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Finding out that you need an x-ray, MRI, CT or other scan can be scary for people of all sizes, but fat* people can face a lot of additional and, unfortunately, well-founded fears about the experience. Here are some tips and tricks for people who offer these scans to make the experience better for higher-weight patients.
I know that many people won’t be able to do all of these things, what I’m asking is that you use any power/privilege/leverage you have to do what you can (and know that anything you can do WILL make a difference) and then consider finding allies who you can work with to push for larger changes.
1. Know what you are working with
Know everything you can about the equipment and facility. What is the weight-rating of the table/bed/chair? What is the bore size of the scanner? Are there any other size/weight limitations? If you don’t have the most accommodating equipment that exists, proactively create a list of who does so that you can refer patients. Make sure all of that information is easy to access for everyone who might be patient-facing.
2. Know the people you are working with
Be aware of all the patients you may work with. Sometimes when it comes to inclusion, identities can become siloed. So even if there are protocols for higher-weight patients and protocols for wheelchair users who need to transfer, there may not be protocols for higher-weight patients who are wheelchair users who need to transfer. Sometimes a lot of focus is put toward accommodating patients physically, but less focus is put on making sure patients, including neurodivergent patients, are psychologically comfortable. Consider bringing in educators and/or consultants to help you think through all the patients you might work with and proactively create protocols so that every patient will have a positive, seamless experience.
3. Communicate what you are working with to the people you are working with
Give as much information as you can – including the weight ratings and bore sizes of your equipment, any accommodations you offer (for size, disability, neurodivergence etc.) be honest about who you can’t accommodate (and offer referrals to places that can). Don’t wait for patients to ask and don’t make assumptions about who needs to know. Provide this information to every potential patient early, often, and through as many delivery methods as possible – on your website, when patients call, on their MyChart or other online patient record, in appointment reminder texts, literally in every possible way.
Communicating about accessibility and accommodations helps people who need the access and accommodations AND it educates people who may currently have privilege that puts them in a situation where they don’t know what they don’t know. It can help them stop taking their access for granted, help them to be more educated for the people in their lives who may not typically be accommodated, and help them in the event that their needs change.
4. Create an accessible experience start-to-finish
It’s not just about the equipment. Do you have armless chairs in your waiting room and in any treatment rooms? Do you have the largest possible gowns? If you take blood pressure do you have cuffs that work for all arm sizes? Don’t take the patient’s weight for no reason (ie: “routine weigh-in.”) If you truly need to get the patient’s weight (for example, if you’re using weight-based contrast medium dosing) instead of just asking their weight (which might be jarring/upsetting to them) explain it to the patient in a non-judgmental way. For example “The contrast is dosed by weight. We don’t care about your weight except to get the dose right!” There is a size-inclusive healthcare office audit here.
5. Center the patient’s experience
Story time! (Shared with permission, of course.) I was recently acting as an advocate at an orthopedic appointment that included an x-ray. Ortho appointments can be some of the most fraught for fat patients so the patient was nervous and I was on high alert. We had talked through scenarios and worked out a signal they would use if they wanted me to jump in (in a nod to The West Wing, they would tug their ear lobe.)
Things had gone very well so far - great chair options in the waiting area, no fat-shaming, a positive response to declining weigh-in, and the tech knew exactly what the weight-rating of the x-ray table was (650lbs). The patient had limited mobility and was moving slowly (because they had a knee injury, which is why they were at the orthopedist!) They explained that they could walk from the exam room to the x-ray room at which point the tech said “great, you can stand for the x-ray.” They explained that, in fact, they couldn’t do that so they would need to use the table. The tech sighed audibly. As the patient worked to get onto the table without using their injured dominant leg the tech continued to sigh.
The patient said “I can tell I’m frustrating you” and the tech said, “this is just taking a LOT longer than normal.” Earlobe tug. I stepped in and cheerily said “Isn’t it interesting how there isn’t really a ‘normal’ and different patients need different amounts of time!” Then I put my body between the the tech and the patient, turned to the patient and said calmly “take all the time you need.” (The rest of the appointment was outstanding. It may be in part that the patient’s issue is genetic, but the ortho said that he didn’t think surgery was warranted but never mentioned weight loss or suggested that surgery would not be an option for this super fat patient.)
This is an example of a tech centering their own experience. I know that often techs are under time pressure and that sucks, but it’s certainly not the patient’s fault, and making the patient feel guilty and embarrassed for taking the time they need won’t make things go any faster, but it may make the patient less likely to try to access care in the future. So even if you are feeling pressured or stressed try to center the patient’s experience. Also try to put yourself and the patient on the same team – the two of you against unfair time constraints, rather than you against them.
6. Do The Right Thing When Things Go Wrong
Sometimes things go wrong – it can happen despite the best intentions, and it can often be outside of your control. Maybe the patient was accidentally scheduled on the standard MRI instead of the wide-bore, or even though you tried to get information about the CT weight limit to them they didn’t realize that it would fail to accommodate them. I suggest that you always start by apologizing and making it clear that it’s not the patient’s fault. Even if it’s not your fault, apologizing and taking the blame (or at least shifting the blame from the patient) can help them avoid a shame spiral that will lead to them disengaging from care. Ask the patient what they want – do they want help solving this, do they just want to leave, do they want a list of referrals. Respect the patient’s requests and support them to the best of your ability.
As always, it’s unlikely that you can change everything, but you can change something and what you change will make a real difference in the experiences and lives of your patients, any effort you put into this will be more than worth it. I thank you in advance on behalf of all the patients you help.
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*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 Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
I love this so much. Your advocacy made me tear up a bit. I can’t imagine having someone do that, and it’s really such a simple and basic thing!
Regarding contrast dosing: I needed a CT with contrast a few months ago, and the checkin tech asked my weight. I said I didn’t know, and they told me to guess. I took one of your lines and said we are not at the county fair. (That caught her off guard!) she said the system wouldn’t allow her to proceed without a number, and against my better judgement, I gave her a random number. (I really don’t know my weight. I could’ve been off by 10% or 50%.) she types in my number and then says she thinks they need it for the contrast dosing. I said if it’s a dosing issue, why am I being asked to GUESS? She says there’s basically two doses: for under and over 200lbs.
So here’s my thing: I don’t know if that’s true but if 200 is the cutoff (which seems very sloppy and probably inaccurate for children and adults who are far under and over the 200 lb line), why didn’t they just ask if I was over or under 200lbs?
I'm trying to leave a comment on your apnea post but keep getting "page not found" -- any thoughts?