Creating A Size-Inclusive Healthcare Office
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Over the years of working with healthcare practices, I’ve developed an informal audit for practices to use to become more fat*-friendly. Note that while this audit is specifically about size inclusivity, it is important to do similar work around inclusivity of people with other marginalized identities and those with intersecting marginalized identities.
We’ll start with the questions. The first is a list of questions to answer, the second is a process for an ongoing self-audit. Then I’ll discuss options for any areas where accommodation currently falls short.
I want to point out that this is not about fault or blame, it’s about solving the lack of accommodation (as much and as soon as possible, understanding that various things will be within and outside of individual control) so that a health practice supports people of all sizes.
I also want to acknowledge that this is not an exhaustive list, but rather a place to start, please share other ideas in the comments!
Are all doors wide enough to fit an extra-wide wheelchair/walker/scooter?
Are there armless chairs/love seats in the waiting area and in each of the exam rooms (including for family members/advocates)?
Is there positive representation of people of size in office art, magazines, etc.
Are the reading materials in the office free from weight stigma and diet culture?
Do hallways and treatment rooms have ample space for accommodating and maneuvering of larger bodies and extra-wide wheelchairs/walkers/scooters?
Do you have practitioners and staff who are higher weight people?
If your practice performs weigh-ins, does the scale accommodate higher weight patients (minimum of 500lbs, preferably higher)?
Ideally, do you not require weigh-in unless it’s medically necessary?
If you do regular weigh-ins, is everyone in the practice clear about patients’ right to refuse weigh-in for non-medically necessary reasons? Is that right clearly communicated to patients (verbally, with signage etc.)
Are there protocols for medically necessary weigh-ins in which the patient is not informed of the weight (standing facing away from the scale, number not recorded into chart etc.)
Do you have extra-large adult/thigh cuffs for taking blood pressure?
Are there protocols for what to do when a properly sized blood pressure cuff is not available (ie: take pressure on forearm etc.) so that practitioners aren’t using too-small cuffs on higher weight patients and getting incorrect results?
Is everyone aware of where these cuffs are, and what the protocols are?
Do you have gowns in the largest possible sizes?
Does everyone know where those gowns are located? Are they easily accessed?
Are all exam tables and chairs high-weight rated (minimum of 500lbs, preferably higher)? Are a those tables and chairs also adjustable?
Is everyone in the practice aware of weight/size restrictions for any common diagnostic tools and tests the practice performs or refers patients to (ie: MRI, CT, ultrasounds etc.)?
Do you have a referral list that gives the options for higher weight patients (ie: wide bore MRIs)?
Do you know alternatives/options for any test that might not be able to accommodate your patient?
Is everyone in the practice aware of these?
Have staff and practitioners work to notice any situation in which a higher weight patient is treated differently than a thin patient.
For example, if the proper blood pressure cuffs or gowns are easily accessible for thinner patients, but must be searched for when working with higher weight patients, or if thinner patients get a gown but higher weight patients are asked to wear two gowns or given a sheet etc.
Keep a list and work together with admin staff/procurement to solve inequalities whenever possible, and develop non-shaming protocols for any cases where equality cannot be immediately reached.
What if the practice isn’t able to accommodate?
The goal here should be complete accommodation - so that we’re not creating spaces that only support the health of some people. Where that isn’t possible (at least immediately,) I recommend the following:
In the event that you aren’t able to accommodate people of all size, you should have non-shaming protocols that everyone is aware of. By non-shaming I mean protocols that blame fat bodies for not being accommodated, and don’t create shame in the patient in any way.
This starts with being clear in your online presence and when booking appointments. At a minimum the goal should be that nobody ever arrives at your office just to be turned away for lack of accommodation.
Be specific, take responsibility for the lack of accommodation, and make sure it’s clear that the lack of accessibility is the problem - not the body that is not accommodated. Do your own research to refer to accessible practices.
The doors in our practice are x inches wide. Unfortunately that fails to accommodate some people and mobility devices. We are sorry for the lack of accommodation and working to solve this problem by [doing these things.] In the meantime we’ve created a list of practices that provide accommodation, click here to view that.
Take responsibility for making sure that you are referring clients to diagnostic centers and other practitioners that can accommodate them.
Reach out to other facilities to get accommodation information
Create lists for clients that give specific information (for example, weight limit and bore size for MRIs etc.)
Encourage other facilities to complete similar audits
Note that accommodation isn’t just about the space, it’s also about the experience. Fat patients often find themselves standing by (often in a too-small gown in a high-stress situation) while practitioners discuss how they might be accommodated (ie: “which room has the big table?” or “I’m not sure if this is going to work” etc.)
That is something we want to avoid, the process should be just as seamless for fat patients as for thin patients. If only some of your space is accommodating (for example, only some tables are high-weight rated, only some rooms would accommodate a mobility scooter etc.) make sure that everyone knows which rooms/equipment work for higher-weight patients and that getting them into those spaces is a seamless process for the patient.
Finally, remember that the fatphobic nature of our healthcare system does not lend itself to this type of accommodation. Especially if you are part of a larger healthcare system it may be more difficult to make things happen. Be committed, keep working on systemic inequalities, get creative in the meantime, and remember that lives are literally at stake.
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For a full bank of research, check out https://haeshealthsheets.com/resources/
*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings: Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrisons Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.