So many things have changed for the better in the past decade when it comes to a patient’s transparency and ability to access their medical records. Online portals make such access to review your medical file as easy as logging in and start reading.
But with transparency comes an unexpected downside — too much information, not always couched in gentle language. Knowing what your health care practitioner thinks of you can have emotional consequences few people are ready for — and that few physicians or therapists understand.
That’s what my friend recently read over and over again when she logged on to review her medical records after a recent checkup. My friend — who is anything but obese and well within a normal range of weight for her height — was devastated.
She works so hard on her fitness and watching what she eats. She tries not to snack too much in-between meals, and goes to the gym faithfully many times a week. Like too many of us, much of her conscious time spent on this earth is worrying about her weight and diet.
So when she read the word, “obesity,” over and over again in her medical record, she was understandably distraught.
How Do We Define Obesity?
The problem with the word “obesity” is that different people use the word differently, and mean very different things with it. Most physicians are still used the scientifically-flawed Body Mass Index (BMI) to determine obesity. But no health care professional should be using BMI any longer, because the BMI mis-classifies nearly half the people.
Height and weight are the two factors that determine a person’s body mass index (BMI), a measure of body fat and general health. However, this one-size-fits-all approach may be flawed, according to researchers from the University of California, Los Angeles (UCLA). Published in the International Journal of Obesity, their study reveals how ineffective BMI is, as well as the number of people who may be inaccurately deemed overweight or obese.
BMI is a calculation that divides people into one of four categories: People who are underweight, with a score of less than 18.5; normal weight, with a score between 18.5 and 24.9; overweight, with a score of 25 to 25.9; and obese, with a score of 30 or greater. Basing this calculation on height and weight alone, however, doesn’t take into account a person’s bone, muscle, or fat proportions. […]
Nearly half of those whose BMIs labeled them as overweight were actually healthy, according to data on their other health measures. Fifteen percent of those who were classified as obese were also considered healthy. And when the researchers looked at participants classified as healthy, they found 30 percent were actually unhealthy when their health measures were taken into consideration.
So here is a seriously flawed measure that doctors continue to insist on using because (a) they’ve always used it (laziness) and (b) it’s quick and easy (more laziness). And just like your height, your BMI may be primarily influenced by your genes — not something you can easily change.
To accurately diagnose obesity, a physician needs to take into account many more factors than whether your BMI is simply 30 or above. They need to assess your diet and your activity level, including physical exercise. Obesity — as a medical concern needing medical attention — should only be diagnosed after all of this is taken into consideration.
If obesity isn’t an actual current medical concern or reason for the medical visit, it should not be included in the patient’s chart — especially if the health care professional hasn’t properly run through the diagnostic questions for it (e.g., not just using the flawed BMI score).
The Emotional Consequences of Reading Your Medical Chart
I believe it’s wonderful that many patients now have unfettered online access to their medical charts. It’s a step in the right direction.
But physicians and other health care workers haven’t yet caught up to this innovation. They are still writing their chart notes as though nobody but another medical or healthcare professional is going to read them.
That’s got to change. Language has emotional consequences, and lazy use of language as a short-hand is commonplace in people’s medical records. If physicians and other healthcare workers don’t update their charting practices, they are going to cause a lot more emotional and psychological suffering beyond that of my friend’s.