Responsibility for your own health

I was shocked to see that the NHS could ban surgery for the obese and smokers.  That’s socialized medicine.  You take a conglomerate group of people (the UK) on a limited budget for healthcare… and basically find the cheapest most cost-effective way to deliver healthcare.  But in a way, it’s empowering patients to take responsibility for their own health.  Smoking, for sure — I agree 100% that surgery should be banned for this population.  Obesity is a bit trickier — there’s genetics and environmental factors at play in this one.  I don’t think anyone chooses to be obese.  But, people do have the power to change their eating and exercise habits.  Despite these efforts, there are some people who are still obese…. and these people should not be faulted.

Why single out the obese and smokers?

From SlideShare
From SlideShare

Smokers and the obese have elevated surgical risk and mortality, which means more cost to treat and hospitalize and provide ongoing care.

From HealthStats

I think the NHS is on to something here.  They’re opening doors to moving the liability and responsibility away from physicians and towards patients.  This is a plus.  Outsiders may see it as separatism and elitist to only provide care for people who are healthy.  But look at the facts and the data…. obesity has a lot of co-morbidities associated.  Smoking has a lot of co-morbidities associated as well.  Why should physicians be penalized for re-admissions, poor wound healing, longer hospitalizations when the underlying conditions themselves are already challenging enough?  In fact, I would urge insurance companies to provide incentives to patients/the insured with discounted rates for good and maintained health and wellness.  With all the technologies, medications, and information out there, it’s time patients take responsibility for their own health.  I take responsibility for mine — watching my diet, exercising, working on getting enough rest, maintaining activities to keep my mind and body engaged, meditating for rest and relaxation.  It’s not easy, but my health is 100% my responsibility.  I refuse to pass the buck to my husband, my family, my physician, etc.  I do what I can to optimize my health and future — and if that doesn’t work… I call for backup.

Patients need to change their mindset re: health.  It is not your spouse’s responsibility to track your meds.  It is your responsibility to know your medical conditions and surgical history.  The single most important (and thoughtful) thing a patient can do is keep an up-to-date list of medications, past/current medical history, surgical history, and allergies to bring to every doctor’s appointment and surgery.  This helps streamline and bring to the forefront your conditions and how these will interplay with your medical and surgical plan and postoperative care.  Please do not forget recreational drugs, smoking habit, and drinking habit in this list.  It is very important to know all of these things.  Also, your emotional history is very important.  Depression, anxiety, failure to cope, etc.  This all helps tie in your current living situation with stressors and your medical history.

Links for educating yourself in taking responsibility for your health:


Walk the line

March 2, 2010

OB Anesthesia can offer a wide entertainment of cases and patients. For example, there is the “uncomplicated” mom who delivers smoothly without complication. There’s the “drug” mom who requests everything under the sun to be comfortable…. or the literal “druggy” mom who is able to tell you where they have the best IV access. Let’s not forget the “perfectionist” mom who has everything planned out from conception to birth. There’s the “multips” who have been through the pregnancy process and are seasoned…. who for the most part are very cooperative and know what to do. The “teeny bopper” moms who often wince at just getting an IV — someone should tell these guys that pregnancy and birth isn’t just about the intercourse and then the baby. There’s the “IVF-ers” who tend to be very nervous about everything along the way, but they’re often the most appreciative of everything you do for them. And finally (maybe I covered them all, but I’m sure I haven’t), there’s the “I just want to be knocked out” mom who basically wants an elective c-section and general anesthesia so they don’t know or feel anything.

Of course, these are just my opinions of the populations I have come across; not true facts. And yes, I realize pregnancy can be a very nerve-racking process. These are just MY descriptors….

Came across an interesting OB anesthesia case. A pt who had an accreta. This was most likely due to her previous 4 c-sections… and she desired a hysterectomy.

Our plan: Multiple large bore PIVs. Arterial line. Type & crossed blood pre-op. Pre-op labs. Blood and fluid warmers. Belmont. Backup RIC and MAC lines available in the room. Peripheral phenylephrine with backup norepi if needed. Epidural anesthesia with backup emergent GA. Constant communication with the surgeons. SICU bed available if needed.

Outcome: Baby delivered and did beautifully. Roughly 1.5L EBL, 2.5L LR. Post hysterectomy ABG with stable Hb. A-line d/c’d. Pt back to OB Labor floor for a couple of hours of monitoring. No SICU bed needed.

Sometimes a full day’s plan helps ward off the evil. It’s nice when you get to deviate away from the “normal” OB anesthetic…and everything goes well. Even if it does seem like over kill.