health and psychological well-being, and as medical providers, we’re part of the problem. We cause distress in our patients through disrespectful treatment and medical fat shaming, which can lead to cycles of disordered eating, reduced physical activity, and more weight gain. We discriminate based on weight, causing our patients to delay health care visits and other provider interactions, resulting in increased risks for morbidity and even mortality. We make assumptions that a patient’s presenting complaints are due to weight rather than other causes, resulting in missed diagnoses. And we recommend different treatments for obese patients with the same condition as nonobese patients simply because of their weight.

One study has suggested that over 40% of adults in the United States have suffered from weight stigma, and physicians and coworkers are listed as some of the most common sources. Another study suggests that nearly 70% of overweight or obese patients report feeling stigmatized by physicians, whether through expressed biases or purposeful avoidance (patients have previously reported that their providers addressed weight loss in fewer than 20% of their examinations).

As health care providers, we need to do better. We should all be willing to consider our own biases about body size, and there are self-assessments to help with this, including the Implicit Associations Test: Weight Bias. By becoming more self-aware, hopefully we can change the doctor-patient conversation about weight management.

Studies have shown that meaningful conversations with physicians can have a significant impact on patients’ attempts to change behaviors related to weight. Yet, many medical providers are not trained in how to counsel patients on nutrition, weight loss, and physical activity (if we bring it up at all). We need to better educate ourselves about weight science and treatments.

In the meantime, we can work on how we interact with our patients:

• Make sure that your practice space is accommodating and nondiscriminatory, with appropriately sized furniture in the waiting and exam rooms, large blood pressure cuffs and gowns, and size-inclusive reading materials.
• Ensure that your workplace has an antiharassment policy that includes sizeism.
• Be an ally and speak up against weight discrimination.
• Educate your office staff about weight stigma and ensure that they avoid commenting on the weight or body size of others (being recognized only for losing weight isn’t a compliment, and sharing “fat jokes” isn’t funny).
• Remember that a person’s body size tells you nothing about that person’s health behaviors. Stop assuming that larger body sizes are related to laziness, overeating, or a lack of motivation.
• Ask your overweight or obese patients if they are willing to talk about their weight before jumping into the topic.
• Practice (patients are more likely to report changing their exercise routine and attempting to lose weight with these techniques).
• Be mindful of your word choices; for example, it can be more helpful to focus on comorbidities (such as high blood pressure or prediabetes) rather than body weight, nutrition rather than dieting, and physical activity rather than specific exercises.

Regardless of how you feel about reciting the Hippocratic Oath, our patients, no matter their body size, deserve to be treated with respect and dignity, as others have said in more eloquent ways than I. Let’s stop playing the fat shame game and help fight weight bias in medicine.

Dr. Devlin is president, Locum Infectious Disease Services, and an independent contractor for Weatherby Healthcare. She reported no relevant conflicts of interest. A version of this article first appeared on Medscape.com.

A recent article on Medscape entitled “Online Reviews Most Important Factor in Choosing a Doctor: Survey” really got me thinking about my online presence. According to the results of a new Press Ganey survey, online reviews and star ratings are the most important factor for consumers when choosing a new health care provider, even more so than the recommendation of another doctor. Almost 85% of the survey respondents said they wouldn’t make an appointment with a referred provider if they had a rating of less than 4 stars.

To be honest, I’ve rarely thought about my ratings or online reviews, and I almost never enter my own name into a web browser to see what might emerge. I don’t use most popular social media apps, I don’t have a professional website, and I was completely late in joining LinkedIn. After considering the Press Ganey survey results, though, I’m wondering how many patients (or potential patients) have found me online. And what exactly did they see?

So, I just searched online for my ratings and reviews. There weren’t many direct hits (although I’m not sure if that is a good thing or not). One of the results listed me as a “Fibromyalgia Doctor” at www.lymeforums.org. To be clear, I’m a locum tenens infectious diseases provider with a focus on inpatient consultations and teaching. I couldn’t find any reviews for myself on WebMD, but I had one rating on the Healthgrades website – I was pleased to see someone gave me 5 stars (though there weren’t any comments) until I realized the site listed my address at an ob.gyn. office; I’m not even sure if that rating was meant for me.

Use of the Internet to assess my qualities as a physician is clearly limited, and much of the online information about my specialty and practice sites is completely inaccurate. Yet, according to the Press Ganey survey, the average consumer uses three different websites and reads more than five online reviews before making a provider decision. Once they’ve seen a provider, though, patients rank practice customer service and communication as more important than “bedside manner” when considering a 5-star review. So, it appears that many physician reviews and ratings probably reflect the performance of the office staff, not the provider.

Given the few hits that I encountered when searching my own name, I’m not convinced I need to do anything differently about my online presence; essentially, I don’t really have one. However, there were certainly a lot of other physicians with the same last name as mine who did have impressive numbers of reviews and ratings. One doctor of cosmetic surgery had more than 200 reviews on multiple sites; almost all were positive, but a few patients rated him at 1 or 2 (out of 5) stars, suggesting that patients should find a new surgeon. What does one do about those outliers?

Medicine is indeed a business and patients behave as consumers when searching the web for a health care provider. Another survey has suggested that just one negative review may cause a business to risk losing 22% of its customers, and that multiple bad ratings are even worse – nearly 60% of customers will avoid a business with three or more negative online reviews.

A few years ago, The Washington Post published an article about doctors who were fighting back against bad reviews. Unfortunately, while trying to directly combat inaccuracies, some providers divulged sensitive patient information and suffered the consequences of HIPAA violations. Many legal experts suggest that, in most cases, physicians should restrain from responding publicly to negative online reviews, however tempting it may be to react.

If a negative review is attributed to a specific patient, some lawyers recommend contacting them privately by phone to address their concerns; this may clear the air enough to result in a withdrawal of the negative review or rating. Flagging and reporting fake or unsubstantiated negative reviews (or reviews that violate the Terms of Service of a specific platform) can be done. Consultation with an Internet defamation attorney might be helpful in some circumstances, though hopefully, legal action such as a lawsuit or a cease-and-desist letter can be avoided.

For physicians who do maintain an online presence, engaging with an online reputation management service can help suppress fake or negative reviews while offering strategies for building a better reputation. As for me, I think that I’m grateful my name hasn’t attracted a lot of attention at physician ranking and review sites. I guess we’ll see if it stays that way.

Dr. Devlin is president of Locum Infectious Disease Services, and an independent contractor for Weatherby Healthcare. She has disclosed no relevant financial relationships. A version of this article first appeared on Medscape.com.

A recent article on Medscape entitled “Online Reviews Most Important Factor in Choosing a Doctor: Survey” really got me thinking about my online presence. According to the results of a new Press Ganey survey, online reviews and star ratings are the most important factor for consumers when choosing a new health care provider, even more so than the recommendation of another doctor. Almost 85% of the survey respondents said they wouldn’t make an appointment with a referred provider if they had a rating of less than 4 stars.

To be honest, I’ve rarely thought about my ratings or online reviews, and I almost never enter my own name into a web browser to see what might emerge. I don’t use most popular social media apps, I don’t have a professional website, and I was completely late in joining LinkedIn. After considering the Press Ganey survey results, though, I’m wondering how many patients (or potential patients) have found me online. And what exactly did they see?

So, I just searched online for my ratings and reviews. There weren’t many direct hits (although I’m not sure if that is a good thing or not). One of the results listed me as a “Fibromyalgia Doctor” at www.lymeforums.org. To be clear, I’m a locum tenens infectious diseases provider with a focus on inpatient consultations and teaching. I couldn’t find any reviews for myself on WebMD, but I had one rating on the Healthgrades website – I was pleased to see someone gave me 5 stars (though there weren’t any comments) until I realized the site listed my address at an ob.gyn. office; I’m not even sure if that rating was meant for me.

Use of the Internet to assess my qualities as a physician is clearly limited, and much of the online information about my specialty and practice sites is completely inaccurate. Yet, according to the Press Ganey survey, the average consumer uses three different websites and reads more than five online reviews before making a provider decision. Once they’ve seen a provider, though, patients rank practice customer service and communication as more important than “bedside manner” when considering a 5-star review. So, it appears that many physician reviews and ratings probably reflect the performance of the office staff, not the provider.

Given the few hits that I encountered when searching my own name, I’m not convinced I need to do anything differently about my online presence; essentially, I don’t really have one. However, there were certainly a lot of other physicians with the same last name as mine who did have impressive numbers of reviews and ratings. One doctor of cosmetic surgery had more than 200 reviews on multiple sites; almost all were positive, but a few patients rated him at 1 or 2 (out of 5) stars, suggesting that patients should find a new surgeon. What does one do about those outliers?

Medicine is indeed a business and patients behave as consumers when searching the web for a health care provider. Another survey has suggested that just one negative review may cause a business to risk losing 22% of its customers, and that multiple bad ratings are even worse – nearly 60% of customers will avoid a business with three or more negative online reviews.

A few years ago, The Washington Post published an article about doctors who were fighting back against bad reviews. Unfortunately, while trying to directly combat inaccuracies, some providers divulged sensitive patient information and suffered the consequences of HIPAA violations. Many legal experts suggest that, in most cases, physicians should restrain from responding publicly to negative online reviews, however tempting it may be to react.

If a negative review is attributed to a specific patient, some lawyers recommend contacting them privately by phone to address their concerns; this may clear the air enough to result in a withdrawal of the negative review or rating. Flagging and reporting fake or unsubstantiated negative reviews (or reviews that violate the Terms of Service of a specific platform) can be done. Consultation with an Internet defamation attorney might be helpful in some circumstances, though hopefully, legal action such as a lawsuit or a cease-and-desist letter can be avoided.

For physicians who do maintain an online presence, engaging with an online reputation management service can help suppress fake or negative reviews while offering strategies for building a better reputation. As for me, I think that I’m grateful my name hasn’t attracted a lot of attention at physician ranking and review sites. I guess we’ll see if it stays that way.

Dr. Devlin is president of Locum Infectious Disease Services, and an independent contractor for Weatherby Healthcare. She has disclosed no relevant financial relationships. A version of this article first appeared on Medscape.com.

A recent article on Medscape entitled “Online Reviews Most Important Factor in Choosing a Doctor: Survey” really got me thinking about my online presence. According to the results of a new Press Ganey survey, online reviews and star ratings are the most important factor for consumers when choosing a new health care provider, even more so than the recommendation of another doctor. Almost 85% of the survey respondents said they wouldn’t make an appointment with a referred provider if they had a rating of less than 4 stars.

To be honest, I’ve rarely thought about my ratings or online reviews, and I almost never enter my own name into a web browser to see what might emerge. I don’t use most popular social media apps, I don’t have a professional website, and I was completely late in joining LinkedIn. After considering the Press Ganey survey results, though, I’m wondering how many patients (or potential patients) have found me online. And what exactly did they see?

So, I just searched online for my ratings and reviews. There weren’t many direct hits (although I’m not sure if that is a good thing or not). One of the results listed me as a “Fibromyalgia Doctor” at www.lymeforums.org. To be clear, I’m a locum tenens infectious diseases provider with a focus on inpatient consultations and teaching. I couldn’t find any reviews for myself on WebMD, but I had one rating on the Healthgrades website – I was pleased to see someone gave me 5 stars (though there weren’t any comments) until I realized the site listed my address at an ob.gyn. office; I’m not even sure if that rating was meant for me.

Use of the Internet to assess my qualities as a physician is clearly limited, and much of the online information about my specialty and practice sites is completely inaccurate. Yet, according to the Press Ganey survey, the average consumer uses three different websites and reads more than five online reviews before making a provider decision. Once they’ve seen a provider, though, patients rank practice customer service and communication as more important than “bedside manner” when considering a 5-star review. So, it appears that many physician reviews and ratings probably reflect the performance of the office staff, not the provider.

Given the few hits that I encountered when searching my own name, I’m not convinced I need to do anything differently about my online presence; essentially, I don’t really have one. However, there were certainly a lot of other physicians with the same last name as mine who did have impressive numbers of reviews and ratings. One doctor of cosmetic surgery had more than 200 reviews on multiple sites; almost all were positive, but a few patients rated him at 1 or 2 (out of 5) stars, suggesting that patients should find a new surgeon. What does one do about those outliers?

Medicine is indeed a business and patients behave as consumers when searching the web for a health care provider. Another survey has suggested that just one negative review may cause a business to risk losing 22% of its customers, and that multiple bad ratings are even worse – nearly 60% of customers will avoid a business with three or more negative online reviews.

A few years ago, The Washington Post published an article about doctors who were fighting back against bad reviews. Unfortunately, while trying to directly combat inaccuracies, some providers divulged sensitive patient information and suffered the consequences of HIPAA violations. Many legal experts suggest that, in most cases, physicians should restrain from responding publicly to negative online reviews, however tempting it may be to react.

If a negative review is attributed to a specific patient, some lawyers recommend contacting them privately by phone to address their concerns; this may clear the air enough to result in a withdrawal of the negative review or rating. Flagging and reporting fake or unsubstantiated negative reviews (or reviews that violate the Terms of Service of a specific platform) can be done. Consultation with an Internet defamation attorney might be helpful in some circumstances, though hopefully, legal action such as a lawsuit or a cease-and-desist letter can be avoided.

For physicians who do maintain an online presence, engaging with an online reputation management service can help suppress fake or negative reviews while offering strategies for building a better reputation. As for me, I think that I’m grateful my name hasn’t attracted a lot of attention at physician ranking and review sites. I guess we’ll see if it stays that way.

Dr. Devlin is president of Locum Infectious Disease Services, and an independent contractor for Weatherby Healthcare. She has disclosed no relevant financial relationships. A version of this article first appeared on Medscape.com.