Completely disagree

Post #292,942 by bepatient 9/14/07 6:07:56 PM Reply	Completely disagree It doesn't guarantee a negative outcome, it just creates >potential<. His prior surgery had a poor outcome that had nothing to do with his smoking, as he contracted an infection from the hospital. Is it reasonable then that even should he quit smoking they do the surgery in the doctors office because using the hospital "increases his chances of having a poor outcome?". Sheesh. Too much of today's music is fashionable crap dressed as artistry._{Adrian Belew}
Post #292,945 by Lily 9/14/07 6:28:07 PM Reply	Now you're being disagreeable. They arent denying him treatment. They are telling he needs to invest in his health before they treat him. If he invests, so will they. His condition isnt emergent. He needs to quit smoking to get the results he wants from the surgery. A negative outcome isnt guaranteed, but it is highly probable based on current research and medical knowledge. Why risk it? If someone needs a liver transplant and still drinks, they dont get one. If someone needs a new heart but continues to smoke, they dont get one. If I need to have a procedure done and the doctor says I need you to do XYZ before I perform this procedure, I will do XYZ. It aint rocket science. You dont get something for nothing. It boils down to taking responsibility for your health.
Post #292,948 by jake123 9/14/07 6:50:05 PM Reply	I disagree What's next on the list for reasons not to treat? Alcohol consumption? Driving too fast? Don't forget, this person is being treated under a public health system, a sort of system which most people on this board have little to no experience in. While private systems control costs by raising prices so as to drive part of the market out, public systems do it by rationing. It's ok to ration; that's not the point. The point is the rationale under which rationing occurs; in Canada, it's done with lists on a first-come first-served basis. However, past behaviour is not used to change places on the list. It's a bad idea (esp. under sole-payer and/or public health systems) to do it based on other criteria, as it creates very real potential for abuse based on value judgements by people working within the system: Your parents are born-again nutjobs? No abortion for you! Under a public system, this is an extremely undesirable outcome. This is not the same in a many-payer private system; either the guy can afford a doctor who will do it anyway, or he's screwed anyway so it doesn't matter. Instead, they should add a clause to his permission to treatment form absolving the doctors and institutions involved of any liability should his treatment end in the outcome feared by his doctors, and then do it anyway.
Post #292,949 by boxley 9/14/07 6:57:14 PM Reply	you are not allowed to be sensible, its SMOKING CIGGARETTES! Quantum materiae materietur marmota monax si marmota monax materiam possit materiari? Any opinions expressed by me are mine alone, posted from my home computer, on my own time as a free american and do not reflect the opinions of any person or company that I have had professional relations with in the past 51 years. meep reach me at [link\|mailto:bill.oxley@cox.net\|mailto:bill.oxley@cox.net]
Post #292,964 by pwhysall 9/15/07 2:19:23 AM Reply	Stopping smoking is basically part of the pre-op If you go in for an operation, you'll be nil-by-mouth for a period of time beforehand. If you then eat a bacon buttie in that time, the surgeon won't operate. If you're an alcoholic, you won't be operated on whilst pissed. This is exactly the same. (BTW, Jack: in the UK for compos mentis adults, there is no form to complete. For now.) Peter [link\|http://www.no2id.net/\|Don't Let The Terrorists Win] [link\|http://www.kuro5hin.org\|There is no K5 Cabal] [link\|http://guildenstern.dyndns.org\|Home] Use P2P for legitimate purposes! [link\|http://kevan.org/brain.cgi?pwhysall\|A better terminal emulator] [image\|http://i66.photobucket.com/albums/h262/pwhysall/Misc/saveus.png\|0\|Darwinia\|\|]
Post #292,957 by bepatient 9/14/07 8:53:52 PM Reply	Re: Now you're being disagreeable. Yes they are denying him treatment. Its >ANKLE< surgery. What they are doing is not related. Next they will tell overweight people that hip and knee replacement will not be done until they lose 30kg. Then they will tell old ppl that they won't get help because they're gonna die soon. Its BS. Too much of today's music is fashionable crap dressed as artistry._{Adrian Belew}
Post #292,963 by pwhysall 9/15/07 2:15:42 AM Reply	Incorrect. Heavy smokers have a greatly increased chance of non-union in fractures, plus they're a big risk for general anaesthesia, plus there's a greatly amplified risk that it'll be leg off time. Part of his treatment will be to cease smoking for a period beforehand and during the treatment so that the chance of success is maximised. Basically, he's being a whiny little bitch who should just grow a pair and pack the fags in like the doc says. He can always light up again when it's all done with. (and yes, morbidly obese people are sometimes denied treatment until they lose a certain amount of weight, in order to bring the risks down to an acceptable level) Peter [link\|http://www.no2id.net/\|Don't Let The Terrorists Win] [link\|http://www.kuro5hin.org\|There is no K5 Cabal] [link\|http://guildenstern.dyndns.org\|Home] Use P2P for legitimate purposes! [link\|http://kevan.org/brain.cgi?pwhysall\|A better terminal emulator] [image\|http://i66.photobucket.com/albums/h262/pwhysall/Misc/saveus.png\|0\|Darwinia\|\|]
Post #292,976 by bepatient 9/15/07 12:16:49 PM Reply	I see. And so to help this poor sod kick an addiction, they use all their good doctoring techniques and prescribe him another highly addictive substance. Here bud, I know you can't kick this habit...so why not try >this one< instead? Sorry, I ain't buyin. If they were interested in the welfare of the patient, then they would check him in a week prior, load him up with Zyban and treat the man. They're not interested in helping him. Only themselves. Too much of today's music is fashionable crap dressed as artistry._{Adrian Belew}
Post #292,978 by Lily 9/15/07 1:17:09 PM Reply	Inpatient nicotine detox? I dont think so.
Post #292,984 by bepatient 9/15/07 8:51:47 PM Reply	Why not if its that important a factor to his general health...and NOT doing it forces the doctors to get him addicted to something else (morphine)...I'd say this guy might actually qualify for that. They inpatient detox for heroin and alcohol, don't they? Too much of today's music is fashionable crap dressed as artistry._{Adrian Belew}
Post #292,985 by Another Scott 9/15/07 8:55:55 PM Reply	It's elective surgery. He needs to do what is necessary to meet the requirements or he doesn't get a spot in the queue. As long as it's elective surgery, it's up to him. Cheers, Scott.
Post #292,986 by crazy 9/15/07 9:14:32 PM Reply	Oh bullsh*t Geetting 3 broken bones set is not elective. That would be an immediate emergency surgery here. Yeah, he's probably screwed becuase he delayed and was willing to put of with the pain, for a while, but he's reached the end of his rope. And yes, the smoking may affect his recovery. So what. Sign the waiver and fix him.
Post #292,989 by Another Scott 9/15/07 9:34:06 PM Reply	Disagree. If having an ankle repaired is emergency surgery, then there wouldn't be an issue. According to the Telegraph story, the no-smoking requirement only applies to elective surgery. Also, if it were an emergency, what physician would have signed-off on merely setting the ankle in a cast? It clearly isn't an emergency procedure - at least in his case. As long as medical care is a right, as it is in the UK, it has to be rationed. There will never be enough money to treat every condition that everyone has, so reasonable choices have to be made about timing, priorities, etc. That includes the right of the NHS to impose conditions before treatments are started. If Nuttall isn't willing to accept reasonable requests of him as a condition for his treatment, then he should travel elsewhere to get it done. I'm sure he could get his ankle treated for a very low cost in Albania or Sierra Leone or Burma with no questions asked. He could probably have paid for it with the money he's wasted on smokes. ;-) The NHS has no obligation to treat him if he won't accept reasonable conditions. Being asked to do without nicotine for 4 weeks is not an unreasonable request, and there are medically valid reasons for it. Sorry, Crazy old chap, but you're wrong about this. IMHO, of course. Cheers, Scott.
Post #292,990 by crazy 9/15/07 9:52:48 PM Reply	And WHO classified it as elective? The same people who don't want to do it. Conflict of interest, not to be trusted to make that judgement. Let's put it another way. If you broke your foot in 3 places, and your health plan said they were not going to pay for it because it was "elective", would you agree with them?
Post #292,991 by Another Scott 9/15/07 10:18:56 PM Reply	Come on now. [link\|http://www.timesonline.co.uk/tol/news/uk/health/article1875561.ece\|Times OnLine]: NHS managers want patients not to have smoked any cigarettes for a full month before surgery. But as they would be expected to take about two months to stop, operations could be delayed by up to three months. The managers do insist, however, that it is up to doctors to decide whether the surgery can still go ahead if the patient fails to give up. Some doctors argue that the policy could deter smokers from attending appointments because they believed that they would not qualify for treatment. By December next year, all patients will need to have had surgery within 18 weeks of having been referred to hospital by their GP, according to new government targets. To avoid endangering the targets, patients would not be added to waiting lists until they had given up smoking. His GP could recommend the surgery if s/he thought the NHS policy was wrong. The GP obviously doesn't think the smoking cessation is an onerous requirement. You ask: If you broke your foot in 3 places, and your health plan said they were not going to pay for it because it was "elective", would you agree with them? Like the story about whether [link\|http://z.iwethey.org/forums/render/content/show?contentid=292604\|Rudy was correct in saying that undocumented immigration wasn't illegal], it depends on what the words mean, doesn't it? [link\|http://www.medterms.com/script/main/art.asp?articlekey=14367\|Elective surgery] is different from [link\|http://www.answers.com/topic/emergency-surgery?cat=health\|emergency surgery]: Most surgery is elective and is performed after a diagnosis based upon a history and physical of the patient, with differential test results and the development of strategies for management of the condition. With emergency surgery, the team, as well as the surgeon, may have less information about the patient than would ordinarily be required and work under very time-dependent conditions to save a patient's life, help avoid critical injury or systemic deterioration of the patient, or to alleviate severe pain. Because of the unique conditions for urgent acute surgery, operations are usually performed by a surgical team specially trained for management of a critical, or life threatening event. Repair of Nuttall's ankle is elective surgery. Cheers, Scott.
Post #292,992 by bepatient 9/15/07 10:21:39 PM Reply	If you had enough pain to require daily morphine...how elective do you think >you< would feel it was? Too much of today's music is fashionable crap dressed as artistry._{Adrian Belew}
Post #292,993 by Another Scott 9/15/07 10:42:04 PM Reply	If I needed morphine every day... and I was healthy enough for surgery, then I would do what it took to qualify for surgery so that I wouldn't need opiates. Some people, like Nuttall apparently, make other choices. My FIL took morphine (MS Contin) daily for years near the end of his life, and took Percocet "as needed" during that time. He basically became an addict because he would lose track of how many he took during the day, and would call up his various physicians crying that he needed an emergency prescription before the end of the month (when the pills should have run out). Once he moved in with us, we were able to successfully wean him off the stuff over a period of time and the last year or two of his life he didn't need it (Tylenol was sufficient, and opiates were very bad for him because they suppress respiration). If an 85+ year old man with chronic back pain from scoliosis can be weaned off a long-term addiction to morphine and Percocet, then a 57 year old man can quit smoking for a month. I may not convince you and crazy, but you'll not convince me that Nuttall is being treated unfairly by his GP and the NHS. Cheers, Scott.
Post #292,994 by crazy 9/15/07 10:59:12 PM Reply	"alleviate severe pain." 3 broken bones. On a foot, which means either use a wheel chair or be in agony on every step. Just lovely.
Post #292,995 by Another Scott 9/15/07 11:02:07 PM Reply	"Life sucks, then you die". :-/
Post #293,003 by Arkadiy 9/16/07 1:56:53 AM Reply	Good Saying Do you want it to be the motto of your healthcare system? I've just read the thread - I am at a loss for words. To think that a doctor would use patient's pain as a leverage to get him to alter his lifestyle... In any decent system, the patient should be explained the risks, and if he chooses to go on, it should be his right to go on. ------ 179. I will not outsource core functions. -- [link\|http://omega.med.yale.edu/~pcy5/misc/overlord2.htm\|.]
Post #293,010 by Another Scott 9/16/07 9:12:46 AM Reply	It's from The Fools. [link\|http://www.thefools-band.com/FoolsMP3/lifesucks.mp3\|Life Sucks] (.mp3 excerpt). [link\|http://digitaldreamdoor.com/pages/lyrics2/nov_lifesucks.html\|Lyrics]. It's a good party song. ;-) In any decent system, the patient should be explained the risks, and if he chooses to go on, it should be his right to go on. I disagree; but I'd be repeating myself to say much more. Do note that the UK has recently [link\|http://news.bbc.co.uk/2/hi/uk_news/politics/4709258.stm\|banned smoking] in public enclosed places and private clubs. For medical reasons. In Scotland, where the ban was imposed last year, [link\|http://news.scotsman.com/health.cfm?id=1451402007\|heart attacks have dropped by 17%-20%]. It's not unreasonable to require that a surgery patient quit smoking before he gets a place in the queue. They're not refusing to treat his pain. Cheers, Scott.
Post #293,009 by pwhysall 9/16/07 8:14:58 AM Reply	If I had that much pain... ...I'd be doing whatever my doctors told me to, up to and including macrame models of the Eiffel Tower, if I thought it'd speed up the process. Peter [link\|http://www.no2id.net/\|Don't Let The Terrorists Win] [link\|http://www.kuro5hin.org\|There is no K5 Cabal] [link\|http://guildenstern.dyndns.org\|Home] Use P2P for legitimate purposes! [link\|http://kevan.org/brain.cgi?pwhysall\|A better terminal emulator] [image\|http://i66.photobucket.com/albums/h262/pwhysall/Misc/saveus.png\|0\|Darwinia\|\|]
Post #293,015 by Lily 9/16/07 12:04:08 PM Reply	Because Withdrawal symptoms from nicotine dont require an inpatient level of care and withdrawal from etoh and narotics sometimes do. A lot of docs will even do outpatient detox for etoh and opiates if the patient doesnt have severe withdrawal symptoms or serious comorbid conditions. It's a balancing act to provide adequate and appropriate treatment with the resources available.
Post #293,008 by pwhysall 9/16/07 8:13:11 AM Reply	Nonsense. The bloke's more interested in showboating for the media instead of growing some vertebrae, exercising some willpower and actually doing what his doctor tells him. He's not a "poor sod". He's an idiot. Peter [link\|http://www.no2id.net/\|Don't Let The Terrorists Win] [link\|http://www.kuro5hin.org\|There is no K5 Cabal] [link\|http://guildenstern.dyndns.org\|Home] Use P2P for legitimate purposes! [link\|http://kevan.org/brain.cgi?pwhysall\|A better terminal emulator] [image\|http://i66.photobucket.com/albums/h262/pwhysall/Misc/saveus.png\|0\|Darwinia\|\|]
Post #292,975 by Lily 9/15/07 10:40:04 AM Reply	Nuh-uh Example: Before any elective surgery, the patient is always told: Stop aspirin and ibuprofen products, nothing to eat or drink after midnight, etc, etc. If you dont follow the orders, you dont get your surgery. Why? Because you could bleed out or aspirate on your vomit and the docs arent going to risk that happening. They want your surgery to be as safe and successful as possible. It's good doctoring. If he looked hard enough, Mr. Ankle guy might be able to find a surgeon who will do his procedure. One who isnt concerned with liability. Because you can bet if there is a poor outcome, this guy will turn around and sue. ....And it already standard medical practice to have overweight patients lose weight prior to joint replacement. Extra weight puts a lot of stress on the joints.
Post #292,977 by jbrabeck 9/15/07 12:57:20 PM Reply	Acquaintance of mine Had to drop 60 pounds before doctor would how hip replacement... She whined and bitched, but did it. A positive attitude may not solve all your problems, but it will annoy enough people to make it worth the effort. (Herm Albright)
Post #292,979 by crazy 9/15/07 4:36:21 PM Reply	Nuh-uh back They told me that and I countered with No Fucking Way. There is no way I'm stopping my NSAIDs just because I might bleed out on the table. The pain is not worth it. They said: Ok, never mind. And did the procedure anyway.
Post #292,980 by Lily 9/15/07 7:11:21 PM Reply	Dont you start They did the procedure because they were hoping for the chance to autopsy your weird-ass body.
Post #292,981 by boxley 9/15/07 7:56:07 PM Reply	you mean it would be faster to identify what didnt kill im? Quantum materiae materietur marmota monax si marmota monax materiam possit materiari? Any opinions expressed by me are mine alone, posted from my home computer, on my own time as a free american and do not reflect the opinions of any person or company that I have had professional relations with in the past 51 years. meep reach me at [link\|mailto:bill.oxley@cox.net\|mailto:bill.oxley@cox.net]
Post #292,996 by Simon_Jester 9/15/07 11:03:45 PM Reply	Asprin is dropped because it's a blood thinner. The bleeding from the surgery will be worse if a patient takes asprin even just 12 hours before. (no idea on ibuprofen) <Shrug> this one is a tough call for me. I'm assuming that the surgery is going to require more than local anathesia and that might explain the smoking aspect. (Note: the guy doesn't work because of smoking related chest problems) That said, it does seem to indicate that this is a general attack on smoking rather than mere surgery. (Note: no one stated that the patient couldn't have smoked 2 weeks prior to surgery or whatever....they're demanding that he quit without a timeline.) And while I hate smoking....looking at an ankle, it's hard to justify it. Course, the guys an idiot. He refused the treatment the first time around. Frankly, I think it's probably that the bones have calcified together...meaning the surgury won't work this time either.

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