, May 31, 2006
This article is required reading for the course.
Overeaters, smokers and drinkers: the doctor won't see you now
Health care is meant to be open to everyone equally. But some doctors question, even deny, treatment to those with
NICHOLAS KOHLER AND BARBARA RIGHTON
It's a touchy subject. So touchy that after an hour-long interview, one Calgary orthopaedic surgeon decides
he wants to remain anonymous. From New Brunswick, where a surgeon recently cancelled an operation on
a crippled man's leg, a Moncton Hospital spokesperson calls asking
to stop trying to contact the
doctor. At issue: health care for patients with self-destructive vices -- overeating, smoking, drinking or drugs.
More and more doctors are turning them away or knocking them down their waiting lists -- whether patients
know that's the reason or not. Frightening stories abound. GPs who won't take smokers as patients.
Surgeons who demand obese patients lose weight before they'll operate, or tell them to find another doctor.
Transplant teams who turn drinkers down flat. Doctors say their decisions make sense: why spend
thousands of dollars on futile procedures? Or the decision is the product of frustration: why not make
patients accountable for their vices? Others call it simple discrimination. But in a health system with more
patients than doctors can treat, where doctors have discretion over whom they'll take on, some say it's
inevitable that problem patients will get shunted aside in favour of healthier, less labour-intensive cases.
So here's the question: if people won't stop hurting themselves, can they really expect the same medical
treatment as everyone else? Health care in Canada is supposed to be about equal treatment for all comers.
For some doctors, however, there are patients who are less equal than others. Winnipeg GP Frederick Ross
is one. In 2002, he told his patients he'd no longer see them if they continued smoking. "I said, this is stupid.
I told my patients, you have three months to quit or I am going to ask you to find another doctor," recalls
Ross, a genial man. "I said, your smoking is impeding my progress in treating you." Some people left in a
huff. One challenged him on the basis of human rights (a tribunal later threw the case out). Others --
hundreds, he says -- stayed and quit smoking.
Cutting out the cigarettes might have helped some patients avoid an appointment with Dr. Alberto de la
Rocha. As a former thoracic surgeon in Timmins, Ont., de la Rocha operated on lung cancer patients for 17
years before quitting. "I burned out in an atmosphere of indifference and lack of accountability -- public and
personal accountability," says de la Rocha, who is now a medical officer of health in northeastern Ontario.
Smoking, says de la Rocha, goes hand in hand with entitlement. "It goes like this: 'I am sick. You are the guy