Star1234 Posted November 9, 2009 Report Share Posted November 9, 2009 I just came back from a medical conference where one surgeon was commenting how the big Ottawa area hospitals send all of their obese patients to him. Apparently the surgeons at those hospitals refuse to operate on these patients since there is a higher risk for complications. Is this ethical? Isn't there some written rule about how physicians aren't supposed to discriminate when treating patients? Link to comment Share on other sites More sharing options...
NewfieMike Posted November 9, 2009 Report Share Posted November 9, 2009 I just came back from a medical conference where one surgeon was commenting how the big Ottawa area hospitals send all of their obese patients to him. Apparently the surgeons at those hospitals refuse to operate on these patients since there is a higher risk for complications. Is this ethical? Isn't there some written rule about how physicians aren't supposed to discriminate when treating patients? depends? is it elective? Link to comment Share on other sites More sharing options...
Star1234 Posted November 9, 2009 Author Report Share Posted November 9, 2009 No, this was for total knee and total hip replacement surgeries. Link to comment Share on other sites More sharing options...
Jochi1543 Posted November 9, 2009 Report Share Posted November 9, 2009 I don't think this is discrimination because there's a clear increased risk to these patients. It's not like the surgeons are refusing to operate just because they don't like them because they are fat. But yeah, you can definitely drop a patient from your practice, I don't even think a referral is required (although it would definitely be the polite thing to do). And you can refuse to take on someone else's patient, as well, although of course the polite thing would once again be to not refuse. I remember one of the family docs in one of our courses joked that some doctors like to give themselves a Christmas present by dropping a belligerent patient or two. Link to comment Share on other sites More sharing options...
future_doc Posted November 9, 2009 Report Share Posted November 9, 2009 They want to maintain their batting average. What patient is prepared to take on a surgeon and try to force him to operate on him against the doc's will. So, your question is interesting but only from an academic point of view. Doubtful any potential patient would bother to complain as thereis no purpose from a practical viewpoint. Link to comment Share on other sites More sharing options...
Star1234 Posted November 9, 2009 Author Report Share Posted November 9, 2009 Ok, but my question is can doctors basically choose who they treat based on the patient's health history? For example, can a physician refuse treating a smoker or a diabetic patient because they are more difficult to treat? I dunno....this just seems kind of unethical to me. Link to comment Share on other sites More sharing options...
HBP Posted November 9, 2009 Report Share Posted November 9, 2009 Ok, but my question is can doctors basically choose who they treat based on the patient's health history? For example, can a physician refuse treating a smoker or a diabetic patient because they are more difficult to treat? I dunno....this just seems kind of unethical to me. I would argue surgery is different than treating. The doctor should be able to say he/she does not want to take the risk Link to comment Share on other sites More sharing options...
future_doc Posted November 10, 2009 Report Share Posted November 10, 2009 Well, I guess the response may be. "I am not comfortable in the best interests of the patient treating a patient with such a history Link to comment Share on other sites More sharing options...
Star1234 Posted November 10, 2009 Author Report Share Posted November 10, 2009 But then if all surgeons refused to operate because of the higher risk, the patient would never get treated. Is this fair in a system where everyone is supposed to be entitled to equal care? Link to comment Share on other sites More sharing options...
dreamer87 Posted November 10, 2009 Report Share Posted November 10, 2009 i don't think they would turn away patients with diabetes, but i would not be surprised if family doctors turned away certain extremely old patients who require a lot of time and attention....also you have to factor in that old patients constantly need referrals/prescription refills/notes which adds to the time spent by people working in offices overall, and also when they fall very sick doctors need to make home visist etc which not all doctors are able to do. it's not that these doctors are unethical or don't care about the seniors. the problem is that family doctors these days already have too many patients and when they feel that they cannot do justice to a patient by agreeing to take them under their care, they simply turn the patient away and allow the patient to find a doctor who perhaps has more time to look after the patients and attend to their time consuming needs in a more orderly fashion. if you think about it, this is simply the doctor being realistic and honest. i think it's worse if doctors keep taking more and more patients and then make the patients wait for a week to see their family doctor. some doctors don't want to do that to their patients and would rather see them in a couple of days to attend to their needs, and therefore don't take on too much when they know they will not be able to handle it. you can draw an analogy to courses - you don't take on 8 courses a semester right? why? because you know you would not be able to do justice to all of them. same for doctors.....if they can't do justice to the patients, they will not take them. hope this helps Link to comment Share on other sites More sharing options...
Star1234 Posted November 10, 2009 Author Report Share Posted November 10, 2009 But then don't we run into the potential problem where the healthier patients are getting treated first and the patients that really need immediate care are not being looked at because no doctor is willing to take the extra time or energy necessay to treat them? Sorry if I'm sounding idealistic here but I was just kind of taken off guard when I heard this type of picking and choosing exists. Link to comment Share on other sites More sharing options...
future_doc Posted November 10, 2009 Report Share Posted November 10, 2009 Star, I agree with you. And when the family doctor releases an elderly pateint from his practice, it is often virtually impossible for that patient to find a family practititoner. For many years all members of my family have been without a family doc, and we go to walk-ins when we need medical attention - far from an ideal situation. Link to comment Share on other sites More sharing options...
rmorelan Posted November 10, 2009 Report Share Posted November 10, 2009 But then don't we run into the potential problem where the healthier patients are getting treated first and the patients that really need immediate care are not being looked at because no doctor is willing to take the extra time or energy necessay to treat them? Sorry if I'm sounding idealistic here but I was just kind of taken off guard when I heard this type of picking and choosing exists. The colleges really frown on "hand picking" people for the practise. Also with the new family funding models doing so might not make any sense anyway. You get paid more for more labour entensive groups to match the increase in extra work involved. Link to comment Share on other sites More sharing options...
dreamer87 Posted November 10, 2009 Report Share Posted November 10, 2009 But then don't we run into the potential problem where the healthier patients are getting treated first and the patients that really need immediate care are not being looked at because no doctor is willing to take the extra time or energy necessay to treat them? Sorry if I'm sounding idealistic here but I was just kind of taken off guard when I heard this type of picking and choosing exists. you're very much correct but it can be argued that this is not the fault of doctors but rather the government for not increasing funding and increasing the number of seats for medical students and IMGs, because if they did, we'd have more doctors who would be able to meet with the needs of a population of baby boomers who are getting old. of course nothing is so black and white - some say doctors should do more, some say the government should - but it's just the patients who are suffering in the end. and as far as healthy people being treated first, and others not getting a chance, that's just how life is my dear. i used to wonder the same when my dad had been diagnosed with cancer and had to wait for many months for a surgery. by the time they got an operating room, it was too late, it had metastasized and he passed away a few months later....exactly 11 months after his diagnosis, 5.5 of which he spent waiting for surgery. so if you ask me if it's fair that people have elective bypass surgeries or cosmetic surgeries and that was an operating room that my dad could have used, then i will say no, it was unfair. but it's a reality of the system we live in. it's not that no one tries, but there are limitations. you can't tell the hypochondriac that shows up at your office every second day and goes on and on about stuff, that he can't have healthcare. and it's not that doctors turn away all old people....they have a certain number and they stop once they have too many, because no doctor wants to take a patient, rush through visits, miss something important and get sued. Star, I agree with you. And when the family doctor releases an elderly pateint from his practice, it is often virtually impossible for that patient to find a family practititoner. For many years all members of my family have been without a family doc, and we go to walk-ins when we need medical attention - far from an ideal situation. yes this is the case for many people these days and it's quite sad because some people abuse the family doctors so much it's not even funny when others are left without a proper physician to follow them. i guess the only solution is getting more family doctors! Link to comment Share on other sites More sharing options...
dreamer87 Posted November 10, 2009 Report Share Posted November 10, 2009 The colleges really frown on "hand picking" people for the practise. Also with the new family funding models doing so might not make any sense anyway. You get paid more for more labour entensive groups to match the increase in extra work involved. funny that you mention that because MOH actually pays family doctors 180 bucks to take on a new elderly patient's care and significantly less for an adult patient.....so they kind of give you the incentive to hand-pick the older ones! they've also inceased funding for other costs associated with elderly patient's care like travelling costs, so they're really luring doctors with the money incentive! Link to comment Share on other sites More sharing options...
future_doc Posted November 10, 2009 Report Share Posted November 10, 2009 The colleges really frown on "hand picking" people for the practise. When it occurs, it is done one patient at a time, and I would imagine this is beyond the effective control of the college even if they wanted to stop it. They may be of moral suasion generally but dollars and cents talks louder in individual decisions. Link to comment Share on other sites More sharing options...
future_doc Posted November 10, 2009 Report Share Posted November 10, 2009 funny that you mention that because MOH actually pays family doctors 180 bucks to take on a new elderly patient's care and significantly less for an adult patient.....so they kind of give you the incentive to hand-pick the older ones! they've also inceased funding for other costs associated with elderly patient's care like travelling costs, so they're really luring doctors with the money incentive! Most interesting....so the government is acting in a proactive manner, a good thing! Link to comment Share on other sites More sharing options...
rmorelan Posted November 10, 2009 Report Share Posted November 10, 2009 funny that you mention that because MOH actually pays family doctors 180 bucks to take on a new elderly patient's care and significantly less for an adult patient.....so they kind of give you the incentive to hand-pick the older ones! they've also inceased funding for other costs associated with elderly patient's care like travelling costs, so they're really luring doctors with the money incentive! Sorry I might hand picking healthy ones specifically! It dawns on me you could hand pick the other way - select for the "sicker" patients They are figuring it will balance out - you get more for eldery but you are going to see them more often etc (a lot of the plans are fixed income for the year, regardless of whether you see them at all if I recall right). In theory if they did it right you get exactly the same income for the same numbers of hours you commit regardless of who your patient pools is (fewer visits from the healthy adults but less set income, or more repeat visits from people in other groups but more income per person). I kind of like this system! Link to comment Share on other sites More sharing options...
NLengr Posted November 10, 2009 Report Share Posted November 10, 2009 But then if all surgeons refused to operate because of the higher risk, the patient would never get treated. Is this fair in a system where everyone is supposed to be entitled to equal care? Everyone is entitled to equal care, but that does not mean that everyone needs to be offered the same type of treatment, especially if treatments are contraindicated in the patient. You are mixing up surgery with treatment. Surgery is only a small subset of potential paths of action the patient could choose. Physicians are not required to offer medical services that they consider futile or of too high of risk to the patient. If the person is morbidly obese and is too high of risk for the surgery, the physician doesn't have to offer it. Advice to lose weight would probably a good first step in treatment if the person is too obese for surgery. If the person loses enough weight to no longer be high risk, than the surgery can be offered at that time. Link to comment Share on other sites More sharing options...
future_doc Posted November 10, 2009 Report Share Posted November 10, 2009 I think the issue may have been that the surgeon simply refuses surgery so as to maintain the existing batting average, not that the patient necessarily is too obese for surgery. Link to comment Share on other sites More sharing options...
moo Posted November 10, 2009 Report Share Posted November 10, 2009 If you are technically taking new patients as a family doc you CANNOT refuse patients based on their medical history or personality or race or any other factor you can think of. However, that doesn't mean it doesn't happen. The Colleges in Ontario and BC (probably the other provinces too) are really starting to crack down on this. As an example of this, my own personal family doc told me he once refused a patient because his practice was "full." (It wasn't that this patient was complicated or anything.) He was only accepting relatives of existing patients. However, this patient got wind of this rule, went to the College, and my family doc was told he had to either stop taking any and all patients PERIOD or continue taking new patients. As an aside, in one of my leadership courses for my MPH right now, we had a surgeon speak to us who told us a story of another surgeon who refuses to operate on First Nations because they are either "late for appointments, drunks, high or deadbeats." Now that is blatant discrimination. As a surgeon, if you refuse to operate on a patient because he/she is obese (or has other health conditions) that is legit, provided the surgery is elective, of course. It's like how we don't biopsy the prostate of 80 year olds with elevaed PSA's--you can call that age-ism but really the risks outweigh the benefits here so you'd be justified not to operate. Link to comment Share on other sites More sharing options...
rmorelan Posted November 10, 2009 Report Share Posted November 10, 2009 I think the issue may have been that the surgeon simply refuses surgery so as to maintain the existing batting average, not that the patient necessarily is too obese for surgery. Other than ego, is there a real consequences of having a ARTIFICALLY high "batting average" by selecting only easy clients? Obviously we want surgeons to do well but beyond that? Link to comment Share on other sites More sharing options...
future_doc Posted November 10, 2009 Report Share Posted November 10, 2009 Re the family doc, so he learns to tell his receptionist to say "The doctor is not taking any new patients" and then he quietly makes the occasional exception and nobody is any the wiser. In your aside, you got the inside story. The discriminated population would never have a clue or get to first base if they launched a complaint of discrimination. Link to comment Share on other sites More sharing options...
future_doc Posted November 10, 2009 Report Share Posted November 10, 2009 Other than ego, is there a real consequences of having a ARTIFICALLY high "batting average" by selecting only easy clients? Obviously we want surgeons to do well but beyond that? We cannot underestimate ego, there may be malpractice considerations I imagine and the surgeon may just want to follow the easy path without serious challenges. He may want to maximize his time on a revenue stream basis. Link to comment Share on other sites More sharing options...
rmorelan Posted November 10, 2009 Report Share Posted November 10, 2009 We cannot underestimate ego, there may be malpractice considerations I imagine and the surgeon may just want to follow the easy path without serious challenges. He may want to maximize his time on a revenue stream basis. The idea of a surgeon that doesn't like challenges causes the equivalent of a divison by zero error in my brain Link to comment Share on other sites More sharing options...
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