GP attacked for removing 60-a-day smoker from list

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The Independent Online

Health Editor

A GP who does not like the smell of cigarettes, and is refusing to treat an elderly arthritis patient who smokes up to 60 a day, has been roundly criticised by fellow doctors and patient groups. Dr Ian Farmer, of Ashford, Surrey, wrote to Elizabeth Pratt, 75, informing her that her name has now been removed from his patient list. The letter states: "I find that I am unable to tolerate the environment within your home. I am a non-smoker, andI fi nd the heavy odour of cigarette smoke in your flat makes my eyes water, my chest feel tight and my clothes smell." Last night, Mrs Pratt's daughter, Janet King, with whom Mrs Pratt lives, reacted furiously to the doctor's actions. "At 75, you have earned yourself a doctor, surely," she said."This could open the floodgates ... to doctors being selective about their pa tients." Dr Farmer's actions have renewed fears about the creation of a group of NHS patients whose social behaviour or moral beliefs are limiting their chances of treatment. A GP in Presteigne, on the Welsh borders, came under fire last year after removing eight children from his patient's list because their parents did not want them immunised. The Patient's Association has said it is increasingly concerned at the number of patients being struck off GP's lists for apparently superficial reasons. In some cases cost is thought to be a factor, with chronically ill patients who require expensive dr ugs, although hard evidence of this is scarce. The British Medical Association said that a dislike of cigarettes was "insufficient reason" for a GP to strike off a patient. "There may be other factors involved which have led to a breakdown of the patient-doctor relationship but this on its own does n ot seem acceptable." Dr Farmer, who was unavailable for comment yesterday, told Mrs Pratt that he had thought the matter over "long and hard" before reaching a decision. He told the Sunday Telegraph: "I could not spend the 20 minutes or so with her that I would want to durin g a home visit, so she was not getting the treatment she deserved. If I am unable to do my job then the patient would be better advised to see another GP." Mrs Pratt worked at Ashford Hospital for more than 20 years before ill health forced her into retirement. Mrs King said she had offered to take her mother to the surgery so that home visits were unnecessary, or have her see another doctor at the practice who does smoke. Both suggestions had been rejected, she said. Mrs Pratt, who suffers from osteoarthritis, needs regular prescriptions for pain killing drugs and steroids, and was seeing a doctor once every two or three months. She had been on Dr Farmer's list for six years. An estimated 85,000 patients were removed from GP's lists in 1993-94. An attempt to have the law changed so that GP's could only remove a patient under clearly defined circumstances, such as violent behaviour, failed last year.