Can You Discriminate Against Patients?

4 thoughts on “Can You Discriminate Against Patients?”

1. What about operating on a Jehovah’s Witness patient that refuses all blood products for religious reasons?
   In the case in question 35 years ago, with limited ability to replace blood, a deceased surgeon I knew refused to do a tonsillectomy on a Jehovah’s Witness patient. He felt that even though the risk of a need for blood transfusion was low, it was not zero. IF that patient needed a blood replacement, under their religious principles, and he was precluded from doing so, the patient might die. He told the patient that it was against his religious beliefs to let a patient die unnecessarily because he needed to use all means available to save that patient’s life. The patient took the clash of religious beliefs well, and decided to seek out care elsewhere.

   Most OB/GYNs do not do abortions. Most states have only 1 OB/GYN doing abortions at an abortion clinic. The OB/GYNs don’t do abortions because they feel it violates their Hippocratic oath to save lives, as well as their religious beliefs.
   In a free society one cannot compel someone to do something against their beliefs. We used to have enough tolerance to allow differences of beliefs.

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2. Many orthopedic and podiatric surgeons are very concerned about doing bone operations on people who are still smoking cigarettes. This is now “crossing over” to chronic marijuana smokers. (At least those who admit to it).

   There are many reasons why surgeons are concerned about the healing of bone, especially in the legs, feet and ankles for smokers. Some plastic surgeons are also concerned about slow and interrupted healing.

   There is a larger prevalence of infections in people who use alcohol chronically. Antibiotics often fail in that population, adding enormous risks to elective surgery and surgery after accidents.

   We wonder if there is push-back from the civil rights lobby on these issues? Once a surgeon witnesses a good surgery go sour due to bad patient habits, it reasonably tends to frighten us.

   I had one patient after a bilateral leg procedure who attended his high-school reunion the same day as his discharge from the hospital. In order to make it, he had to drive almost 100 miles in each direction, and his wife admitted (to one of my residents) that he got very drunk and walked on his casts all night.

   He came back with a massive reflex sympathetic dystrophy. By chance, his wife disclosed his “misadventure” to one of my surgical residents. At least we discovered why it happened. He never told me directly. After more surgery decompressing his tibial N. I got him repaired, but he ended up with one leg/foot being smaller than the other. He never sued me. I said some prayers during his case.

   I am not the only surgeon who has had such experiences. Why would we take a pre-determined excessive risk entirely on US?

   Michael M. Rosenblatt, DPM

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3. It gets even worse today, because any patient that is reasonably risky is diverted from the local hospital, to regional hospitals. Why you may ask? Well in the old days, surgeons, and anesthesiologists were fee for service, take all comers, do the best we could with what we had to work with, handled the immediate care and all of the after care.
   Today surgeons are most often hospital employees. They do not get compensated for taking on higher risk patients. So the don’t.

   In many rural hospitals surgeons in different specialty areas are on special visas, due to the fact that they completed medical school and residency in their home country, then did three years of individual one year fellowships each in different hospitals so they qualify for licensure, but not board certification. That class of surgeons is notoriously risk adverse. These are often not the superbly trained surgeons that I worked with, in decades past, who had done medical school, and often residencies in their home countries, and then did full residencies and fellowships here.
   This class of surgeons is notoriously risk adverse. One bad outcome, employment is terminated, and they are likely not to get other employment. That means they don’t get to stay in the US.

   Do patients understand that in days past they would have been cared for locally?
   Doubtful.

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4. I routinely discriminated against patients with unruptured aneurysms, and who smoked cigarettes. I explained that their risks were somewhere between 10x and 100x those of non-smokers, and that I refused to accept such a high-risk patient. I never took flak about that.

   In a parallel fashion, if a doctor feels so spooked by a patient–for whatever reason–that he or she cannot safely care for him, it’s that doctor’s duty to disclose that to him. And assuming he wants to be treated, to refer him to someone braver. Or more foolhardy. Or who just doesn’t care.

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