Questions are being raised about the case of a 36-year-old Ontario woman who died of liver failure after she was rejected for a life-saving liver transplant after a medical review highlighted her prior alcohol use.
Doctor here who has referred patients for transplant. No. You must be six months sober to be eligible for the transplant list. There’s so few livers to go around, they need to be sure the recipient isn’t going to just break the next one.
It’s rare to suddenly need a liver; they usually take months to fail and this gives the patient and doctor months of notice to try treating the failure first (including lifestyle changes and meds) before getting sick enough to go apply for a transplant.
I used to trust HCPs, but I know many of them now and have heard them shit-talk and judge their patients for mental health issues and drug use (among other things). I would NEVER, EVER tell a doctor or nurse about any form of drug or alcohol use now, or any kind of anger issues that could possibly be interpreted as aggressive. Especially not in a hospital where everything gets recorded in an electronic chart and may be used against you in the future. Fuck that.
I’m sorry you have such a low opinion, maybe you heard someone venting about their job after work?
You really think lying about your drug use is safe? It’s dangerous to give many types of anesthesia if you’re on drugs or alcohol. We don’t particularly care if you use or not, we don’t tell police or family, you just need to be honest so we can do our job correctly.
If I was going under anesthesia for a planned procedure, I would not drink or use drugs beforehand. If it was an unplanned emergency, I guess it would depend on the circumstances, but you are citing an extreme circumstance. If someone is actively high at the time they end up in the emergency department, well, that’s bad luck and it might be wise to disclose since the staff will figure it out pretty darn quick anyway. Same if you are a severe alcoholic or opiate addict. That’s not what I’m talking about, though. I’m talking about when doctors or nurses ask you about it as a lifestyle question.
You know as well as I do that the health care system classifies people in terms of their risk factors and then use that profile to make decisions about you. Once classified as a “drug user” in your chart, many doctors and nurses will treat you differently. They may or may not “care” from a moral perspective, and we know that they won’t tell family or police, but that won’t necessarily stop them from denying you necessary pain relief or deprioritizing you in triage. That’s the actual concern.
There is absolutely no reason to tell a doctor if you use cannabis or engage in moderate alcohol use or occasionally use cocaine, LSD, or psylocibin. If you are prescribed a medication that has an interaction with a recreational drug, the doctor can simply tell you that. They don’t need to know if you use that drug from time to time. Only you, the patient, need to know that so you can avoid the interaction. More extreme forms of drug use are a different story, of course.
Edit: Let me add one other overarching point. I think people are sick and tired of having doctors make decisions for them. I don’t need a nanny. I need information about risks and benefits in order to make an informed choice. Doctors rarely do that. Instead, they decide what should be prescribed, or not prescribed, regardless of the patient’s wishes. I know the reason is fear of liability, but here we are nonetheless.
Ah, you think you know better than doctors. Many people think this. Many have bad outcomes with nobody to blame but themselves.
I don’t care if you use cannabis, heck I can legally prescribe you some if you need it. Doctors are not law enforcement. I don’t bat an eye if you tell em you use cocaine, I’ll still give you morphine after surgery but I need to know you used cocaine so I can avoid beta blockers. You’re paranoid we’re judging you but you’re wrong. You’re not as rare as you think. We know you’re in pain regardless of your drug use and treat you anyway.
Only you, the patient, need to know that so you can avoid the interaction
Many idiots who died in hospital thought that too, which is why we make you sign consent forms so that your family can no longer sue us for your stupid mistake.
It’s like you have no idea how doctors work and have an outdated idea of them. Your loss.
You misunderstand me. I don’t think I know better than doctors. Far from it. What I want from a doctor is information and informed choice, not a gatekeeper who makes decisions for me. As a group, physicians have been slow to adopt the patient-centered informed choice mentality that, for example, nurse practitioners and midwives have more thoroughly adopted.
The fact that you’ve doubled down here on calling patients idiots for being somewhat distrustful of the typical arrogant physician attitude confirms what I’m saying.
Doctor here who has referred patients for transplant. No. You must be six months sober to be eligible for the transplant list. There’s so few livers to go around, they need to be sure the recipient isn’t going to just break the next one.
It’s rare to suddenly need a liver; they usually take months to fail and this gives the patient and doctor months of notice to try treating the failure first (including lifestyle changes and meds) before getting sick enough to go apply for a transplant.
I used to trust HCPs, but I know many of them now and have heard them shit-talk and judge their patients for mental health issues and drug use (among other things). I would NEVER, EVER tell a doctor or nurse about any form of drug or alcohol use now, or any kind of anger issues that could possibly be interpreted as aggressive. Especially not in a hospital where everything gets recorded in an electronic chart and may be used against you in the future. Fuck that.
I’m sorry you have such a low opinion, maybe you heard someone venting about their job after work?
You really think lying about your drug use is safe? It’s dangerous to give many types of anesthesia if you’re on drugs or alcohol. We don’t particularly care if you use or not, we don’t tell police or family, you just need to be honest so we can do our job correctly.
If I was going under anesthesia for a planned procedure, I would not drink or use drugs beforehand. If it was an unplanned emergency, I guess it would depend on the circumstances, but you are citing an extreme circumstance. If someone is actively high at the time they end up in the emergency department, well, that’s bad luck and it might be wise to disclose since the staff will figure it out pretty darn quick anyway. Same if you are a severe alcoholic or opiate addict. That’s not what I’m talking about, though. I’m talking about when doctors or nurses ask you about it as a lifestyle question.
You know as well as I do that the health care system classifies people in terms of their risk factors and then use that profile to make decisions about you. Once classified as a “drug user” in your chart, many doctors and nurses will treat you differently. They may or may not “care” from a moral perspective, and we know that they won’t tell family or police, but that won’t necessarily stop them from denying you necessary pain relief or deprioritizing you in triage. That’s the actual concern.
There is absolutely no reason to tell a doctor if you use cannabis or engage in moderate alcohol use or occasionally use cocaine, LSD, or psylocibin. If you are prescribed a medication that has an interaction with a recreational drug, the doctor can simply tell you that. They don’t need to know if you use that drug from time to time. Only you, the patient, need to know that so you can avoid the interaction. More extreme forms of drug use are a different story, of course.
Edit: Let me add one other overarching point. I think people are sick and tired of having doctors make decisions for them. I don’t need a nanny. I need information about risks and benefits in order to make an informed choice. Doctors rarely do that. Instead, they decide what should be prescribed, or not prescribed, regardless of the patient’s wishes. I know the reason is fear of liability, but here we are nonetheless.
Ah, you think you know better than doctors. Many people think this. Many have bad outcomes with nobody to blame but themselves.
I don’t care if you use cannabis, heck I can legally prescribe you some if you need it. Doctors are not law enforcement. I don’t bat an eye if you tell em you use cocaine, I’ll still give you morphine after surgery but I need to know you used cocaine so I can avoid beta blockers. You’re paranoid we’re judging you but you’re wrong. You’re not as rare as you think. We know you’re in pain regardless of your drug use and treat you anyway.
Many idiots who died in hospital thought that too, which is why we make you sign consent forms so that your family can no longer sue us for your stupid mistake.
It’s like you have no idea how doctors work and have an outdated idea of them. Your loss.
You misunderstand me. I don’t think I know better than doctors. Far from it. What I want from a doctor is information and informed choice, not a gatekeeper who makes decisions for me. As a group, physicians have been slow to adopt the patient-centered informed choice mentality that, for example, nurse practitioners and midwives have more thoroughly adopted.
The fact that you’ve doubled down here on calling patients idiots for being somewhat distrustful of the typical arrogant physician attitude confirms what I’m saying.
Their boyfriend was willing to be a living donor for them. So you aren’t talking about a scarce resource here.