Quote:
Home > Specials > Health > Article
Surgeon urges lower priority for smokers
By Michael Bradley
April 5, 2004
Print this article
Email to a friend
Smokers who do not quit should be refused elective surgery, argues a Sydney doctor who says post-operative infection rates are higher for smokers and that their treatment wastes healthcare resources.
In an editorial in today's Medical Journal of Australia, Matthew Peters said patients must stop smoking at least six weeks before surgery, as research had shown quitting three weeks before has no benefit.
"Public heath systems are faced with overwhelming demand and must generate the greatest benefit from limited resources," said Dr Peters, head of thoracic medicine at Concord Hospital. "Continued smoking in the face of elective surgery increases the risk to the individual and stretches already stretched healthcare resources and expenditure unnecessarily. The community has to decide whether this is justified."
But his suggestion that smokers be given lower priority has raised concerns among some surgeons.
The head of the department of surgery at the University of Sydney, Professor John Fletcher, said: "There is no doubt the risk of post-operative complications is higher in patients who smoke, and certainly the optimum would be for smokers to cease six weeks before surgery. But some patients, no matter how they try, just can't get off [cigarettes] completely and we have to take that into consideration. I think it would be unfair."
advertisement
advertisement
Associate Professor Stephen Gatt, program director of anaesthesia and intensive care for the Prince of Wales Hospital and the Children's Hospital at Randwick, said: "I think it is desirable people stop, but I don't think it's practical to tell people you will not operate on them if they don't. We can't discriminate against those who smoke."
It is widely believed higher levels of carbon monoxide and other chemicals in a smoker's blood decrease oxygen supply to body tissue and impair a wound's capacity to heal.
Dr Myles Coolican, an orthopaedic surgeon at Royal North Shore Hospital, said he insisted that a patient stop smoking 12 weeks before surgery for operations needing a high degree of healing and the cutting of bone.
Yet for other, more minor procedures he saw no need for smokers to quit at all. "There is no question that complications are greater in smokers because they don't heal as well or as quickly and infection rates are higher," he said. "You have to suggest they give it up, but in the finish, it's not me who gets the infection, it's the patient. All you can do is tell them the risk."
Dr Peters said his critics "have their head in the sand" if they believed individual smokers were the only people whose rights needed to be considered. ". . . You will certainly do more good for more patients if you only operate on non-smokers."
|
Original source.
"Listen sir, your grandma didn't live a very healthy life. Now she has a lot of medical problems in her 80s, that frankley, require a lot of care. Because we have to consider the rights of more than just old people, we're going to let her die."
Granted, that's extreme, but it's where this train of thought ends up.
The idea that you may not care for my smoking has occurred to me. That's why I take great pains to save the hordes of sanctimonious non-smokers from my secondhand smoke. The idea that someone would actually condone not granting me medical care is a bit much for me to consider.
Given the trend over the past 20 years, of making the logical fallacy "slippery slope" a reality, I think fat people are next.
Obesity has risen over smoking as the number one killer, so if someone can (with a straight face) deny a smoker medical care because they contend that a smoker's care is more expensive, than it's certainly no stretch apply the same logic to the obese.
Or, it could be applied to someone with high blood pressure that the doctor says comes from .... whatever.
This is not a good idea.
I'd also like to rebut the good doctor on smokers costing more.
That may possibly be true, but smokers pay more, so shove off.
I have to check the "smoker" box, which raises my insurance rates. I pay for my habit in more way than one.
I also pay more taxes than a similar non-smoker. Everyone needs to remember that almost every state raises taxes on smokes and booze as soon as there is a budget issue. Smokers often pay for more than their share.