Dr. gives deadline to smoking pts

adrienurse, LPN · Dec 5, 2002

Oh Mario, you certainly do have a talent for convoluting the topic of threads. I just can't follow your logic.

Another point, although there is currently a shortage of family doctors in the Province of Manitoba, people do have the ability to choose who to see. If Dr. Ross will not take them as a patient, they can go elsewhere. I would just suggest that they not go to see my soon to be ex-doctor.

Rena RN 2003, RN · Dec 5, 2002

oh dear, i'm sorry if this has already been said but .......

if the good dr. wants his patient's to try to quit with medical assistance or they should find another dr, then he should be saying the same to his morbidly obese patients when they eat that extra serving, etc.

the patient that smokes and has related health care problems is the same as the patient that doesn't follow the prescribed healthiest of diets and developes complications of obesity. smoking and poor nutrition habits are both choices made by individuals.

what's he gonna tell ms. jones that weighs 450 lbs? join Weight Watcher's or get out?

Nurse Ratched, RN · Dec 5, 2002

Whew!

I have not been shy in the past commenting re: my anti-smoking bias. However, I do feel people should have the right to do as they choose, but we as health care providers need not be forced to enable directly poor choices.

Nurses get to choose their patients (to a degree - we choose to work in certain specialties, and if that patient population is not to our liking for whatever reason, we can go elsewhere.) This doc is just saying he no longer chooses to work with what is clearly, for him, the most frustrating part of his patient population. Gotta give the guys props for acknowledging his bias and encouraging his patients to seek treatment from someone who can give "unbiased" care. Patients fire doctors; it goes both ways. If he can make a living working only with patients he feels are more receptive to his efforts at healing, I guess more power to him.

Unfortunately, if you take this trend to its extreme conclusion, some health care provider somewhere will ultimately become the dumping ground for the worst of the worst "noncompliant" patients (whether that be the diabetic eating anything he wants or the CA pt smoking through his trach in between drags of O2.) Folks won't just sit at home and die - they still call ambulances and arrive in our ED's and get admitted to our units. Will we simply have a list of those to whom we will not grant admission because they have too many black marks against them?

In the end, as a person I don't really care what other people do with their lives or bodies; I just don't want to pay for it. As a nurse, I will educate where appropriate on the impact of lifestyle choices on health, but I am not the health police. We treat what shows up on our doorstep. Again, tho, we have the choice not to directly "aid and abett" poor choices.

Interesting discussion....

Tweety, BSN, RN · Dec 5, 2002

I work in a setting where we treat everyone regardless. But if I were in private practice I would be the same way. "You need to quit smoking in order to help me help you". kudos to him.

bravegirlamy · Dec 5, 2002

i say "bravo" to this doctor for taking a stand!! I, too, hope that more M.D.s will follow in his steps.

RN2B2005 · Dec 5, 2002

I can't see how it's abandonment, he's given plenty of proper notice and has provided referrals to other physicians.

Whether or not it's fair, he has a right to terminate the patient-doctor relationship with ANY patient for ANY reason, provided he gives adequate notice. As a 'social smoker' (5-7 cigarettes smoked per month), I wouldn't want to see a physician who would criticise or otherwise be uncomfortable with me smoking, so in my view, they're better off elsewhere. If the doctor shortage in Canada makes it difficult to find a new physician, well, that's a bummer but not Dr. Ross' problem.

mario_ragucci · Dec 5, 2002

Now after being through nursing school for aphew months, I can see this smoking thingas a purely ethical/moral/values dilema.

Just like abortion, euthenasia, silicon pharmachology....people are conditioned to polarize, and then freeze.

What about the nursing values of "doing good" and "doing no harm?"

Recognizing how smoking angers some folks, it's okay for the doctor to "flat-leave-you" in this land of the free and home of the brave :-(

Lausana · Dec 5, 2002

Just curious how this is working out for him? How many of his patients left or quit. :confused:

Interesting idea!

JMP · Dec 5, 2002

Mario

IF you go back and read my orginal post you will see that the DR. in question is in CANADA, not the US.

If you see smoking in the light you just described then you need a few more "months" of nursing school.

Just the way I see things of course, sorry if I sound hard about it, but I have seen more than a fair share of people die of lung cancer. I have suctioned crap out of ET tubes that is truly gross.

Smoking and drinking to excess are things that if we where able to stop, 1/2 to 3/4 of our hospital beds would be empty. The health care system continues to focus on illness...RATHER THAN PREVENTION!

I will get off my soap box now.

renerian, BSN, RN · Dec 5, 2002

My Dr told me she would not give me any scripts. Since I wanted my ESTROGEN, LOL I quit that day.

renerian

mario_ragucci · Dec 6, 2002

JMP - If smoking related illness disturbed me, then I would avoid it. How would you interact with a person who smokes? Would it affect you professionally? You are free to expound on respiratory and carcineogenic factors...it's all known and undisputed. Don't let it affect your professional demenour. Medics still go into battle with soldiers. Imagine the lunacy at work there. You know what I mean. Men and women choose to fight, as well as smoke, or anything else. Nurses help them, but can't prevent war or carcinoma. :-) Intervention, but respect too.

Gromit · Dec 6, 2002

JMP, I >REALLYVERY

Fine. We can all deal with that. We all have our opinions.

Personally, I think the doctor at the beginning of the thread (yeah, way back there) made a personal decision. I think he is a bit off ONLY because its biased at smokers. If the Good Doctor made that statement regarding ANY patient who refused to try to get help or fix their bad habits, I'd say 'Fine. Kudos to you.' (I'd also find another physician).

You continue to reiterate how bad things look, what you've seen, etc. Well, I'm still a year away from my RN, but I DO work as a CNA/Tech in an ICU, and while ours is a small one, we get our share of gross, oddities, and repeat customers. Thats good, I like a variety, and it only solidifies my resolve to get my schooling done, and get in there and do my part.

HOWEVER, I've spent a LOT of years (more than a decade) on the streets, in an ambulance and seen enough of that as well. Everyone (or nearly) on here has seen these things, and we all choose the path we have taken, for our own reasons.

Cardiology is my love of choice. Trach care is probably the nastiest thing I've ever done, but the patient also breathed a lot better afterward.

Now, before you go and tell me I'm naive as you seem to think of Mr. Mario, let me explain my own experience in this:

I dislike cigarettes with a passion. HOWEVER, I do enjoy an occasional (and I mean rare) fine hand-rolled premium cigar. (The kind you DON'T buy anywhere except a quality tobacco shop). I burn one once in a while, to relax and reflect on a 'job well done', or some special accomplishment. A 'once in a while event'.

I'm a good cook, and really need to pay a bit more attention to my waist.

I ride motorcycles. Its my main mode of transportation. I'm not talking about the rockets, but the big heavy cruisers. Chrome and all.

--I USED to ride helmetless, but do not any longer. I support those in their right to choose, even though I think its rediculously risky.

I like a drink, from time to time. I used to drink like a fish, but nowdays, a 'six-pack' will last for well over a month, or two, or even longer. A glass of wine is even rare these days, and I used to make my own.

We all have habits, and in moderation, they will NOT affect our health. My bloodwork is exemplary, and my lungs are as clean as a whistle (used to have a job that required regular scans. The job scared me, and I no longer do that).

For the record, you say you have seen the ills of alcohol (tobacco use, and all the others), and the little girl that (ultimately) died due to the drunk driver. >I

The realities of poor choices are seen by all aspects of the health-care industry.

Don't preach about what you've seen, and how others should see it, and 'it will change your opinion' if you SEE it the way >I

You will have to deal with your own obsessions as we all must, and when it comes to opinions, I usually just 'live and let live'.

--But to berate someone else, and even be so bold as to suggest that they change their career path, well, I've heard that one myself, and I HAVE to jump in on such talk.

OK, I've said far more than enough.

NOW, I have to get back to the books. :)

btw, its truly nice meeting all of y'all!