Pts refusing to weigh

Have Nurse, ADN, RN · May 12, 2018

I work in a specialist office but what do you do in the hospital if a pt refuses to get on the scale? It's not as big a deal with us, although I get tired of pts asking why they need to be weighed when they're seeing us for a sinus infection, but if someone's coming into the ER couldn't weight be a factor? We can document "pt refused" for the weight, or "pt states she weighs 125 lbs" but at what point, if ever, is a pt made to get on the scale? Women tell us their weight and they're typically way off, either under (in denial) by 10 pounds or over-estimating by 15-20. I know they have the right to refuse, I can cover the numbers on the scale when they're on it, and I can even have their family member stay back where they can't see the scale, but it bugs me when they cop an attitude about it. Just wondering what you all think about it. No harsh comments or judgements. :)

Yes, it can be a bit disconcerting not to have that data. Let me share with you why I don't get on the scale. It has nothing to do with embarrassment or ego or denial, honestly. I'm not obese either.

I was taught in Nursing school, the best time to get an accurate weight is first thing in the morning, after the patient voided or had a BM, and before they got dressed. That was how we did it in the hospital and in LTC.

There can be as much as a 4 pounds or more difference, due to clothing, shoes, eating, fluid intake, etc. so it wouldn't be accurate anyway, even if the scale was a good one.

Due to my own regimen with my doctor, he prefers that I keep track of it for accuracy due to a tricky thyroid and such.

With his endorsement, there is a certain plan that I follow which involves keeping track of weekly weights. I do that faithfully and that is what the Dr. uses, as it is more accurate.

We all know that the patient has the right to refuse. Of course, if we are dealing with someone with dicey circulation or renal issues that can be scary if they do refuse.

But rather than charting "refused," which sometimes has a negative connotation, I chart "declined".

I think too, that part of it is the privacy concern. It's too bad that they don't put scales in the treatment rooms instead. They might get more cooperation if they did.

Try not to take it personally. You are doing the best you can! :sniff: :geek:

Have Nurse, ADN, RN · May 12, 2018

Declined is a much nicer word than refused. Respect that it is a very difficult issue for many.

I agree!!

peacockblue · May 12, 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.

mmutk, BSN, RN, EMT-I · May 12, 2018

We weigh our patients in their bed so they don't even know it. Some cardiac patients do require a 'standing weight'.

Patients can refuse anything they want, I don't care. I don't force healthcare on anyone it's their choice and they will suffer any

consequences as a result.

trytounderstand · May 12, 2018

I work in a specialist office but what do you do in the hospital if a pt refuses to get on the scale? It's not as big a deal with us, although I get tired of pts asking why they need to be weighed when they're seeing us for a sinus infection, but if someone's coming into the ER couldn't weight be a factor? We can document "pt refused" for the weight, or "pt states she weighs 125 lbs" but at what point, if ever, is a pt made to get on the scale? Women tell us their weight and they're typically way off, either under (in denial) by 10 pounds or over-estimating by 15-20. I know they have the right to refuse, I can cover the numbers on the scale when they're on it, and I can even have their family member stay back where they can't see the scale, but it bugs me when they cop an attitude about it. Just wondering what you all think about it. No harsh comments or judgements. :)

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.

RainMom · May 12, 2018

Most stretchers now also have the capability of weighing pts which would probably be what ER uses if necessary.

Everline · May 12, 2018

We always weigh our patients and no one has ever declined it. I wouldn't care if they did. I'd just document and move on.

On a personal level, I have, in fact, declined to get on a scale when I went to see a doctor. I saw no no need for it given the reason I was there. The nurse seemed put off by me politely refusing and she actually felt the need to ask the doctor if it was ok that I didn't get on the scale. He came out and took a look at me and excused me from being weighed. Not sure what the nurse thought was going to happen there. I am thin and always have been but I go through phases that I get triggered by knowing my weight. Without going into more details, this was one of those times. I have also put off going to the doctor due to anxiety about stepping on a scale. I'm not about to make anyone step on the scale if they don't want to.

DowntheRiver · May 12, 2018

I work in Oncology, and since many treatments are based off of weight, we actually don't accept refusals/declinations for most treatments. Sadly, many of our patients can easily lose 20-30 pounds in a month. I saw one guy who lost 50 (!) pounds in a month between his 3rd and 4th chemos after being hospitalized.

So, for the most part, declines are acceptable but there are some instances where it isn't appropriate.

Editorial Team / Moderator · May 12, 2018

I have never been weighed more in my life than in the last year! Between my pregnancy and subsequent peripartum cardiomyopathy/congestive heart failure, I get on that scale a lot. Even in the Army, I only got weighed twice a year! Very publicly, too. Lol.

Unless they need weight-based meds, document the declination and keep on truckin'.

Tenebrae, BSN, RN · May 13, 2018

I'm happy to be weighed if there is a clear reason for it, eg medication based on weight, surgery etc

Otherwise I usually politely decline

allnurses Guide · May 13, 2018

I weigh everybody in triage, and it is assumed fully clothed and shod. Skip it if they are in a wheelchair, or major distress. I have had people be reluctant, but still comply. Some say outloud "I can't know! Don't tell me!" and I reassure them, tell them to stand facing outward with their back to the number and I promise not to say it out loud. Not to mention we do it in kilos :)

My daughter had an eating disorder, and frankly, getting weighed is a way of tracking what some young women are trying to hide. A PCP office should do them routinely, but for heaven's sake, refusal is always an option.

She got really upset at a clinic where the tech insisted on a weight, she told the girl not to say anything and instead had her weight announced loudly.

Way to establish trust! not

T-Bird78 · 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. :)