Time to stop enabling patients?

So I saw this article today, it’s worth a read.

http://www.pulsetoday.co.uk/commissioning/commissioning-topics/referrals/consultants-refuse-to-accept-gp-referrals-for-smokers/20007532.article

Everyone. Eventually.

                Everyone. Eventually.

There’s a lot of chat going around the NHS at the minute about charging people to use their GPs or A&E. Most of this is driven by the Tories wanting us to privatise the NHS (ridiculous, even the Americans are moving ever so slightly closer to a civilised democratic health system, seems to be only us that are moving away from it). However, this precedent in this article from the vascular surgeons in Edinburgh is different.

It is sensible.

Sensible, progressive action in the NHS.

I nearly fainted when I saw it. You can tell it’s come from practicing clinicians not politicians.

This makes complete sense, if a patient has a vascular problem and continues to smoke, it is going to get worse, no matter what the surgeon does, it will get worse. We don’t give lung transplants to smokers, livers to alcoholics, so why stop there? The NHS needs to save a shit ton of money, there’s no other way around it, if we are going to keep it, we need to save money (despite it being the most efficient, pound for pound healthcare system in the world – there was some article.. google it if you want). I spent a morning in a vascular clinic a couple of months ago, we saw about 12 new patients in the 3 hour clinic. If 9 of them had never smoked, or stopped smoking in their twenties or thirties then they would not have been in that clinic, the consultant would have had the time to see more of the people with varicose veins or carotid problems not due to smoking (well, not directly due to smoking anyway). This saves money, allows the consultant to see the patients who are in need through no fault of their own and also sends a message.

If you do things that are bad for you, you know they are bad for you, but you keep doing them anyway.. then the NHS is not going to pick up the bill for it.

Smoking is a good example of this, people know that smoking causes all sorts of problems, and I am not for a second suggesting that because you smoke you should not be given care. I just do not believe that we should waste NHS money funding futile surgery. In the vascular clinic we saw a bloke who was about 40, certainly not older than 45. He was a follow up after having 3 toes amputated the month before – the consultant asked him had he stopped smoking – he said “yes doc” (he was a massive chav, so was the whole of his clan that had followed him into the clinic). He absolutely stank of fags – it turns out what he meant by given up was that he was now only smoking 10 a day. The consultant proceeded to explain that more than 2 a day was enough to fuck his arteries. The nicotine being the biggest killer – causing the arteries to spasm and shut down, reducing the blood supply to his foot, causing it to die, toes first.

The consultant explained in very simple terms.

“Stop smoking, or come back and I’ll cut your foot off. Your choice.”

The chav laughed.

I have no idea if he has gone back. But I would put a lot of money on him losing that leg.

I get the impression he enjoys cutting off legs..

I get the impression he enjoys cutting off legs..

I think it is a very brave thing that these consultants have done – refusing to take the referrals. I think the GP quoted at the end is spineless and part of the problem, we are far too soft with patients. Sometimes they just need to be told. You need to stop smoking or you foot the bill for treatment.

It’s the same with diabetics. I have absolutely zero sympathy for type 2 diabetics who could control their problem by cutting down on their weight. Diabetes costs the NHS £11 BILLION a year. That’s 10% of the NHS budget. I’m willing to bet that a lot of that could be saved if people cut back a bit.

Only thing the Daily Mail is good for is the occasiomal amusing picture.

Only thing the Daily Mail is good for is the occasiomal amusing picture.

I am not saying that we shouldn’t treat these people. My point is that there’s all this chat being flung around about charging people when they present to A&E – with a broken arm, or an MI – people that need treatment. Instead of charging these people, charge smokers who continue to smoke despite advice, charge diabetics who continue to eat 3 take aways a day. Money is a great incentive for people, a far better incentive than their health it seems.

What a backwards world this is.

Another example of the backward nature of the world..

Another example of the backward nature of our world..

 

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