Doctors with attitude

According to the UK’s Daily Telegraph (Don’t treat the old and unhealthy, say doctors)

Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone…

One in three said that elderly patients should not be given free treatment if it were unlikely to do them good for long. Half thought that smokers should be denied a heart bypass, while a quarter believed that the obese should be denied hip replacements…

Gordon Brown promised this month that a new NHS constitution would set out people’s “responsibilities” as well as their rights, a move interpreted as meaning restric­tions on patients who bring health problems on themselves. The only sanction threatened so far, however, is to send patients to the bottom of the waiting list if they miss appointments.

The survey found that medical professionals wanted to go much further in denying care to patients who do not look after their bodies.

Ninety-four per cent said that an alcoholic who refused to stop drinking should not be allowed a liver transplant, while one in five said taxpayers should not pay for “social abortions” and fertility treatment.

Paul Mason, a GP in Portland, Dorset, said there were good clinical reasons for denying surgery to some patients. “The issue is: how much responsibility do people take for their health?” he said.

Even if I am generally sympathetic such thinking, I find such attitudes among physicians troubling, for multiple reasons:

  • I’m sure such views are being put into practice even if it’s not official policy
  • Doctors can’t be counted on to judge whether people are too old for treatment. I saw it happen with a relative, who was judged “too old” for chemo by his oncologist, even though that’s not well supported by the evidence. The old are often discriminated against in treatment decisions
  • Who’s going to make these judgments about whether someone’s on the right side of the line or not?

PS: just saw this article in the Washington Post (Weighty Assumptions) about the tendency of some physicians to treat overweight people unfairly:

Overweight and obese patients have long complained that doctors treat them insensitively and are too quick to attribute health problems to their weight. But their claims of bias were often met with skepticism — until recently. Now research from such academic powerhouses as Yale University and the University of Pennsylvania is adding to evidence that the problem may be real and may affect patients’ quality of care. And actions by the giant health maintenance organization Kaiser Permanente show the medical establishment is beginning to respond.

Two studies in the journal Obesity Research in 2003 found that many physicians harbor negative attitudes toward fat people: A University of Pennsylvania study of 620 primary care physicians found that more than half reported viewing obese patients as “awkward,” “unattractive,” “ugly” and “noncompliant”; a Yale study reported that health professionals strongly associated being overweight with being “lazy” and “stupid.”

January 29, 2008

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