Pts refusing to weigh

T-Bird78 · May 14, 2018

If you are working in an office unless the weight is needed for a specific medicine or because the patient has a condition that weight actually plays a factor in why embarrass the patient by insisting they get weighed in a hallway where anyone passing by can sneak a peak at the scale? Is it a specialist that weight would play a big factor in such as ob/gyn, cardio, etc. Perhaps if your scales were moved into an alcove that was more private you would not have as many patients refusing to have their weight taken. Just about the same as small exam gowns and sheets in front of a door that could be opened by any passerby. Patients should be considered as well. And if it is bugging you the patient probably perceives that and may get a little more flustered and cop more of an attitude. Some people just don't like for others to know how much they weigh. Just explain and if they still refuse after you give them a viable reason other than that is what we always do, document it and let the doctor sort it out.
In the hospital they can usually weigh on the bed if needed. Any time that I have entered an ER from an ambulance they didn't stop to get my weight or height. That was a question I answered. I am sure they probably had a way to get my weight if it was needed for computing medicine or whatever they may actually need a weight for.

Our scale is in an alcove around the corner at the end of a hall, so the only people who could see it are people physically standing on the scale and those of us recording the weight.

Katillac, RN · May 14, 2018

Weight is not one of the vital signs. Patients to whom you express this may "cop an attitude" because they know they are being given misinformation.

A patient should not need to be "really freaking out" before you cover the numbers. The fact that you describe resistance to getting weighed as "freaking out" is disrespectful and judgmental.

I'm guessing people "get mad" because you are pressuring them to do something they don't want to do and have a right not to, whether you and your managers want them to or not. If the MD is required to counsel around BMI and doesn't have a weight, the counseling should reflect that. Refusal means something.

Until you show more sensitivity around the issue and understand that it's not necessarily about you (as in judging patients or the fact that you want to weigh them so they should just quietly cooperate) but about PATIENTS' preferences and issues, you're likely to have continued push back around weighing patients.

Wuzzie · May 14, 2018

I do document the refusal (pt has right to refuse) but was wondering how hospital settings/ER handle it. My manager wants us to weigh pts at every visit, even if it's a one-week follow up visit or if we can tell they were seen by another practice the day before (our EMR shows the vital signs for the previous 3 office visits for any physician in our system). Our physicians are also requried to document that they counseled pt on BMI every 6 months. I do cover the numbers if they're really freaking out. I have one pt who comes in annually and refuses to weigh or even give a weight, says she "doesn't have to" and says I'm rude for asking her to get on the scale. I do tell pts it is one of the vital signs and some meds are weight-based. I guess I don't understand why people get so mad. I'm not juding anybody for that number. :)

The BMI is a junk number that means pretty much nothing. That being said "counseling" on BMI does not require a weight. You can pretty much tell who is over the recommended BMI by looking at them. How about you just counsel every patient about it and tick off that box that's so important? A weight is not a vital sign. In most cases it isn't necessary at all. Also, I'm pretty sure the patient doesn't care whether you are judging them or not. It's the self-judgment that's the issue. And it's a big one. There are hundreds of thousands of people who have or once had an eating disorder. To these people being put on a scale is traumatizing whether they see the number or not. So is ticking off a box on a form to meet an insurance requirement worth causing one of your patients to feel bad about themselves? Is it worth triggering an eating disorder? Is it worth making a patient so uncomfortable that they stop getting medical care to avoid it? The terminology you have used ("freaking out" "I don't know why they get so mad" "cop an attitude") is troubling and I'm not seeing very much sensitivity coming through your words despite the things we have explained to you.

psu_213, BSN, RN · May 14, 2018

I'm guessing people "get mad" because you are pressuring them to do something they don't want to do and have a right not to, whether you and your managers want them to or not.

It really is impossible to tell on here with the typed word, but I did not get the vibe that the OP was "pressuring" patients. Every time I go to my PCP, the nurse or MA says "step on to the scale so I can get your weight." I'm not sure how the OP approaches that, but I don't look at that as being pressured. Unsure, though, how the staff would react is a pt refuses.

I still can't figure out why they need to measure my height with every visit.....

Ruby Vee, BSN · May 15, 2018

I do document the refusal (pt has right to refuse) but was wondering how hospital settings/ER handle it. My manager wants us to weigh pts at every visit, even if it's a one-week follow up visit or if we can tell they were seen by another practice the day before (our EMR shows the vital signs for the previous 3 office visits for any physician in our system). Our physicians are also requried to document that they counseled pt on BMI every 6 months. I do cover the numbers if they're really freaking out. I have one pt who comes in annually and refuses to weigh or even give a weight, says she "doesn't have to" and says I'm rude for asking her to get on the scale. I do tell pts it is one of the vital signs and some meds are weight-based. I guess I don't understand why people get so mad. I'm not juding anybody for that number. :)

A number of people have already mentioned that they've dealt with eating disorders and that stepping on the scale is a trigger. Others have mentioned that they may have just seen another provider the day before and that the information is in the easily accessible electronic chart. Here are some other things to consider:

My (former) PCP's office required a weight at every visit. The scale was out in the hall, between the doors of two exam rooms. There was no where to set my winter coat and purse. Further, they required that shoes be removed so they could get a height at the same time. There was no where to sit down to remove or replace shoes. There was nothing to hang on to for balance. After my two knee replacements, I was unsteady just stepping up. I put my shoes on with great difficulty in the morning, and took them off when I went to bed. That weight was an incredible ordeal for me . . . and no one could explain to me why they needed a weight at every visit -- even if the previous visit was earlier in the week.

Then there was the time the narcissist I was married to step up to the scale as I was weighed (after being asked not to), incredulously exclaimed in a voice that carried to all and sundry that he knew I was a porker, but XXX pounds is ridiculous! and then hounded me incessantly to lose weight for the next five years. Every time I step on a scale, it triggers that memory.

Even if YOU aren't judging anyone for the number on the scale, others are. Enough others are -- and do a search for threads about overweight healthcare workers -- that patients can be forgiven for suspecting that you might be judging. And they (or their spouses) may be judging.

broughden · May 15, 2018

I guess I don't understand why people get so mad. I'm not juding anybody for that number. :)

Because people hate to be reminded that they are doing something that is extremely unhealthy and will likely kill them sooner rather than later.

But its like telling smokers not to smoke, they are going to do it anyway but want to ignore the consequences of their actions.

Same reason every obese person you meet blames their thyroid or genes, rather than simple over eating.

Here.I.Stand, BSN, RN · May 15, 2018

So refusal of an unnecessary measurement is "copping an attitude?" Interesting.

Weight is a measurement -- NOT a vital sign, any more than height or % of body fat is a vital sign.

If the provider is going to prescribe a med that is weight-based, they as the prescriber should explain to the pt why the info is needed.

Providers can follow their q 6 mo. BMI counseling policy if it has been 6 months with or without a current weight... although I personally think it's stupid. The BMI doesn't take muscle mass or fat % or edema into account, so honestly why use it? It's not like an obese or emaciated person is invisible until a weight is taken. But in any case: "The current recommended weight for someone of your height and sex is x-to-y pounds. Do you have any questions or concerns about weight, or is there anything you need more information about?" And then of course if the pt's weight is of concern to her, the next steps can be discussed. If her weight is NOT HER priority, she is within her rights to end that conversation. I would bet my houses on it: overweight people know that they are overweight. But in any case, weight has been addressed, and the esteemed box can be checked.

cleback · May 15, 2018

I get not like being weighed... I gained 10 lbs this past year from stress overeating. I contemplated not stepping on the scale this past MD visit. But that just seemed to be counterproductive to having a health check up. And yes, the doctor and I discussed it and that's something we're going to watch.

OP, people engage in a lot of unhealthy behaviors-- overeating, smoking, drinking, sedentary lifestyles, eating too much sodium, not taking their medications as prescribed, the list goes on... Life is hard and we tend to pick up bad habits as we go. But unless the person is willing to change that aspect of their life, no amount of documented counseling will change that. It's ok to put refused/declined/whatever word you want to use for "not going there today" and move forward.

blondy2061h, MSN, RN · May 15, 2018

When I was on a step down unit, that is how we did it if a pt could not stand. Take off the "top" linens so that all that was on the bed was the pt, their gown, and the fitted sheet. Right before an admit, 'zero' the bed scale with a fitted sheet and gown on the bed.

We do hoyer weights. Bed weights are severely frowned upon where I work. Even zeroed there's a lot of variance.

psu_213, BSN, RN · May 16, 2018

We do hoyer weights. Bed weights are severely frowned upon where I work. Even zeroed there's a lot of variance.

I don't know exactly how accurate they are, but combined with I&Os they give enough of a picture that the cardiology service gets a general idea. We had an NP who would write "daily weights with sheet removed from bed." Again, not sure how accurate that weight was, but it was good enough for her.

ETA: Even with bed scale weights, there were still plenty of times where daily weights did not happen, and it drove cardiology nuts. Different discussion though.

Have Nurse, ADN, RN · May 17, 2018

Getting weighed kept me from going to the doctor when I should. I am very ashamed that I am overweight and type 2 diabetic. My last doctor was very judgmental about this. My current doc is much better about this. It is hard when you know your lifestyle is contributing to your disease and yet you struggle so hard to change it. Just be glad some of them showed up. I have cancelled appointments over weight anxiety.

I would like to share what helped me a lot. A book written by Haylie Pomeroy. She is a certified Nutritionist and Wellness Coach. She explains things with humor and compassion.

The Fast Metabolism Diet (Not a diet really, just a life style,) and The Burn.

She explains how hormones, inflammation and digestion issues affect us and how to help balance out naturally. My doc loves this because it's the only thing that worked for me.

No guilt, no shame, no lecture, no calorie counting, no points, no "diet" foods, no hunger, but exercise of course, not to the point of killing yourself!

Just comfort, kindness, education, humor and easy peezy recipes.

I am in my 60s and lost 21 pounds in 2 months, without exhaustion. Just something I thought I'd throw out there.

KatieMI, BSN, MSN, RN · May 17, 2018

As a provider, I can honestly say that "daily weights" are rarely helpful in hospital (we have other, more precise tools to measure fluid status and way more things than we need to know than a scale can produce) and monthly weights done in office are 98% useless. A pair of jeans weights at least 2 lbs, and let me not to start about winter coats, keys and holders with guns still in (yes, I saw it done). The proverbial "more than 5 pounds/week gain" can be used for well-educated and reliably compliant patients, who are very rare birds to see nowadays. Only one "benefit" of weighting patients daily is, for all honesty, is satisfying those checklists for insurance and getting some patients in a kind of routine of care they actually need more than anything else.

If patient refuses to weight, it is just as plain and simple as refusing to take a med, wash, eat, drink, etc. That's his life, he is free to use of abuse it as he wishes. Counting to uselessness of these weights, it is prudent enough to document and move on.