Doctors are refusing to operate on smokers. Here’s why the trend will grow

Smokers and obese people have more complications from surgeries. You have to also think about this from a liability stand point. The fact someone is out of shape and a smoker won't stop ambulance chasing attorneys from filing wrongful death lawsuits against a Doctor if the surgery doesn't turn out well.

I recall a story a couple of years ago where some kid needed a heart transplant but the doctors refused to do it because the kid simply would not follow instructions - no drugs and other behavioral issues that made him a high risk for a heart transplant. The doctors didn't want to do the surgery. Turned out the kid was a straight up thug. Anyway, the kids Mama made all kinds of stink about it and racist accusations and the media picked up the story and eventually the pressure from poor PR got the hospital to go ahead and do the surgery.

Less than a year later, the kid gets killed running from police in a stolen car. Complete waste of a good heart that could have gone to someone who actually deserved and appreciated it.

a reply to: seasonal

Anti-smoking campaigners are famous for lying through statistics.

Lets put this in perspective.

Statment: smokers have an increased risk of 80 % for post operative infections.

Well, what is the risk of a surgical infection?

www.uptodate.com...

SSIs are the most common nosocomial infection, accounting for 38 percent of nosocomial infections. However, the overall risk of SSI is low; it is estimated that SSIs develop in 2 to 5 percent of the more than 30 million patients undergoing surgical procedures each year (ie, 1 in 24 patients who undergo inpatient surgery in the United States has a postoperative SSI) [1-3].

So, in actuality the risks are only 2-5 % so if smokers have an 80 %increase of risk, that would be and increase of between 1.6 % and 4.0 %.....so between 3.6 % and 9% risk or 0.035 and 0.09.

If I was refused surgery because I smoke, I think you would be well within your rights to sue your insurance or government payer because smokers are already charged for the increased assumption of risk.

Further - the word "nosecomial" means

The term "nosocomial" comes from two Greek words: "nosus" meaning "disease" + "komeion" meaning "to take care of." Hence, "nosocomial" should apply to any disease contracted by a patient while under medical care. However, common usage of the term "nosocomial" is now synonymous with hospital-acquired. Nosocomial infections are infections that have been caught in a hospital and are potentially caused by organisms that are resistant to antibiotics. A nosocomial infection is specifically one that was not present or incubating prior to the patient's being admitted to the hospital, but occurring within 72 hours after admittance to the hospital. A bacterium named Clostridium difficile is now recognized as the chief cause of nosocomial diarrhea in the US and Europe. Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics and may be acquired during hospitalization.

Infection requires you to be exposed to a germ. The germ came from the hospital and CAUSED the infection.

Now they are just trying to make smokers responsible for the negligence of hospitals in proving a suitably clean environment!

originally posted by: VegHead
What about morbidly obese patients? They have very high complication rates, tend to not heal well, etc. If surgeons refuse to operate on smokers, I would think the same logic would apply to morbidly obese patients too.

Which you might either think is justified or a slippery slope, depending on your perspective...

In many cases a morbidly obese patient has to lose a certain amount of weight to make it safer to operate.

originally posted by: TiredofControlFreaks
a reply to: seasonal

Anti-smoking campaigners are famous for lying through statistics.

Lets put this in perspective.

Statment: smokers have an increased risk of 80 % for post operative infections.

Well, what is the risk of a surgical infection?

www.uptodate.com...

SSIs are the most common nosocomial infection, accounting for 38 percent of nosocomial infections. However, the overall risk of SSI is low; it is estimated that SSIs develop in 2 to 5 percent of the more than 30 million patients undergoing surgical procedures each year (ie, 1 in 24 patients who undergo inpatient surgery in the United States has a postoperative SSI) [1-3].

So, in actuality the risks are only 2-5 % so if smokers have an 80 %increase of risk, that would be and increase of between 1.6 % and 4.0 %.....so between 3.6 % and 9% risk or 0.035 and 0.09.

If I was refused surgery because I smoke, I think you would be well within your rights to sue your insurance or government payer because smokers are already charged for the increased assumption of risk.

Further - the word "nosecomial" means

The term "nosocomial" comes from two Greek words: "nosus" meaning "disease" + "komeion" meaning "to take care of." Hence, "nosocomial" should apply to any disease contracted by a patient while under medical care. However, common usage of the term "nosocomial" is now synonymous with hospital-acquired. Nosocomial infections are infections that have been caught in a hospital and are potentially caused by organisms that are resistant to antibiotics. A nosocomial infection is specifically one that was not present or incubating prior to the patient's being admitted to the hospital, but occurring within 72 hours after admittance to the hospital. A bacterium named Clostridium difficile is now recognized as the chief cause of nosocomial diarrhea in the US and Europe. Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics and may be acquired during hospitalization.

Infection requires you to be exposed to a germ. The germ came from the hospital and CAUSED the infection.

Now they are just trying to make smokers responsible for the negligence of hospitals in proving a suitably clean environment!

That is a fairly high risk level when the downside could be losing hundreds of thousands of dollars if not millions in a wrongful death lawsuit.

I work in mortgage finance. Only about 1-2% of mortgages typically go bad at any given time. So 1 out of a 100. Sounds low right? It is but the reality is that one mortgage going bad can wipe out the profit of a substantial amount of loans so a lot time is spent trying to prevent those 1 or 2 loans from going bad.

Would you fly on an airline that had 1 crash for every 100 flights? In your case, 9 crashes for every 100 flights?

My mother has diabetes. She was scheduled to have a major surgery. The day of the surgery, they did some pre-op testing and her blood sugar levels were just slightly off. Surgery cancelled. My mother was literally getting ready to go into the operating room when they cancelled. If she had complications or died, the first thing that would have happened would be blaming the surgeon.

a reply to: seasonal

Well, this was predictable.

When other people start paying for your healthcare, they start deciding what kind of care you will get, because their money is on the line.

The hand that pays is always above the hand that receives in the hierarchy of things, and right now Insurance companies (and at other times government agencies) are the payers.

I would expect less and less freedom of decision for patients over their own care onward from now.

So in other words, the surgeons don't want to operate on people who smoke because it is less profitable than operating on people who don't smoke. Also it makes their success rate look worse. Ok, I can see why they are doing this.

The lifestyle of smokers is the issue. Usually not the chemicals in the cigarette. Smokers as a tendency do not eat as good as those who are more health conscious. deficiencies of zinc and magnesium are higher in smokers. These two minerals help healing. Also a smoker will go out and do more than a nonsmoker, tobacco smoke is a pain reliever too. The meds they give for recovery also interact with the chemistry of the tobacco. Tobacco also slows cell division and that is a nicotine based thing. Niacin does the same thing, so hot peppers also slow the cell division, so do most nightshade chemistries.

I think the main reason the doctors do not want to work on smokers is because of profit and prestige though. A good doctor would advise his patients and still operate. I'll stay neutral on this, the doctors have rights too. Having a lot of patients have complications can suck too. Next they will be saying that men can't get operations because they go out and do things before the healing process is done. I guess that would be true, I was moving big rocks around the garden, some weighing over two hundred pounds, the day after my hernia surgery. I went out and mowed the grass with a push lawnmower two hours after getting my nuts cut. Now that was a mistake, I needed ice packs for three days after that.

I don't blame it on the doctors though.

I think there is a really good answer to this PC nonsense. Take ALL medical people, surgeons, doctors and nurses, and if they smoke sack them immediately and give them life time bans from the medical profession, even from handing out pills in a pharmacy. The same goes for obesity, sack ALL obese medics who are obese.
Either three quarters of your hospitals will shut from lack of staff or they'll shut their silly prevaricating and get on with the job for which they are employed.
What's next? Will they refuse to operate if you eat bacon because their wives like pigs.

a reply to: TiredofControlFreaks

With some hospitals using bundle payments for each surgery this means the hospital gets a set amount for the entire surgery, and keeps any money that is not used for the treatment including complications. This of course will lead to letting the sickest patients go with out treatment/surgery. The US medical system is based on $$$ and only $$$$.

originally posted by: VegHead
What about morbidly obese patients? They have very high complication rates, tend to not heal well, etc. If surgeons refuse to operate on smokers, I would think the same logic would apply to morbidly obese patients too.

Which you might either think is justified or a slippery slope, depending on your perspective...

Definitely a slippery slope.

People with immune system compromised diseases, would heal even slower would they not? Also, their chances of not surviving would be higher. Anyone going through chemo or with HIV/AIDS would have high complication rates. When does care stop and start? If I used to smoke, quit and then get cancer because of it, am I of more or less value than someone who gets cancer and never smoked before?

Too slippery a slope for me. Humans are humans and the Hippocratic Oath should be taken seriously no matter if you are a crack smoking prostitute or a tree hugging carbon neutral hippie.

a reply to: Fowlerstoad

I think this has more to do with money. The hospitals don't care if there is a govt subsidy or not, they care about green and lots of it. As long as there is insurance, if you don't have insurance, this whole thing is a mute point. You are not having surgery with out insurance.

a reply to: seasonal

That's true. I had a smoker-client who let his health insurance lapse in May. Couldn't afford the $300 a month, but could afford cartons of cigarettes.

July.. diagnosed with cancer. Was given the minimum chemo that the EMTALA law requires.. on a gurney in the hospital basement.. once a week. Died the next month at home.

a reply to: VegHead

Can you quit being obese for 6 months?

a reply to: seasonal

Many times hospitals do not get fully reimbursed. My hospital was getting 20% reimbursement for services rendered from medicare/medicaid. They basically say this is what it should cost, and then do not reimburse for complications increasing length of stay.

If you pay for complications, and get no reimbursement, that's a huge loss.

As a smoker, this doesn't surprise me. Don't forget, we live in a society that tries to convince everyone that a wisp of smoke from a cigarette is more harmful to be around than the 100s of thousands of tons of toxins tossed into the atmosphere by chemical factories EVERY day. Yeah, ok.

a reply to: seasonal

Trump will sue the surgeons who refuse to operate.

a reply to: carewemust

Yep, life is full of choices. He did what he wanted, could he have been saved? The only way we would know is if he had insurance.

a reply to: OccamsRazor04

Depends on what the cost of the product or service is. Just because the hospital charges 458$ for a recovery bed after a spinal tap, doesn't mean this is what the bed costs.

originally posted by: seasonal
Disturbing trend, look at the last quote in this thread. I see the point, but when you introduce money into or loss of money on how someone recovers, the sickest will not get treated. Knowing our medical system in the US, this is going to get bad, or should I say worse.

There is research that points to the fact that smokers don't recover as well as non smokers. This is influencing some Dr.'s to not operate on them unless they quite smoking.

Most of us know that smoking is linked to heart disease and cancer. But in recent years, research has shown that smoking also inhibits wound healing because it decreases blood flow. As a result, smokers don’t do as well as non-smokers after having spinal fusion surgery and joint replacements.

www.macon.com...

Infection is another thing smokers encounter more than non smokers. One study says 80% higher chance of an infection with joint surgery, this means more surgeries.
This is the reason that it is a growing trend to have the patient quit for 6 months before and stay off cigs for an additional 6 months after surgery.

One study found that smokers who got joint replacement surgery had an 80 percent higher chance than nonsmokers of needing repeat surgery because of complications from infection.

For this reason, surgeons who do those procedures have begun asking patients to quit smoking – or at least stop for four to six months before and after surgery.

“We want the best results possible,” said Dr. Bryan Edwards, head of orthopedic surgery for Novant Health. “We’re not denying you a surgery. We’re preventing you from having a complication.

Some hospitals use bundle payments for each surgery. This means the hospital gets a set amount for the entire surgery, and keeps any money that is not used for the treatment including complications. This of course will lead to letting the sickest patients go with out treatment/surgery. The US medical system is based on $$$ and only $$$$.

In Charlotte, some surgeons who perform spine surgery and knee and hip replacements have begun using a “value-based” system that means accepting a single “bundled payment” for each patient encounter. This gives doctors an incentive to provide the best care for each patient.

If all goes well and care is delivered for less than the contract price, the doctor or hospital keeps the savings. If there are complications and the patient needs more care, the doctor or hospital absorbs the extra cost.

So, operating on smokers, with potentially expensive complications, could hurt the bottom line for physicians.

Read more here: www.macon.com...#storylink=cpy

How is this "Bundle" pricing not straight out through and through theft? Essentially they give you an estimate, that's going to be in their favor to give you one that is high, and then when you do the surgery -- they do it for cheaper, and then they keep the change?

What in the actual eff.

originally posted by: seasonal
a reply to: OccamsRazor04

Depends on what the cost of the product or service is. Just because the hospital charges 458$ for a recovery bed after a spinal tap, doesn't mean this is what the bed costs.

They charge that because other people have complications and cost more, and they don't get reimbursed for it.

a reply to: SRPrime

Insurances do it by bundle. They save money by lowballing it and saying this is what it should cost so this is all we pay for this procedure.