Treating smokers wastes health care resources - Non-smoker care should be prioritized

So says this Australian doctor as noted in the link and quote below.

Is may be an obnoxious opinion, but is he truly wrong from a pragmatic point of view in assigning limited health care resources to yield the maximum public health benefit?

Surgeon urges lower priority for smokers

I think that is an interesting mutilation of what the doctor is saying.

He never said that “non-smoker care should be prioritized” - he said that smoking increases the risk of post-op infection and smokers should quit for the 6 weeks before a surgery.

The vast majority of medical problems come from not following the correct lifestyle. Not exercising, too much stress, smoking, being obese, etc. So i dont see how this particular unhealthy lifestyle is any different than any of the others. next they might ask people to cut their stress levels down 50% if they want to get elective surgery so BP will be lower and immune function will be higher.

Lest we forget obesity is the cause of major health problems as well. Would you also suggest that doctors lower the priority for those who regularly eat fast/junk food and don’t exercise?

Doctors often give patient orders to prep for surgical procedures already for the purpose of avoiding complications, don’t they? Along the lines of no alcohol , nothing by mouth, no strenuous activities, etc. for x hours/days/weeks before surgery. I feel it is the right and responsibility for a doctor to tell the patient that if his orders were disregarded, the doc is not able to perform the elective procedure due to increased risk of complications and then to reschedule it.

Well as others have noted its not really what he said , but to be honest , others have thought that way. It really depends on what type of surgery is being contemplated , elective or emergency.

If my doctor was to tell me to quit smoking several weeks before some sort of surgery , i probably would tell him no problem ,and then keep smoking anyways.

To me , this is just a trial balloon , I have heard it mentioned in Ontario ,and it went nowwhere , I expect that it will go no where in Australia too.


Presumably the author of the news article I referenced does has access to the referenced article, and the direct implication in the newspaper article seems to be that there is a recommendation in the medical article that smokers should be bumped to the back of the line in receiving care, if they don’t stop smoking for the recommended time prior to surgery.

Here is the original article -

- Smoking cessation and elective surgery: the cleanest cut - Matthew J Peters, Lucy C Morgan and Laurence Gluch MJA 2004; 180 (7): 317-318

Read the link to the Doctor’s Med Journal article. I have just posted above. I think the newspaper article give a relatively accurate take on the recommended “prioritization” aspect with respect to smoker treatment.

So because some newspaper editorialization says so, we should make a blanket rule that smokers don’t get elective medical care? The doctors sound more concerned about the post-op infections than they do about offing smokers. They seem to want no smoking to be one of the pre-op preps, which makes plenty of sense.

This is not akin to a “doctor saying that non-smokers should be treated last.”

I’m a bit confused re your reply. I thought the relatively narrow issue I was addressing in responding to your post, was the accuracy of the newspaper’s characterization of the doctor’s recommendations in the article as “prioritizing”. Even the Med Journal article uses the word “priority” and the implication in the article seems to be that care for smokers, if they don’t stop will indeed be “prioritized”.

See the med journal article I linked to in my follow up post which is what the newspaper article refers to.

From an actuarial point of view, smoking can have some impact on the financial quality of care and post mortem benefits. To me, this is only appropriate, and probably the best way to deal with the issue raised by the OP. You wanna play, you gotta pay, as the saying goes. Don’t mess with triage and dilligent medical care, I say; but it is reasonable to expect that if a patient is bent on self-destruction, society as a whole should not have to suffer the consequences. I do appreciate the medical nature of addiction, and I do think it is appropriate to help patients kick the habit; however many smokers are simply non-compliant patients who enjoy their addiction without concern, and somehow look at their habit as a lifestyle choice and an inalienable right on the order of aesthetic preferences. I most respectifully disagree. For those who choose to be refractory, financial prioritization (or deprioritization, as the case may be) is the most effective way of dealing with the problem.

Ok, once we’re done with the smokers, we can “prioritize” voluntary drivers who get hurt, all obese people, those who refuse to quit working at dangerous jobs, and those who refuse to move away from carcinogenic hotspots in general.

Don’t forget drinkers and any elderly people who get injured doing something they should have left to a younger person, as well as those who develop complications from any lifestyle-related illness such as Aids. Yep, we’ll save the HMO’s a pile.

It drives me crazy to treat the same patients with the same problems night after night, but who am I to tell them that they have to stop? They have made a choice to live their life in whatever fashion they choose to. I have made my choice to practice medicine, that I am going to do whatever I can to help sick people get better, no matter if they brought it on themselves or not.

In short – I don’t believe that doctors should choose who should or should not recieve healthcare. If the surgery was to be delayed because the patient was supposed to be NPO, and was not, that can be relatively easily resolved. I don’t think that surgeries should be delayed because the patient doesn’t want to quit smoking for six weeks. I understand it is easier to not eat for 12 hours.

What, even for elective surgeries, when we see that failing to quit leads to more bad outcomes? What surgeon in his right mind wants to do an elective case on a non-compliant patient whose behavior increases not only their own risk, but the surgeon’s malpractice costs and in-house morbidity rate?

From Astro’s second link:

So which is it? Are we punishing people for smoking, or are we refusing to electively operate on those who are non-compliant and have a pre-existing issue that results in increased post-op problems?

Because if it’s all about the increase in post-op problems, why would we give a pass to those who “tried”? Sounds to me like it’s more of an attack on smokers, with a reprieve for the ‘good’ ones who at least ‘tried’. :rolleyes:

Is it true that you can get booted off of the waiting list for liver transplants if you drink?

If so, it makes sense to say that smoking would cause you to be taken off the list for lung transplants.

It’s still a leap to get to the idea postured in the OP however.

So, it’s safe to say that if you suffered any of post-operative complications any claim you wished to file for compensation would be lowered since you assumed a higher percentage of said risks by disregarding the advice of your doctor. It also follows that the doctor may have some claim against you for negatively impacting his medical reputation, if he can show damages, as a result of your direct noncompliance.

It is still the patients choice to be non-complaint with the MD’s orders. I’m not saying patients should not be advised to stop doing things that may make their chances of survival less, but if the patient chooses not to, why should they not recieve the surgery? Should they get to sign all sorts of paperwork stating that they were non-complaint and give up their rights in case something goes wrong? Absolutely.

Even in emergency situations patients have the right to refuse as much or as little of our treatments they want. Patients in auto accidents who do not want to be on a backboard can say no. Patents who do not want specific meds to treat their heart attack can say no. I just get to advise them that in my opinon it is not a smart move, document the hell out of it, and continue with what they will let me do.

That’s the great thing about socializing medicine. Suddenly every individual surgery becomes a political decision.

Mechanic: You need an engine overhaul. When was the last time you changed the oil?

Idiot Driver: I’ve never changed the oil.

Joe Q. Public (watching from the street): Mr. Mechanic, you can’t work on his car! It would be a waste of limited auto-repair resources!

[Devil’s Advocate] Bear in mind that smokers and the tobacco industry they support contribute a massive revenue stream for many governments through excise and corporate/income taxes. Particularly the ones in countries with universal healthcare. With regard to people with diseases that are directly smoking related, I wonder if they are at least revenue neutral after taking into account the costs they incur for the health system. If this is the case then I would assert that their treatment is a waste of resources but they are the ones contributing those resources. A whole different story to the rest of us paying. [/Devil’s Advocate]

Personally, I believe a smokefree society would be generally healthier because non-smokers are healthier for not smoking and healthier again because the other aspects of their lives are generally healthier as well. We’re only looking here at the cost of treating smoking-related diseases and ignoring the fact that a healthier, fitter non-smoker will be more inclined to exercise. Obesity is now the leading health issue and for this reason, the multiple indirect benefits of society-wide quitting could more than offset the loss of the tobacco revenue stream.

So I guess my Devil’s Advocate position falters when looking at the broader picture. Assuming the smoker revenue surplus isn’t gigantic, smokers do ultimately drain the system.

I think smoking is a fairly unique activity, in that giving it up should in no way alter normal activity. People need to drive to get around. People need to work, and some jobs obviously are riskier than others. Old folks need to do strenuous things sometimes because they don’t always have young folks around to help them. As for drinking, if you drive or work while inebriated, you get fined, fired, or put in jail. If you happen to live in cancer valley, it’s probably not your fault; the polluter should cough up the dough for cleaning up the environment and compensating victims.

Smoking, so far as I can see, is purely voluntary, and completely inessential to life. It also has been scientifically proven to the nth degree to be a direct cause of cancer and heart disease (among other problems). Passive or active smoking probably claims about 500,000 lives a year in the US alone, and it is completely unnecessary and avoidable. Driving, working, and having an unfortunate address are simply not in an analogous catagory (though I do know for a fact that are actuarial penalties involved if you own certain real-estate, e.g. tornado insurance in Kansas trailer parks).

Again, I think it’s too much for health care professionals on the clinical end of things to be burdened with triage issues related to smoking or other vices. However, smokers who choose to smoke, despite warnings and subsidized detoxification programs, should be penalized at the insurance level. All credible evidence points to associated risks for certain cancers and cardiovascular disease that can be, literally, several fold greater than for non-smokers. From an actuarial point of view, it’s a no-brainer. It’s not about saving the HMOs money. It’s about saving me money. I don’t want to subsidize the health care of someone who is demonstrably reckless with their health. If their willful self-abuse, given the purely voluntary and eminently avoidable nature of the risks involved, affects my insurance premiums, that’s wrong.