Doctors To Breathalyse Smokers Before Allowing Them NHS Surgery (bbc.com) 486
Smokers in Hertfordshire, a county in southern England, are to be breathalysed to ensure they have kicked the habit before they are referred for non-urgent surgery. From a report, shared by several readers: Smokers will be breath-tested before they are considered for non-urgent surgery, two clinical commissioning groups (CCGs) have decided. Patients in Hertfordshire must stop smoking at least eight weeks before surgery or it may be delayed. Obese patients have also been told they must lose weight in order to have non-urgent surgery. The Royal College of Surgeons (RCS) said the plan seemed to be "against the principles of the NHS (the publicly funded national healthcare system for England)." A joint committee of the Hertfordshire Valleys and the East and North Hertfordshire CCGs, which made the decisions, said they had to "make best use of the money and resources available." Patients with a body mass index (BMI) of over 40 must lose 15% of their weight and those with a BMI of over 30 must lose 10%, or reduce it to under a 40 BMI or a 30 BMI - whichever is the greater amount. The lifestyle changes to reduce weight must take place over nine months.
Take care of your body (Score:2, Insightful)
It's not society's job to do it for you
Re:Take care of your body (Score:5, Informative)
Um, but isn't this exactly society forcing you to?
Re: Take care of your body (Score:4, Insightful)
Re: Take care of your body (Score:5, Insightful)
Which wouldn't bother me if we had private-funded healthcare as a viable option. But since we don't, I guess it's up to Big Brother, since the moment a third party pays, it's no longer just about me and my doctor, right?
That third-party being either the Government or private insurance - so how are they different? I private insurer can deny you coverage or payment for treatment and can have their own rules for access to care/procedures.
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But in that case there is a fourth and fifth and sixth party you can elect for.
in theory. In America, most people get their insurance from their employer, and have no choice. .
Most do have a choice. People can choose to not get insurance at work, and instead get their own plan at an insurance company. Or at least, could a few years ago. Now with Obamacare, what was true may longer be the case.
Re: Take care of your body (Score:5, Informative)
In the UK? Yes, we have private-funded healthcare as an option - go take out any one of the dozens of private healthcare plans and check yourself into a Spire hospital for whatever you want cut off, adjusted, added or fondled.
The NHS isn't the only option in the UK.
But be warned - if you arrest on the private hospitals operating table, they are 100% going to be calling an NHS ambulance to deal with it.
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>"In the UK? Yes, we have private-funded healthcare as an option - go take out any one of the dozens of private healthcare plans "
And you can get back the money you "contributed" to the NHS?
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Absolutely not. Read the last sentence of the post you replied to.
Re: Take care of your body (Score:5, Insightful)
No - you are voluntarily choosing not to use the NHS, thats your choice. The NHS will always be there to scrape you off the road after a car accident, to treat your cardiac arrest when you fall over in a shopping mall, to reset your broken leg when you fall down stairs after a boozy night out.
It will always give you treatment - just not on *your* terms alone. And thats perfectly fine.
Re: Take care of your body (Score:5, Informative)
It's elective surgery, not car crash surgery.
The reasoning is sound. The cost of the procedure goes way up if you're overweight, and since surgery is one of the most stressful things yor body will ever experience, you're more liskely t push an overwight body to failure when you're under the knife.
https://health.usnews.com/heal... [usnews.com]
What art of "costs more, and is more likely to kill the pateint" don't you understand?
Smoking increases risk of complication, but not as extreme as weight.
https://www.ncbi.nlm.nih.gov/p... [nih.gov]
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I don't see why it is so important to win while young at the cost of losing while older, it's the lifetime win you're looking for
I have not seen the figures, but maybe it's the middle aged high earners that are paying most for healthcare compared to the benefits. After all, the young paid nothing at all until they started getting an income and assuming their income ramps up over time then maybe the biggest payment to sickness ratio doesn't come in until later in life. So if you take life in, say 25 year chu
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even inefficiency is only a minor player in what drives cost in the US.
in the US the primary reason care is so expensive is simply because: it can be.
ie, because they can get away with it.
because healthcare is not and never will be a truly free market situation.
-when you are dying you need care NOW, and aren't going to tell the ambulance driver "no, go to the other, farther away hospital, it's cheaper"
-when you need a specific high cost medication to NOT DIE, the majority of people are going so "ok", not "c
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It's not society's job to do it for you
Unless you have socialized medicine, then it is. At the same time, if "society" is footing the bill for your medical care, you shouldn't be surprised when "society" puts constraints on your behaviors.
Re:Take care of your body (Score:5, Insightful)
It's not society's job to do it for you
Unless you have socialized medicine, then it is. At the same time, if "society" is footing the bill for your medical care, you shouldn't be surprised when "society" puts constraints on your behaviors.
Makes sense to me. Now tell us how you feel about drug tests for recipients of public assistance.
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It's not society's job to do it for you
Unless you have socialized medicine, then it is. At the same time, if "society" is footing the bill for your medical care, you shouldn't be surprised when "society" puts constraints on your behaviors.
Makes sense to me. Now tell us how you feel about drug tests for recipients of public assistance.
TFS and TFA are about "non-urgent" surgery. If the the drug tests were limited to cases like this, I'm not sure I see a problem - as long as access to urgent surgery is unconstrained. I imagine this logic (critical vs. non-critical) could be expanded to handle general public assistance, if that was what you meant.
Re:Take care of your body (Score:5, Informative)
It's not society's job to do it for you
Unless you have socialized medicine, then it is. At the same time, if "society" is footing the bill for your medical care, you shouldn't be surprised when "society" puts constraints on your behaviors.
Makes sense to me. Now tell us how you feel about drug tests for recipients of public assistance.
The idea behind drug testing for for recipients of public assistance is for States to save money by booting out drug users. It has been implemented in 7 U.S states and not only did they find that drug rates usage among recipients on all states was below estimated usage among the population at large (in most of them significantly below), all the states ending up loosing money to the testing programs due to the cost and low rates of drug usage. Not only do all of these States continue this ineffective program, it has been proposed in several more states as the true driver behind it is Conservative ideology that the poor are mostly lazy addicts. Something which ironically their own data disputes
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Makes sense to me. Now tell us how you feel about drug tests for recipients of public assistance.
I'm against both. Now tell us how you feel about bread lines.
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Its not society - its the people who are taking onboard the *risk* of your surgery, in other words its the doctors and hospitals.
This is about *elective* surgery - non-essential. Which means that risk factors come into play considerably more - the CCG and the surgeons involved are improving their risk considerations by telling you to lose weight or stop smoking, as both of those things increase odds of complications during surgery.
Its quite simple - if you yourself are not willing to take action to reduce
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I would submit that "risk of complication" is simply a shield to hide behind. The NHS has limited funds and too many people that want access to them. The game becomes one of finding ways to deny players access to those funds. You can't have perfect health care for everybody for free on the cheap.
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You can submit anything you like, but a surgeons license isn't beholden to budgets or funding, and risk taking can and will open a surgeon up to GMC investigation.
Society has changed massively in the past 20 years - people have largely stopped taking responsibility for their own bodies and have started treating the medical profession as a quick-fix you-work-for-me solution.
In the UK, GPs have a hard time denying antibiotics to patients with viral infections - if the patient doesn't get the antibiotics durin
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No, they aren't paid to take the risk, they are paid to perform successful surgeries.
Risk taking surgeons are people that the GMC love to smack down - no surgeon is going to risk their doctoring license simply because you think you have more of a right to demand treatment rather than take personal responsibility for destroying your own body.
Re: Take care of your body (Score:3, Insightful)
Socialized medicine inverts the usual relationship and gives an effective monopoly to the consumer who can then dictate the terms, not least because they collectively (and with the help of surgeons, statisticians etc) know how much knee operations do and should cost.
Of course there are other reasons why the US spends twice as much as everyone else on healthcare, for instance the amounts each physician, insurance company, health scheme, hospital and drug company takes out in profit and spends on advertising,
Everyone mocked Sarah Palin's "Death Panels" (Score:2, Insightful)
but this is a big step towards them.
Re:Everyone mocked Sarah Palin's "Death Panels" (Score:4, Insightful)
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What to you think the phrase "step towards them" means?
Re:Everyone mocked Sarah Palin's "Death Panels" (Score:4, Funny)
What to you think the phrase "step towards them" means?
A slippery slope toward logical fallacies?
Re:Everyone mocked Sarah Palin's "Death Panels" (Score:5, Insightful)
Slippery slope does not apply when there is a clear, inevitable path from point A to point B. If I tell you that if you keep increasing the pace of your binge drinking it is going to ruin your liver, I have not made a slippery slope argument. I've told you that A must lead to B. There is not enough money to give every person every medical service that they would like. At some point, someone would have to decide who gets what. In a western culture, that decision maker would most likely be a panel ('cause that's how we roll). That panel would be deciding who lives and dies, i.e. a Death Panel.
Re:Everyone mocked Sarah Palin's "Death Panels" (Score:5, Insightful)
I don't think this falls into slippery slope territory. Smoking and obesity aren't things that increase risks in your surgery by something small value, they increase it by large values. Acting like this is some slope that leads us to "death panels", is much like saying, "The Federal government mandates seatbelts, next thing you know they'll be installing cameras in your car and watching you every minute you're in your car." or my personal favorite, "You let your barber cut your hair, next thing you know they'll be lopping off your limbs."
It might be just me, but I think we're really reaching here thinking that this is a gateway to death panels in any country.
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Smoking and obesity aren't things that increase risks in your surgery by something small value, they increase it by large values.
Seriously? If I trip and tear some ligaments in my knee, what does smoking have to do with it? What does obesity have to do with it? I pay into the healthcare system, fix my damn knee.
What is "non-urgent surgery," anyway? If it wasn't urgent, why would it require surgery?
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This is typical of the bullshit doctors have to put up with these days - patients saying "I want X fixed and I don't want to take any personal responsibility for it".
You've torn some ligaments in your knee - thats terrible, it must hurt and you must be restricted in your movement.
Being obese means you put more weight on that knee - its going to take considerably longer to heal because you are going to struggle to exercise the knee while its healing, because you are fat and can't put your weight on it.
Being
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For both of those things, your recovery is massively impacted. The doctor can't just "fix your damn knee", your body is going to do that - and you aren't helping it one little bit.
But how does that impact the surgeon? He does the surgery, he takes his gloves off, he never sees me again.
Re:Everyone mocked Sarah Palin's "Death Panels" (Score:4, Insightful)
What about people who like running or sports? They are putting extra stain on their knees. Should they be required to give up running for good to get that knee fixed?
Maybe the queue could be ordered based on an evaluation of each patient's risky behaviour. Do they drive? Do they live in an area with bad air quality? What is the criteria?
What about people who gained weight as a result of the thing they want fixed? Bad knee, less exercise... Weight gain is not an uncommon symptom of many ailments. What if it's due to some other health problem unrelated to the knee, does that count?
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What is "non-urgent surgery," anyway?
Non-Urgent is also known as elective surgery. These are surgeries where a date and time can be set that best meets the doctor's and patient's schedule. There's no need to rush for the surgery because it, at the present time, poses no significant immediate risk to life. This can be things like cataract surgery, mastectomies, vasectomies, donation of a kidney, and so on. None of these surgeries represent an immediate risk to life.
In contrast there are two other groups. Urgent surgery that must be perform
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Urgent surgery (or as we call it here "emergency") = you are at grave risk of dying if it doesn't happen immediately
Non-urgent (or as we call it here "elective") = you won't die without it happening immediately
Note that "emergency surgery patients" are at higher risk of anaesthetic problems and surgical site infections because they haven't been (and can't be) properly assessed and prepared.
Within the elective category, there's categories [qld.gov.au].
Even surgery for reducing fractures can be delayed if urgent cases com
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"they had to make best use of the money and resources available"
Their healthcare system doesn't have the money or resource to care for everyone, so they're wait-listing smokers and the obese. If everyone were in similar condition, they would still have to ration care since they have neither the money or resources available. This absolutely falls under "death panel". The goal here isn't to promote healthy lifestyle choices, it's to shorten the queue of people waiting for surgery.
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Obesity and smoking are not protected classes. Besides which, organ donation already works this way in the US.
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The quoted line is right from the summary. The motive isn't promoting health, it's rationing due to insufficient funding and availability.
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And yet: seat belt laws -> stop light cameras -> cameras everywhere
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It means something which isn't required immediately. So, it either shouldn't be covered at all, or it should be covered immediately so it doesn't become a more expensive to treat urgent issue.
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You make the mistake in thinking that all non-urgent issues eventually become urgent - they do not.
Re: Everyone mocked Sarah Palin's "Death Panels" (Score:2)
Does not mean it will become urgent either. Thereâ(TM)s a difference.
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How dare they refuse to save people's lives just because they're trying to kill themselves!
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Nothing new. Old people are denied kidney transplants, cancer treatments etc all the time in England.
To clarify, they are denied them everywhere for medical reasons, in England they are denied them for financial ones.
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They're denied everywhere for financial reasons too. Or do you think Steve Jobs and an uninsured person had the same odds of a liver transplant?
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Do you have any proof of that?
Because my wife is a GP - and she disagrees with you. She successfully referred a 90 year old for cancer treatment just a few weeks ago.
Re:Everyone mocked Sarah Palin's "Death Panels" (Score:5, Insightful)
We've always had "death panels" in that we've never been able to afford to keep treating people with every last-ditch expensive possibility and always need to decide when it's better for the patient's comfort to just give up.
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Everyone mocked Sarah Palin's "Death Panels" but this is a big step towards them.
Requirements for non-urgent surgeries isn't anything new. The issue is that in their current state the patient has an elevated risk of dying as a result of the surgery. Do no harm is something that is taken seriously.
However, we've already had death panels, you just didn't know about them. Just read about this history of dialysis. [davita.com]
In 1962, Scribner started the world’s first outpatient dialysis facility. Immediately the problem arose of who should be given dialysis, since demand far exceeded the capacity of the six dialysis machines at the center. In another brilliant move, Scribner decided that the decision about who would receive dialysis and who wouldn’t—a matter of life and death for the patients involved—would not be made by him. Instead, the choices would be made by an anonymous committee composed of local residents from various walks of life plus two doctors who practiced outside of the kidney field. Although his decision caused controversy at the time, it was the creation of the first bioethics committee, which changed the approach to accessibility of health care in this country.
When resources are limited, doctors treat the patients (with life-threatening ailments) that have a higher chance of survival. This has been and will remain true as long as th
Re:Everyone mocked Sarah Palin's "Death Panels" (Score:5, Insightful)
We already have death panels in US healthcare.
They are called medical insurance claims processors, or adjusters.
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You do realize that this is pure crap, right? The actual initiative was to provide payment for voluntary counseling on end-of-life care, that was already in the law, not any denial of healthcare. From Death Panels [wikipedia.org]
Section 1233 of bill HR 3200 which would have paid physicians for providing voluntary counseling to Medicare patients about living wills, advance directives, and end-of-life care options. ...
Legislation providing for counseling patients on advance directives, living wills and end-of-life care had been on the books for years, however, the laws did not provide for physicians to be reimbursed for giving such counseling during routine physical exams of the elderly.
Re:Everyone mocked Sarah Palin's "Death Panels" (Score:5, Insightful)
The baby died because its condition was untreatable, no matter what some dodgy US quack says.
When you've stopped being the place that Andrew Wakefield legged it to so he could continue spouting lies about mercury and autism and profiting off three-jab vaccines, come back to us.
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It shouldn't be up to the government to "allow" it.
Re:Everyone mocked Sarah Palin's "Death Panels" (Score:4, Insightful)
It wasn't "up to the government".
The child had rights independent of its parents - the doctors and hospitals are required to protect the patients rights, especially when they are being violated by the parents.
It was the hospital that went to court to fight the issue - not the government.
The government had no involvement in the case.
Of course, you do know all about the case, right? A few points for you to consider:
1. The US doctor, Professor Hirano, pushing the treatment had massive financial interest in his own treatment
2. He had never actually tested his treatment on the condition Charlie Gard had, not even in animals
3. International experts were consulted for second opinions by the hospital all the way through the case
4. Professor Hirano was invited to consult on the case in January 2016, but did not take up the invitation until July 2017
5. Professor Hirano stated in court that he had supplied opinions to the court without examining the patient, reading his notes or studying any scans taken of the patient. He basically admitted to the court to "guessing" without being in possession of any medical facts about the patient.
Re:Everyone mocked Sarah Palin's "Death Panels" (Score:5, Informative)
Once again, the government was not involved in this case - it was the hospital against the parents.
There is an overriding "right" beyond the "right to live", and that is "the right to not suffer at the hands of others", and that was the right being protected here.
The child was already brain dead - he had been since January 2017. He had no prospect of recovery, no prospect of any quality of life and yet the parents wanted to keep him alive artificially and subject him to unproven, untested treatments (which is illegal in the UK) by a doctor with a significant financial interest who hadn't actually taken any *medical* interest in the child.
Re: Everyone mocked Sarah Palin's "Death Panels" (Score:2)
Actually, I'm pretty sure the US doctor was saying, "ummmm... I suppose it's not inconceivable he might benefit, but I'd have to examine him to know for sure" before he personally examined the baby... then, after flying to England to examine the baby directly, pulled the parents aside & told them, "erm... perhaps I was a bit over-optimistic. Frankly, at this point, it's hopeless. Really. It is."
That said, I think Charlie Gard's parents SHOULD have been allowed to take him to the US at their own expense
Re:Everyone mocked Sarah Palin's "Death Panels" (Score:4, Informative)
The CSRs have already been found to be in violation of the law by a Federal Court. They were only allowed to continue because the ruling has been under appeal since it was made last year.
Appropriations for the CSR was never part of the ACA and by law, and yes the constitution, only the legislative branch can appropriate the money to pay for them and thus far they have declined (both Dems and Reps). Obama used his 'pen and phone' powers (I can't seem to find those defined in the constitution but apparently you have a different copy) to use a completely different fund to make the payments, Trump is simply putting an end to that practice.
At any time Congress can actually pass real legislation to appropriate money for the CSR payments and then they would be perfectly legal. There has been some movement in that direction, but as of today, as they have been since most of the time the AHA has been active, they are a complete fabrication of the Executive branch and have no legal standing.
Liposuction Industry Beware (Score:2)
Obese patients have also been told they must lose weight in order to have non-urgent surgery.
Seems like this will remove the entire point of liposuction surgery. Or at least make those clinics move outside of Hertfordshire.
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Obese patients have also been told they must lose weight in order to have non-urgent surgery.
Seems like this will remove the entire point of liposuction surgery. Or at least make those clinics move outside of Hertfordshire.
or -- it will get a boost from those looking for a shortcut to "lose weight" and reduce their BMI
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Think a little harder.
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Obese patients have also been told they must lose weight in order to have non-urgent surgery.
Seems like this will remove the entire point of liposuction surgery. Or at least make those clinics move outside of Hertfordshire.
or -- it will get a boost from those looking for a shortcut to "lose weight" and reduce their BMI
Except that liposuction is a non-urgent surgery, meaning they'd have to reduce their BMI *before* they can have liposuction...
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Seems like this will remove the entire point of liposuction surgery.
This is a risky non-medical (cosmetic) surgery that insurance or the NHS probably won't cover anyways.
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Liposuction isn't available on the NHS for weight loss - its used for reconstructive purposes, but you can't get it for free for weight loss.
So the situation remains - if the person is unwilling to diet, they go to a private clinic and pay £2000+ for liposuction.
Being obese is a large risk factor in surgery (Score:5, Interesting)
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Yes, absolutely.
First do no harm.
My Dad told me about one of his friends, a cardiologist, who had a patient in for a triple-bypass. Dr. L. went to check on his patient and found him laying in the *hospital* bed smoking cigarettes. Dr. L. canceled the surgery immediately.
Risk due to performing the surgery on that day was significantly greater than the risk due to NOT performing the surgery on that day.
If the surgery is "non-urgent" this means that the risk due to NOT performing the surgery *today* is trivi
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Find a different doctor then. You think people just give up if the first surgeon says no, they just go home and die?
Not surprising (Score:2)
Healthcare is a product with infinite demand and limited supply. There must always be a rationing system. In the US it can cost an absurd amount of money. In the UK it is "free" and therefore there will need to be another rationing method.
Cost savings: Only healthy people treated! (Score:5, Interesting)
How long before we see this catch-22 in the Daily Mail:
Guy with bad knees can't walk. Gains weight. Needs knee replacement surgery. Ordered to loose weight before surgery can be approved. Told to get out and walk more to loose weight. "I can't walk!" Sorry, sucks to be you. BTW, I see you have a liver donor card...
Re:Cost savings: Only healthy people treated! (Score:5, Informative)
Walking is great for improving your health in general, but for the sole purpose of losing weight, it's way less effective than just putting less into that pie hole.
uh, yeah, physics and chemistry say diets work. (Score:3)
we have decades of overwhelming evidence now that diets don't work
No, we have decades of evidence that people do not stick to their diets. Diets do work. If you burn fuel faster than you take it in you will lose mass. There is no way around it.
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Yeah, sounds like the typical Daily Mail bullshit.
There are plenty of ways for non-mobile people to lose weight - dieting, upper body exercise etc etc.
Your story sounds like the typical "the doctor said to do something impossible!!!!!!!!" bullshit the Daily Mail loves to push - manufacturing outrage because the patient didn't get what they wanted on the first consultation and actually had to *do* something.
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There are plenty of ways for non-mobile people to lose weight - dieting, upper body exercise etc etc.
Methods exist, yes.
However, as we all know, if it were easy to lose body weight there wouldn't be any fat people.
Even though methods exist, it is still critical to recognize that substantial weight loss is difficult, it requires major life changes for most people, often changes including changes to friendships or careers and/or psychological care, and only the smallest percent of people who attempt to lose significant weight will actually succeed.
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You don't need to walk to lose weight, just eat less.
Starving people don't walk around much, and they don't get fat.
Losing weight requires discipline, thats all.
BMI? (Score:2)
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Cases where BMI is badly off (ie, those with a big muscle mass) tend to be distinct from obesity. Also, more accurate methods have the downside of requiring a costly measurement, while all you need to know for BMI is weight and height.
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It can be used in such extreme cases without problem (unless the guy is 4m wide or a pyramid), but yes, its deprecated.
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Non-urgent (Score:5, Insightful)
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Directions in health care (Score:3)
The number of emergency patients that can be cared for over 24 hours given the services needed in tax payer hospitals will be set.
What to do when too many patients need emergency services and gov funded hospitals cant accept any more patients at that time?
Wealthy governments will start to place their tax payer covered emergency patients in private hospitals removing services from the fully insured.
Such new costs will have to be covered more rationing in the public health sector.
Longer waits to see a specialist
Rationing of service to a few main city hospitals. Not in a city? A long wait to get to any services.
New standards about what level of care will be offered for any elective surgery. Rationing on an age scale. Medications and services just don't get offered to older people.
A set number of medications. Generic medications that have less of that "new" cost to the tax payer healthcare system. Fewer new drugs get added to the tax payer supported healthcare system so governments can keep funding under control.
Not empty moral nagging, this is good medicine (Score:5, Informative)
I am not a surgeon, but I am a doctor who recently finished residency. Testing for recent smoking is a very good policy, and it will save lives and reduce complications, as smoking interferes with recovery from surgery like you wouldn't believe. Even if a patient can't stop smoking long term, they need to at least stop for a few weeks (preferably for at least a few weeks before and a few weeks after surgery).
Cigarettes are a vasoconstrictor, meaning they cause blood vessels to clamp down, reducing blood flow. It contains carbon monoxide, which reduces oxygen carrying capacity. It suppresses the immune system -- all this interferes with wound healing, and the post-surgical period is often a race between wound-healing and breakdown/infection. Patients literally can have poorly healing surgical sites split wide open or bits of themselves turn black and necrotic, because they couldn't stop smoking at least temporarily.
Smoking is pro-coagulant, increasing tendency of blood to clot -- this is not a good thing, as it tends to do so in all the wrong places at the wrong times, and a major potential complication with bed-bound patients and patients recovering from surgery can be abnormal blood clots in the veins and lungs. It paralyzes the respiratory cilia that clean your airways, and it reduces lung function, at a time when a patient is at elevated risk for pneumonia.
You want to keep smoking after you're all done healing up? Fine, we'll tut-tut at you about the long-term risks when you're following-up in the outpatient office later, but stopping around the time of surgery can literally be a matter of life or death.
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Two words: supplemental policy. The math isn't that hard, try using your brain.
However, one does have to ask whether this is a wise choice based on the evidence. If the patient is in pain, for example, forcing that patient into the traumatic experience of withdrawal may be contraindicated, and if the surgery has preventative merits, patients may delay to avoid that experience and end up burdening the system even more once the need progresses to an urgent state.
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However, one does have to ask whether this is a wise choice based on the evidence.
Agree. A much better strategy would be to require a mandatory annual checkup.
During the checkup, the patient will be checked for all the normal stuff, And in addition they will be checked for "Hazards" --- for example, checks will be made to determine if they are Obese or a Smoker.
Patients will be assessed an annual Penalty or additional charge that will append to taxes owed; E.g. $1400 fine for failing to report
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the fine will be reduced to zero if this is the first year they showed in a 'Hazard' category and make a marked improvement.
So they get dinged the second year if they don't remove the "hazard" despite their best efforts, right? "This year you showed up as 'obese'. You got rid of half of that weight in a controlled, lasting manner, but this year are still obese. Pay up, sucker!" Or is it better to have people yo-yoing their diets, crashing to get under the "hazard limit" and then picking it all back up, plus some?
And, pray tell, what do you do with the people who have gained weight because of the medication you've put them on to
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Yes, I totally want our thoroughly corrupt government deciding who lives or dies. That's clearly better than a profit-motive based implementation where an increased demand for surgeries prompts new facilities and more doctors to fulfill the need. Whereas the government would likely ration care and wait-list patients that can't survive that long, with taxpayer funded bonuses to the heartless bastards responsible.
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You don't understand how insurance works. Pre-existing condition clauses are necessary. Insurance is a risk pool. You spread out the risk by having healthy people paying in to protect themselves should they need care, and that money is used to fund care for people in need. Without the pre-existing condition clause, healthy people wouldn't buy in until they need care. They won't have paid anything in. Enough people do that and there is no pool to draw from.
Personal policies are expensive because the va
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I understand exactly how insurance is supposed to work for it to provide the type of service people want/need as healthcare. It's a general risk pool with people paying in. The thing ACA did was attempt to force everyone into the pool. It seems to have been somewhat successful at increasing the general pool. Single payer fixes it by having everyone in the pool. Your scenario would hold more water if there was a credit system for paying into the pool. But what happens with insurance is they're happy to take
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The real problem is that "health insurance" isn't insurance, it's just a means for moving money around. Unless you wander off into a forest and die or fall into a volcano or a vat of molten lead, there is a 100% chance that you will require medical care. As for pre-existing condition clauses being required, imagine if Homeowner's insurance had "fire" as a pre-existing condition that followed you for the rest of your life. You have one grease fire in the kitchen and
Re:Single Payer Health Care is Great ! (Score:4, Funny)
Whats the Fucking Spaghetti Monster have to do with the price of rice in China?
Higher consumption of spaghetti would result in lower consumption of rice, resulting in lower demand and thus lower price.
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Funny, Canada has had single-payer for decades, and hasn't pulled this kind of nonsense.
Are Americans such sheep that they'd put up with it? I have my doubts.
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America does have one of the Worlds Best Health Care Systems."Money Can Buy"
FYI
Canadians Increasingly Come to U.S. For Health Care [usnews.com]
Canadian Politician Comes to U.S. for Heart Surgery [medpagetoday.com]
Why Canadian premier seeks health care in U.S. - SFGate [sfgate.com]
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Those myths and deceptive half-truths have been utterly blown out of the water by this lady, a Canadian doctor testifying in front of the US Senate:
https://www.youtube.com/watch?v=xxtGepwXaes
Yes, a Canadian politician went to the US to get a minor heart operation done. He is well-known up here as a loudmouthed posturing idiot with more money than brains. He is now retired and out of our hair, mercifully. Also, you may be surprised to learn that we have more than one politician, many of them quite wealthy
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But one example of why having the government that involved in our lives is a really bad idea. The budget will be manipulated, best not to have the government holding the reigns at all.
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Because as we learned from Wall Street in 2008, private entities never manipulate their budgets or balance sheets.
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The doctor's trying to save your life, not deny you healthcare. Where's the controversy here? I don't see it.
The controversy is that everyone interprets the statements in their own world view, and generally comes to conclusions they don't like.
Taking the time to deeply understand the issues, even the hard parts, before forming the conclusions and jumping on the bandwagon with pitchforks and torches.
Certain things increase the risk factors. As you point out, when that happens and the risks of doing the surgery could be reduced by making some changes and doing the surgery later, then it makes sense to postpone it.