Dr. gives deadline to smoking pts

Nurses General Nursing

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Just heard a news item ........... Dr. Ross in Manitoba has issued a deadline to all pts who smoke......by March 1st.....today...... seek treatment to stop the addiction of smoking or lose him as a Dr.

Apparently Dr Ross is frustrated with smokers who keep coming back with smoking related problems....who do not seek treatment to quit. Understand he is not saying he will not treat smokers what he is saying is I WILL NOT CONTINUE TO TREAT PTS WHO DO NOT SEEK MEDICAL TREATMENT TO STOP.

I find it interesting and as a nurse understand his frustration when people smoke their brains out....... don't even try to quit and end up with tons of chronic smoking related problems.

Now I know this board and I know certain people will try to liken this to bad diet choices, drinking ect.....but understand his point.....he wants people to TRY or LEAVE his practice.

The Canadian Medical Association has stated no one has made a compliant against him....... but several civil lib types are up in arms...... it will certainly make people think. Especially with the doctor shortage there is in Canada.

to rncountry:re:the self destructive pt. Why has he not been committed to a mental health unit?He is clearly a danger to himself with these behaviors. Obviously a PD,we have had much experience with these types. They make bad choices and often cut on themselves or eat things like spoons or razors. The surgeons get really mad when they have to get these objects back,and then we put them on 1:1 watches and they have no choice to refuse as they are a danger to themselves. Please ask for a psych consult when you gety this type of pt.

well it seems as though once again many of you are failing to at least appreciate the other side of this issue, therefore I am deciding not to comment on it any further, except for this one last part

JMP - I *DID* infact read your post , and I do understand the situation fully, you are right that dr ross is offering to help his pts quit, however if they dont, he is refusing to care for them anymroe

hence the discrimination

and some of you are living in a dream world if you think that alcoholism, drug abuse and even overeating binging/purging are not in the same category as smoking, get real, the point isnt that smoking isnt harmful its that it seems to be the popular thing to put down.

if your fuzzy logic theory about a glass of wine or junk food in moderation is true, whens the last time you saw a person die from smoking one cigarette? what about the other things a person might smoke, does dr ross not have an opinion about marijuana smoking, cigar smoking, pipe smoking?

we have all seen the horrific side effects and health issues that have come up with smokers,

my question is, how is it in any way proactive (like nurses and other health care professionals are supposed to be!) to just refuse care to a person with an addiction?

maybe some of dr ross's patients are not ready to quit yet, ultimatums dont work, plain and simple.

if youre gonna start thinking on this train of thought , there has to be equality, hey I got it!

No health care for anyone that you deem as non compliant!!!

that'll work!

JMP to quote you "I recently read an article that said if everyone who smoked quit, half of all hospital admissions would simply not be there."

ok lets do the math , the smokers take up the half of the admissions, why not force diabetics to be compliant, alcoholics to stop drinking, drug abusers to quit using drugs and that will account for the other half! *idealistic sigh*

I'm not suggesting live and let live, I'm suggesting not treating one addiction different from the others.

I'll let you come to the floor I work on so you can see the side effects of smoking, alcoholism , drug abuse and yes even overeating .......

I myself would be hardpressed to figure out which is the worst way to die, but seems some of you have it all figured out !

I respect everyones opinions here, I just dont enjoy people seeming to "attack" what I say..

I respected peoples posting here on the topic enough to post my own beliefs about it

but if its gonna come down to who's belief is right and who's is wrong......

count me out..

neither one is right or wrong, they are just different, I'm just a big believer in health care for all people.

but honestly, JMP your rationalization of smoking vs drunk driving is highly debatable at best...

and as a non smoker, even I find that a terrible

comparison to make.

Specializes in Trauma acute surgery, surgical ICU, PACU.

here's some info about whether or not what he is doing is actually having any effect on his patients. keep in mind we have free health care in canada, but also a severe doctor shortage, and finding another dr might not be easy. there are many sides to this issue, for sure!

md's tough love working

50 smoking patients choose quitting over leaving doctor

(march 2nd, 2002/ winnipeg free press)

a tough stand by a winnipeg doctor who declared he would not treat smokers who are unwilling to give up the habit seems to have worked with some of his patients.

dr. frederick ross, a family physician at park west medical centre, posted messages in the clinic on dec. 1 telling smokers to butt out by march 1 of this year or find a new doctor.

yesterday, ross said only about a half-dozen of his smoking patients requested that their medical records be transferred to another physician.

however, he said at least 50 have told him they would rather quit than change doctors.

"i thought it would have a major impact on my practice, that i would lose a lot of patients," said ross.

ross, who has been practising medicine for 27 years, treats approximately 5,000 patients, of whom he said between five and 10 per cent are smokers. ross said he does not yet know what the majority of his smoking patients have decided to do.

during the past week, his ultimatum has attracted national attention, not all of it favourable. while the college of physicians and surgeons of manitoba has said that ross is not breaching any rules, some members of the health-care community claimed it unethical to withdraw medical treatment from people with an addiction.

"i know i've taken a hard stand and some people think i'm a jerk, but all i'm interested in is their health," said ross. "i'll never give up the beat. i'm always going to try and encourage patients to quit smoking."

he said if patients want to quit, he will bend over backwards to help them.

ross said he wished the province would do the same. he said the government should pay for smoking-cessation products like nicotine patches and gum. he pointed out that manitoba has one of the highest smoking rates in the country.

ross said he decided to issue the ultimatum when a patient resumed smoking after she had been successfully treated for lung cancer.

he said his smoking patients often suffer from chronic bronchitis and heart disease.

This reminds me of something I heard on the radio the other day about a doctor refusing to prescribe any form of birth control to women or Viagra to single men (young, gay or straight). Hmm. What's going on?

I see both sides of the argument and can't seem to make up my mind about which side is more right. I guess these patient's will be forced to go elsewhere, but there will always be sick patient's to see, patient's being born, patient's getting a terminal disease not related to smoking (unfortunately), and he knows this. It's a revolving door. I don't think his financial burden will be too great or last indefinitely. I wouldn't want a doctor who is disgusted with me or my smoking habit to treat me for anything. Regardless of how long this man has been my doctor, I would say "hasta" to him and part ways. You have your beliefs and I have mine.

I agree with Hapeewendy. Smoking is an addiction. Why is it ok to treat patient's with other addictions? This man's personal feelings are obviously interfering with his patient's care. I just can't imagine turning sick people away. I guess he has had about all he can stand with smoking related illnesses, or maybe he lost someone close to him. I do admire him for standing up for what he believes in even if I do not support his beliefs. God Bless him if he can stop just 5 people from smoking. That would be considered triumphant.

: )

Wildhoney

Specializes in Trauma acute surgery, surgical ICU, PACU.

I think that yes, smoking is an addiction, and you can say what about other addictions, etc. But you have to start somehwere. After seeing several of our "repeat offenders" with ETOH related pancreatitis come back lately, I am feeling like the system is enabling them to avoid trying to get better. We patch them up. Nobody has the time, energy or resources to enforce that they try to quit at all OR motivate them, assist them in any way at all. They leave and go right back to the addiction with no effort whatsoever to quit.

I don't agree with punishing people who have been "morally bad" ie having an addiction, by withdrawing medical care. Addiction IS an illness. People who refuse to learn how to manage their diabetes - get neuropathy, etc. Every person with any illness at all has to participate in their own care to try and get better - we *cannot* do it all. This doctor is just saying he is refusing to TRY to do it all any more. He is dropping the facade. I applaude him.

I also think more public education, press exposure to hammer home the idea that people are not just recipients of care but must actively participate - can only be a good thing.

Originally posted by pebbles

I think that yes, smoking is an addiction, and you can say what about other addictions, etc. But you have to start somehwere. After seeing several of our "repeat offenders" with ETOH related pancreatitis come back lately, I am feeling like the system is enabling them to avoid trying to get better. We patch them up. Nobody has the time, energy or resources to enforce that they try to quit at all OR motivate them, assist them in any way at all. They leave and go right back to the addiction with no effort whatsoever to quit.

I agree with your comment about "repeat offenders," especially the liver transplant people who continue to drink. That really irks me. How much is a liver these days? I also have a problem with people on oxygen who continue to smoke.

Smoking is a bit different however from diabetes. You really can't compare the two. Diabetes is acquired and smoking isn't. You can take insulin for that condition, if you don't you die, you have no choice but to manage it and educate yourself. Smoking is a drug, you crave it, your body shakes if you don't get it, smoking takes forever and a day (most of the time) to kill, you think you have plenty of time left. It's easier to manage Diabetes, all you need is a insulin and a good diet. You can manage a Neurological condition most of the time with medication, of course that depends on what it is. These people are fully aware they have a problem. Smokers are in denial, they feel they don't need any help. Why would they even want to educate themselves? Alcoholics are in denial also.

We need doctor's to help us quit smoking, we need nurses to help us quit smoking, we need doctor's to help us quit drinking, we need doctors (and weight watcher's : ) to help us stop overeating, etc..

It's either stop smoking or you can die from the illness smoking caused (even though you probably will), and I'm not going to treat your sickness. Shouldn't a doctor try to ease their discomfort/pain? I'm not going to give you your meds anymore, find another dr. That's ok because there will always be another doctor out there to treat them. You're an alcoholic and drunk drivers kill so I don't want to treat you, I'm sick of seeing people with alcohol related illnesses. You overeat and you have too many obesity related problems from overeating, so I don't want to see you anymore. Maybe if doctor's stop seeing obese patient's they'll stop over eating and drive the message home? Where do we draw the line?

But again, that doctor can do what he wants to do. We can't look down on these people because they have a problem or make them feel as if they're second class citizens. Yes, smoking is ugly, it does terrible things to a body, I curse the person who ever made cigarettes, but these people are not stupid, they still have a right to be treated like human beings and not suffer regardless of their addiction.

Some doctor's have obviously become very disillusioned and bitter.

Patadney, the patient I referred to is being seen by a psych doc. He cannot go to a psych facility because he is too medically complicated, and they will not accept him. We did attempt to place in a medical psych unit at U of M hospital, they first had no beds, then when a bed became available it was denied by medicare as unnecessary as his needs were being met at my facility. We would have been better off if we had not done the psych consult, at least the patient would have gotten to a place that would have been better suited for him. According to the psych doc he is alert and oriented, with poor judgement. Not an active threat to himself because everything he is doing will not kill him immediately. Therefore if he refuses a sitter he is well within his patient rights to do so, and we most certainly cannot restrain him. Because we do long term acute care we also do team meetings on the patients once a week for utilization and appropriateness etc... we have done everything we can for this patient at this point. What eventually happens is up to the patient.

Is his course of action best for the individual patient? His stance encourages patients to examine individual preferences and values, not just follow unexamined advice. I support Dr. Ross' stance because whether they quit smoking or not , it leads the patient take responsibility for examining interventions and understanding the impact acceptance or rejection has on their health.

Disher

You hit the nail on the head.

JMP,

I, as a smoker (who tries to quit every two or three years) am deeply offended, when you compare me and other smokers with a drunken driver.

Now that really stinks!

Renee

Semtr

The comparison was made to show how socialable unacceptable it is to drink and drive....... it was once accepted. Smoking is hopefully on the same track.....becoming more and more socially unacceptable. People, in my never to be humble opinion, can not continue to smoke and not understand that there are significant health concerns and issues waiting for them down the "road". Trying to argue it is their god given "right" galls me. It costs us big time tax dollars in cour country ( and no it is not covered by the tax on cigs) and costs us our health when we or smokers children have to inhale the stuff when smokers smoke in public. It also costs our family grieve, worry and heartache when we watch someone we love die of lung ca or COPD. The denial has to stop and if that offends you, well, what can I say, except.....maybe you should stop smoking?

JMP - the introduction of the doctor's move to enforce intervention is noteworthy. It draws light to a medical professional's stance on one unhealth lifestyle choice of his patients. But don't abuse this information by turning it into a plank to start your own crusade here. Please consider not waste bandwidth on a lifestyle issue we all know about. Do you think we just walked out of the cotton fields or something? Stop trying to incite and polarize folks with kindergarden rhetoric, please. This is a nursing electronic forum, remember? We all know about health, and the year is 2002! Yawda know something about human nature, in that, if you keep telling folks they shouldn't do something, a measurable number of them will do it just because YOU are telling them not to. :mad:

And RN country, sugarbaby honeybunny, please don't be addressing me with no petname . Gosh - you know - I don't like to point stuff like this out, but, again, this is an electronic forum, and unless you indicate you are kidding with me, pet names should be reserved. If we are talking to each other in person, well, thats different. Many people read these boards, okay? You shouldn't make a inappropriate comparison, then play like I get my feelings hurt. Remarking that I remind you of your teenage son is cheap shot. You don't see me comparing you with some 80 or 15 year old person. Address me like you want to be addressed, with respect. And don't be mistaking me for another body. Thanks :-)

I respect this forum as a place that has taught me plenty. To me, its a place to vent, talk, chit-chat, learn ,and respect other peoples ideas. What are your ideas of how this thread can be used to help people?

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