Blatant Discrimination

I recently learned some surprising discrimination. A local committee part of the NHS in the UK has decided to institute what I call blatant discrimination.

"...one local health committee in the UK has announced a controversial policy "to support patients whose health is at risk from smoking or being very overweight."

For an indefinite amount of time, it plans to ban access to routine, or non-urgent, surgery under the National Health Service until patients "improve their health," the policy states, claiming that "exceptional clinical circumstances (will) be taken into account on a case-by-case basis."

The decision comes from the clinical commissioning group (known as a CCG) for the county of Hertfordshire, which has population of more than 1.1. million.

The time frame for improving health is set at nine months for the obese in particular; those with a body mass index over 40 must reduce the number by 15% over that time period, and those with a BMI over 30 are given a target of 10%.

The target for smokers is eight weeks or more without a cigarette -- with a breath test to prove it."

I could not believe this. Some 'holier than thou' sorts have clearly decided that they are better than those evil people who are overweight or smoke.

Look I was a smoker for far too many years to count. Its not an easy habit to quit. Smoking has been called more difficult to quit than heroin. It takes many people months or years and many tries to quit. Eight weeks to quit is a very tight deadline. And a breath test? Seriously? Like a breathalyzer?

I find the obesity one even more offensive. Is it my fault that I have managed to gain multiple pounds (so many that I find appalling) over the past twelve years? Is it because I have so many ailments? Is it because I am on so many medications with the side effect of 'may cause weight gain'? Is it because I like to make a nice dinner for my husband every night? 

Can I lose weight? With great difficulty. If I wasn't recovering from knee surgery I would regularly exercise. But that wasn't making me much thinner. Its very difficult for me to lose weight. And I am not the only person who has problems losing weight. There are many people with medical problems, metabolism issues, and more that would have to eat only lettuce leaves to lose weight. Some people just have a predisposition to being heavy.

Finally, the BMI is not a perfect measurement. There are many who disagree with it.

I cannot believe in this day and age, people in medical professions would blatantly discriminate against people who are fighting hard issues - quitting smoking or losing weight. And then denying them medical care based on these same issues. Well, at least I am not the only person who finds these policies horrible:

"The new policies came under immediate attack from experts and interest groups.

"Singling out patients in this way goes against the principles of the NHS," said Ian Eardley, senior vice president at the Royal College of Surgeons in the UK. "This goes against clinical guidance and leaves patients waiting long periods of time in pain and discomfort. It can even lead to worse outcomes following surgery in some cases."

The conversation has been going for some time, experts agree, but the question is the ethics -- and whether it would even work.

"Rationing treatment on the basis of unhealthy behaviors betrays an extraordinary naivety about what drives those behaviors," Robert West, professor of health psychology at the UCL Research Department of Epidemiology and Public Health, wrote in an email."

I am not alone but these are just blatant discrimination.

Being A Bad Patient Vs. Being A Rude Patient

There is a vast difference from being a bad patient as opposed to being a rude patient. Yes I know often when we go to the doctor we are not feeling are best and are probably prone to over reactions and stress. But there is no reason to be rude.

So I was appalled when I read this article on the amount of the abuse faced by doctors. Medical doctors have studied for many years. They know what they are doing. They are professionals who are trained to take care of people. They are human beings, just like you or me. So there is no reason to be rude to them.

"A wide-ranging survey of more than 800 U.S. physicians, conducted by WebMDand Medscape in collaboration with STAT, found that 59 percent had heard offensive remarks about a personal characteristic in the past five years — chiefly about a doctor’s youthfulness, gender, race, or ethnicity. As a result, 47 percent had a patient request a different doctor, or ask to be referred to a clinician other than the one their physician selected.

Fourteen percent said they had experienced situations in which the patient complained, in writing, about the doctor’s personal characteristics.

African-American and Asian-American physicians were more likely to face such attacks, and female doctors were more often the victims of bias than males. But patients found targets in every imaginable corner: 12 percent of physicians, for instance, endured offensive remarks about their weight."

Does it really matter about a doctor's age, weight, gender, race or ethnicity when they are treating you? I do realize that some people prefer a male or female doctor for certain exams but there is no good reason to be rude to them about any of those demographics.

And certainly swearing or using derogatory or racist terms when referring to the doctors is just plain wrong. What does it matter what they weigh? I know all my doctors seem to be toothpicks, at that perfect BMI, and I feel fat next to them. 

When I first saw the title to this article,  I assume it was about the abuse nurses face on a daily basis - where they are hit, bit, pushed, shoved and more. This is another significant example about how a profession is being abused by the rest of us. 

A significant part of this issue is that many doctors have to resources to support them when faced by this kind of treatment from patients. What are they supposed to do, bite their tongue and keep treating them? Verbal abuse can leave emotional bruises where no one can see them but they still deserve help. And its just sad if hospitals need to provide resources to protect the people they hired to take care of others.

There is no room in the world for this kind of treatment. No one deserves this kind of treatment, especially someone who has studied for many years and wants to take care of people.

Cancer Discrimination and Bias

We live in a society full of bias which leads to racism, discrimination, fear and hatred. The media recently has reflected this with headlines full of racism, bias, discrimination, alt-right vs alt-left, protests, anti-protests, riots, deaths, fear, hatred and more. But it reminds me that there is bias, fear, and discrimination for those of us with cancer.

We are born one way and learn about bias, fear, and discrimination based on where we start. With a cancer diagnosis, all of this is turned upside down and we learn about more bias, fear and discrimination based on that single word 'cancer'.

First, let me say times are changing and it is getting better for those of us with cancer. I met a young woman once who was diagnosed with thyroid cancer at age 17 about 1980s. Her parents were embarrassed that their family member (daughter) had cancer and never told her and never allowed he to have the appropriate follow up treatment, radioactive iodine. She has had multiple recurrences since. Times are certainly better but not perfect, as seen in today's headlines.

For those of us with cancer, we face these issues all the time:

Fear: how many of you have been avoided after your cancer diagnosis? All? I think so. Those are the 'friends' who are scared cancer is 'catching'. Or they do not know how to react to someone with cancer.

Discrimination: Don't tell your current or any potential boss you have cancer or you will face discrimination somewhere along the line. "She's a perfect candidate, but with her health will she be able to do the job long term? She will probably need a lot of time off for doctor appointments." This is illegal but it happens. Its not shouted but whispered. And all it takes is one person to think this who looks at your resume to put it in the discard pile to seal your fate.

Bias: You are sick so obviously cannot be expected to be in with the 'cool kids' any more. You are in with the dweebs at the back of the class again. Your social fate is also doomed. And those who welcome you are doing so with phony smiles over their secret fears.

With our cancer diagnoses under our belts, we learn who are friends are and go forward with them to face the fear, discrimination, and bias that is now in our lives forever. With big smiles on our faces.

Health discrimination

Discrimination can be in many forms. Sometimes its overt and sometimes insidious (I can use big words today but needed spell checker's help) and sometimes hidden away. But now health discrimination based on weight? That's taking it a bit too far.

A chef from South Africa was told by New Zealand authorities that he was too fat to live there. He has been there for six years and has lost 66 pounds since arriving. He now weighs 286 lbs which is not healthy unless he was really, really tall. Upon renewing his annual work visa, he was told his weight would cause health problems and they didn't want him. A little ironic since obesity is a big problem with 30% of New Zealanders being obese....

This is clear health discrimination. So what if I decided to move to New Zealand with my health background? Would I be welcomed? I have many more health problems than being fat. I would be a burden to any health care system....

So seriously New Zealand. Really? If 30% of your population is obese maybe its time to work on your national health guidelines instead of singling out a chef who has actually lost a fair amount of weight.
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Now on to happier news. I always wonder if anyone reads my blog and anyone cares about what I write. But apparently people do read it and do care. I am honored to say my blog was just named as one of the top 24 breast cancer blogs of 2013 by Healthline. I have a perky new label on the right and you can read about all the other blogs which also named here. I recommend following them to keep up on some great stories with coping with breast cancer.

Fired for breast cancer

It appears that Kathleen Mason worked for the most unreasonable and insensitive bunch of people around. She was the CEO of Tuesday Morning, a Dallas based retailer. She was diagnosed with breast cancer in January and February and was fired over the phone (over the phone - really?) three months later even though she had insisted that her diagnosis and treatment would not interfere with her ability to do her job.

Now I don't know all the facts of her diagnosis and treatment - what protocol she had - surgery, chemo, radiation or what. It is clearly her decision on being able to cope with treatment and her job at the same time. Many women work through treatment.

She also had the job for 12 years and the excuse was that sales have been down for recent years. If sales were down maybe they could have asked her for a plan of action to correct that but you don't fire a 12 year executive with out advance warning over the phone. Stupid and discriminatory.

And they want to keep her as a consultant for the next 10 years - meaning they still value her opinion - so why did they fire her? Did the word cancer scare them? Or were they just stupid as now they have lost a good employee, destroyed their reputation (I would boycott them if they were local), and opened themselves up to a lawsuit. Maybe not stupid, just chicken. And dumb.

Equality and preventative care

So the benefits from the new health care act are starting to kick in. Starting today, insurance companies need to provide women with contraceptives, breast-feeding supplies and screenings for gestational diabetes, sexually transmitted infections and domestic violence, as well as routine check-ups for breast and pelvic exams, Pap tests and prenatal care. Well many insurance companies will. Some are still grandfathered in but as their plans are forced to change in the future they will lose their grandfather status.

If you read this article over on CNN.com and the comments that follow, its interesting how many men are against this because they feel its not fair. (Allow me to be a bit sexist on this.) Oh, the poor things, they have nothing to do with making babies, sexually transmitted diseases, and domestic violence. They are claiming its unequal. Well pooh to them. They get their Viagra paid for.

And to those who say free means everyone else pays for it the point of preventative care as these mostly are is to catch things early before they are discovered too late and the treatment costs are exorbitant and often result in death. That's a really big expense.

Bias against disease

This article reminds me of the bias that exists with a disease diagnosis. How often do we hear 'Did you hear Susie's brother has cancer?' 'How sad. He was such a nice man.' Instantly a diagnosis becomes a mental death. The patient is written off and sent to some other world. When their death finally occurs, whether in one year or fifty years, you hear 'he was such a fighter, he struggled so long and hard'. But I don't think these people actually knew the patient and what he went through as they wrote him off at the diagnosis.

Leper colonies were the previous centuries way of creating bias and discrimination against those with a disease that was understood and feared. Now we don't physically  put people in hidden colonies as much. (I believe still in parts of Asia those with an HIV diagnosis are sent to secret villages.) But we still mentally write people off when we hear such a bad thing. No they didn't move to Australia, they still live down the street and go to the doctor a lot.

So I am very happy to see the kind of support people who get it do know. I 'know' Michelle from her blog which was recently renamed 'Mission Remission'. She is a young mother who was diagnosed with colon cancer in 2008 and now is going through a recurrence. She has amazing support. In addition to her blog she has a fan page on Facebook with hundreds of supporters who help her with donations to help her and her family and support her through this latest cancer adventure. This is a good story.

However, then I read the story of an Iranian woman who is trying to get permanent residency in Canada. She has been there on a student visa since 2005 and trying to get the residency visa. However, since her application she has been diagnosed with breast cancer. So now the concern is that a return of her breast cancer would cause a strain on the health care system. (First of all who knew that you need a medical exam to get permanent residency in Canada - how's that for discrimination?) You can't live there if you are sick and might strain the health care system. This woman is a victim of circumstance. I am sure this would not be an issue if she did not have a breast cancer diagnosis.

Phooey to the Canadian government on this one. This is bias. Along with a bit of stupidity as well. One case of breast cancer is not going to destroy the Canadian health care system and if it is, then the healthcare system is in very poor condition. And its not like its contagious and going to infect millions of others.

Face it, in our life times, everyone will get there share of medical issues. There are some luckier than others who may not need as much care as the rest of us. Then there are people like me who get more than their share of medical care. There is no way of knowing who will get what and when.  So why do we have people who create and allow such bias and stick cancer people in our modern 'leper colonies'?

Its discrimination

As soon as you start treating people differently because of their health, age, skin color, language, eye color, height, weight, shoe size, pant size, food allergies, eating preferences, ability to use chopsticks or not, career aspirations, job, salary, or whatever, you create discrimination.

When you are first diagnosed with cancer, you believe everyone will know that you have cancer as it is tattooed on your forehead for the world to see. They see the word cancer and either:

a. Run away - because they might catch cancer cooties or they just don't know how to talk about this.

b. Tell you how you can be cured - they know because their neighbor's second cousin's hair stylist's dog groomers, great nephew had a completely different kind of cancer thirty years ago and it cured him.

c. Ignore it and pretend you have nothing wrong with you. Now there is an upside to this - they aren't treating you differently but they still expect you to go drinking and bar hopping until 3 am and call you a party pooper when you say you can't because you have to get up early for chemo and they frown on patients with massive hangovers.

d. They treat you just about the same but understand you may not feel up to snuff for everything you used to do. This is not treating them differently this is adapting to a change in their life.

In my professional opinion with 29 years (yes really) of experience in this is that answer d is correct. Don't really treat them any differently. The other answers are a combination of fear, stupidity, ignorance, and discrimination (which is really stupidity and ignorance and fear combined).

So now the NCAA wants to start requiring all student athletes to be tested for the sickle cell anemia trait. Why are they doing this? Because lawyers and insurance companies got involved after a student athlete died because of his sickle cell issues. (Now there is nothing wrong with lawyers and insurance companies, they do a lot of good in the world, but this is clearly another case of a CYA maneuver.)

First of all, the rate of sickle cell traits in African Americans is 8 times that of Caucasians. This would reinforce bias and prejudice for the wrong reasons. Can you say 'genetic discrimination'? Regardless of skin color, this is creating two classes of athletes.

Second, just because you have the sickle cell trait, doesn't mean you have health risks. Apparently you need two parents with sickle cell traits to create a child with real problems.

Third, if you have sickle cell issues you are supposed to (and I quote): 'to stay hydrated and know when to take breaks. It's about knowing your body.' And how is this any different than what an athlete or anyone exercising should be doing?

Finally, why can't the NCAA just do what the US military is doing since the 1970's by revamping the training protocol to eliminate the risk of heat-related illnesses and exhaustion for everyone. Why create another possible area for bias?

I feel my health history is on a need to know basis. If you don't need to know, I'm not telling. Same with sickle cell testing - what is it doing as a screening for college athletes other than creating bias and 'haves' and 'have-nots' categories?

Otherwise my day started off on a rosy note - can you say sunrise? We left our adventures in northern WI at 5:50 AM. I didn't sleep well last night due to back pain, etc. Now we are in southern MN - far away from where we started. I am going to productively work from my friend's condo while she has gone to her office. I am exhausted and can't spell (giving spell check a workout). I really do have work to do but the overwhelming urge to nap may take over...