Doctor refusing to treat smokers & obese people

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LJF
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Re: Doctor refusing to treat smokers & obese people

#51 Post by LJF » Sat Mar 15, 2014 9:14 am

Adurentibus Spina wrote:
Larry B. wrote:I think that's a bit unfair. Class warfare is far from being a doctor's fault. If you're going to point fingers, they should be aimed at those responsible for the current economic model, which pushes poor people into being fat and smoking and which guides doctors into not providing services to poor people (which has happened for at least 15 years, since poor people can't really afford medical insurance and/or private doctors anyway.)
In this specific case, this doctor could, by doing his job properly, help a good number of patients live healthier better lives, and he is failing to do so. These patients are likely to be socioeconomically underprivileged (see evidence above), and so his actions are part of a broader attack on social welfare, whether he means them to be or not. That's all I meant. And even if you deny this, he's still not doing his job properly.

Please explain to me how he can force someone to stop smoking?

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Hype
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Re: Doctor refusing to treat smokers & obese people

#52 Post by Hype » Sat Mar 15, 2014 10:24 am

LJF wrote:A.S. I don't take things here personally unless it is an attack on me directly. You and I have very different view points and that is fine. I never said he was being a good doctor towards those you smoke. I said he is a very good doctor towards me. I also said I can understand why people wouldn't agree with what he did. I just have a problem with the class warfare statement. If there is just one 1% that smokes or is obese, which there are plenty, and they can no longer use him how can you call it class warfare. My big problem is this is what this country is all about now, blame the rich for everything. I know you are from our wonderful neighbors up north where the cold air came from and that horrible bastard Sid Crosby. Blaming someone else for your problems will never solve anything.
The problem with your way of thinking is that you don't seem to be able to understand how it could be a problem for other people. You say you can understand why people wouldn't agree with what he did. But you also said you agree with it. This can't be possible. If you really understand why people not just wouldn't, but SHOULDN'T agree with what he did (because it contravenes the Hippocratic oath, it effectively marginalizes at-risk groups including visible minorities, and many other reasons besides), then your reasons for agreeing with it should simply fall away. The reasons are not compatible. But the fact that you maintain your agreement with him suggests that you don't understand why others disagree (and why they, and YOU, have good reasons to disagree with it).
Why is it that the poor smoke more? Does any force them to smoke? I've never seen a 1%er holding a gun to a poor person's head and forcing them to smoke. Any one that smokes has made that decision by themselves, so they need to deal with what happens as a result.
This rhetoric conflates two kinds of liberty. You seem to think that freedom from direct coercion implies positive liberty to make informed, effective, and long-term best interest decisions effectively, regardless of circumstances, environment, history, etc. But this is mistaken. Human beings are not the sort of beings who are able, independently of their external circumstances, to "choose" to either do something or not do it. The causal forces at work in producing human behaviour are vast and largely beyond the control of any individual. Public policies and legislation can and do make major differences to the educational, health, and economic outcomes of individuals. The reasons why cigarette smoking is class-stratified are historical and deep. Tobacco advertisers have long targeted children. Children in poverty are far less likely to be exposed to anti-smoking messages because of failures in education (in their parents and in the current school). Working class culture may maintain traditional attachments to the idea of the "smoke break", or of manliness or whatever, and be less inclined than more progressive/white collar cultures to adopt new habits or healthier lifestyles. These factors, combined with the fact that socioeconomic status correlates with mental health (and mental health and cigarette smoking correlate), suggest that doctors are in a key position to HELP CHANGE the fact that the poor are more likely to smoke (either by treating the underlying mental health concerns, or by educating their patients on the options available to them for quitting smoking).
Were bars and restaurants engaging in class warfare when they banned smoking and what about airlines? I guess clearly all office buildings don't want the poor to work either since you can't smoke in office building either. Now I've seen the light the whole world really is in on this class warfare, by making the poor smoke and then not letting them go to work, bars, fly anywhere and above all else my dick asshole of a doctor won't treat them.
Bars and restaurants do not refuse service to smokers. Nor is the service they don't refuse an essential service. The progressive social policy of banning cigarette smoking inside bars and restaurants has helped produce conditions under which less people smoke, and in which the health effects of smoking are lessened, but it does not further marginalize the group in question.

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Hype
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Re: Doctor refusing to treat smokers & obese people

#53 Post by Hype » Sat Mar 15, 2014 10:29 am

LJF wrote:
Adurentibus Spina wrote:
Larry B. wrote:I think that's a bit unfair. Class warfare is far from being a doctor's fault. If you're going to point fingers, they should be aimed at those responsible for the current economic model, which pushes poor people into being fat and smoking and which guides doctors into not providing services to poor people (which has happened for at least 15 years, since poor people can't really afford medical insurance and/or private doctors anyway.)
In this specific case, this doctor could, by doing his job properly, help a good number of patients live healthier better lives, and he is failing to do so. These patients are likely to be socioeconomically underprivileged (see evidence above), and so his actions are part of a broader attack on social welfare, whether he means them to be or not. That's all I meant. And even if you deny this, he's still not doing his job properly.

Please explain to me how he can force someone to stop smoking?
He can HELP make it more likely that his patients quite smoking by: treating underlying conditions (especially mental health), prescribing them anti-smoking drugs or counselling or hypnosis, nicotine patches/gum, showing them emotionally charged images and stories of what happens to smokers, and their families, in old age, by being positive about what their life will be like if they quit. This isn't about the doctor's ability or inability to force anyone to do anything -- but it does sound like your doc basically got frustrated with his inability to make people stop smoking or being fat simply by telling them to stop smoking and eating so much... That is, it sounds like he threw an adult temper tantrum.

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Re: Doctor refusing to treat smokers & obese people

#54 Post by clickie » Mon Mar 17, 2014 5:25 am

If I was a smoker I wouldn't even tell him. Same with being obese.

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Essence_Smith
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Re: Doctor refusing to treat smokers & obese people

#55 Post by Essence_Smith » Mon Mar 17, 2014 12:36 pm

clickie wrote:Same with being obese.
:lolol:

Desri
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Re: Doctor refusing to treat smokers & obese people

#56 Post by Desri » Tue Mar 18, 2014 3:20 am

This doctor's concept also highlights a way bigger problem, at least in Oz it is a problem and I suspect America may be similar, that many GPs don't like treating patients with chronic conditions. The fact is treating both obesity and smoking is effectively a long term, time consuming and ongoing thing just like dealing with Diabetes management or drug dependence. It's way more time consuming than just having in and out patients with colds and stuff. From the second article that was posted the problems described with obese patients also kind of made it sound like GPs are handling stuff that really should be going to specialist clinics, which would make it way more challenging to deal with obesity management. But again, I just don't know enough about the American primary care sector to really be sure that is the case.

Ultimately though, it is not the role of a doctor to stand in judgment over their patient. As soon as they start doing that where do you draw the line? This doctor says they won't see current smokers, what if their patient quit an hour ago? :hehe:

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Hype
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Re: Doctor refusing to treat smokers & obese people

#57 Post by Hype » Tue Mar 18, 2014 4:55 am

Desri wrote:This doctor's concept also highlights a way bigger problem, at least in Oz it is a problem and I suspect America may be similar, that many GPs don't like treating patients with chronic conditions. The fact is treating both obesity and smoking is effectively a long term, time consuming and ongoing thing just like dealing with Diabetes management or drug dependence. It's way more time consuming than just having in and out patients with colds and stuff. From the second article that was posted the problems described with obese patients also kind of made it sound like GPs are handling stuff that really should be going to specialist clinics, which would make it way more challenging to deal with obesity management. But again, I just don't know enough about the American primary care sector to really be sure that is the case.

Ultimately though, it is not the role of a doctor to stand in judgment over their patient. As soon as they start doing that where do you draw the line? This doctor says they won't see current smokers, what if their patient quit an hour ago? :hehe:
Fuck those shitty doctors. LIFE is a long-term chronic problem, and doctors are supposed to be specialists in making sure we're as healthy as possible while we waste those 80 years being tools for corporations!

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Re: Doctor refusing to treat smokers & obese people

#58 Post by Romeo » Tue Mar 18, 2014 11:51 am

Adurentibus Spina wrote:LJF, I know you think we're just destined to disagree, and that I probably just disagree with you because it's personal or something, but you should know by now that I don't just say things for no reason. So to call my claim about 'class warfare' a joke is really a joke. You must have been able to guess that I had evidence for that claim.

As for your most recent claim, I'll just assert the opposite, and then provide evidence for all of this. Contrary to what you assert, your doctor is not very good at treating smokers and obese people.

I won't post much content from the first two links. You should just check them out. The last link supports my contentious claim that in actual fact, your doctor is effectively engaging in "class warfare", by which I mean, quite simply, his decision to refuse treatment to a very specific group actually ends up (whether he is aware of it or not) targeting poor people (the very people who, by libertarian lights, should be able to choose to go get better jobs... but how can they do this if their goddamn doctors are refusing to treat them?!) Not only is it targeting the poor, but it's targeting the poor and mentally ill -- the most likely group to become homeless, the most likely group to be taken advantage of, etc. That is why your doctor is an asshole. He should know better.

http://www.webmd.com/diet/medical-reasons-obesity
Medical Causes of Obesity
Usually obesity is the result of overeating, but in a small percentage of people excess weight gain is a symptom of another disease.

Medical causes of obesity can include:

Hypothyroidism. This is a condition where the thyroid gland, located in the neck, produces too little thyroid hormone. Thyroid hormone regulates our metabolism. So too little hormone slows the metabolism and often causes weight gain. If your doctor suspects thyroid disease as a cause of your obesity, he or she may perform blood tests to check your hormone levels.
Cushing's syndrome. This condition results when the adrenal glands (located on top of each kidney) produce an excess amount of a steroid hormone called cortisol. This leads to a build-up of fat in characteristic sites such as the face, upper back, and abdomen.
Depression. Some people with depression overeat, which can lead to obesity.
There are also certain inherited conditions and other diseases of the brain that can cause excess weight gain.

Certain medications, notably steroids, some antidepressants, high blood pressure drugs, and seizure medications can also cause increased body weight.

A doctor can determine if any of these conditions or treatments are responsible for your obesity.
http://www.drugabuse.gov/publications/r ... omorbidity
There is clear evidence of high rates of psychiatric comorbidity, including other substance abuse, among adolescents and adults who smoke. For example, it has been estimated that individuals with psychiatric disorders purchase approximately 44 percent of all cigarettes sold in the United States, which undoubtedly contributes to the disproportionate rates of morbidity and mortality in these populations. In addition, studies have shown that as many as 80 percent of alcoholics smoke regularly, and that a majority of them will die of smoking-related, rather than alcohol-related, disease.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169799/
Why do low–socioeconomic status (SES) groups more often act in ways that harm their health than high-SES groups? Health behaviors such as use of tobacco, lack of exercise, and poor diet contribute importantly to—though by no means completely explain (Lantz et al. 1998)—SES differences in health and mortality (Rogers et al. 2000). In addition, these behaviors have a characteristic that makes them of special interest: They involve more than the inability to purchase goods and services that promote good health. Smoking involves expenditure of money to purchase an unhealthy product, and some forms of exercise such as walking cost little. The tendency of low-SES groups to adopt unhealthy behaviors despite the monetary and health costs is a puzzle that many studies have examined but, with one very recent exception (Cutler & Lleras-Muney 2010), not addressed in a comprehensive way.
:nod:
I have hypothyroidism along with Hashimoto's thyroiditis (which is a autoimmune disease). I am not obese but I can not lose weight. I am on Synthroid and I am gluten free. I also eat extremely healthy and I can not get my ass back into a size 6 (which I was for many many years) :sad:

My sister died from morbid obesity, which stem from long term depression and anxiety/panic attacks.

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Re: Doctor refusing to treat smokers & obese people

#59 Post by Pure Method » Tue Mar 18, 2014 1:44 pm

Now I see there's a pediatrician refusing to treat kids that are not vaccinated.

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Hype
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Re: Doctor refusing to treat smokers & obese people

#60 Post by Hype » Tue Mar 18, 2014 3:00 pm

Pure Method wrote:Now I see there's a pediatrician refusing to treat kids that are not vaccinated.
The claim there was that such kids pose an immediate threat to the lives of patients who have yet to be vaccinated (infants below the age where vaccines are given), etc..

But in such cases, I think the doc should tell parents of those kids where they can go to get their kids vaccinated. :nod:

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Re: Doctor refusing to treat smokers & obese people

#61 Post by Desri » Tue Mar 18, 2014 3:30 pm

Don't quite a lot of pre-schools require kids to be vaccinated to attend too? I don't think that is necessarily unique to doctors.

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Re: Doctor refusing to treat smokers & obese people

#62 Post by Pandemonium » Tue Mar 18, 2014 4:44 pm

Desri wrote:Don't quite a lot of pre-schools require kids to be vaccinated to attend too? I don't think that is necessarily unique to doctors.
Despite increasing requirements for vaccinations in both public and private schools, it's still easy to opt a child out of this requirement on various religious and other vague "personal belief" grounds.

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Re: Doctor refusing to treat smokers & obese people

#63 Post by Bandit72 » Wed Mar 19, 2014 12:47 am

Pandemonium wrote:
Desri wrote:Don't quite a lot of pre-schools require kids to be vaccinated to attend too? I don't think that is necessarily unique to doctors.
Despite increasing requirements for vaccinations in both public and private schools, it's still easy to opt a child out of this requirement on various religious and other vague "personal belief" grounds.
Yes. We've not had ours 'herd' vaccinated (MMR). We've done it privately. Ours wasn't a vague reason, I just don't trust what's in the government vaccine.

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Re: Doctor refusing to treat smokers & obese people

#64 Post by tvrec » Wed Mar 19, 2014 7:34 am

Bandit72 wrote:Yes. We've not had ours 'herd' vaccinated (MMR). We've done it privately. Ours wasn't a vague reason, I just don't trust what's in the government vaccine.
Not sure I follow... what does "done it privately" mean? that the brood was vaccinated but not with government issued vaccinations? I believe what Pande meant is that people are opting to not vaccinate their kids at all because they don't trust vaccinations--mainly, if I can paint the movement in a broad stroke, in the misguided belief that vaccinations are a leading trigger of autism. The government in the US doesn't, for the most, develop or administer vaccinations, as the health-system is a market based one (even allowing for all the exceptions of government provided health care like the VA, the government is a buyer of vaccinations in such cases). Anyway, it's been in the news--again--as of late because of the resurgence of measles in schools and towns where kids have had parents who opted-out for various reasons, misinformed ones, I would add, if passionate.

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Re: Doctor refusing to treat smokers & obese people

#65 Post by Hype » Wed Mar 19, 2014 8:01 am

:waits:

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Re: Doctor refusing to treat smokers & obese people

#66 Post by Bandit72 » Wed Mar 19, 2014 8:05 am

tvrec wrote:
Bandit72 wrote:Yes. We've not had ours 'herd' vaccinated (MMR). We've done it privately. Ours wasn't a vague reason, I just don't trust what's in the government vaccine.
Not sure I follow... what does "done it privately" mean? that the brood was vaccinated but not with government issued vaccinations? I believe what Pande meant is that people are opting to not vaccinate their kids at all because they don't trust vaccinations--mainly, if I can paint the movement in a broad stroke, in the misguided belief that vaccinations are a leading trigger of autism. The government in the US doesn't, for the most, develop or administer vaccinations, as the health-system is a market based one (even allowing for all the exceptions of government provided health care like the VA, the government is a buyer of vaccinations in such cases). Anyway, it's been in the news--again--as of late because of the resurgence of measles in schools and towns where kids have had parents who opted-out for various reasons, misinformed ones, I would add, if passionate.
Yes, not with government issued vaccines, that is correct.

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Re: Doctor refusing to treat smokers & obese people

#67 Post by Essence_Smith » Wed Mar 19, 2014 11:40 am

Romeo wrote:I am not obese but I can not lose weight
Don't worry, I've seen your size on fb and you're just fine the way you are... :boobs: :love: :hehe:

A question that comes to mind... is LJF's doc or any of these people at least willing to refer people to doctor's that will treat them?

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Re: Doctor refusing to treat smokers & obese people

#68 Post by LJF » Wed Mar 19, 2014 1:04 pm

Essence_Smith wrote:
Romeo wrote:I am not obese but I can not lose weight
Don't worry, I've seen your size on fb and you're just fine the way you are... :boobs: :love: :hehe:

A question that comes to mind... is LJF's doc or any of these people at least willing to refer people to doctor's that will treat them?

I think he gives them a pack of cigs and a sandwich and tells them to beat it.

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Hype
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Re: Doctor refusing to treat smokers & obese people

#69 Post by Hype » Wed Mar 19, 2014 1:16 pm

LJF wrote:
Essence_Smith wrote:
Romeo wrote:I am not obese but I can not lose weight
Don't worry, I've seen your size on fb and you're just fine the way you are... :boobs: :love: :hehe:

A question that comes to mind... is LJF's doc or any of these people at least willing to refer people to doctor's that will treat them?

I think he gives them a pack of cigs and a sandwich and tells them to beat it.
If only he told the obese people to start chain-smoking, and the smokers to switch to eating cold turkey, he'd actually be treating them!

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Re: Doctor refusing to treat smokers & obese people

#70 Post by SR » Wed Mar 19, 2014 1:40 pm

I'm still in awe that this doesn't give thin non smoking patients serious pause.

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Re: Doctor refusing to treat smokers & obese people

#71 Post by Essence_Smith » Wed Mar 19, 2014 2:52 pm

Another thing I'm wondering...can he legally refuse to treat people??? The corporate business side of me wants to understand this logically but the regular Brooklyn guy in me still think this guy's just being an ass...

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Hype
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Re: Doctor refusing to treat smokers & obese people

#72 Post by Hype » Wed Mar 19, 2014 3:36 pm

SR wrote:I'm still in awe that this doesn't give thin non smoking patients serious pause.
Yeah, but if they think like LJF, then the justification (psychologically, but not morally) is: "He's still an excellent doctor for me."

The interesting thing about it is that while I think that that line of reasoning fits perfectly well with the way humans are built (Hobbes was right), it's myopic... it stops at the immediate and the first-order direct connection of the patient to the doctor, rather than considering the broader implications of this pattern of thinking on the part of the doc.

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Re: Doctor refusing to treat smokers & obese people

#73 Post by Hype » Wed Mar 19, 2014 3:39 pm

Essence_Smith wrote:Another thing I'm wondering...can he legally refuse to treat people??? The corporate business side of me wants to understand this logically but the regular Brooklyn guy in me still think this guy's just being an ass...
http://biotech.law.lsu.edu/Books/lbb/x220.htm (This source is from 1993... so maybe the law has changed... I don't know)
Refusing to Treat Patients

Physicians do not have unlimited discretion to refuse to accept a person as a new patient. Because much of medicine is involved with federal regulations, physicians cannot refuse to accept a person for ethnic, racial, or religious reasons. Nor can they discriminate based on the person's sex, unless the sex of the patient is relevant to the physician's specialty. Outside these protected areas, physicians have great latitude in refusing to accept persons as patients.
The most common reason for refusing to accept a patient is the patient's potential inability to pay for the necessary medical services. Patients should be given some indication of the financial requirements when they make an appointment for treatment to prevent them from delaying making other arrangements for care while waiting for an appointment at which they will receive no treatment. While it has not been clearly established that making an appointment creates a physician-patient relationship, it would be difficult to explain to a jury why someone in urgent need of care was turned away after having waited for an appointment. A defensible decision not to accept a patient for financial reasons can appear questionable in retrospect if the person was injured by the subsequent delay in receiving medical care.
Some physicians will not treat certain individuals or classes of patients. Perhaps the most common restriction is refusing to treat patients involved in accidents that will lead to litigation. Some physicians refuse to treat attorneys. Many obstetricians refuse to treat a pregnant woman who first seeks care after the sixth month of pregnancy. These decisions are shortsighted in a competitive market and ethically questionable in a market where they may make it difficult for the affected persons to obtain care; but they are not illegal.
:confused:

http://www.nytimes.com/2003/03/16/magaz ... -door.html
When can a doctor refuse to treat a patient? Not surprisingly, there are rules. In 1987, Dr. John Bower, a kidney specialist at the University of Mississippi Medical Center, was sued after dismissing from his practice a patient who regularly missed dialysis appointments, verbally abused nurses and even threatened to kill Bower and a hospital administrator. Bower cited medical noncompliance and violent threats as grounds for terminating care. The Fifth Circuit Court of Appeals, in New Orleans, agreed with him, ruling that doctors can refuse to treat violent or intransigent patients as long as they give proper notice so that the patient can find alternative care. Forcing doctors to treat such patients, the court said, would violate the 13th Amendment, which prohibits involuntary servitude.

Sometimes doctors can refuse to treat on the basis of conscience. I once took care of a man in his 50's who had metastatic tongue cancer and respiratory failure requiring a ventilator. His family refused to turn off the machine and let him die, choosing instead to escalate treatment with even more aggressive interventions. Medicine is a stochastic science -- no doctor can predict the future -- but in this case the outcome was never in doubt. Advanced cancer patients who end up on ventilators die during their hospitalizations. Life support was futile, and continuing to insert catheters and tubes into this man seemed inhumane. After the attending physician and I consulted with the hospital's ethics committee, we told the family that we could no longer obey their wishes. We gave them the option of transferring the patient to another hospital. They didn't want to do that; treatment was scaled back, and the man died a few days later.

In rare cases, doctors have objected to treatment on moral grounds. In February 2001, it was reported that surgeons in Melbourne, Australia, were refusing to provide heart and lung transplants, coronary-bypass surgery and lung-reduction surgery to smokers.
Notice that that last case isn't a refusal to provide treatment at all from a GP, but just specific moral refusals, presumably on grounds that going ahead with transplants removes organs that could go to people with a better chance of long-term health outcomes, etc.

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Re: Doctor refusing to treat smokers & obese people

#74 Post by Larry B. » Wed Mar 19, 2014 4:06 pm

George Best, a very famous footballer from Northern Ireland, was an alcoholic. He got a liver transplant in 2002 (at the expense of the NHS.) Not even a year had gone by when he was back to his old antics.

It's a strange line, really. I don't think Best would've received that transplant had he not been one of the greatest football legends of the UK.

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Re: Doctor refusing to treat smokers & obese people

#75 Post by LJF » Wed Mar 19, 2014 6:20 pm

Adurentibus Spina wrote:
SR wrote:I'm still in awe that this doesn't give thin non smoking patients serious pause.
Yeah, but if they think like LJF, then the justification (psychologically, but not morally) is: "He's still an excellent doctor for me."

The interesting thing about it is that while I think that that line of reasoning fits perfectly well with the way humans are built (Hobbes was right), it's myopic... it stops at the immediate and the first-order direct connection of the patient to the doctor, rather than considering the broader implications of this pattern of thinking on the part of the doc.
I paused and thought, "well good call by him." With smokers enough is enough if they don't know it isn't good for them they never will. Us non-smokers deal with their second hand smoke, them littering their cigarette butts, and just the general smell of smoke now they can deal with this one doctor.

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