Nurses have compassion - why don't patients show themselves some?

2 July, 2010

Sunburn, obesity, smoker’s cough - are patients a bit thick or have public health campaigns failed miserably?

Patients suffering from ailments that are arguably self-inflicted or easily preventable is nothing new - barely a day goes by without a news story about binge drinking, overeating, or other lapses in basic self-preservation.

Always the misanthrope, Beyond the Bedpan is personally in the “let them suffer” camp. The UK is plastered with public health posters, TV ads and websites - surely by now it’s sink or swim.

Or maybe you disagree. Apart from sticking yet another poster on the side of a bus, is there some way the health service could help excessive sunbathers, smokers and drug-takers without breaking the bank?

Perhaps instead of drugs and surgery, you could start sending patients off with a pat on the back and a prescription for a preservation instinct. Here are a few things they could try, just for starters:

stand back from the edge of cliffs
cut up large foods (eg courgettes and carrots) before eating
open doors before attempting to pass through them
hold knives and forks by their blunt ends
and, for crying out loud, listen to nurses when they give you advice

Well, have you got a better idea?

Readers' comments (71)

mike | 3-Jul-2010 7:33 am
No I am firmly with you on this one. People have had enough free treatment, enough advice and enough help over the years, yet they still continue to purposely poison themselves and treat their bodies like s**t. It is their own damn fault.

I think one of the main reasons, apart from sheer stupidity, is the huge safety net that the NHS supplies. People know no matter what they do to themselves, the NHS will look after them.

Removing this safety net, by refusing to treat people if they refuse to change their lifestyle choices, or charging for the full cost of their care (the government can even call it a stupidity tax if they like?) will let all those smokers, alcoholics, drug users and obese people know that they have to take responsibility for their own choices.

Basically it will send a message, if you eat too much and don't excercise, you will get fat and it is your fault. Don't come crying to us. If you abuse drugs/alcohol/tobacco, you will develop serious health problems and probably die, then you can't come crying to us anyway.

Or on the other end of the scale how about offering a carrot to those of us who DO stay fit and healthy as well as a stick for the idiots out there.

For people like myself who are fit and healthy, do not smoke/take anything/drink etc, perhaps there should be a DECREASE in NI contributions? After all we will probably use it less. How about local councils building and offering a lot more gyms/pool facilities at subsidised prices?
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Anonymous | 3-Jul-2010 8:58 am
Agree with the first comment. The NHS is failing because the public abuses it, they have unrealistic expectations and they lack personal responsibility.
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Anonymous | 3-Jul-2010 9:37 am
NEXT YOU WILL BE SAYING ANYONE WHO CHOOSES TO LIVE OR WORK WITH A SMOKER AND GETS LUNG CANCER ITS THIER OWN FAULT SO DONT TREAT THEM EITHER. I THINK YOU ARE FORGETTING THE NHS PROVIDES SERVICES TO PEOPLE AND NON OF US ARE PERFECT. GET INTO THE REAL WORLD
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Anonymous | 3-Jul-2010 11:49 am
As I keep saying, it's time to stop pandering to the masses and get them to stand on their own two feet and be accountable for their own health.
We bang on about 'Public Health', there is only so much eduucation one can dish out and there is very little evidence that what is being done to reduce alcohol intake, increase exercise and eating healthily is making any difference at all.
We live in a 'Nanny State' and it has to change!
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Anonymous | 3-Jul-2010 12:16 pm
Excuse me, but if that smoker was your child (as is mine) would you refuse them care? I have tried everything; education, enouragement, bribary, bullying and loss of privilleges, but to no avail. She is an intelligent girl, but is addicted. No ghastly pictures on packets, chest infections or high price has made her change her habits. Shall I just say "go on then kill yourself why don't you"? Please think again fellow nurses, all our patients are someone's loved one, and we (as public servants) are not there to judge them. I agree that public money is wasted trying to change the habits of those like my daughter, but many are helped to quit risky behaviours through the support and advice from professionals like you and I. I won't stop helping my fellow man just because i disagree with thier life choices. They pay taxes too you know.
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mike | 3-Jul-2010 1:56 pm
Anonymous | 3-Jul-2010 9:37 am, No, that is why laws against smoking in the workplace were introduced, because society has started to realise how selfish smokers are and how damaging passive smoking is.

Anonymous | 3-Jul-2010 12:16 pm, Yes I would actually. My own parents are smokers, as is my brother. I am not. And I am perfectly willing to say they should be refused treatment if they refuse to stop smoking. As would I if any person became ridiculously obese and refused to lose the weight, or became addicted to drugs and refused to kick the habit.

I am not judging them for their choices (okay I am a little as I think those choices are pathetic, stupid and wrong), but I believe it is their choice to make. If they want to be obese, fine, you are only harming yourself. If you want to inject yourself with poison, same rule applies. Smoking is slightly different as their selfish habits affect others too, but the principle is the same. What I object to is having to pick up the pieces every time and pay for it. And yes, we all pay the same amount of taxes, but they are a lot more likely to use the services than I am, so where is my discount?

I am not against giving advice, I am not against giving support and choices and help through the NHS for those who want to change, who want to quit smoking/drinking/taking drugs/whatever and live a healthier lifestyle, but there HAS to be a limit. The resources of the NHS are finite, and running out fast.
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mike | 3-Jul-2010 2:03 pm
What I was originally saying though, rather than turning this into a slightly different debate, was that if the crux, the safety net was not there, then would people really still carry on with these self destructive behaviours? I dont think so, at least not to the same extent.

I also think the education needs to start earlier, in schools. The whole culture in this country is dead set against looking after yourself. Compare us to Australia for example, where sports are a big part of school life and everyone does at least some excercise almost every day. Over here the playing fields have pretty much been sold off and kids are lucky to get an hour or two of excercise a week! The outdoor healthy lifestyle is the norm in Oz, over here the norm is Jim Royal and the TV! Don't get me wrong, there are excpetions of course, but something cultural needs to change here, and fast. And I think that there are a whole raft of things needed to get that done. Removing the safety net of the NHS and the increasing of competitive daily sports in schools are just two of many.
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Anonymous | 3-Jul-2010 2:06 pm
Hmmmm!! Am l missing something here? I thought we, as nurses, are supposed to be non-judgmental and to treat everyone, and l mean everyone, without prejudice.
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mike | 3-Jul-2010 2:16 pm
Anonymous | 3-Jul-2010 2:06 pm, and we do. But that does not mean that we cannot have personal views or debate them in here without doing our jobs professionally. That is the definition of professional practice I think. It does also not mean that we cannot debate where the NHS resources should be spent. For example, it was recently said by an MP that health tourism should stop and anyone from abroad should pay private. Is he being judgemental? After all they are still human beings and need treatment? Get real.

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Anonymous | 3-Jul-2010 2:42 pm
Mike, l hear you loud and clear. I am married to an Aussie and we live here in blighty, things are not as perfect as you may think in Oz, but beaurocracy is certainly far less and things get done. However, in your words " get real " we have to do the best that we can with what we have. Yes we are all entitled to our personal opinions, but where does that stop? Would we be having the same conversation, for example if it were about race, age or sexual orientation. I think not. Self centure against bigotry of any kind is to be endorsed, professionally or privately.
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Anonymous | 3-Jul-2010 2:48 pm
Mike, I agree the public do appear to think the NHS can wave a free magic wand and repair damage caused by whatever action they have (or have not ) taken and if there was a mechanism to wake them up to the costs involved perhaps it would help.However I fear that would involve setting up several new departments.
Can I ask though Mike, on your planet does the cost for the elderly person who in an fit of complete selfishness decides to get up and walk and then falls over-do we not treat them for being so stupid? The terrible day trippers who go on a saga tour and withold their frusemide ? The list is endless.These selfish people who grow old !
Perhaps you're frustration lies in the fact that possibly too many social problems are medicalised and that is a problem that needs to be addressed but for goodness sake we're human beings life is difficult enough without the the standards committee being on guard at every hospital entrance or GP practice.
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Anonymous | 3-Jul-2010 3:34 pm
i think the government are responsible for smoking as they should have banned it years ago - then there would be no availability of cigarettes for the young to start. as long as they are readily available, people will be silly enough to start. i started smoking years after it was found to be harmful - i was idiotic enough to start, but it is an addiction and i have been labelled selfish...! it is the government who is selfish by continually importing and condoning this deadly habit, enabling vulnerable youngsters to start so they can be taxed to hell all their lives and suffer in health. as smokers are practically paying for their treatment in tax, i dont think anyone can point the finger at the individual. grow up, ban smoking, give the remaining addicts support for giving up or a special prescription, so within 70 years or so smoking will be abolished forever, and save the people who would otherwise fall foul to this sentence!
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Anonymous | 3-Jul-2010 4:49 pm
People's choices are often influenced by their environment, circumstances and then the affect of their genes on those choices.

Mike, you are far to simplistic and narrow in your view - of course you won't agree.

To start rationing health care on the basis of fault would be difficult - where would it end, people who crash their cars? people who have had sporting injuries, children who fall off trampolines?
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Anonymous | 3-Jul-2010 5:58 pm
The problem with banning smoking though, is that it will not work.
There are lots of substances that are banned, however people can and do still obtain them. And if anyone will know how to get their hands on them it'll probably be the young. Its a sad fact, but true...
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mike | 3-Jul-2010 7:48 pm
Okay, once again I seem to have a lot of comments aimed at me, it seems I get feathers ruffled! lol! So I will answer one at a time if I may.

Anonymous | 3-Jul-2010 2:42 pm: Of course there is a line of self censorship. Some may have that line a degree or two higher or lower than others, but the vast majority of us I think would know where the line of bigotry is, and this discussion is not.

And I know things aren't perfect in Oz, but they are far closer to that ideal than our own country in my opinion.

Anonymous | 3-Jul-2010 2:48 pm: There is a vast and obvious world of difference between poor lifestyle choices and accidents or growing old. Accidents and growing old are not CHOICES! I have argued against that particular tack many times and I am afraid your argument never comes off well. Let us take sporting injuries for example. People who partake in sports of any kind, whilst at risk of injury, gain far more benefits than risks, and are far less likely to ever need the NHS. Furthermore the cost of treating an acute injury (say a broken bone) is often far, far less than treating an LTC such as COPD due to smoking.

Anonymous | 3-Jul-2010 3:34 pm, you never aimed your post at me but I will reply if I may? I absolutely agree with you that the government should completely ban tobacco. However it is still individual choice at the end of the day, so I think that fingers can be pointed.

Anonymous | 3-Jul-2010 4:49 pm. Ah, simplistic and narrow in my view? Try educated and broad minded and you may be on the right track.

Yes socio economic, cognitive, religious and psychological factors can affect choice, this is the fundamental tenet of Glassers choice theory. All Total Behavior is chosen, but we only cannot control two aspects of it, feeling and physiology. We have no choice ove these directly at least. We DO have direct control over the acting and thinking. For example, if 'I' as a person act in a certain way, (I smoke), and I think in a certain way (I think smoking is good) then we have control over these choices. I can for example say I choose to think smoking is bad. I choose not to smoke. We can only control our feeling and physiology indirectly through how we choose to act and think

Basically the same fact always comes through. The choice is yours. The reasons behind the choice are often arbitrary, the point is it is still a CHOICE.

Simplistic and narrow? Try again!
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Anonymous | 3-Jul-2010 10:02 pm
Well if alcohol and tobacco were discovered today they would never get off the table, because they are so addictive and anti social.

If we are going to start rationalising NHS care and treatment then we really should be looking at the majority of corrective surgery and I'm afraid IVF.

Nobody has ever died of not having a baby or a breast enlargement have they. No I don't mean all 'plastic' surgery having worked in a regional unit I appreciate the difference some surgery makes to peoples lives.

Life choices should not be funded by the NHS to the extent they are at present, but there have to be limits.
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mike | 3-Jul-2010 10:23 pm
Anonymous | 3-Jul-2010 8:29 pm, I agree that some Nurses are the worst culprits, but I am innocent of all of these so let the stone chucking begin! Ha!

And Anonymous | 3-Jul-2010 10:02 pm, I absolutely agree on all your points.

However I think we have gotten slightly off topic. The big question is why the hell are people in this country in general so crap at looking after our own health and taking responsibility for our own lifestyle choices?
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Anonymous | 4-Jul-2010 0:44 am
they are not, just the ones we see in a&e are. However if you want to hand out a pistol whipping to those guilty of health naivte, followed by an execution with the cost of the bullet sent to the victim/patients family I suggest you are in the wrong job. Or maybees it's just a bit of burnout. Just a wee thought.

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Anonymous | 4-Jul-2010 7:54 am
In my experience some nurses have compassion and in some it seems pretty hard work to detect.
I suggest we stop pedalling the myth that 'of course we all have compassion and are not judgemental' because, even going by this small post, it simply is not true and usually followed by a big fat BUT......
I would also suggest that a punitive, martial approach does not sit very comfortably with a compassionate, patient centred attitude as a public servant.
Maybe we need to call Supernanny!

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mike | 4-Jul-2010 8:37 am
Anonymous | 4-Jul-2010 0:44 am,

It is not just the people we see in A&E though is it? How many obese people do you see waddling round the town centre? How many people chain smoke? Binge drink? Take drugs? Burn themselves a wierd shade of orange on a sunbed?

As I said earlier it is not a pistol whipping I want to hand out, I think health choices are a person own choice to make, regardless of how stupid I think a lot of those choices are. It is their buisness. I just do not see why the NHS has to foot the bill for these choices every single time?

What I would like to see is more and more people taking responsibility for their own health and making the right choices. If they don't, then that is their choice, but they should live with the consequences of those choices.
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