MedCity Influencers

I made a new young mother cry

The Happy Hospitalist outlines the speech he gives to any patient who smokes. Doctors should feel free to borrow it — and he says he’ll be happy to change it if physicians are properly paid for the problems smokers cause.

The Happy Hospitalist is a board certified internist who works in the hospital and writes regularly on several blogs, including The Happy Hospitalist.

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So I saw a 19 year old three weeks after delivering her baby. During my evaluation she admitted to smoking her entire pregnancy. She also continued to smoke during breast feeding.

Not only does this toxic residue stick to everything around the mother (including the baby) but the baby is certainly at risk for consuming any one of the 4000 + toxic compounds in cigarette smoke that is absorbed into the mother’s blood stream with every puff.

So she got Happy’s smoking lecture.

I have a very routine cigarette lecture. I have been told on numerous occasions by many patients, who have been lectured a thousand times before, that my lecture is the best one they have ever heard. I show them why it’s never too late to quit. I show them what they are in for if they don’t.

I draw pictures of normal lung tissue as a function of time, in smokers, nonsmokers and prior smokers.I explain very clearly why smoking is a disease of blood vessels far more than it is of the lung. I explain all the side effects they will get if they keep smoking. Side effects most people never knew about.

  • Stroke
  • Dementia
  • Blindness
  • Heart attacks
  • Heart failure
  • Kidney failure and dialysis
  • Leg amputations
  • Cancer

I tell all my smokers to look in the room. For every smoker in the room, including friends and family, every other one will die an early death from smoking. And every one of them will have a disabling illness for which they will struggle with for years.

I tell all my smokers with dogs and cats that they are placing their loved animals at a big risk of getting cancer and dying a miserable death. This factor alone is a powerful motivator for many to quit.

I tell every one of them with children that their second hand smoke is a toxic cesspool of asthma, allergy and cancer for their kids. If they smoke in the house or car, or any enclosed area where their kids reside, I tell them they are showing a selfish disregard for their children’s welfare.

I tell every one of them that they should avoid near contact with any of their children.

I tell them at just one pack per day, at only $5 per pack, they are burning almost $2,000 a year. I tell the 25 year olds that saving the money from just one pack per day and investing it at 5% would generate 500K by age 65. At age 35, you’d have an extra $250,000 to enjoy in retirement.

I tell all smoking young adults of my patients that if they do not quit now, they will not be allowed to get needed health care services that are deemed to be lifestyle related illnesses. Our government will ration lifestyle disease at the rate of bankruptcy we are heading for. That they have to do everything in their power to stay healthy today to prevent a future catastrophic illness and be left in the dark.

This is my smoking lecture. It takes time, something that is not compensated under RVU economics. Most folks, pressed for time will not take the time to practice good medicine. To spend the time necessary to make a difference.

This is what volume generated fee for service buys you.

This is also why I think bundled care, when paid appropriately can generate profit for physicians, who prevent complications, prevent unnecessary testing, and use sound clinical practices to improve their patient’s bottom line and their own. If I could prevent my patient from experiencing an expected smoking related complication by taking the time to counsel them, I should benefit in the cost savings of that counseling.

Right now, I get nothing to counsel and I get no profit in the savings. Some folks might mistakenly believe that my job is to counsel smokers to quit, whether I am paid for it or not. That I have a moral obligation to provide uncompensated care as a part of my professional obligation. To that I say, the day you wake up and agree to go to work for free day in and day out is the day you have a say in what my duty is as a physician. You don’t work for free.

Neither do I. When I do it, I do it out of my own free will. That has nothing to do with your sense of my moral obligation to provide it on your terms. Some days I may not feel generous enough to provide free tobacco counseling. Other days I may. As long as my time commitment is uncompensated, you have no say in my duties as a physician. My decision to counsel or not to counsel is entirely based on my time schedule and my generosity.

Now tell me I will be paid to provide smoking cessation counseling and I will gladly entertain my patients with marker in hand. Tell me I will be rewarded with gain sharing on the down hill savings and I will gladly bring a slide projector into every smokers room.

In the case of my new young mother, my lecture brought her to tears. It wasn’t the stress of the delivery. It wasn’t the stress of being a new mom. It was the thought of her smoking causing her baby harm. How do I know that? Because she told me.

To that I say good. Selfish disregard for your child’s safety should bring you to tears. I hold no sympathy for those who consider themselves fully informed and educated and choose to harm themselves or their children by their own actions, nicotine addict or not. What we need in this world are more people breaking down in tears.

After five patients and five strokes (paid for by my increased premiums and government taxes) I have no sympathy for the plight of smokers.

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