Dr. gives deadline to smoking pts

hapeewendy · Mar 6, 2002

JMP, you have mentioned your opinion on the topic

many times, and although I will never agree with your cast iron views about the situation , I stil respect what you have typed

why does it seem you are showing such lack of respect to others though?

especially mario, your suggestion about his taking philosophy had a holier than thou tone to it

if I am wrong , I apologize but I've sensed that feeling from other posts of yours

and yes you keep mentioning the dangers of smoking but you always seem to neglect alcoholism and drug abuse, I put those in the exact same category as smoking , the addiction category

pebbles, BSN, RN · Mar 6, 2002

i will absolutely continue to provide compassionate care to smokers and non-smokers alike. i am not a holier than thou snob for agreeing with dr ross' perspective. ( actually, most of the smokers i have talked to agree with dr ross, and know they are responsible for thier own state of their lungs... )

but i will (and do) say to people "i can't do it all. if you want to be more healthy, if you want to stop getting sick all the time, having this terrible cough, if you want to avoid lung disease later in your life, you have to quit. i cannot wave a magic wand and make you healthy again - you have to take some responsibility for what happens to your own body, your own health."

people who engage in self-destructive behaviours, then go to the doctor and expect to be "fixed", and go right back to their same behaviour should not be enabled by free universal health care. these people have been helped to find another doctor, the action is not one of abandonment or shunning. (and they are recieving *free* asistance in quitting, from dr ross, so lets not preach about refusing to see addiction as illness)

but they are being "warned", in a big way - if more doctors choose this policy, as they are legally allowed to do - smokers will have limited places to go to get treatment for illnesses they have knowingly contributed to. how is this different from the shortage of doctors who are willing to perform abortions? anybody think gynecologists should be forced to provide abortion services?

having some degree of choice as a health care provider is vital to progression in the field of medical care. doctors who push the boundaries a little are the pioneers in many fields - why not be a pioneer in changing attitudes towards health and medical services? we have been trying to move awa from society seeing "doctor" as "all-powerful fixer of all ills" for a long time now. when is it appropriate to put the onus on the patient?

hapeewendy · Mar 6, 2002

the onus has been on the patient for a long time pebbles, it always is on the patient..

no one blames a dr for a smoking patient

unless he set the pt on fire or something anyway

but the point is that the whole anti smoking bandwagon is the most PC one to jump on and I personally find it hypocritical that everyone who is so down on smokers do not apply the same cast iron views on alcoholics etc......

and I was referring directly to JMP's post when I said the term holier than thou, I wasnt directing it to you.

I will probably get flogged yet again for showing my liberal openminded views but I also dont think that drs should be allowed not to perform abortions.

its part of the job, an ugly part, but as long as the woman has the right to choose, and she does, she shouldnt have to troll for willing drs.

I dont agree with using abortion as a form of birth control in any way shape or form and would agree with the idea of a patient having to pay for subsequent abortions - u know the kinda "frequent flyer" attitude.

what it comes down to is that we all have a specific role, a job to do, and that job in my mind doesnt include the process of excluding patients whose lifestyles we dont agree with.

Stargazer · Mar 6, 2002

Excellent post, pebbles.

At the risk of being redundant, I will restate what I said earlier: let's give Dr. Ross the benefit of the doubt and NOT assume that his stance is an effort to rid the world of all non-smokers within 90 days or strong-arm his patients by telling them it's his way or the highway.

Let's speculate, instead, that he is being refreshingly honest by saying, in essence: "Look, there are a lot of docs out there who don't really care if their patients follow their instructions or not. I'm telling you that I'm not one of them. Unfortunately, I have simply become too frustrated to be a good or objective caregiver to those patients who cannot, or will not, at least attempt to modify their harmful lifestyle practices. I'm sorry, and I will refer you to another physician if you have no interest in quitting smoking."

As to those folks who keep wondering why he isn't making the same demands of drinkers or obese pts, well, maybe those just aren't hot-button issues for him. Clearly, smoking is. We all bring our personal biases to the job, like it or not, and personally I'd rather deal with someone who puts his right out front where you can deal with them. I've worked with judgemental nurses who refuse to care for alcoholics, and oncologists whose pts are chronically undermedicated because they (oncologists) equate any form of IV narcotic administration with euthanasia.

When a caregiver's biases directly impact the kind of medical care they can deliver, I think it's preferable that they are able to recognize them and advise their pts or prospective pts accordingly.

Perk · Mar 7, 2002

Did the Dr. in fact stop seeing these patients? or was it just a scare tactic. I know a Dr. here in Montreal has said to pt's that she will not renew perscriptions untill the pt has gone for certain blood tests, or mamogram for those "non-complient" pts, but when push comes to shove she will fill out the perscription (though with a lecture for not following through). I comend this Dr. for trying out a technique to see if it would give pt's more initiative to quite, I just hope he was a great Dr. to start off with.

:kiss

woundnurse · Mar 18, 2002

As an ex-smoker I try to have an understanding of smokers but as a wound care nurse will tell patients with wounds that they will heal slower (or depending on where the wound is and esp. if they are diabetic) that the wound will not heal and they could lose a limb. Understand the doctors frustration esp. if his motivation is to heal and not to make $$$.

pebbles, BSN, RN · Mar 18, 2002

Well as far as making money, the way this province structures health care, the dr gets paid (reimbursed) by the government for each patient visit in his office. (so if a patient has several issues to discuss, some docs tell them to make a separate appointment for each one!)

If he wanted to make more $$$, he would not be telling pt's to find a new doctor..... the more people he sees , the more $$$ he gets, period.... regardless of quality of care, etc. Conveyor belt. The average family doc here makes only about 60-65 thousand a year. Some even less. I made 54 by working lots of overtime. Not a staggering difference.

Perk, I don't know if he actually put his foot down about not seeng patients who refuse to quit, but I do know that many of his smoking pt's were willing to admit their own shortcomings and did request their charts to be referred to another doc. I'll see if I can find out anything....

micro, RN · Mar 18, 2002

just agreein with happeewendee!!!!!

woundnurse · Mar 19, 2002

Thanks Pebbles, I know as a wound care home health nurse I can make more by seeing patients over and over again. But if I can get them to take better care of themselves they will heal quicker and they don't need to see me (fine with me-I like new challenges and there are plenty out there) Its a win-win for everyone.. we can see more patients that need care, people are healthier and the system remain solvent. Your'e right, if the doc was only in it for the money, why help to get people better quicker?

Cory

woundnurse · Mar 19, 2002

Just wanted to clarify. In my field smoking is directly related to results seen. For the most part obesity doesn't affect the type of wounds I am called for and neither does alcoholism. If I did think these (or other) factors were inhibiting healing I would have to call attention to them. In home health it gets tricky as we can't continue to see patients unless we can actually see an end to the treatment, teach them or family to do the care or stabilize the wound, in which case we also discharge them. Maybe this doc feels if he can't have an influence on their care its their right to find someone who can/ or doesn't care to. With all us baby boomer out their (opps gave my age away) the health care system is gonna collaspe unless people start to take a little bit better care of themselves--sorry not preaching, just how I feel.

Cory (middle-aged nurse)

deathnurse · Dec 5, 2002

I know of a doctor who doesn't give a damn if patients are stupid or not. Ya' want another heart surgery? He's available. Milk em' for everything they've got.

Just off the vent? Have a cigarette, idiot.

The downside is that personal choice and preference is subsidized by all of us by way of higher insurance costs. Indeed, 90% of my ICU victims are there because of lousy lifestyle choices. That's why I'm so hard on them and so indifferent to the whiners and their families.

Attention whores, wanting more, more, more. Obese COPD diabetics, leaning back on the bed with chest pain can't figure it all out. You want sugar in your coffee? You GOT IT!

I'm not going to change their years of self-abuse, unless they're nice to me. And you have to wait a long time for one of those to show up. I just want more babysitting money.

adrienurse, LPN · Dec 5, 2002

I am from Winnipeg, as is Dr. Ross -- so I have heard a lot about the situation. The important thing to note is, it's worked! People who would not have quit are not no longer smoking.