Dr. gives deadline to smoking pts - page 7
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... Read More
Mar 18, '02Well 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....
Mar 19, '02Thanks 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?
Mar 19, '02Just 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)
Dec 4, '02I 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.
Dec 4, '02I 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.
Dec 4, '02Oh 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.
Dec 4, '02oh 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?
Dec 4, '02Whew!
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.
Dec 5, '02I 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.
Dec 5, '02i say "bravo" to this doctor for taking a stand!! I, too, hope that more M.D.s will follow in his steps.
Dec 5, '02I 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.
Dec 5, '02Now 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 :-(