Smokers are being refused surgery by doctors unless they quit
August 14, 2014
AUSTRALIAN doctors have owned up to postponing the treatment of smokers, as doctors in Britain refuse to even see patients who are not willing to kick the habit.
Vascular surgeon Zahid Reza, from the Edinburgh Royal Infirmary, sparked outrage in Scotland when he revealed his clinic is refusing to accept GP referrals for patients who continued to smoke, unless it was an emergency.
‘Evidence shows that they would not do well with the treatment. In around 80% of cases, a smoker’s condition will improve just simply by stopping smoking and making other lifestyle changes,” he told The Scotsman.
Refused treatment … A clinic is refusing to accept GP referrals for patients who continued to smoke. Picture: John Appleyard Source: Supplied
Australian and New Zealand Society of Vascular Surgeons’ President, Dr John Quinn says while Australian doctors would not refuse to see a patient “some are refused immediate treatment”.
Patients who were suffering vascular pain when they walked but who were not yet in danger of losing a limb would be urged to quit smoking to cure the problem rather than get an operation for a stent, he said.
“As surgeons we have the right not to treat in certain circumstances like obesity or smoking, if the patient doesn’t change behaviour,” he said.
The public purse does not have enough money and “if you’ve got to ration treatment, there are better outcomes for those who are off the cigarettes and they should be treated first in certain circumstances,” Dr Quinn said.
He said there needed to be a public debate about whether some people should be denied treatment if they refused to change their lifestyle because it meant the chances of the surgery failing were greater.
COMMENT BELOW: Should people with unhealthy lifestyles be denied treatment?
Unhealthy even a fatal pursuit … More than 100,000 cigarette butts collected from Bondi Beach where smoking is illegal. Picture: John Appleyard Source: News Corp Australia
Vascular surgeons treat problems with the arteries and veins by ballooning openclogged arteries or bypassing blocked arteries.
More than 482,000 Australians are hospitalised due to cardiovascular disease each year and 45,000 die, around ten per cent of the cases are linked to smoking.
A heat attack costs on average $17,685 to treat, a coronary angiogram costs $9,000, the insertion of a stent to hold open an artery costs $8,300 and coronary bypass surgery costs $33,000.
Medical evidence shows a year after they quit smoking a person’s coronary risks are halved and two years on they have the same risk as nonsmokers
AMA board member Professor Geoff Dobb says with concerns growing about the sustainability of health expenditure in Australia “I suspect it is only a matter of time before we start to look at the cost benefit of procedures here”.
“We already do it for pharmaceuticals and at times decisions are made not to list drugs on the pharmaceutical Benefits Scheme even though they have a benefit because of the cost,” he said.
The government has a Medical Services Advisory Committee (MSAC) that has the job of reviewing new treatments for Medicare subsidy as well as deciding whether existing treatments should continue to be covered by Medicare.
Professor Dobb said if MSAC considered any such restriction on treating smokers in Australia it would be “something doctors would struggle with”.
Australian Medical Association president Dr Brian Owler says he “understands the frustration and futility you feel treating people who continue to smoke”.
However, he says refusing to treat them “is not the right thing to do”.
“It’s the same thing with obesity, we wouldn’t not treat a patients diabetes,” he said.
Instead, doctors should seize the opportunity provided by the treatment to encourage and support people to quit smoking and make other lifestyle changes, he said.
Sydney University Professor of Public Health Simon Chapman says 50 per cent of smokers will die from a smoking related disease but that meant the other half would not.
No smoking … Signs in the grounds of a hospital. Picture: News Corp Australia Source: News Corp Australia
That is why it was not possible to impose a blanket ban on treating smokers, instead each individual patients would have to be assessed on merit to determine if they should be treated or not.
The Heart Foundation said it does not support the refusal of treatment for patients who are suffering from smoking-caused diseases.
“The focus of the debate should not be on these patients, but on the tobacco industry that continues to ruthlessly market, promote and make widely available a lethal and addictive product that kills more than 15,000 Australians every year,”. said Mr Maurice Swanson, the Heart Foundation’s national spokesman on tobacco control.