Why Doctors Should Rethink Smoking

I went to the doctor recently to get my hormones checked.  I was positive I was beginning the long, slow descent into the black hole of menopause.  That HAD to be it.  I was moody and angry and depressed.  There were so many good things happening in my life, and yet I had this big ball of intense crying just behind my eyes waiting for the slightest provocation to burst forth.

I mentioned all of my symptoms to my doctor, plus I added that I had quit smoking (again!) about a month before.  He nodded, ordered blood work, referred me to a gynecologist, and scheduled me for a transvaginal ultrasound.

The labs came back within normal limits.

The gynecologist will be seen in two weeks simply because I’m due for a Pap smear.

The ultrasound was cancelled.  I thought it was overkill, and since I consider myself to be the primary player in my own healthcare, I get to trump the doctor.

I knew what the truth was.  I was jonesing.  I’ve tried to quit smoking at least 746 times . . . diligently.  I have rarely made it through an entire month stretch.  The symptoms that drove me to the doctor were simply brought on by moving through another threshold of withdrawal.  The key to my issues was completely overlooked by my well respected primary care physician.

A few years ago, a friend of mine was in the hospital.  I was visiting her when the doctor came in the room.  In the course of their conversation, he asked, “You don’t smoke, do ya’?”

“Sure do,” she replied.

“Oh,” he said.  “I thought you were smarter than that.”

It took me a few minutes to process this conversation.  By the time I determined a reply, he was down the hall.  I should have chased him.  I should have grabbed him by his white-coat lapels and said, “How dare you?  How can you call yourself a medical professional and belittle your patient in this way?  If she had just declared that she was an alcoholic or a heroin addict or a little too dependent on prescription painkillers, you would have addressed her issue with the gravitas expected from a medical professional.  You would have considered that information in her treatment plan.  You would never dare look an Oxycontin addict in the eye and say, ‘I thought you were smarter than that.'”

Nicotine addiction is a serious issue, and the approach that doctors and nurses usually take desperately needs to be reconsidered.   Belittling your patient is neither effective nor professional.  Ignoring that aspect of a patient’s overall health picture is perhaps missing the easiest path to a diagnosis.  Doctors need to have honest conversations with patients about smoking without that undercurrent of moral judgment.  Save the guilt trip for my mother.

Smoking isn’t a wise choice.  Most smokers I know wish they could go back in time and never start.  But, belittling someone is not likely to help her abandon an addiction that some say is one of the most difficult to conquer.

My next step is an e-cigarette.  I’m hearing good reports about the success of this transition and the vastly reduced health risks.  But, for now, nicotine is my Paxil.  You can start nagging me about it when you get off your anti-depressant and stop drinking coffee.