This is the Weight and Healthcare newsletter. If you like what you are reading, please consider subscribing and/or sharing! People of all sizes had difficulty getting the updated COVID-19 vaccine but, as it often does in healthcare, weight stigma can turn a situation in which it is difficult to get care into a situation where it becomes impossible.
I am so, so, SO tired of nurses and healthcare providers who don’t know the very basics of their job.
ALSO! Seems like every provider and their dog believes that we (fat people) need to be reminded at every possible turn that fatness is bad and that we are bad for being fat, but so few of them actually know anything about how to take care of us. It’s like they want to shame and blame us out of existence, and never want to have to help us.
Not sure if this is still a source at no charge, but at a time Kat was injured and unable to travel and getting home care visits covered by Kaiser, she asked for a vaccination when they first came out, only to be told they had just shut down the provision for doing this through home care. Thinking on my feet, I called our County Health System, and a couple days later they sent a whole team of four people just for the purpose. Score one for socialized health care!!!
As an RN and a teacher of RN students, I agree that this is a huge problem that many healthcare providers are unaware of and may often need reminding of the evidence around this issue. It’s a best practice that I have mentioned repeatedly to my students, both when teaching about intramuscular injections and when discussing how we can properly provide appropriate evidence based and non-stigmatizing care for larger bodied folks. I’m glad you are raising awareness about it too on the patient advocacy side of things.
You and other commenters discuss nurses in the post. I’m certainly not defending any healthcare colleagues that may be unaware (or worse, uncaring if they do know) about this practice. The tricky part is that it is more and more likely the case these days that the person who may have vaccinated you is not actually a nurse.
Most primary care clinics are chiefly staffed by medical assistants. These are the staff that get you back to the exam room (and try to weigh you in the hall!), take your vitals and a quick history before the provider comes in to see you, and they then will administer vaccines and some other treatments as delegated by the supervising provider. MAs do not have the same level of training as RNs, though the general public often conflates the two. When I was a nursing student, I worked as an admin person in several medical clinics. Very often patients would call in asking to speak to “my doctor’s nurse” when the person they sought was an MA. I can’t speak to the requirements of MA training specifically, but I do know in some places they are actually just trained by the provider and clinic staff and may not have gone through a formal education program.
The other people who are more and more frequently tasked with vaccination in the US these days are pharmacists. While pharmacists have doctorates and are very well educated folks, I’m not clear how rigorous their practical training on actually administering vaccines has been. I’ve had a few that have given me shots with frankly lousy technique (and also others with great technique). I know that the job of a retail pharmacist is really hard, conditions are often pretty brutal. Many are asked to work crazy hours with little help or backup coverage and deal with a high volume of clinical decisions that can be of high importance to get right. Add in the line of waiting walk-in vaccine folks and it’s often an unsustainable workload. This does not excuse them from giving proper care of course, but it’s easy for me to see how they could be put into a position of cutting corners or maybe not being given the right equipment by their cheap corporate retail management. I also have noticed that the trend now seems to be that they are being tasked with giving vaccines that used to be available in the PCP office. I asked to get the shingles shot at my last visit and they said, we don’t carry that one anymore in clinic and you’ve gotta go to the pharmacy for it. I’m sure that’s a financial thing driven by cheaper reimbursement costs or whatever. I feel like we were going in that direction already and, like so many other issues in healthcare, Covid just accelerated the full switchover to pharmacy as the expected place to go for vaccines now.
Anyway, that got long. Just trying to provide some context as to why this issue could be happening. Ragen, while I’m here, I do want to say that I really appreciate your work. I have referred to things you’ve written and references you’ve provided when I’ve been prepping for my lecture on obesity. I try very hard to focus on the stigma within healthcare around obesity with my students. Thanks for doing what you do and helping us all to do better in this profession.
When I got my COVID booster this fall, I asked the nurse about longer needles for fat people and she SCOFFED at me -- and told me that was ridiculous and I needed to read better info. Still irate about it. I will download and print the card and script! Thank you!
I hate this for these patients and honestly, puts me on edge as I have Kaiser and thus far, have gotten the longer needle quite easily (your cards are wonderful, I've used them after my first). And sidenote: personal experience to back up the science--prior to your educating us about the longer needle rec (grateful, but God, why can't medicine be on top of these things 🤦🏼♀️), I received my first vaccinations and had a terrible goose egg that no one else had experienced. I'm quite sure that damn liquid never reached my muscle and was just chilling in my far forever, as every time thereafter with the longer needle, no goose egg 🤷🏼♀️
I am so, so, SO tired of nurses and healthcare providers who don’t know the very basics of their job.
ALSO! Seems like every provider and their dog believes that we (fat people) need to be reminded at every possible turn that fatness is bad and that we are bad for being fat, but so few of them actually know anything about how to take care of us. It’s like they want to shame and blame us out of existence, and never want to have to help us.
WOW, this is really something (and by something, I mean fucked up). Thank you so much for this today, Ragen, and for all you do!!!
Thanks again Ragen for bringing this to our attention. It never stops amazing me, this ignorance among healthcare workers.
Not sure if this is still a source at no charge, but at a time Kat was injured and unable to travel and getting home care visits covered by Kaiser, she asked for a vaccination when they first came out, only to be told they had just shut down the provision for doing this through home care. Thinking on my feet, I called our County Health System, and a couple days later they sent a whole team of four people just for the purpose. Score one for socialized health care!!!
As an RN and a teacher of RN students, I agree that this is a huge problem that many healthcare providers are unaware of and may often need reminding of the evidence around this issue. It’s a best practice that I have mentioned repeatedly to my students, both when teaching about intramuscular injections and when discussing how we can properly provide appropriate evidence based and non-stigmatizing care for larger bodied folks. I’m glad you are raising awareness about it too on the patient advocacy side of things.
You and other commenters discuss nurses in the post. I’m certainly not defending any healthcare colleagues that may be unaware (or worse, uncaring if they do know) about this practice. The tricky part is that it is more and more likely the case these days that the person who may have vaccinated you is not actually a nurse.
Most primary care clinics are chiefly staffed by medical assistants. These are the staff that get you back to the exam room (and try to weigh you in the hall!), take your vitals and a quick history before the provider comes in to see you, and they then will administer vaccines and some other treatments as delegated by the supervising provider. MAs do not have the same level of training as RNs, though the general public often conflates the two. When I was a nursing student, I worked as an admin person in several medical clinics. Very often patients would call in asking to speak to “my doctor’s nurse” when the person they sought was an MA. I can’t speak to the requirements of MA training specifically, but I do know in some places they are actually just trained by the provider and clinic staff and may not have gone through a formal education program.
The other people who are more and more frequently tasked with vaccination in the US these days are pharmacists. While pharmacists have doctorates and are very well educated folks, I’m not clear how rigorous their practical training on actually administering vaccines has been. I’ve had a few that have given me shots with frankly lousy technique (and also others with great technique). I know that the job of a retail pharmacist is really hard, conditions are often pretty brutal. Many are asked to work crazy hours with little help or backup coverage and deal with a high volume of clinical decisions that can be of high importance to get right. Add in the line of waiting walk-in vaccine folks and it’s often an unsustainable workload. This does not excuse them from giving proper care of course, but it’s easy for me to see how they could be put into a position of cutting corners or maybe not being given the right equipment by their cheap corporate retail management. I also have noticed that the trend now seems to be that they are being tasked with giving vaccines that used to be available in the PCP office. I asked to get the shingles shot at my last visit and they said, we don’t carry that one anymore in clinic and you’ve gotta go to the pharmacy for it. I’m sure that’s a financial thing driven by cheaper reimbursement costs or whatever. I feel like we were going in that direction already and, like so many other issues in healthcare, Covid just accelerated the full switchover to pharmacy as the expected place to go for vaccines now.
Anyway, that got long. Just trying to provide some context as to why this issue could be happening. Ragen, while I’m here, I do want to say that I really appreciate your work. I have referred to things you’ve written and references you’ve provided when I’ve been prepping for my lecture on obesity. I try very hard to focus on the stigma within healthcare around obesity with my students. Thanks for doing what you do and helping us all to do better in this profession.
When I got my COVID booster this fall, I asked the nurse about longer needles for fat people and she SCOFFED at me -- and told me that was ridiculous and I needed to read better info. Still irate about it. I will download and print the card and script! Thank you!
I hate this for these patients and honestly, puts me on edge as I have Kaiser and thus far, have gotten the longer needle quite easily (your cards are wonderful, I've used them after my first). And sidenote: personal experience to back up the science--prior to your educating us about the longer needle rec (grateful, but God, why can't medicine be on top of these things 🤦🏼♀️), I received my first vaccinations and had a terrible goose egg that no one else had experienced. I'm quite sure that damn liquid never reached my muscle and was just chilling in my far forever, as every time thereafter with the longer needle, no goose egg 🤷🏼♀️