Templates to Ask for Accommodation

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We shouldn’t have to ask for accommodation in healthcare. Those in charge of creating the spaces where healthcare is delivered should be fully committed to creating spaces that are fully inclusive, including for people of all sizes.

Unfortunately, that is not the world we live in. From something as simple as accommodating chairs, to something used at nearly every appointment like a blood pressure cuff, to something that can be as life and death as an MRI machine, far too many healthcare spaces are designed to fail to provide even the most basic needs to higher-weight patients, with the most harm, as always, being done to those of the highest weights and those with multiple marginalized identities.

So what can be done?

If you work in healthcare, consider using this office audit to identify ways that you can be more inclusive. If you’re not the decision maker, consider using whatever channels are available to you to make suggestions and/or try to gather a group together so that you have more cloud to push for change.

If you are a patient, you can make a request, which is what the rest of today’s post will be about.

Reader Dr. Dev Seacrest recently reached out to me to ask:

”Do you have or know of a repository for templates for advocates requesting that hospitals and clinics obtain a variety of cuffs, accessible seating, etc.?”

I mentioned that was a great idea and that I would create some. It turns out that Dr. Seacrest successfully convinced a clinic to get accommodating chairs and offered his email as an example.

Content note: Some of the links I use below will lead to pages and research that are based in weight stigma and utilize stigmatizing terms and concepts, unfortunately weight-neutral research doesn’t always exist to support the need for size accessibility.

Chairs (by Dr. Dev Seacrest)

Hello, 

I'm writing to ask that you look into chairs to accommodate the variety of people at our clinic. That would include chairs of different widths, chairs with and without arms, and taller chairs that allow larger people and people with limited mobility to sit and stand safely.

This is important both for patients and for their caregivers. If a caregiver needs to sit on the exam table because there is no armless chair in a room, that not only demeans the caregiver, but it may also lead to the patient being unable to get adequate care.

Having appropriate chairs for everyone encourages people to come in for both prevention and treatment when they need it, rather than waiting until a problem is severe.

It can also reduce patient falls, which The Joint Commission found to account for 48% of reported serious adverse effects in 2023 in a healthcare setting.

If there's someone else I should discuss this with, please feel free to forward this email to them or to let me know. Thank you so much for your help.

I want to point out the specific things that Dr. Dev did that are important to these kinds of letters with, one more time, a reminder that none of this should be necessary.

First, he asked for chairs in the exam rooms not just the waiting room. This is critical and frequently overlooked. Sturdy, accommodating seating should be available anywhere people may need to sit. This is important for patients and also those who attend appointments with them including caregivers, advocates, family, and friends.

He also provided reasons that are important to what are likely some of the goals of the clinic (preventative care and reducing falls) with a link to research to support the point he was making.

Thinking about those things and using Dr. Seacrest’s letter as a guide here are a few more templates. Please feel free to change these in any way that works for you.

I do want to say that, while the templates have a personal story element, if you are a person who lives in a thinner body, making requests like this can be an excellent way to work in solidarity with higher-weight people. If you have permission to share a story from a higher-weight person you can use that, or just leave out the personal story.

General Template

Hello, 

I'm writing to ask you to look into acquiring [insert item that you need here].

[Insert personal story here if you have one.]

Patients of all sizes should have [insert the thing that you are looking for.]

[Insert research that you have, if any, to support your request.]

Having [thing that I’m requesting] ensures that all patients of all sizes have equal access to healthcare.

If there's someone else I should discuss this with, please feel free to forward this email to them or to let me know. Thank you so much for your help.

Blood Pressure Cuffs

Hello, 

I'm writing to ask you to look into acquiring troncoconical blood pressure cuffs for your higher-weight patients.

[Insert personal story here if you have one. For example: At my last appointment I was in a lot of pain during the blood pressure measurement, they had to take it twice and after I left I noticed a bruise that was left behind from the cuff. My blood pressure was much higher than it typically is when I take it at home.)

When blood pressure cuffs that are either too small or the wrong shape (including standard rectangular cuffs when used on conically shaped arms) are used, they are found to significantly overestimate blood pressure. This, in turn, can lead to overmedication which can expose patients to unnecessary side effects and blood pressure that is too low. Also, blood pressure cuffs that are too small or the wrong size can cause discomfort that can make patients delay or avoid future visits.

Research has found that only troncoconical (also known as conical, contour, or bariatric) cuffs provide accurate readings for people at the highest end of the weight spectrum.

Having appropriate blood pressure cuffs ensures that all patients have equal access to correct blood pressure information.

If there's someone else I should discuss this with, please feel free to forward this email to them or to let me know. Thank you so much for your help.

Gowns

Hello, 

I'm writing to ask you to look into acquiring larger gowns for your higher-weight patients.

[Insert personal story here if you have one. For example: At my MRI I was told that I had to wear a gown, “no exceptions.” However, you did not have a gown that accommodated me and when I pointed that out I was told that I could wear my own clothes. I don’t know the reason for the “wear a gown, no exceptions” policy so I had a lot of anxiety that wearing my own clothes might cause a problem. Also, it made me feel like you don’t care about patients like me.]

Patients of all sizes should have access to gowns that fit them.

Research finds that experiencing weight stigma, like not having access to the basics of healthcare, drives healthcare avoidance and disengagement in patients.

Having gowns of all sizes ensures that all patients of all sizes have equal access to healthcare.

If there's someone else I should discuss this with, please feel free to forward this email to them or to let me know. Thank you so much for your help.

Finally, I want to say that when you make these requests, you are doing the facility a courtesy by letting them know about something they should have already known about and taken care of. That said, if they are not receptive and they fail to make the changes you request, it’s important to understand that it’s not your fault. We can only control the work that we do, we cannot control the outcome and should not shift the blame from a healthcare facility that is actively failing us to ourselves, including if the facilities for which we are doing a favor fail to take the opportunity to do the right thing.

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More research and resources:
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 Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.