Doctor refusing to treat smokers & obese people

[LJF]

I went to the doctor today and at the front desk there was a sign that said," Dr. XXXXX is no longer treating active smokers or obese people." He went on to define what was obese as anywhere with BMI of 40 or more. I think it is fine that he has made that decision. I was wondering what others thoughts are on this. When does something like this become discrimination, what are people willing to let slide and what not?

[tvrec]

Off the cuff and without any other context, I think it is discriminatory and probably wouldn't stand up legally, were it to be challenged. It's also kinda dickish and antithetical to his/her ethical and professional mission as a doctor. At the same time, I can see where the stance comes from and can even sympathize if it were a policy applied to actual patients that have a demonstrable pattern of refusing his/her medical behavioral prescriptions to lose weight and/or quite smoking. In other words, why continue to treat someone who will not follow the treatment plan? This latter position is one that I could probably be persuaded to accept, but it would still be difficult.

[Hype]

I went to the doctor today and at the front desk there was a sign that said," Dr. XXXXX is no longer treating active smokers or obese people." He went on to define what was obese as anywhere with BMI of 40 or more. I think it is fine that he has made that decision. I was wondering what others thoughts are on this. When does something like this become discrimination, what are people willing to let slide and what not?

I think it's a pretty clear violation of the Hippocratic oath (see modern version from JHU here: http://guides.library.jhu.edu/content.p ... sid=190964 )

Look especially at this line:
"I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism."

It seems Dr. XXXXX has fallen victim to therapeutic nihilism. (It turns out this is also a traditional Conservative ideology, dating back to Burke... but the medical definition is here: http://www.medilexicon.com/medicaldicti ... hp?t=60488 ) He probably also has demonstrably false views about what is wrong with smokers and the obese. For starters, treating these groups as monoliths is probably not a good idea, since they aren't.

One might object that if one really wants his treatment, or to retain his services as a family doctor, one may by this notice be motivated to quit smoking or lower one's BMI, but this, again, relies on a false view of causality and the monolithic view of the people with these lifestyle conditions. Some smokers and some obese people are able to self-consciously and with strong internal motivation quit smoking or lose weight. But not all are, and, just like with people in poor economic circumstances, people with poor health may need much external help.

It sounds like this doctor is probably exasperated at a lifetime of telling patients what is wrong with them and what he thinks they should do to fix it, only for them not to successfully follow his instructions. But this is a failing of the doctor, not a failing of the patients.

Frankly, if this were my doctor, I'd try to switch to someone with a more accurate view of human nature.

[LJF]

Funny I have even more respect for my doctor. What if he feels he can no longer treat this people probably. Did you feel the same when smoking was banned from planes, bars and restaurant, was that discrimination? Funny that you blame him for what others are doing.

[Pure Method]

I understand the doc's frustration, but he seems like a dick and I don't agree with his position.

[LJF]

I understand the doc's frustration, but he seems like a dick and I don't agree with his position.

A man who has dedicated his life to helping others is a dick, really. Would you say people that smoke and subject others to the second hand smoke are dicks? What if after reviewing his practice he realizes that he is spending a disproportionate amount of time with a few patients who happen to be smokers and obese. This is taking away from his other patients that he can no longer properly take care of. Smoking is a choice, he should have the choice also.

[Pure Method]

I understand the doc's frustration, but he seems like a dick and I don't agree with his position.

A man who has dedicated his life to helping others is a dick, really. Would you say people that smoke and subject others to the second hand smoke are dicks? What if after reviewing his practice he realizes that he is spending a disproportionate amount of time with a few patients who happen to be smokers and obese. This is taking away from his other patients that he can no longer properly take care of. Smoking is a choice, he should have the choice also.

Just because someone is a doctor does not make them a good person. And a doctor takes an oath. Picking his patients and avoiding the more difficult ones makes him a dick. Just let those other doctors deal with those problem patients. They don't deserve treatment.

[farrellgirl99]

i think its definitely discriminatory. i know its not exactly comparable, but what if someone had a sign that they were no longer treating a certain racial group because they were more likely to have certain health problems? just because a person is one thing, doesn't mean they should be refused treatment. in my opinion, t's dangerous territory and unethical.

[LJF]

You have no choice in your race, you have a choice in smoking so should the doctor. The not seeing obese people to me is a bit more questionable. There are certainly a lot of people that are over weight do to their bad habits, there are some that can't help it.

We are also missing the point that if the doctor has reviewed his practice and found he is taking more time on smokers vs non smokers and they represent a small group how is that fair? He is doing his another clients a disservice.

By the way I asked this question because I find this subject very interesting. Like I said I agree with his decision, but I also understand why others wouldn't. I also think calling him a dick is a little drastic. If he feels that not treating those type of patients is better for his practice, meaning he can better serve those he still sees it is a good decision.

http://www.theguardian.com/society/2012 ... kers-obese

[Artemis]

I would be curious to know why he chooses not to treat smokers and obese people. Is it less profitable? Maybe the smokers and obese who have health coverage do not get as much coverage as a non-smoker or average weight person;hence a lower payout from the insurance company to the doctor??

[Larry B.]

I like your doctor. Seriously, just tell him "a friend in Chile says 'great decision. Controversial, but that only makes it greater.'"

As long as he's an efficient doc with his patients, of course.

[SR]

I don't think this will end well for dr. Xxxx.

[Pandemonium]

I suspect there's more to this than meets the eye. IMO, for this particular doctor it sounds like a cheap attempt to garner controversy aka publicity. Ethically, he's practicing selective discrimination - why stop at smokers? Why not habitual alcohol and drug users? Obese people? Why stop there - surely hardcore athletes that punish their bodies beyond their boundaries requiring normally unnecessary numerous knee, hip and other surgeries along with long term rehab before middle age should know better. What about homosexuals that get specific STDs? Some dude sticking his cock in some other guys chocky starfish is a choice, right? The list can go on and on. This "movement" basically chose the two easiest targets while ignoring scores of other issues that can fall into his unspoken argument of people he won't "treat."

But (this specific doctor) *is* part of the growing movement in British and American corporate-run healthcare - insurance companies and even employers are beginning to set guidelines targeting these two specific demographics along with diabetics (which mostly fall into the obese category) with drastically higher rates and even testing the grounds by limiting coverage. Just until the last decade (and it isn't 100% with all agencies), autism and similar mental issues were not covered under any typical insurance plan. At some point, those with other open-ended conditions like cancer, heart conditions and so on will fall under this umbrella. As noted in the article you linked, the primary driving force behind this is the NHS budget with the grand idea of "lifestyle rationing" mostly an excuse to deny services to target groups. Perhaps the UK can lead the way by instructing firemen and rescue services not to answer 911 calls that likely are the result of human mistakes like drunk driving accidents, smoking in bed, heart attacks among obese people, etc. Thin the herd.

Part of being a medical professional is practicing blind compassion. Not balancing national health care budgets.

[Bandit72]

Is that his real name dr. Xxxx? Cool. Very Austin Powers.

Seriously though, it's quite an interesting debate. I agree with Pandemonium regarding the set guidelines targeting these two specific demographics. Over here you get little 'hints' in the media all the time suggesting 'IF YOU SMOKE YOU MAY NOT RECEIVE HEALTH CARE' or 'YOU MAY BE TOO OBESE TO RECEIVE MEDICAL HELP'. I guess they're just more subtle warnings droning over the media channels. The same as you get on cigarette packets. Yes, we know smoking's bad, but I get the impression a lot of people want to stop and need help stopping, so give them the help? Is this not beneficial long term? It was suggested last week that a high protein diet was worse than smoking. Will this lead to non treatment of people who eat too much protein based food? I've heard heavy taxing on fizzy drinks, chocolates, sweets in the media.

http://www.huffingtonpost.co.uk/2014/03 ... 01756.html

I'm sure if you repeat yourself often enough, the masses will believe you, I guess that's happened throughout history. The power of media and advertising! Don't knock it.

Could we not just educate better? If anything, I've noticed an increase in people looking after themselves, drinking and smoking less.

[kv]

he's an asshole

[tvrec]

There's also the counter-intuitive research that shows smokers actually lower health-care costs in the long run (ah, because they die far earlier than non-smokers) (see: New England Journal of Medicine http://www.nejm.org/doi/full/10.1056/NE ... 0093371506).

And for something completely different, where is the discussion of Obama on Between Two Ferns?


http://www.funnyordie.com/videos/18e820 ... rack-obama
The video from YouTube doesn't want to embed.

[LJF]

I really didn't expect this type of reaction but oh well. I'm still in favor of what he did and guess what if you were a patient and didn't like his decision you can look for a new doctor. Ultimately I think he is doing this so he can better care for his existing patients. He is the only doctor there and only has so many hours in the day.

[LJF]

And for something completely different, where is the discussion of Obama on Between Two Ferns?



Start your own about this. Talk about an, oh well forget it better watch what I say about him maybe the NSA is reading this.

[SR]

I really didn't expect this type of reaction but oh well. I'm still in favor of what he did and guess what if you were a patient and didn't like his decision you can look for a new doctor. Ultimately I think he is doing this so he can better care for his existing patients. He is the only doctor there and only has so many hours in the day.

He's obviously a GP and not a pulmonologist, in which case it would be funnier.

Frantic person: 'My spouse broke his leg!. It looks like a compound fracture.....the bone! The horror, the horror."

Dr. XXXXX: "Okay, his teeth look a bit stained. Later, it's t time."

[tvrec]

And for something completely different, where is the discussion of Obama on Between Two Ferns?
Start your own about this. Talk about an, oh well forget it better watch what I say about him maybe the NSA is reading this.

Yeah, it should be a different thread probably, but it isn't wholly unrelated; the spot/spoof is about health care and a large part of the new law focuses on preventing the denial of medical coverage because of pre-existing conditions, which is related, if only by degree.

[Essence_Smith]

he's an asshole

Pretty much...and isn't obesity considered a disease?

[Hype]

he's an asshole

Pretty much...and isn't obesity considered a disease?

I was going to quote kv too, since I already did my standard "Here's a bunch of words that explain in detail what I think." route, and it didn't seem to convince LJF (then again, I almost never do...).

This doctor *is* an asshole. But worse than that, he's endangering lives. LJF's claim that you can just go to another doctor may be true in this case, but it's not always true. If a rural doctor did this, it would be even more dangerous. That's why we don't allow doctors with personal moral views to refuse to provide Plan B, etc. It's not a matter of personal choice, it's a matter of public policy.

The claim that smoking is a "choice" and so doesn't require a doctor to treat a patient who does it is about as stupid as not treating the diseases of alcoholics, or those who chose to drive a car and got in an accident, or who chose to leave the house and thereby got mugged. It's a completely useless, trivial standard of "choice", with arbitrary boundaries that, by the way, affect mostly the working poor (who are far more likely to smoke or be obese than the middle class or wealthy). It's class-warfare under the guise of liberty.

[Larry B.]

[Hype]

Gervais is a smarmy tool, even when I agree with him.

[tvrec]

Ultimately I think he is doing this so he can better care for [some of his selected] existing patients.

I am surprised that you're surprised by the reaction here. Your position on the doctor's decision is consistent with others you've brought to the board, and it has been met with equally consistency in the responses this thread has garnered. As great as free markets "might" work for delivering us a wide variety of consumer goods--clothes or telecommunication devices--(and even there, many, many caveats come into play), health care is a completely different beast and is not really subject to freedom of choice, market corrections, etc. that undergird a free market. If you're in an accident, for example, you don't get to choose which ambulance comes to pick you up or what hospital you go to. If you're in an insurance network, this or that doctor might be the ONLY one approved by the plan. If you need insulin for Diabetes, sure you can choose not to take it, but with severe consequences (like death). The basic point: health care is not simply a matter of choosing between one product and another, like other commodities, and shouldn't be treated as such, like it's some cornershop with a "we reserve the right to refuse service" sign.

No one is faulting Dr. X for having a limited amount of time in which he can treat patients or questioning the quality of care he provides, but rather his failure to uphold the Hippocratic oath he took by selecting which patients he will see and which he will not. Pandemonium's post above effectively lays out several logical extensions of Dr. X's position as well as the ethical and legal problems with it.