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Doctors To Breathalyse Smokers Before Allowing Them NHS Surgery (bbc.com)
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.
It's not society's job to do it for you
Isn't it ?
but this is a big step towards them.
"I don't know, therefore Aliens" Wafflebox1
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.
-- All that is necessary for the triumph of evil is that good men do nothing. -- Edmund Burke
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.
"I have never let my schooling interfere with my education." - Mark Twain
... we're talking about non-urgent surgery after all.
Why not work with the patient to reduce the risk of anaestesia before putting them under the knife? Moreover, reduce health problems that may contribute to the underlying condition and/or will impair recovery, before going through with complicated and risky treatment.
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.
Halting smoking and/or losing weight when you're obese before you have major surgery means you're less likely to die on the table.
The doctor's trying to save your life, not deny you healthcare.
Where's the controversy here? I don't see it.
and couldn't agree more.
For non UK residents understanding the Conservatives *who are currently in power* want to kill the NHS, but as it is one of our best loved institutions can't, yet. As such are acting to strangle break it or make it feel worse in every way they can without being too obvious.
nothing to see here
That's just crazy!
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...
Isn't the BMI measurement widely deprecated these days?
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?
When someone says, "Any fool can see
with in 10 years, because America is going to go single payer.
If you Drink, Do Drugs, Smoke or are Over Weight you will not get health care.
FYI for Kids in America
FYI for Adults in America
Will be interesting to see how the government bureaucrats and politicians handle denying health care. My money is on "SECRET BOARDS". Unless you are on the right team, then you get what ever you need.
Before everyone goes crazy about how bad the NHS is and how "we don't want that here", please bare in mind that the only reason it has reached this point is because funding for it is cut at every turn, so as to make it nearly unsustainable. Very much as Trump is trying to do by cutting the CSRs.
The UK government isn't refunding the taxes that these fat smokers pay for the NHS, are they?
-jcr
The only title of honor that a tyrant can grant is "Enemy of the State."
Isn't this the point of a vice tax?
If smokers want to smoke, let them do so, just add a vice tax at the register.
They get freedom and direct personal responsibility for their choices, so everybody wins.
We know Trump's height and we can closely estimate of his weight.
How do we calculate his BMI?
Any guess what it is?
Prioritizing patients based on risk and resources is a good idea, but doing it by BMI is aggressively ignorant. Anyone with above-average muscle mass -- not just crazy jacked-up bodybuilders, but blue-collar men who work physical jobs all day -- will have elevated BMIs even though they are not obese in any sense of the word.
The values released to the press were:
Height = 74 inches
Weight = 236 pounds
This would classify him as borderline obese with a BMI of 30.3
However, Trump has claimed to be 74 inches for many years, and at his current 71 years, he has probably shrunk about at inch. In addition, photos taken since the election reveal about 5 pounds of additional weight.
Applying these updated metrics gives him a BMI of 31.8, clearly obese.
Are they also announcing an effective weight loss program? As I understand it, outside of surgical interventions, there are basically no weight loss programs that are known to work for at least 50% of participants and are effective over a period of 2+ years. I'm not claiming there are no ways to lose weight or anything like that, merely that we don't seem to have a handle on how to reliably make it happen for the typical person in the long term.
Am I wrong? Is there something known to be reliably effective? Or is this just the health service trying to opt out of serving high-risk patients?
You've been paid, it is your job.
So what? Hillary's BMI is over 32 - same as her dress size.
Big Mamma Index
throughout the 4 years in-between acceptance and the actual operation taking place?
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.
Domestic spying is now "Benign Information Gathering"
before the exam for this. That way its easier to lose the required amount.
An urgent surgery is the one which will save your life now and you must have it now. A non-urgent surgery is the one that you will have in the far future when there are no more urgent surgeries to perform
Why? Because if you die it is a stain on the party but if you suffer huge pain a year or two waiting for surgery spot to appear then it is fine. Welcome to government run medicine my capitalist friends. Good thing is that the surgeries are free so are the pain meds and the subsequent de-junkiefication course.
we have decades of overwhelming evidence now that diets don't work
No, we have decades of evidence that people do not stick to their diets. Diets do work. If you burn fuel faster than you take it in you will lose mass. There is no way around it.
1. Pay your taxes
2. Don't receive government services
3. War.
4. Rinse, repeat.
First: socialized healthcare. Margaret Thatcher brilliantly and succinctly summed it up when she famously said (essentially) "the problem with socialism is that you eventually run out of other people's money". America's founders warned about Democracy when they created the USA as a Republic - they warned that Democracies always fail when the masses discover that they can vote to loot the treasury.
Second: government-run anything (in this case, healthcare). Government is run by politicians, and politicians are political, therefore government operates by POLITICAL rather than any other rules. In a Government-run system, decisions will be made for POLITICAL rather than any rational reasons. Some groups will be favored and others disfavored based on political popularity. Smokers and the obese are currently politically unpopular AND they are more difficult to treat so they could push-down success rates and make government-run healthcare look bad (something politicians running that healthcare system do not want)
This is all generally fine with people on the political left who prefer to lump people into groups by superficial things like skin color and then treat all (presumed) members of those groups as interchangeable elements. In this way of thinking one worries about how hispanics or african-americans, or women, or gays are treated (as a group) but one can ignore how an individual hispanic or gay etc is treated and if a member of one of these groups does not behave and operate as a member of the groups is expected to that individual is labelled as "not really black" or "white hispanic" etc. Free people who wish to be treated as individuals, however, find this all to be repulsive and a bit too jack-booted.
You Socialist/Commie types always complain about this. Why do you always want to use other peoples money to pay for uneconomical treatments?
was that Wall Street's big banks are NOT private entities at all - they are crony-capitalist jokes thoroughly involved with government where their employees are in a revolving-door relationship with the establishment of BOTH political parties and they cannot lose money. Any time they are going to lose, the rules of capitalism go out the window and the politicians they have purchased with bribes [err... sorry.... "campaign contributions" and "speaking fees"] will bail them out with taxpayer money and mysteriously be unable to prosecute them despite their actions being more damaging that the simple robbery of a convenience store for which an inner-city punk would be jailed.
No, do NOT try to use Wall Street bankers as proof that capitalism is worse than government-run anything. Those bankers are government-entabgled and NOT an example of the "free market" in ANY way. In a free market, those banks would have gone down in flames and the investors would have sued the executives into the dirt while government prosecuted them all for financial crimes. The bankers who survived would have been the smart & honest ones and the entire industry would now be healthier and safer.
At that time, Palin was pointing out that Obama's right-hand man Rahm Emmanuel (now Chicago's mayor) had a brother named Zeke Emmanuel who was a health policy guy working on Obamacare. Zeke Emmanuel was pushing a scheme he called the "Whole Life" system. In that scheme, a child under a certain age would be deemed easily and cheaply replaced by the presumably still young-and-fertile parents so such children would be allowed to die rather than getting expensive treatements for severe disabilities or illnesses. Also under that scheme, the elderly would be of little value to society being no longer of reproductive age and no longer in the workplace, so a committee would determine what conditions would be treated for the elderly and what conditions would warrant only pain pills until death ensued.
This was further inflamed by two things: [1] Obama answered a question in a public forum by saying that in some situations, the elderly should just be given pain pills rather than surgery and [2] the people in congress pushing Obamacare kept demanding that it include free end-of-life counseling for the elderly in which they would be encouraged to decide not to try everything possible to stay alive, and opt for hospice and/or palleative care.
Sarah pointed all this out but the press were busy decieving the public into thinking she said she could see Russia from her house (something she NEVER SAID), and that she could not read (because she was caught off-guard when asked what she reads and did not give a properly vetted list that did not contain something the press could then run with for days as a "gotcha")
Like here in the US I already pay a multiple of my Medicare insurance/supplements in penalties simply because my retirement income is more than the government likes to see. It's to the point I'd like to opt out of Medicare because private insurance is cheaper.
This is my single payer nightmare. Rationing care, and requiring people to conform to certain rules to get it. It's like the VA system. At the end of the day, the problem with single payer is that if I am paying for your health care, I expect you to eat right. And since it's illegal to have private care, we've just legislated your diet.
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.
suggest that "second hint" is mostly wrong:
https://www.quora.com/Does-the-body-burn-fat-before-it-burns-muscle-for-energy
---- From the referenced article on Quora:
Liang-Hai Sie, Retired general internist, former intensive care physician.
Answered 72w ago
We prefer not to burn our muscle proteins, since this we need to function well, so mostly fat first, although we all know that when losing weight we also lose muscle mass, which can be partially prevented by exercising see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2650077/
and having more protein 25 - 30 gram three times a day ( 1 - 1.2 gram/kg/day) instead of the normal RDA of 0.8 gram/kg/day - if possible within 30 minutes after resistance training - see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276215/. we think because this prevents muscle breakdown to acquire the needed essential amino acids instead of acquiring that from breaking down you own muscles.
----End of Quora quote
(1) Do you realize that some people are obese becuase of other conditions and that many smokers got started when they were "young-and-dumb" and then were so hooked they could never muster the resolve to quit?
(2) Do you have the same view toward pot users and towards young black men whose interactions with the police are all-too-often tainted with a "chip on the shoulder" attitude that then escalates?
Be careful about who you decide is "trying to kill themselves" and who should be abandoned to die.
“Many that live deserve death. And some that die deserve life. Can you give it to them? Then do not be too eager to deal out death in judgement.” - J.R.R. Tolkien's "Gandalf" in The Fellowship of the Ring
was very obese and had just received an total knee replacement.
Knee problems are often caused by obesity. So is the sudden death that I observed after trying to get her out of bed the day after the surgery.
TKRs are non-urgent. She might have lived if the surgeon had told her instead, "Why don't you lose 60 pounds then tell me how your knee is?".
Government euthanasia for the unwashed masses.... Perfect for all the lemmings that believe in progressive, liberal, democrats.
This explains a lot, Stiff Upper Lip unfolding, hold on tight: ... next thing you know, non-smokers will need to be celibate too! :-p
* I have an _unsolicited_ note in my private NHS/GP record file (visible via my mobile phone) as an ex-smoker; what? huh? and I've avoided _smoke_ since ever?
- Now, I've repeatedly informed the GP office that this record wrong; next thing you know? Now I am marked as both ex-smoker and non-smoker; yeah right!
- Let me guess: now we'll have rejections/delays on the basis of the ex-smoker field?
* I went yesterday to the nearby GP to book an appointment (true story); no questions asked: I got 7th Nov.! huh? anybody care to count the days until then?
- How do they know someone's health situation won't deteriorate in such a long span? Or, are the GP appointments casual discourse about population's health?!
- Since I am too much of a "smoker" and more "obese" than the NHS would ever tolerate, could I perhaps pay less taxes for getting such a lesser service?
* The 2 Doctors I came to trust in the nearby practice (but not the practice) have now both left since last month (for greener pastures?)
- Would you put your confidence on such a stable GP practice or, would you start paying a private doctor instead? hurray... we ARE saving public money!
* Come on NHS, let's talk about PKIs here, and let's compare to other national health systems:
- Maternal death risk in the UK is one in 6900, more than 6 times higher than Belarus; really? really?!?
- Are obese smoker pregnant mothers (yeah, oddity) to be kicked out and let wait another 9 months before a surgery intervention?
Think of NHS programs for drug addicts: oh, yeah, you need to cut it first, man.
The thing that is happening with NHS is borderline tort: at least, there should be a choice to not pay it, if NHS presents a choice to not treat someone.
Another fellow here said this, unfortunately it applies to some Doctors: "Do they even take that oath anymore? Does anyone still take it seriously?"
If it's gonna be free market folks, let's go all the way: no social blanket health system support, all doctors' time sold in bidding wars, drug cartels, let's just do it right!!!
maybe switch the coke with coffee/tea assuming the cost/benefit is worth it for you, though this depends on personal taste.
There is at least some evidence that sweeteners can get into your blood and have the same effect on your body's fat on/off regulatory systems as the real thing,
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820882/). There are also other studies with mixed results on their effect on your gut bacteria, sugar sensitivity, habits/cravings, and other stuff. Unfortunately the evidence is for a clear or quantitative answer on the affects, but it is probably best to think of "diet" drinks as more to save your teeth than your waistline.
....its like guns....they're so brainwashed by their corporate masters and owners there's just no point.
Nothing ever sinks in as the mental capacity was bred out of them generations ago.
I thought that NHS is going to get £350 million per week that are now going into the EU? The bus said so!
I pay my National Insurance like everybody else in "society".
>>It's not society's job to do it for you
This is the typical view of someone who goes private and then feels disheartened that they have to "foot the bill" for everyone else. We all pay for it, we all have a right to use it. Simple.
the tragic thing is that for brits there's no way to get a surgery privately. they have to go the socialized NHS route - and if they do something to their body the government doesn't like (like smoking) then it's no surgery for you and continued suffering.
just like the boy that recently died because the NHS didn't think he was worth saving and banned the parents from getting private medical care in the US...
My next door neighbours are both doctors. Coming from a medical family myself, and being naturally curious, I frequently chat with them about the stuff that's going on in medicine...
One of them was recently involved in a study that dealt specifically with post operative recovery rates of smokers, comparing those rates between smokers who had and had not had a cigarette in the immediate period prior to their operation.
The results were not what you'd have expected. In fact those smokers who were still smoking, even though they'd been told not to, had faster recovery rates and less complications than those smokers who had not had a cigarette from an extended period prior to their operation.
Of course we discussed possible reasons for this extremely counter-intuitive result but only two of the reasons we could come up with made any real sense: the effect was significant and real, and based on 'unknown' psychological (must get better, faster, so I can get up and have a fag...need a fag...) or physiological (for example the pre-op stress of giving up smoking weakened the 'non smokers' in some way or otherwise predisposed them to complications) factors; or the study results were a statistical fluke, exacerbated by the small sample size (the somewhat technical breath test has not been widely used on pre-op patients).
The slightly troubling aspect, I found, was that he was asked not to present the findings in any way that could be construed as suggesting that there was any positive benefit in smoking (which is a bit hard to do when that's what the results showed) at a recent conference, as there's still very much a 'war on cigarettes' going on. Don't get me wrong, I'm not advocating smoking. Any benefit demonstrated in this study is vastly outweighed by the harm that smoking does. The results are however intriguing and, in my opinion, worthy of further study; covering up inconvenient results is neither good science nor a basis for good policy.
Disclaimer: Sorry, I have no links to the study I'm talking about. I'm not even sure it has been published yet (or ever will be). You have every right to treat everything I've just said as an anecdote of dubious provenance, and be appropriately skeptical.
The NAZIs went even farther and killed people for being fat. I wonder how long it will take NAZI Britain to slide down the same slippery slope? Or will the slide into Muhammedan Law first?
God Damn the Queen! That fucking cunt.
This is a lesson about publicly-funded anything. If the Government pays for it, they can refuse to pay for yours while making you pay for everybody else's.
Even worse: The government can refuse to let your pay for your own. Either you get your medication from our approved vendors that we pay, or you are doing ILLEGAL DRUGS.
The world needs a clear standard: You can buy and use any medication, medical device, and/or medical procedure you can pay for. The sellers only need to be up front about the benefits and risks.
Nevermind the yellow #5, or the bpa from the plastic we're touching all day. Nevermind the asbestos dust from the brakes in all the cars we're surrounding ourselves with. Hopefully it's just ceramic dust. Nevermind the cleaning chemicals used in the hospitals contributing to lung cancer rates globally. Nevermind the MRSA you'll probably get in the hospital while you're there. Nevermind the 6 months of sun radiation you get with 1 single CT scan. Nevermind the compounds in the drinks served in the hospital cafeteria that contribute to bladder cancer and like the bpa, bioaccumulate in your skin to contribute to skin cancer. Nevermind the asphalt being used to repave the driveway of the hospital which also contributes to lung cancer and copd. Nevermind the scents used, sprinkled on the hospital carpet to sanitize and freshen, that also contribute to lung cancer and copd. It's also a good thing while you're there, you get the addiction genes perked by the percocet or oxycodone. Nevermind the liver degradation from the acetaminophen they give you while you're there for any reason. And don't worry, before you leave to go back outside to the toxic soup the world has created aside from cigarettes, if you ask for it, they'll give you a sucker. A nice glob of cancer inducing and feeding sugar. Mmmm, yes, tumors love it!
While it sounds like a great way to save the NHS money by getting people to become healthier problems will arise in practice.
Anybody who smokes and doesn't want to quit can simply resume smoking after the test... Just like how drug addicts who are forced into detox usually return to using after they are released.
With obese patients the idea is even worse because if they simply diet to lose the weight they will end up losing a combination of fat and muscle, which lowers their metabolism. After surgery if they then return to the bad habits that made them obese in the first place they will gain all the weight back and probably some additional... Your just perpetuating a cycle of yo-yo dieting.
Dealing with addiction and obesity is not easy... To be effective the person has to want to change, forcing them simply won't have the long term effects you want.
Technology is most abused by the very people it was created to help
Anyone who smokes in this day and age is an idiot. Anyone who had taken up smoking in the last 40 years is an idiot..
Hi I'm here for my Gastric By-pass surgery!
Loose some weight first...
What?!
It's only for non-urgent operations. The powers that be in the merrie old land of England just want these people to wait until their condition worsens to the point where it becomes urgent. Then its all good.
The shepherds did so well protecting the flock that the sheep no longer believed that wolves existed.
Isn't healthcare supposed to be a "right"?
I could also create a long list of other reasons, including:
1. people who eat meat are not approved, they don't live as long as vegetarians, evidence of poor risk
2. vegetarians, who may lack adequate protein intake.
That solves it all!