Smoking

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    Is anyone spending more than 2 seconds addressing smoking during a visit? My employer requires discussion, etc. I personally ask, "do you smoke" "do you want to quit" and done.

    I personally don't care if patients smoke. It is the nastiest habit I can imagine short of smearing feces on ones body instead of cologne, but i just don't care if they smoke or not. I know talking about smoking to a 40 pk/yr COPDer is a waste of my precious time better well spent reviewing labs and the overall plan of care with the PT. I do occasionally find time to tell them that eventually none of those vitals or labs will matter since they will be dead from smoking. That gets mixed reviews as you can imagine - but I can call it couseling for nicotine dependence and code it

    Any thoughts - strategies - etc?
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  3. 8 Comments so far...

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    i did not learn this until last week. It is all about money so that they can code that you taught patient that smoking is bad and they should quit. A friend of mine who is also in np school told me this.
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    BTW the further I get into my program the more I learn that it really is ALL ABOUT MONEY. Very sad times.
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    You're a sculpter chipping away.

    Over the past year I've had at least 5 patients that hvae come around to trying pharmacotherapy for their smoking/tobacco dependance.

    Yes, it is about the bottom line. Lowering the risk for progression of comorbidities is preventative. Truly does help the bottom line.

    I keep my chronic care/follow-up visits friendly with my patients and make a deal with them. The first time I bring up the smoking bit, I remind them I'm going to bring it up EVERY visit until they agree to try quitting. They get annoyed by the 2nd or 3rd visit when I bring it up. But that's the point.
    BCgradnurse likes this.
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    I work with dialysis pts. Many smoke. I point out the ones who cont to smoke: Missing two legs, blind. Heck what else is there at that point? I will say that many of my younger pts grew up with the no smoking ad campaigns and they have chosen not to smoke.
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    I agree with TX RN. I bring it up at every visit. I've had several pts. at least try to quit, and some that have been successful. I think smoking is one of the worst things someone can do healthwise, so I'll keep chipping away.
  9. 1
    Quote from traumaRUs
    I work with dialysis Pt's. Many smoke. I point out the ones who cont to smoke: Missing two legs, blind. Heck what else is there at that point? I will say that many of my younger Pt's grew up with the no smoking ad campaigns and they have chosen not to smoke.
    Yep. I inform all of my DM Pt's - we are going to amputate your toes, feet, legs. Then you are going on dialysis - then you'll have a stroke and survive. It's going to be awesome!! Without fail - they reply "yeah - my mom was on dialysis and didn't have no legs". just amazing - what a proud badge of courage. The stop smoking and start living mechanism just never kicks in - Darwin was on to something - maybe we are just witnessing the human species evolve.
    traumaRUs likes this.
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    Maybe instead of taking the approach that you are a nagging mother, you should try giving some professional advice and leave it up to your patient to take it or leave it. People might respect your advice more if given in that fashion. Don't think that nagging someone by repeatedly using terror tactics is going to advance your point with them.
    Dazglue and ixchel, rn like this.
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    If they don't hear the stop smoking message from their HCPs then we are doing them a disservice. Because ultimately what does it matter sending them for more labs, PFTs, CXRs, if we don't counsel them on stopping smoking? And who are we to write off all our patients who are smokers. I had a 74 yo guy with a bladder mass stop smoking and he said he did it cause I always mentioned how he needed to stop smoking. And jeez its so much more pleasant to sit in the exam room with him as he no lomger smells of cigarette smoke. I
    hate to say I'm fairly cynical too when it comes to patients with chronic problems but someone has to tell them and hopefully in a way that offers them assistance either giving Rx for NRT, zyban or chantix, or giving them info on quit lines, etc.
    I can't just summarily dismiss all smokers as not interested in quitting. There will always be some who do want to quit. If we don't address their smoking habits then we are doing them a disservice.


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