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Consultants refuse to accept GP referrals for smokers

Consultants at one hospital have announced that they will refuse to accept GP referrals of patients who smoke.

Vascular surgeons from Edinburgh Royal Infirmary have defended their right to demand that patients stop smoking before accessing certain kinds of treatment.   

The hospital, part of NHS Lothian, has argued that medical intervention for vascular disease could be avoided altogether if patients stopped smoking and adapted to healthier lifestyles.

Mr Zahid Reza, a consultant vascular surgeon at ERI, said that his clinic was refusing to accept GP referrals for patients who continued to smoke, unless it was an emergency.

He told the Scotsman: ‘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.

‘Some patients have written to their MP demanding to see a consultant. I have written back to the MP to explain our position.’

NHS Lothian have denied the existence of a ‘blanket ban’ on refusing referrals, saying that each patient is treated on a case-by-case basis. However, Dr David Farquharson, medical director at NHS Lothian, said that some kinds of surgery had a lower chance of success, and that the chances of complications arising during surgery were higher for patients who smoke.

He said: ‘The best option can actually be to refer a patient into smoking cessation, fitness and diet intervention programmes to help them change their lifestyle, which will in turn improve their condition and if necessary the outcome of any medical intervention.’

But patient groups have attacked the decision, describing it as ‘shocking’.

Dr Jean Turner, a former GP who heads up the Scotland Patients Association, said that she was ‘extremely disappointed’.

She added: ‘You should not refuse to see anybody and certainly not penalise patients who are smoking. It is very God-like and highly unfair to refuse to see people referred from general practitioners.

‘If I was a GP I would be very angry. It’s not for a doctor to make a judgment. Doctors are there to see if they can help and relieve symptoms.’

A Scottish Government health spokeswoman said that a blanket ban on surgery for smokers was ‘not acceptable’ and denied that either the Government or NHS Lothian had proposed such a ban.

She added: ‘Smoking is never good for you. Patients who continue to smoke need to think very carefully about the increased risks involved, if surgery is being considered as a treatment option.’

Readers' comments (42)

  • We don't need to refuse to treat people who self harm with activities like smoking and drinking, but I approve completely of refusing to do it on the NHS. I do not pay taxes to support people trying to kill themselves. If they want that they can go private and pay for it themselves. So well done to the consultants, now lets move on, make it throughout the UK and make people face up to the responsibilities of their own actions and stop expecting the rest of us to pay for their selfish misbehaviour.

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  • Pranged your knee ski-ing?
    Fractured your femur on a donorcycle?
    Where will it stop....

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  • Bravo, to the vascular surgeon. Brave decision indeed. Bt it would have been even better if they had announced conditional acceptance of referral with three months to try give up. They have not turned down emergencies anyway, so what's the fuss!?

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  • That's the answer then. Grandchildren.

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  • I would kindly draw the attention of Dr Turner and colleagues to 'Cigarette smoking and musculoskeltal disorders', a review article by Abate M et al in Muscles, Ligaments and Tendons Journal 2013; 3 (2): 63-69 as well as Vo N et al 'Differential effects of nicotine and tobacco smoke condensate on human annulus fibrosus cell metabolism. J Orthop Res 2011; 29(10):1585-1591.
    Its not the question of surgery/intervention or not- its the best outcomes later. Where do we draw a line in managing and treating patients if they continue to ignore advice and recommendations?

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  • A previous blogger had the answer. Have grandchildren!

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  • "so what's the fuss!?"

    The fuss is that the hospital has transferred the medicolegal responsibility and risk to the GP. If a Consultant surgeon doesn't want to operate after seeing the patient, that's fine.

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  • Indeed from a general point of view it seems a bit too much to say a total ban is being imposed. But read between the lines - "emergencies would still be accepted". Maybe the total ban is not as total as it sounds. Indeed a smoker undergoing any form of surgery is putting him/herself at risk of serious complications. I think it would be very useful to highlight this to all smokers and have a direct referral pathway to the stop smoking clinic. Being refused surgery and continuing to smoke is not really an option to consider at all.

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  • There is a certain irony in members of a privileged social group reinforcing the already well demarcated health inequalities between 'classes'. Smoking is the single greatest killer among the less well off. To then suggest that particular groups of patients should not access certain treatments because they smoke seems to compound the problem. It is also hypocritical because similar judgements don't seem to have been applied to heavy drinkers. I wonder why.

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  • So they would refuse to treat a patient to prevent further damage but would happily accept patient when it's deteriorated enough to have become critical as an emergency (and likely more harmful to patient)?

    That's alright then!

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