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UK To Ban Surgery For Smokers and The Obese To Reduce Health Care Costs
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svetskisampion wrote: »Rosemary7391 wrote: »VintageFeline wrote: »To further my point, I actually walked myself to my local A&E at the time because of dreadful chest infection that as an asthmatic could kill me. They have both a walk-in centre and A&E. I actually went to the walk in first who promptly told me to bugger off to A&E because I should be seen more urgently (turns out they thought it was pneumonia, thankfully wasn't quite that bad!).
I think that model would be a great way to triage people whichever place they walk into first, send them where they should actually be.
Yes, that would make a lot of sense for those turning up at the wrong place. Even if they don't get the message and keep turning up at A&E for colds that would minimise the time wasted (assuming they didn't kick up a fuss about it, which is an assumption...). I think it would be most effective to decide this sort of policy at a local level - different areas will have different problems.
Usually if you look up your symptoms on the NHS website it'll suggest where to go and when. That's helpful too. Posters in GPs and pharmacies less so because if they've gone there they're already doing something appropriate... I think we need to do more to encourage healthy living outside of direct engagement with the health services.
Wasn't the 111 telephone service introduced as such a measure?
Last time I used that, it decided I had to go to an urgent GP appointment at St George's (also London at the time) RIGHT THEN.
I got there and the GP chatted to me, and then asked if I came through 111 because they over dramatise things and I didn't need to be there. I'm not sure they can win frankly. If 111 under-diagnose and people die, then they may be liable. So the tendency seems to be to over-diagnose which doesn't help too much...!0 -
VintageFeline wrote: »VintageFeline wrote: »To further my point, I actually walked myself to my local A&E at the time because of dreadful chest infection that as an asthmatic could kill me. They have both a walk-in centre and A&E. I actually went to the walk in first who promptly told me to bugger off to A&E because I should be seen more urgently (turns out they thought it was pneumonia, thankfully wasn't quite that bad!).
I think that model would be a great way to triage people whichever place they walk into first, send them where they should actually be.
That's if you have a local walk in centre though. I live in London so 9/10 I would always chose walk in over A&E (including the time I had to hop there when I had glass embedded in my foot) but many people in other areas are not so fortunate.
That's my point. I was saying the presence of both on the same site is a great idea, not that they should be sent off across a city/town to a walk in. I am also in London, the hospital I went to was St. George's.
Barts walk in also very good, and queues normally very short.
Charing Cross not so much. I think I waited 3 hours there the day that my face randomly swelled up so much that I couldn't really see!1 -
Does anyone know if the rule is intended to have long-term impact on obesity and smoking in the people receiving the surgery, or is just directed at surgery risk? In my opinion, most people who improved their lifestyle for the surgery will revert right back to their original ways as soon as the incentive is satisfied.
edited to add missing words1 -
May I apologise, I typed in miss judged anger in my original post.
I, my late husband and my family all have had wonderful treatment from the NHS.1 -
Smoking is a huge risk factor for poor outcomes after surgery including death. They are more likely to develop clots, which can go to the lungs (pulmonary embolus), heart (heart attack), or brain (stroke). It makes it difficult to breath under anesthesia and destroys your lungs, which makes it difficult to get enough oxygen into the body to deliver tissues. Recovery takes longer too.
Source: https://health.clevelandclinic.org/2013/08/facing-surgery-kick-cigarettes-now/
The obese also have a lot of risks with surgery. Anesthesia is extremely difficult to dose because it is based on weight, but too much can stop one from breathing. They are at great risk for skin breakdown because of all that weight and it is difficult to reposition them. It is also very difficult to keep their skin folds clean because they are not exposed to air, so they trap moisture and can breakdown. They are at high risks for clots too because they are immobile. Often the obese have comorbidities such as high blood pressure and diabetes which can complicate recovery.
Source: https://www.sciencedaily.com/releases/2009/06/090615161659.htm
In general they are more difficult to look after. For example, you may only need two nurses to reposition a 200 pound patient but you may need four or more nurses to reposition a 400 pound patient. The heavier patient will unfortunately have to wait longer while enough staff is found to help them. I know this seems unfair but it is not fair for nurses to put their health and backs at risk trying to move these heavy patients. They have to follow hospital protocol.
Source: Nursing school clinicals.
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I had to have a basic toe surgery, and the doctor specified it would not get done until i quit smoking, my friend faced the same dilemma when she needed a non urgent operation. So i think it may be up to the individual doctor, and only for elective surgery...
Of course I'm sure plenty of people will lie and say they are non smokers!0 -
Not sure about smoking, but I didn't think having to lose weight before a surgical procedure was anything new.0
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Rosemary7391 wrote: »Isn't that discrimination! What about alcoholics? What about drug addiction? That will improve overall health, shouldn't they be restricted too? Oh wait a minute, I forgot, providing help to these individuals will cost the system more money, so we can't do that!
I think it isn't quite the same. Let's say alcohol has trashed your liver. I guess it makes little difference to the outcome whether you stop drinking then get a liver transplant or get a liver transplant then stop drinking, since alcohol leaves the body pretty quickly. (Although I don't know what'd happen if you turned up for surgery drunk!) But if you lose weight, then get a hip replacement, you're gonna do much better in the long run than someone who gets a hip replacement then loses weight, since all the time you're losing the weight you're also putting extra wear on the new hip. Aren't second replacements less effective as well?
Nutmegoreo - yep, that makes sense. Although that presumably isn't specific to the type of surgery as well, like weight loss is to hip/knee replacement, so why wouldn't they ask for any surgery? It makes sense to ask people to take measures to make treatment more successful though - it's normal to be asked not to eat before some things isn't it? And I'm sure there are plenty of drugs you're not supposed to mix with alcohol/etc.
I'm pretty sure over here, if you're still drinking, no new liver for you.1 -
If I'm not mistaken, there are limitations on joint replacements here in the US as well. Patients over a certain BMI are denied the surgery unless they lose weight.
This isn't some nightmare of socialized medicine, it's a practicality of successful surgical outcome.4 -
Alatariel75 wrote: »Rosemary7391 wrote: »Isn't that discrimination! What about alcoholics? What about drug addiction? That will improve overall health, shouldn't they be restricted too? Oh wait a minute, I forgot, providing help to these individuals will cost the system more money, so we can't do that!
I think it isn't quite the same. Let's say alcohol has trashed your liver. I guess it makes little difference to the outcome whether you stop drinking then get a liver transplant or get a liver transplant then stop drinking, since alcohol leaves the body pretty quickly. (Although I don't know what'd happen if you turned up for surgery drunk!) But if you lose weight, then get a hip replacement, you're gonna do much better in the long run than someone who gets a hip replacement then loses weight, since all the time you're losing the weight you're also putting extra wear on the new hip. Aren't second replacements less effective as well?
Nutmegoreo - yep, that makes sense. Although that presumably isn't specific to the type of surgery as well, like weight loss is to hip/knee replacement, so why wouldn't they ask for any surgery? It makes sense to ask people to take measures to make treatment more successful though - it's normal to be asked not to eat before some things isn't it? And I'm sure there are plenty of drugs you're not supposed to mix with alcohol/etc.
I'm pretty sure over here, if you're still drinking, no new liver for you.
In Australia if you have alcoholic liver failure and have not stopped drinking for a period (12 months I believe is the minimum) then you will not ‘qualify’ for a transplant.
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Hip and knee replacements are largely elective surgeries. As others have mentioned, smoking cessation and weight loss for obese individuals optomises the patient to avoid post operative complications (death, cardiac arrest, infection, pulmonary embolism) etc which are not only costly to the health care system but have significant mortality/morbidity implications for the person recieving the surgery.
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Even in emergency situation for invasive procedures consultant cardiac intendivists will ‘talk’ to a smoker who is having an acute myocardial infarction with an entire coronary artery obstructed by thrombus and basically make them promise to quit smoking before they put the stent in to open the artery.
The type of stent used (bare metal vs drug eluting) is largely influenced by the patients smoking status as a person who continues to smoke will eventually block off again, so why put the $5000 drug stents in when you could put the $1000 bare metal instead?
Of course they all promise not to smoke while their on the table but long term compliance is poor.
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Point is though, smoking and obesity both increase a person’s risk of death or morbidity with surgical/invasive procedures.
It is perfectly medically and ethically reasonable to address modifiable risk factors such as these before undertaking elective procedures for non life threatening conditions.
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Alatariel75 wrote: »Rosemary7391 wrote: »Isn't that discrimination! What about alcoholics? What about drug addiction? That will improve overall health, shouldn't they be restricted too? Oh wait a minute, I forgot, providing help to these individuals will cost the system more money, so we can't do that!
I think it isn't quite the same. Let's say alcohol has trashed your liver. I guess it makes little difference to the outcome whether you stop drinking then get a liver transplant or get a liver transplant then stop drinking, since alcohol leaves the body pretty quickly. (Although I don't know what'd happen if you turned up for surgery drunk!) But if you lose weight, then get a hip replacement, you're gonna do much better in the long run than someone who gets a hip replacement then loses weight, since all the time you're losing the weight you're also putting extra wear on the new hip. Aren't second replacements less effective as well?
Nutmegoreo - yep, that makes sense. Although that presumably isn't specific to the type of surgery as well, like weight loss is to hip/knee replacement, so why wouldn't they ask for any surgery? It makes sense to ask people to take measures to make treatment more successful though - it's normal to be asked not to eat before some things isn't it? And I'm sure there are plenty of drugs you're not supposed to mix with alcohol/etc.
I'm pretty sure over here, if you're still drinking, no new liver for you.
In Australia if you have alcoholic liver failure and have not stopped drinking for a period (12 months I believe is the minimum) then you will not ‘qualify’ for a transplant.
...........
Hip and knee replacements are largely elective surgeries. As others have mentioned, smoking cessation and weight loss for obese individuals optomises the patient to avoid post operative complications (death, cardiac arrest, infection, pulmonary embolism) etc which are not only costly to the health care system but have significant mortality/morbidity implications for the person recieving the surgery.
.............
Even in emergency situation for invasive procedures consultant cardiac intendivists will ‘talk’ to a smoker who is having an acute myocardial infarction with an entire coronary artery obstructed by thrombus and basically make them promise to quit smoking before they put the stent in to open the artery.
The type of stent used (bare metal vs drug eluting) is largely influenced by the patients smoking status as a person who continues to smoke will eventually block off again, so why put the $5000 drug stents in when you could put the $1000 bare metal instead?
Of course they all promise not to smoke while their on the table but long term compliance is poor.
....................
Point is though, smoking and obesity both increase a person’s risk of death or morbidity with surgical/invasive procedures.
It is perfectly medically and ethically reasonable to address modifiable risk factors such as these before undertaking elective procedures for non life threatening conditions.
Is that only alcoholic liver failure? I have a friend who needs a new liver for reasons unrelated to booze (ulcerative colitis) and he isn't on the list because he won't stop drinking (he's not complaining about this, he's a "good time not a long time" dude and isn't actually looking for a new liver, but his mum's annoyed that he won't stop so he can get on the list). He's not a problem drinker and never has been, but because he will drink on weekends, he can't get a transplant (as far as I know).0 -
Alatariel75 wrote: »Alatariel75 wrote: »Rosemary7391 wrote: »Isn't that discrimination! What about alcoholics? What about drug addiction? That will improve overall health, shouldn't they be restricted too? Oh wait a minute, I forgot, providing help to these individuals will cost the system more money, so we can't do that!
I think it isn't quite the same. Let's say alcohol has trashed your liver. I guess it makes little difference to the outcome whether you stop drinking then get a liver transplant or get a liver transplant then stop drinking, since alcohol leaves the body pretty quickly. (Although I don't know what'd happen if you turned up for surgery drunk!) But if you lose weight, then get a hip replacement, you're gonna do much better in the long run than someone who gets a hip replacement then loses weight, since all the time you're losing the weight you're also putting extra wear on the new hip. Aren't second replacements less effective as well?
Nutmegoreo - yep, that makes sense. Although that presumably isn't specific to the type of surgery as well, like weight loss is to hip/knee replacement, so why wouldn't they ask for any surgery? It makes sense to ask people to take measures to make treatment more successful though - it's normal to be asked not to eat before some things isn't it? And I'm sure there are plenty of drugs you're not supposed to mix with alcohol/etc.
I'm pretty sure over here, if you're still drinking, no new liver for you.
In Australia if you have alcoholic liver failure and have not stopped drinking for a period (12 months I believe is the minimum) then you will not ‘qualify’ for a transplant.
...........
Hip and knee replacements are largely elective surgeries. As others have mentioned, smoking cessation and weight loss for obese individuals optomises the patient to avoid post operative complications (death, cardiac arrest, infection, pulmonary embolism) etc which are not only costly to the health care system but have significant mortality/morbidity implications for the person recieving the surgery.
.............
Even in emergency situation for invasive procedures consultant cardiac intendivists will ‘talk’ to a smoker who is having an acute myocardial infarction with an entire coronary artery obstructed by thrombus and basically make them promise to quit smoking before they put the stent in to open the artery.
The type of stent used (bare metal vs drug eluting) is largely influenced by the patients smoking status as a person who continues to smoke will eventually block off again, so why put the $5000 drug stents in when you could put the $1000 bare metal instead?
Of course they all promise not to smoke while their on the table but long term compliance is poor.
....................
Point is though, smoking and obesity both increase a person’s risk of death or morbidity with surgical/invasive procedures.
It is perfectly medically and ethically reasonable to address modifiable risk factors such as these before undertaking elective procedures for non life threatening conditions.
Is that only alcoholic liver failure? I have a friend who needs a new liver for reasons unrelated to booze (ulcerative colitis) and he isn't on the list because he won't stop drinking (he's not complaining about this, he's a "good time not a long time" dude and isn't actually looking for a new liver, but his mum's annoyed that he won't stop so he can get on the list). He's not a problem drinker and never has been, but because he will drink on weekends, he can't get a transplant (as far as I know).
I’m not sure but I would assume so. From my understanding liver problems associated with ulcerative colitis (sclerosis, bile duct issues, abcesses etc? can often be exacerbated by alcohol consumption so probably your friend is speeding up his liver failure. Not really my area of speciality though and certainly tracking off thread.
I have certainly watched more than one person die a slow and agonising death from liver failure because they don’t qualify for a transplant for one reason or another.
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GottaBurnEmAll wrote: »If I'm not mistaken, there are limitations on joint replacements here in the US as well. Patients over a certain BMI are denied the surgery unless they lose weight.
This isn't some nightmare of socialized medicine, it's a practicality of successful surgical outcome.
Yep friend's doctor told him no knee replacement until he lost weight. He was about 6'0" and 250 lbs.0 -
Alatariel75 wrote: »Rosemary7391 wrote: »Isn't that discrimination! What about alcoholics? What about drug addiction? That will improve overall health, shouldn't they be restricted too? Oh wait a minute, I forgot, providing help to these individuals will cost the system more money, so we can't do that!
I think it isn't quite the same. Let's say alcohol has trashed your liver. I guess it makes little difference to the outcome whether you stop drinking then get a liver transplant or get a liver transplant then stop drinking, since alcohol leaves the body pretty quickly. (Although I don't know what'd happen if you turned up for surgery drunk!) But if you lose weight, then get a hip replacement, you're gonna do much better in the long run than someone who gets a hip replacement then loses weight, since all the time you're losing the weight you're also putting extra wear on the new hip. Aren't second replacements less effective as well?
Nutmegoreo - yep, that makes sense. Although that presumably isn't specific to the type of surgery as well, like weight loss is to hip/knee replacement, so why wouldn't they ask for any surgery? It makes sense to ask people to take measures to make treatment more successful though - it's normal to be asked not to eat before some things isn't it? And I'm sure there are plenty of drugs you're not supposed to mix with alcohol/etc.
I'm pretty sure over here, if you're still drinking, no new liver for you.
Interesting! I didn't know that. Is that because they would recover better having been clear of drink for x time? Or just because the scarcity of livers means it's really not on to trash your new one so you have to commit to the change first? I obviously picked a bad example ...0 -
most illiness are life style related, lack of exercise, fat, smoker, drinker, heart diease. If a country allows the sale of products that are harmful then the tax collected from those sales should be used to treat people suffering from the side effects of thee products. Pretty fair I would say no? If the outcomes are not as good so be it, thats on the person2
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Bump0
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Rosemary7391 wrote: »Alatariel75 wrote: »Rosemary7391 wrote: »Isn't that discrimination! What about alcoholics? What about drug addiction? That will improve overall health, shouldn't they be restricted too? Oh wait a minute, I forgot, providing help to these individuals will cost the system more money, so we can't do that!
I think it isn't quite the same. Let's say alcohol has trashed your liver. I guess it makes little difference to the outcome whether you stop drinking then get a liver transplant or get a liver transplant then stop drinking, since alcohol leaves the body pretty quickly. (Although I don't know what'd happen if you turned up for surgery drunk!) But if you lose weight, then get a hip replacement, you're gonna do much better in the long run than someone who gets a hip replacement then loses weight, since all the time you're losing the weight you're also putting extra wear on the new hip. Aren't second replacements less effective as well?
Nutmegoreo - yep, that makes sense. Although that presumably isn't specific to the type of surgery as well, like weight loss is to hip/knee replacement, so why wouldn't they ask for any surgery? It makes sense to ask people to take measures to make treatment more successful though - it's normal to be asked not to eat before some things isn't it? And I'm sure there are plenty of drugs you're not supposed to mix with alcohol/etc.
I'm pretty sure over here, if you're still drinking, no new liver for you.
Interesting! I didn't know that. Is that because they would recover better having been clear of drink for x time? Or just because the scarcity of livers means it's really not on to trash your new one so you have to commit to the change first? I obviously picked a bad example ...
This resource outlining organ transplant clinical guidelines and exclusion criteria may be of interest to you:
http://www.donatelife.gov.au/sites/default/files/TSANZ Clinical Guidelines for Organ Transplantation from Deceased Donors_Version 1.0_April 2016.pdf0 -
suzannesimmons3 wrote: »VintageFeline wrote: »To further my point, I actually walked myself to my local A&E at the time because of dreadful chest infection that as an asthmatic could kill me. They have both a walk-in centre and A&E. I actually went to the walk in first who promptly told me to bugger off to A&E because I should be seen more urgently (turns out they thought it was pneumonia, thankfully wasn't quite that bad!).
I think that model would be a great way to triage people whichever place they walk into first, send them where they should actually be.
That's if you have a local walk in centre though. I live in London so 9/10 I would always chose walk in over A&E (including the time I had to hop there when I had glass embedded in my foot) but many people in other areas are not so fortunate.
I live in cumbria....doctors 3 weeks wait if it's not an emergency and 48 hours if it is....absolutely no walk in centres anywhere in the area so a and e is sometimes the only option....we need better ooh doctors
Penrith & Keswick both have walk in centres.0 -
York & Humber were the first and it is slowly being rolled out across the UK.
The smokers is down to the complications during general anaesthetic I believe.
I worry that it is a dangerous president to set. We open the door for it to then be people who take part in extreme sports etc. I'm not sure you can close the door after the horse has bolted so to speak.
I strongly believe the NHS should start taking voluntary donations from patients. Just leave a secure nailed down box at the receptions. Also start charging for hospital prescriptions. Why do I get me tablets from the hospital free when the NHS is almost bankrupt? Crazy policy.
I believe we could make a lot of extra money that way to help fund a better NHS.
Edit to add, is if you can't tell I'm very left in my views
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RuNaRoUnDaFiEld wrote: »I strongly believe the NHS should start taking voluntary donations from patients. Just leave a secure nailed down box at the receptions. Also start charging for hospital prescriptions. Why do I get me tablets from the hospital free when the NHS is almost bankrupt? Crazy policy.
Totally agree with the donations.
I also think that your discharge letter should include details of what it cost the NHS to treat you. If people were more aware of the actual costs, it might help! I can't believe it's not basically in the computer already, so it might be quite straightforward to pull the data.
Less sure about the hospital prescriptions, but they do need to sort them out a bit better.
Last time I was in for surgery I was sent home with a ton of dispersible paracetamol which I ended up taking to a pharmacy for disposal. 1) They didn't ask me about whether I wanted dispersible paracetamol (ugh, no!
) or tablets, so they gave me something in a form I'd likely never use; and 2) they gave me way too much. I would voluntarily have taken home maybe 50-100 normal tablets - so more than I could get at a pharmacy in one go but enough to cover 6 to 12 days of pain control on 2 tablets 4 times a day - but they gave me way more than that.
They also sent me home with a load of Tramadol, which 1 look one dose of and promptly got rid of because it made me hallucinate. They didn't test it on me in hospital, I'd never taken it before, and they could have saved a ton by sending me home with maybe 3 doses to try if I wanted, and a prescription for me that I could get filled if I needed.
On the upside, I had to self inject heparin while I had my leg in plaster, and I did appreciate that they just sent me home with a big box of syringes to put in the fridge for nothing. Although I would happily have paid standard prescription charge for them.
I think there's plenty to be done, and it probably doesn't start with spending hundreds of thousands on external management consultants... they already tried that
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