Patients Who Smoke

Dr. Frederick Ross of Winnipeg must have become a household name. He has been extensively interviewed and quoted in the media. And his recent actions have rekindled the debate about individual’s responsibility to his own health and physician’s responsibility to educate his patients on preventive medicine.

What did Dr. Ross do?

Three months ago, he informed all his patients that he would not treat smokers who are unwilling to give up the deadly habit. They were given 90 days to quit. The deadline was last week. That’s when Dr. Ross hit the headlines. Some people complained that Dr. Ross’s action was unethical. Manitoba’s licensing body for Physicians thinks otherwise.

As we know, tobacco use is the leading preventable cause of death in Canada. It is responsible for one in five deaths. Half of regular smokers die prematurely of tobacco-related disease. Many patients continue to smoke although they have known or experienced ill health due to smoking.

What are the obstacles to quitting?

The main obstacle to quitting is the addictive nature of nicotine, says an article in the New England Journal of Medicine (NEJM).

Nicotine causes tolerance and physical dependence. If you quit smoking then expect withdrawal symptoms like irritability, anger, impatience, restlessness, difficulty concentrating, insomnia, increased appetite, anxiety, and depressed mood. These symptoms may vary widely in intensity and duration.

The withdrawal symptoms begin a few hours after the last cigarette, peak two to three days later, and wane over a period of several weeks or months.

The second obstacle to quitting is the psychological factor – tobacco use is a learned behaviour, cigarettes become part of a person’s daily routine, says the NEJM article.

It is associated with events, such as finishing a meal; handling stress and negative emotions such as anger or anxiety. To stop smoking, a smoker must learn new coping skills and break old patterns.

Smokers who have good intention to quit have two problems: staying free of cigarettes for a long period of time and putting on weight.

What is effective in encouraging smokers to quit?

A physician can do what Dr. Ross did. But scientifically, two approaches have been found to be effective: counselling and nicotine replacement therapy. Each is effective by itself, but the two in combination achieve the highest rates of smoking cessation, says the NEJM article.

Studies have shown that a physician’s advice to stop smoking increases the rates of smoking cessation among patients by approximately 30 percent.

One report in the Medical Post says that half the specialists surveyed never counselled patients on smoking cessation. That burden seemed to fall on the family physicians, who were eight times more likely to ask patients about a quit date than other physicians.

Nicotine replacement therapy comes in different forms: gum, skin patch, a nasal spray, and a vapour inhaler. Combination of counselling and drug therapy achieves typical rate of cessation at 40 to 60 percent at the end of drug treatment and 25 to 30 percent at one year.

Changing public behaviours is difficult. “The first reform is to stay healthy,” says Mazankowski report. We know that relatively small changes in our lifestyle can markedly reduce several major diseases. But are we ready to do that?

Through these columns and through CHAT TV’s “Medical Moments” we have tried to send the same message of self-help and improvement in once life-style. The slogans we have used are: help your doctor to keep you healthy and if you take care of ELMOSS then ELMOSS will take care of you!

So, what did you do today to keep yourself healthy?

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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