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Inaccurate obesity reports by medical residents require intervention
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Despite national attention on obesity trends, new data from a study conducted by researchers at Massachusetts General Hospital found that medical residents are failing to accurately report obesity status in patient health records upon admission and discharge.
“These results are surprising and shocking,” Gitanjali Srivastava, MD, obesity medicine and nutrition physician/clinical research fellow,told Endocrine Today. “Under-documentation of obesity in inpatients by medical residents demonstrates a severely limited focus on obesity in this setting. Attention to the presence of obesity is enhanced by its inclusion in the outpatient problem list. The low rate of obesity documentation by physicians-in-training is particularly striking, given the intensive public health focus on this disorder.”
In order to evaluate the recognition of and response to obesity in patients evaluated during inpatient admission, Srivastava and colleagues analyzed the admission and discharge notes completed by the admitting resident for 1,158 patients during September, November, March and June in a single academic year (2010-2011).
“The resident inpatient admission note summarizes the patient’s entire medical history and plays a central role in defining the overall clinical history, status, needs and plans for the patient. It is a very sensitive test for inpatients, since even minute details, such as a tonsillectomy 10 years ago, would be included in this note. Given the comprehensive nature of these inpatient admission notes, we hypothesized that review of these notes would provide a sensitive means of assessing residents’ attention to obesity as a medical problem,” Srivastava said.
The researchers recorded basic demographics and comorbidities, and they identified all references to weight, obesity, BMI, adiposity and body fat in each medical resident admission note and discharge summary in the electronic medical record, Srivastava said.
According to data, the prevalence of obesity in the general medicine inpatient population was 35% overall and 40.3% in patients aged 26 to 70 years. In the population of inpatients with obesity, there was a significantly increased rate of hypertension, hyperlipidemia, diabetes, coronary artery disease, sleep apnea and non-alcoholic fatty liver disease.
Further data indicate BMI was reported in the admission notes or discharge summaries in none of the 1,158 patients, whereas a current weight was noted in two patients (0.02%; both of normal weight).
“No patient with obesity had a weight or BMI documented in any of the resident admission notes or discharge summaries,” Srivastava said.
Moreover, the researchers discovered that obesity was incorrectly reported by residents in 11.6% of patients with a BMI of less than 30. Regarding patients with obesity, residents rarely documented the obesity in the present illness, medical history or assessment and plan, Srivastava said.
Additional data found the physical exam had the highest rate of obesity documentation (37.5%). However, the documentation was nonspecific. The residents commonly described the patient as “obese” or as having an “obese abdomen,” Srivastava said.
Finally, data concluded that residents rarely addressed obesity in their assessments and plans (6%), even in patients with a severe BMI of more than 40 (14.5%). Documentation of obesity anywhere in the admission note was significantly higher in patients with documented obesity in the medical record (21.3%) before the admission (80% vs. 40%; P<.0001).
Srivastava said medical residents are at the forefront of medical education, and residency training includes an intensive admission process in which residents perform comprehensive clinical evaluations.
Srivastava and colleagues are in the process of administrating surveys and small focus groups to medical residents exploring their perceptions, behavior and knowledge around obesity. Srivastava said the findings will enable the researchers to develop an appropriate obesity medical education curriculum for medical residents. – by Samantha Costa
For more information:
Srivastava G. 761-P. Presented at: The Obesity Society 30th Annual Scientific Meeting; Sept. 20-24, 2012; San Antonio.
Disclosure: The researchers report no relevant financial disclosures.