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Medicine United Kingdom News

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.
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Doctors To Breathalyse Smokers Before Allowing Them NHS Surgery

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  • It's not society's job to do it for you

    • by Anonymous Coward on Thursday October 19, 2017 @03:31PM (#55399061)

      Um, but isn't this exactly society forcing you to?

    • 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.

      • by tsqr ( 808554 ) on Thursday October 19, 2017 @03:57PM (#55399317)

        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.

        • 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.

        • by Dorianny ( 1847922 ) on Thursday October 19, 2017 @06:53PM (#55400479) Journal

          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

        • 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.

      • 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

        • by Shotgun ( 30919 )

          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.

          • 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

  • but this is a big step towards them.

    • by mean pun ( 717227 ) on Thursday October 19, 2017 @03:27PM (#55399025)
      What do you think the phrase 'non-urgent' means?
      • What to you think the phrase "step towards them" means?

        • by Anonymous Coward on Thursday October 19, 2017 @03:36PM (#55399113)

          What to you think the phrase "step towards them" means?

          A slippery slope toward logical fallacies?

          • by Shotgun ( 30919 ) on Thursday October 19, 2017 @04:59PM (#55399799)

            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.

        • by slack_justyb ( 862874 ) on Thursday October 19, 2017 @03:43PM (#55399175)

          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.

          • Re: (Score:2, Flamebait)

            by PCM2 ( 4486 )

            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?

            • Re: (Score:2, Interesting)

              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

              • by PCM2 ( 4486 )

                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.

              • by AmiMoJo ( 196126 ) <mojo&world3,net> on Thursday October 19, 2017 @05:43PM (#55400107) Homepage Journal

                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?

                • by houghi ( 78078 )

                  They are putting extra stain on their knees. Should they be required to give up running for good to get that knee fixed?

                  Yes. That can happen. At least for a short period to get rest and perhaps even for a longer period and often running or other sports become a big no-no.

                  However they are talking about reducing the risk for the operation. They do not require you to be a non-smoker. They do want you to loose weight so your chances to survive are better.

            • 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

            • by martinX ( 672498 )

              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

          • by OhPlz ( 168413 )

            "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.

          • "You let your barber cut your hair, next thing you know they'll be lopping off your limbs." Historically, this is actually completely accurate. The original surgeons WHERE barbers, because they had steady hands and sharp tools.
          • by Shotgun ( 30919 )

            And yet: seat belt laws -> stop light cameras -> cameras everywhere

      • by msauve ( 701917 )
        "What do you think the phrase 'non-urgent' means?"

        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.
    • How dare they refuse to save people's lives just because they're trying to kill themselves!

    • Re: (Score:2, Informative)

      by HornWumpus ( 783565 )

      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.

      • Re: (Score:2, Insightful)

        by Anonymous Coward

        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?

      • 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.

    • by Gavagai80 ( 1275204 ) on Thursday October 19, 2017 @03:41PM (#55399155) Homepage

      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.

    • by nnet ( 20306 )
      No, no it's not.
    • 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

    • by ardmhacha ( 192482 ) on Thursday October 19, 2017 @04:05PM (#55399405)

      We already have death panels in US healthcare.

      They are called medical insurance claims processors, or adjusters.

    • 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.

  • 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.

    • by naris ( 830549 )

      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

      • by XanC ( 644172 )

        Think a little harder.

      • 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...

    • by mysidia ( 191772 )

      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.

    • 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.

  • by RobinH ( 124750 ) on Thursday October 19, 2017 @03:29PM (#55399035) Homepage
    A friend of mine was talking to a surgeon (a friend of his) about the risks of some surgery, and the doctor quoted his own success rates, so maybe he said "8% had a bad outcome" (I forget the number but it was in that range) but then he added, "but please realize every single one of those patients had serious complications such as being morbidly obese, usually with diabetes", etc. In those cases the risk of not doing the surgery was certain death, so the patient and doctor had little choice but to take the risk. However, I can see why a surgeon would want to avoid "non-urgent" surgery on a patient if they could significantly reduce the risk by losing some weight first.
    • 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

  • 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.

  • by CQDX ( 2720013 ) on Thursday October 19, 2017 @03:43PM (#55399169)

    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...

    • by KiloByte ( 825081 ) on Thursday October 19, 2017 @04:02PM (#55399371)

      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.

    • 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.

      • 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.

    • Re: (Score:2, Insightful)

      by Bert64 ( 520050 )

      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.

  • Isn't the BMI measurement widely deprecated these days?
    • 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.

    • It can be used in such extreme cases without problem (unless the guy is 4m wide or a pyramid), but yes, its deprecated.

    • The actual proposal [easternche...ccg.nhs.uk] says a BMI of 35 or over. That's pretty damn big, in the "severely obese" range. It also states exactly WHY, because obese people have far more complications, infections, and after-surgery complications, as do smokers. Not mentioned in the summary is they are are also screening for alcohol. Reading around, the "real" reason is this area is having a HUGE cash-crunch and is using this to push off costs.
  • Non-urgent (Score:5, Insightful)

    by Translation Error ( 1176675 ) on Thursday October 19, 2017 @03:47PM (#55399211)
    Now the big question is will this result in the patients improving their health before surgery or will surgery just get deferred until it's urgent?
  • by jcr ( 53032 )

    The UK government isn't refunding the taxes that these fat smokers pay for the NHS, are they?

    -jcr

  • by AHuxley ( 892839 ) on Thursday October 19, 2017 @05:21PM (#55399975) Journal
    What will gov funded health care look like globally?
    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.
  • by Guppy ( 12314 ) on Thursday October 19, 2017 @07:16PM (#55400591)

    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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