But why should a doc be obliged to do elective surgery on someone whom he thinks is a bad risk?
I have no problem with this. Provided we stop treatment for alcoholics and drug addicts. Drinking and using drugs are voluntary, why should I pay to treat someone who thinks so low of themselves as to use drugs? How many times must my taxes pay for some no-job having drug addict who has OD for the fifith time?
This is why doctors in public hospitals arent allowed to pick and choose their patients. If you dont want to treat sick people, dont become a doctor. Whats next? AIDS patients? Fat people? Ugly people?
Are you ever, as a doctor, required to perform elective surgery?
Because they chose medicine as a profession, not the priesthood. For the same reason cops should uphold laws they don’t agree with. The equivalent proposition to “just don’t smoke” is “just don’t be a doctor” if you don’t want to treat people.
No?
No!
No doc should be obliged to deliver care he believes is not necessary or not safe. I’ve had people come in and ask me to cut their ears off!! You think I’m obliged to do that? I don’t hand out morphine to people who are not in severe pain either, even if the patient asks me for it.
And if I think is smoker is going to have a higher risk of a bad outcome from an elective procedure (note it is not emergent or even urgent!) I am going to decline to do said procedure. Smoking affects the risk/benefit ratio in a very real way, people!
QtM, MD
I should clarify that I’m not denying elective procedures to smokers. I’m saying that if the fact that the smoker can’t or won’t quit for at least the 6 weeks before and a few weeks after, and this failure alters the risk-benefit ratio enough to make the surgery no longer worth the risk for the proposed benefits, I as the surgeon am entitled to say “Nope, not doing it. Won’t go there”.
Sure lets deny smokers health care. Nevermind the fact that it is an addictive habbit that no one would take up if they knew for a fact that it would lead to there death. As long as we deny health care to people who work in mines who know for a fact that Black Lung disease is deadly, and we deny health care to people who drive cars who know that car accidents kill more people than smoking related disease, and we deny healthcare to obease poeple, and deny deny health care to children whose parents failed to protect them, and deny health care to people who fall down, since they should have been more carefull, and deny heathcare to veterans since they should have known the risks they wer taking, and deny health care to victims of terrorism since they should have known to stay home, and deny health care to those who suffer from from congenital diseases since their parents should have been tested. Heck we should deny health care to everybody. Because if we all were vegetarians, ate granola, took our vitamins, exercised regularly, never left our house, none of us would ever get sick. Right?
People who drive recklessly get fined or even jailed. Employers who maintain unsafe work environments are liable. People born with congenital disorders had no choice in the matters and are hence completely without responsibility for their state. Addicts can, and should be treated, but if they eschew treatment, why are they now my problem? I don’t want to pay for these people! And hey, if we come up with reliable ways to combat obesity, and people blow off their doctor’s advice, maybe they should be penalized too. Sure, if someone gives it their best, follows the doctor’s orders, and there are still problems, they should be helped. But if they are willfully non-compliant, why shouldn’t there be consequences for them, as opposed to the rest of society?
That still is ignoring the right of our patients to live their life in anyway they choose. We don’t have to agree with how they live their life; If the patient has been advised that the surgery has risks, and those risks can help be mediated by quitting smoking, it is the patients choice at that point. Elective just implies that the date and time of the surgery is being chosed, not that it does not need to be done? How many times do you propose delaying the surgery? Wait long enough and it will need to be done if you like it or not…
Bolding mine
C-girl
We do not have that in Ontario, one has limited options for launching malpractice suits , as one would have in the states. Doctors by nature are risk averse , simply because of the nature of the business.
I for one , just do not see the purpose of stopping smoking for a set purpose , cause there might be post op infections. And yes thats my choice.
Should Canada enter the age of Triage , of that nature where the “cost of medical care” decides that a smoker gets put to the back of the line ,simply by smoking , then neo-natal care , geriatric care and long term medical for the handicapped are also gonna become issues , simply cause they use up more money than they are putting in.
I pay enough in extra taxes , to listen to some Quack pontificating on the next wave of social engineering , money that was supposed to go to the state to aleviate the expense to the taxpayer , ya right.
Because we live in different jurisdictions ,you may have more input into your medical community than we do , as is your right to have an opinion on my choices. But you do live in a Society that requires aid goes to those that need it , rather than deciding on who and what gets how much.
Decide now , if you want to live in that type of society , where the mob gets to decide where public health care moneys go.
Declan
We’ll have to disagree here. I do not believe I must be complicit in my patient’s poor choices. If I decide the risks of the procedure outweigh the benefits, I will not perform the procedure. I am the health-care professional, not some hired hand contracted to do any job at the behest of the hirer.
I absolutely agree with you. MD’s should evaluate the potentential success of medical procedures. You are the most qualified to do it. If a persons lifestyle affects the chances of a succesfull outcome of any medical procedure then I will defer to MD’s to decide. However, I think that MD’s should refrain from making policy decisions.
My only point is that an MD should not be permitted to refuse AZT (an example only) simply because they disagree with the patients lifestyle.
I think I misunderstood your post, then.
probably. It took me a while to state it in less incoherent form. Pity me; it’s my first week back from vacation.
It’s true. A relative of mine had serious congestive heart failure, and since he refused to quit smoking/drinking/eating poorly, his doctor would not put him on the waiting list for a heart transplant. (He died not too long ago at age 43)
It makes sense, because unlike elective surgury, the heart they wouldn’t give him went on to save someone else’s life.
But I agree, still a leap.
I’ve never seen a doc be judgemental or prejudice a patient’s care in light of their recreational drug practices, legal (coffee, smoking, alcohol) or illegal (you know the stuff).
As far as smoking goes, the doc always says the requisite “It’s bad for you, you should stop.” And for those with diseases directly stemming from smoking, like COPD, the doc may get a little more aggressive: “If you don’t stop smoking you will die.” But I’ve never seen a doc just give up care.
It is sad to see a patient keep on smoking even when they can barely breathe.
People do get frustrated, Respiratory Therapists most often because the patient demands their breathing treatments in high anxiety, making the therapist do extra work or be interrupted…then goes and smokes.
In end-stages of many diseases, where smoking only exacerbates things, it is frustrating for all, because care and treatment is being provided and the patient is essentially sabotaguing it all. Yes, that is a waste of health care resources, but the resources are still provided up until death.
The health care team may remind the patient frequently that their behavior/addiction is detrimental to treatment and that it is their responsibility (i.e. You keep smoking and you keep ruining the treatment provided. It’s not our fault if the treatment doesn’t work. It is yours.), and they are wise to document that teaching in the medical record.