The individual's responsibility in health care

Farback

This is a bit of a long read, but very interesting. Dr. John Ross is a very respected emergency room surgeon here in NS, with very forward thinking views.

http://thechronicleherald.ca/opinion/1303865-dr.-john-ross-reboot-multi-tier-haphazard-‘disease-care’-system

BigGuy47

Doctor Ross opens and closes the article with a story about "Bill". Bill will not help himself so Doctor Ross suggests that the government should step in and compensate for his lack of self preservation.

Bill is sitting in a wheelchair in the sun outside the main doors of the Halifax Infirmary having another cigarette. The ground is littered with cigarette butts from many others before him. There is a large bandage wrapped just below his knee. He is 61 and is back for his third amputation on his left and now right legs from the complications of diabetes and smoking....

...Now that he has diabetes, he needs to take responsibility for managing it, but the team responsible for his care also needs to identify his discipline challenges and develop a plan to help him. They should monitor him more closely, using various small wearable devices, coach him via home video-conferencing and arrange regular home visits. His whole family and possibly even workmates can be involved. We all own Bill’s problems, because we are all paying a lot for them.

Bill is responsible for himself. No amount of spending by the government, nagging from family or loved ones will change his habits. It's very clear Bill doesn't care enough about his health to make a change. Bill will continue to smoke until he runs out of limbs to hold a cigarette.

Give a man fish and you feed him for a day.
Teach a man to fish and you feed him for a lifetime.

What happens if you teach a man to fish, but he wont fish?

Is it the teachers responsibility to feed the man that refuses to fish?

Should the teacher feed the man that won't fish for himself or should he move on and teach others so they can learn to help themselves?

Governments and individuals should know which care activities are safe, harmful, worthwhile, or a waste of time or money.

How much time at money should be spent trying to change Bill? A man that refuses to change. The average person would have made a change before the first amputation. Three amputations, wow.

luluinca

It's a tricky dilemma IMO. You can't just tell Bill to go off somewhere and die because he's being irresponsible with his health....I don't think. That opens another can of worms.

Most of the people here at MFP are working towards better health but it's still a struggle for most of us and some days we're just not the perfect specimens.

I also think from reading the stories here that a lot of us came to the conclusion to strive for better health and fitness after a health scare so in some ways a certain percentage of the population does take the advice of their doctors, loved ones or their own inner responsible voice.....

burnsgene42

Personally I think I would rather that I or the government that represents me err on the side of too much compassion as opposed to too little.
I do agree that smokers are bringing these problems onto themselves and probably don't deserve the support of the tribe. Brings to mind Government (all of us) Tobacco Subsidies.
But will we withdraw support for everyone who makes stupid decisions ? People who willfully violate traffic laws and end up in the hospital? People who eat Cheeseburgers and fries and end up in the hospital?
It's going to be a really long list if we stop helping folks who make dumb decisions.
Just saying (;

BRaye325

burnsgene42 wrote: »

Personally I think I would rather that I or the government that represents me err on the side of too much compassion as opposed to too little.

I agree with this, however a line needs to be drawn somewhere. People ultimately need to be responsible for themselves. Perhaps the line can just be at a place we would consider generous.

marekdds

That is the question. Where do we draw the line? Who decides who is worthy of help and who isn't? Do we put Bill on an iceberg and let him die? I smoked for years knowing full well how horrible it was, but couldn't get myself to stop. Bill probably feels hopeless as do some of the morbidly obese people I see on scooters in the grocery store. Yes, I stopped smoking, lost weight and got fit. Does that make me more valuable than Bill? I agree that I get fuming mad when I see taxpayers money wasted on people who don't care, but we spend money on a lot less compassionate things.

Farback

It is a real moral dilemma. I work at a re-hab facility, where the clients are allowed to smoke on-site in certain locations. I've brought the question up that if we're supposed to be looking after these people's best interests, and they have diminished capacity to make decisions for themselves, why do we make it acceptable to smoke? I'm the maintenance director, so the care people don't take my thoughts too seriously.

On the fire service side, we help people without question or judgement. That's someone else's job. We had a car accident several years ago where the injured driver was drunk beyond belief, and was a liver transplant recipient after burning their own out at an early age with alcoholism. Tough to remain objective some times.

burnsgene42

Tough indeed. I remember patients in a local hospital emphysema ward sneaking out into the stairwells to smoke (cigarettes probably bought from employees) . One died there. There was a big uproar but Hey he was an adult making his own decisions.
Another thing making it difficult are companies like Big Tobacco and others who have invested in furthering our bad health and pay big for their representation in DC.

nikkib0103

A fascinating article. We all have to be responsible for our own health. Most of us here are keen to improve or maintain our health. The health care system in most countries needs some reworking. There should be more emphasis on prevention but it really is geared to closing the barn door after the horse runs away. If the overall health of the people of our respective nations is ever to really improve it needs to start with strong education in the primary years as well as education for adults. I love his idea of schools being used as community centers and adults and children preparing their lunches together. I also know the huge financial costs of making this wonderful idea happen. It may be possible in areas with a small population and detrmined administrators but I sure can't see it happening here in NYC.