There is no doubt that patients’ lifestyles influence their state of health. Their dietary habits, alcohol consumption, smoking and sexual practices are the main, but not only factors in this. To doctors this is of limited relevance. Certainly we should adopt a preventive role in advising our patients of their lifestyle practices that can potentially impinge on their health, but even this has it’s limits. While no-one would argue that we should encourage our patients to stop smoking, how many doctors would advise patients to give up horse riding (128 deaths/yr per 100,000 participants) or other risky sports.
By the time patients present to us with the consequences of a lifetime of bodily abuse however lifestyle becomes unimportant when it comes to treatment options. At this stage we simply have to treat to the best of our ability. This is crystallised by the GMC good practice guide at para 7; “You must not refuse or delay treatment because you believe that a patient's actions have contributed to their condition.” and “You must not unfairly discriminate against them by allowing your personal views to affect adversely your professional relationship with them or the treatment you provide or arrange. This includes your views about a patient's age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status.”
So what do you do when your Trust proposes to engage in precisely that sort of discrimination as is happening here, and is going to require your co-operation to apply it. To co-operate puts you in breach of GMC good practice guidelines, while to defy puts you most definitely in the firing line as far as your employer is concerned.
The GMC does seem to have this covered as they state; “If inadequate resources, policies or systems prevent you from doing this, and patient safety is or may be seriously compromised, you must follow the guidance in paragraph 6.”
So what does it say at paragraph 6? This is where suddenly the crystal clarity suddenly deserts the GMC and they are a little more wooly” you should draw the matter to the attention of your employing or contracting body. If they do not take adequate action, you should take independent advice on how to take the matter further. You must record your concerns and the steps you have taken to try to resolve them.” Firstly you are supposed to stick your head above the parapet and start making a fuss. And when, inevitably, your expressed concerns are ignored then what. Then all of a sudden it is for someone else (unspecified) to advise you. What a cop out. The logical next step of course is whistleblowing but as I have pointed out before this is likely to have catastrophic repercussions, despite the presence of legislation supposed to protect you.