DR. MAX PEMBERTON: It makes me sad, but doctors need obese dummies to train on

Long before doctors in training are unleashed on patients, they practice important clinical skills on dummies.

Of course, this isn’t the same as with a real patient, but that’s the point: you can make mistakes knowing that the lump of latex and plastic isn’t going to complain no matter how many times you mess it up.

You can practice your technique, get used to the pitfalls and put the mistakes behind you. However, the dummies we train on are not realistic because they always seem thin. There are no fat or overweight manikins. That is, until now.

Trainee doctors at Aston University in Birmingham are being given ‘realistic’ bariatric exercise models to prepare them for the type of patients they will actually see.

I’m sorry to say this, but I think it’s a good idea. Nearly two-thirds of all adults in England are now overweight, and the fact is that doctors and nurses are often woefully unprepared for the reality of carrying out clinical procedures on obese people.

Some of the ‘anatomical landmarks’ – places on the outside of the body that help a doctor orientate themselves and find underlying organs and veins, for example – are often different in a fatter person.

For example, the nipple is used to locate certain spaces between the ribs or where the heart is located.

But in an overweight patient, this may be too far down – if the chest hangs down when the patient is sitting upright – or too far to one side, if the chest slides to the side when the patient is lying down.

There are other considerations too. Once, when I was doing chest compressions on an overweight patient who had collapsed, I remember being struck by how difficult it was to get them all to penetrate deep enough.

The fat acts as a cushion, meaning it’s impossible to measure the impact of each push. If you don’t go down deep enough, the heart won’t compress properly and blood won’t be pumped around the body. This could be a matter of life or death.

But the most difficult daily problem is undoubtedly taking blood. Just this week I was asked to help find a vein in a severely overweight patient after two nurses failed to do so.

It is challenging. You have to feel if a vein under the skin ‘bounces’, but you can’t do that if there is too much fat over the vein. It’s a notoriously difficult skill to master unless you practice a lot.

Having worked in eating disorder services where there were many obese patients, I am used to this.

But imagine it’s late at night and someone is deteriorating rapidly and his or her blood needs to be checked.

Or do you need to find a vein to insert an IV and have only practiced on a skinny, muscular arm with bulging veins?

Intubating someone – placing a tube down their throat to help them breathe during surgery – is also very different if the patient is obese.

First, fat around the face, neck and chest makes it more difficult to position the head correctly. Fat also pushes into the airways, making it harder to keep them open, while fat around the neck and chest increases pressure on the chest, meaning it’s harder to fully ventilate the lungs.

Naturally, woke warriors view the move to “obese” manikins as an act of inclusion. But for me it’s not about being ‘inclusive’. The point is to accept that a large proportion of patients are seriously overweight and we need to ensure that the doctor has experience in dealing with the problems this brings.

I have to say that while I fully support obese people getting the care they need, I don’t embrace the “fat can be healthy” lobby.

It’s not fat-phobic to remind people that being overweight comes with a whole host of health complications, and it’s important to encourage people to get fitter.

It is important to remind obesity of the negative impact it has on their health and longevity. We cannot normalize it.

The trend to modify everything from operating tables to ambulances to cater for obesity comes from America, where the obese use identity politics to justify their shape and deflect criticism.

Obese people there have adopted the language of persecuted or marginalized minorities such as gays and black people. They are now ‘proud’ of their fatness and ‘celebrate’ it. This ridiculous cult of the obese has spread to Britain and is now infecting us.

Yes, we should have these manikins to practice on because they reflect the type of patients we will see in clinical practice. But that doesn’t mean we shouldn’t pause and think about why this is needed in society now, and what it means for the long-term survival of our healthcare system.

Amanda Pritchard, head of NHS England, says she hopes cervical cancer will be eliminated by 2040. To do this, we need women to be screened regularly.

A report from Cancer Research UK has suggested this could be thwarted due to poor uptake of smear tests among people aged 25 to 29.

ROSIE’S IDENTITY CRISIS

I’m sure new mothers will take some solace in the fact that model Rosie Huntington-Whiteley, despite being rich and famous, found it difficult to adjust to motherhood.

“For a period after I had my first son, there was a real change in identity and a kind of mourning for the loss of your old life,” she says. “The rug was pulled out from under me.”

Many women say the same thing. No matter how much money you have, being a new mom can be hard.

A midwife friend described having a baby as “like a bomb going off in your social life.” The world is tilting on its axis. Your focus now is on this screaming, crying, pooping bundle. You rarely have a moment to yourself and when you do, you worry that you’re failing at being a mother.

Of course, having a baby can be wonderful. But many struggle to remember who they were before they gave birth. It’s not helped by the unrealistic portrayal of new motherhood we see on social media.

New moms, remember: you’re doing a great job and if you can, make sure you take some time for yourself.

Research shows that working from home can increase the risk of depression, heart disease and dementia.

Since the pandemic, many have been WFH for part of the week. It may be fun to check your emails in your pajamas, but it doesn’t seem to be good for your health in the long run.

I suspect this is due to two things. First of all, we are sociable, and WFH means we interact with people much less than in the office. Those water cooler moments are good for our mental health and stimulate our brains, preventing dementia.

Those who are isolated, for example due to hearing loss, are at greater risk of dementia, so the opposite must be true: those who are socially connected are at lower risk.

But we are also more active when we go to the office. Not only is it easier to go to the gym, we also walk more. On days when I don’t go to work, my steps drop from 12,000 per day to 3,000. That soon adds up.

DR MAX PRESCRIBES…

A handful of nuts

Replacing an egg in the morning with a handful of nuts has been shown to reduce the risk of developing or dying from cardiovascular disease by 17 percent. It’s easy to swap and nuts are packed with important nutrients that benefit our health.