Smoking.

[Guest Hal9000]

My mind works in strange ways. I was thinking of the detrimental effects of smoking on society today and this thought struck me - how many med school students are smokers?

 

I bet it's a pretty small percentage...

[Guest aneliz]

I would guess less than 10%... there are definitely a few in my class... three that I can think of immediately.

[Guest moo]

I used to... back in High school and first two years of college... rarely now (less than one cig/year, maybe New Years... but now that I don't drink either, smoking kinda has gone by the wayside too)... I agree that it's kinda sick that physicians smoke.

 

A psych resident I met smoked... But for some reason, psychiatrists who smoke don't really bother me that much because they largely don't counsel people on smoking.

 

I think what's worse than smoking (tobacco or even pot) is drinking, especially the binge drinking that goes on in med school. Alcohol really impairs your body and I think a good portion of my patients on Medicine, Surgery and Psychiatry had alcohol-related problems. One guy got kicked out of our school for showing up to the rectal exam session in first year drunk. Now, one or two drinks here and there is fine, but when I first entered med school, people drank like crazy. I think now that we've all matured somewhat and seen what alcohol can do to you, the binge drinking has gone down somewhat.

[Guest tim23]

One guy got kicked out of our school for showing up to the rectal exam session in first year drunk

 

okay remind me not to do that

 

I totally disagree that alcohol is worse then tobacco. Alcohol can be enjoyed in moderation with little negative health effects, tobacco generally can't (unless you count the odd cigar). I also think a little bit of binge drinking for people in there 20's is okay as long as it doesn't impact any other responsibilities, we are human after all.

[Guest marbledust]

On my elective last summer I worked with a psychiatrist who was a chain smoker...he would even go outside and smoke with his patients--in the guise of "talking" but I often suspected it just about getting a smoke break for both him and the patients

 

I was a little taken aback by this, but psychiatry is admittedly much different than other specialties. I guess if you find something that works well with some patients, you go with it. And doctors are people too, with the vices and bad habits we all have.

[Guest UWOMED2005]

At the start of first year, I think we had roughly 5 regular smokers in 1st year, another 10 who smoked on a regular basis when they were at the bars, and another 10 who would sneak cigarettes when they thought nobody was looking.

 

By 4th year, I think we had only ONE regular smoker. . . and the ironic thing is they weren't a smoker in 1st year!! (not public knowlege in the class. . . and I ain't revealing the identity.) Pretty much everyone who had smoked regularly to once on weekends has quit. . . though I did see a few (less than 5) classmates sneak outside last night with out graduation celebrations. . .

 

In general, smoking is NOT socially acceptable in med school. The good news is that it is a fantastic environment to quit.

 

I had an anaesthetist in 3rd year who kept taking off for 10 min "breaks" every hour during procedures. I couldn't figure out what was going on until he got close enough to me to smell the tobacco.

[Guest Jochi1543]

I disagree with the fact that alcohol is "not as bad" as smoking. For your body, in moderate quantities, maybe. But really, I have never heard of someone hitting a pedestrian while driving his car after having a cigarette or deliberately committing a violent crime under the "influence of tobacco". I believe that consumers of alcohol are much more dangerous to the society than consumers of tobacco. AND to themselves. I know way too many people close to me making very dangerous decisions under the influence of alcohol. I've also had multiple opportunities to read ER reports involving patients who accidentally harm themselves while intoxicated. I'm no tee-totaller, I'll have a drink at a club as long as I'm not driving, but I avoid attending parties where alcohol flows freely, and distance myself from people who I know tend to lose control when facing a liquor bottle. I think strict enforcement of underage drinking laws can actually be conducive to this type of irresponsible behaviour, because it causes many teenagers to regard alcohol as a forbidden fruit rather than a substance meant for moderate use in a fun atmosphere.

 

Is :hat appropriate for this thread? :lol

[Guest tim23]

alcohol has more related problems, but fewer direct problems assoicated with it then smoking. In the context of medical students -who hopefully drink responsibly- drinking is far better then smoking in my opinion

[Guest noncestvrai]

I think everything in moderation is good. However, for the cigarette silent killer, it is a bit difficult to determine what that dose is accurately. For instance, I used to smoke socially, at bars, parties, raves etc. The next day, my throat felt like $hit, but at the time I thought smoking gave me an easy in with a girl, like "do you have a lighter" et al...This year, I saw some nasty consequences of smoking, and I don't think I will ever touch it, even not "socially". As far as alcohol, I can say that I like wine with food, and sometimes beer with the guys say after a hockey/softball game, and when I go out, beer is usu the cheapest drink...I still go and get smashed after a unit exam, but not like dead, just a good punch. It's like my little "purgatory". Then, it's off to another couple of weeks of quasisobreness. In reality, I don't see myself doing that ever again once I start clinics, I can't imagine doing that and the next day have to do a P&H, assist in Sx or what not. My career is more important.

 

As for the other "recreational drugs", I will say that there is a time for everything.

 

I'm also getting old...takes me a few days to recup...

 

I think alcohol and tobacco are among the highest "causative" agents of healthcare costs and I would extend it to social costs. I need not to elaborate on this.

 

Use your head, drink responsibly, and respect others if you smoke, quit if you can, because your life will be only better in the long run.

 

noncestvrai

[Guest moo]

Like I said before, drinking in moderation is fine. However, realize that even after one drink, you can be impaired. Med students and pre-meds often think alcohol is the cool and safe drug of choice. It is not. Tobacco, while not completely benign, at least doesn't impair your judgement like alcohol can. I'd take smoking socially at bars over alcohol anyday.

[Guest PanjabiMD]

I'd take smoking socially at bars over alcohol anyday.

The thing with that is, smoking socially can easily become smoking regularly. Drinking alcohol can also become habitual, but cigarettes are far more addictive.

[Guest tim23]

I VERY surprised that people would rather smoke socially than drink. I would probably consider myself a very heavy drinker for a pre-med/med student and not once has it drastically impaired my judgment, made me do something stupid that i seriously regretted etc... but I have a hell of a lot of great memories as for smoking socially, WHAT IS THE POINT??? what is "social" about smoking, people who say there smoking 'casually' are those that generally can't kick the habit. Additionally smoking is gross, if I find out a girl smokes, I loose all interest in them. I guarantee you that smoking is several times more addictive than drinking, if I don't feel like drinking for a couple of months, I won't- not many 'casual' smokers can say that.

 

even after one drink you can be impaired

 

I really have to challenge this statement. Drinking affects different people quite differently. I'm going to come out cockily and say that one drink has little to no effect on me, less so then say a poor nights sleep, or a personal argument, etc When you start considering this type of impairment there's so many things to take into consideration that it is useless, like I said before, we're only human you can't be 100% all the time.

[Guest moo]

Not really. I know many people who say they're "casual drinkers" who end up drinking everyday, causing other problems. They become dependent, tolerant, undergo withdrawal, etc. Yes, smoking is bad, I'm not saying it's not. Nicotine is addictive, probably more so than alcohol. But don't tell me alcohol is not. Ten percent of people across North America are alcoholics. I can't count how many times I've admitted a patient, who's a closet drinker (and therefore denies drinking on admission), and then undergoes withdrawal a day or two into their hospital stay. Then we worry about delirium tremens and end up loading them with benzos.

 

It's great that you've never been impaired, but I've not come across one alcoholic who's said that. It's even greater you've developed this tolerance to alcohol. But not many people have. And you're looking at cost to society as a whole. In addition, many of the social drinkers in my class have been impaired at some point or another and even they will admit that. Like I said before, social drinking is fine, as long as you're not stupid enough to get behind a wheel.

 

Yes, as unhealthy as tobacco is--and even given the number of crimes, both civic and moral, the tobacco companies have committed in promoting smoking--abuse of tobacco is not an underlying foundation to crime and criminal activity the way alcohol is, as someone pointed out earlier. As nasty and unhealthy as smoking is, it is not normally the case that a troubled soul smokes a pack of cigarettes and then, agitated by nicotine, goes on a crime rampage.

 

I'm not defending smoking by any means. I'm just saying alcohol is not the benign drug that everyone makes it out to be.

[Guest tim23]

moo i agree with what your saying, I think that in general society alcohol is probably a bigger problem than smoking, but I think as a med student I'd much rather drink then smoke, for the reasons i said. Also, I'm not crazy enough to say that I haven't been impaired-as in drunk- just that I'm confident with the limitied decisions I make in this state.

[Guest UWOMED2005]

One cigarette is less bad for you than a couple drinks.

 

One night of smoking has less of a chance of causing long terms repercussions than one insane night of drinking (ie risk of drinking & driving or other alcohol related death)

 

BUT. . .

 

There aren't many smokers who can a) smoke one cigarette or smoke one evening only. It's an insanely addictive habit, whereas many (but NOT all!!!) can have a glass of wine per month and/or keep things in moderation.

 

In the end, smoking causes more years of life lost than alcohol. But the dangers of BOTH should be respected!

[Guest TimmyMax]

Hey,

 

I agree with tim23- smoking is just plain gross. I also lose all interest in a girl once I see her light up a cigarette- it's just not attractive and I can't imagine kissing someone that reeks and tastes like an ashtray- disgusting! Someone who reeks and tastes like booze I can handle, but I draw the line at smoking- a definite red flag in my books.

Drinking isn't so bad so long as you are responsible about it. Besides, it makes other people (especially UWOMED2005) more interesting! :lol

 

Best of luck!

Timmy

[Guest nby]

Excuse me because I am not in med yet, so I do not have the experience dealing with this like you guys, but I feel you all seem to miss the central point on this matter.

 

It seems to me the central, ethical position to take is "practice what you preach". Most health care professionals have always preached to me not smoking at all and responsible drinking. So I guess in my opinion then, the ideal med student, would smoke extremely rarely (maybe a cigar every few months for a celebration of some sort), and drink socially. In my humble opinion, drinking socially can involve getting smashed on occasion. I do fairly often, and consider my alcohol habits to be responsible, never has it affected my personal life, professional life, or health. Also I have taken 5 months or so off a few times to prove to myself if it ever becomes a problem i can step back to control it.

 

As far as "rec drugs". I really don't know enough to speak too much on them, but I WAS under the opinion it would be unethical for docs to use contraband substances they are in control of dispensing. For this reason, I assumed (?incorrectly?) that medical school would involve drug testing.

 

I guess that I'm just reiterating noncestvrai's opinion on moderation but adding that its for ethical "practice what you preach" purposes.

[Guest peachy]

It seems to me the central, ethical position to take is "practice what you preach".

I don't think that practicing what you preach has anything to do with ethics at all, personally. Smoking is not something that affects your patients - so why would your patients care if you go home after work and smoke? I couldn't care less if my doctor smokes or not.

[Guest wattyjl]

it's not rational, per se, but if my cardiologist, e.g., was this obese, sweating, smoking, mcdonald's-eating 50yr old, i would feel a lot less inclined to listen to him. i would say most people would agree. it's maybe somewhat similar to how parents shouldn't smoke/drink/etc. in front of their kids (well i think they shouldn't anyway). we're all impressionable, and we all look up to and immitate authority. or base our actions on those of an authority. a doctor, like it or not, is and should behave like a role model for health, at least in front of their patients.

[Guest 4shattered4]

I think if people just look at doctors as professionals who are certified to give advice for a better, healthier life, and ignore what they look like or their personal preferences, then everything would be a lot easier.

 

Personally, I don't care all that much about what the choices my doctors makes in his/her PERSONAL life as long as it doesn't affect their professional ability to give good advice. Everyone is a hypocrite in doing things that we know are wrong, but we can't break bad habits anyway. Why should doctors be exceptions? Sure, they "should" look like role models, but I see the same problem with teachers. Are all of them role models? Idealistically, that would be great, but through volunteering, I've met too many of elementary school teachers who just back-mouth kids in front of them...=(

 

With exception to the obesity and smoking factor, some of the topics here can't really be immediately perceived by patients anyway. For instance, as long as the doctor doesn't drink before your appointment, I'm sure you can't tell if they like to drink a bottle or two a week. And obesity could also be a result of genetics, not just from eating fast food.

[Guest peachy]

it's not rational, per se, but if my cardiologist, e.g., was this obese, sweating, smoking, mcdonald's-eating 50yr old, i would feel a lot less inclined to listen to him. i would say most people would agree. it's maybe somewhat similar to how parents shouldn't smoke/drink/etc. in front of their kids (well i think they shouldn't anyway). we're all impressionable, and we all look up to and immitate authority. or base our actions on those of an authority. a doctor, like it or not, is and should behave like a role model for health, at least in front of their patients.

 

I absolutely disagree with you, watty, on every count. You say that you'd be less inclined to listen to your physician if he was an "obese, sweating, smoking, mcdonald's eating 50 yr old". I'd be a lot less inclined to listen to someone who put people into categories like this, with the clear intent that they come across as derogatory, personally. (You have something against people who sweat? People who go to McDonald's? People who are 50?) Gee, I wouldn't want to even come to a physician as this 50-year old, knowing what the physician thought of me!

 

I think that the concept of doctors as "role models for health" is frankly paternalistic and rather insulting to patients. A person who smokes does not need a "role model" - they know lots of people who don't smoke, they see the graphic pictures on the cigarette box every time they open a pack, and they are constantly bombarded with people telling them they are bad (or gross, or whatever), because they smoke. They need information and understanding, both of which a smoker can provide just as well (or probably better) than a non-smoker.

 

Personally, if I imagine myself in the situation of someone who has smoked for twenty years and is unable to quit, I would far prefer a health care provider who really gets why it's so difficult, and doesn't think I'm "gross" for continuing to smoke over someone who tries to be a "role model" for me.

 

Parents setting examples for children are completely different! After all, that's exactly the origin of the word "paternalistic" - while it may have been okay to think of your patients as your children 50 years ago, it is not normally considered to be the ideal today.

[Guest nby]

-peachy - there is a difference between a parental, role model role and the role of the informed physician, be they somewhat similar.

 

first, you are right that smokers are bombarded with pics of cancerous lungs and whatnot, but the phrase "my grandfather smoked every day of his life and lived to 90" is very common too. People tend to be very skeptical of doctor's advice as they are seen to be very biased towards extreme health without compromise for pleasure when the stakes are low.

 

with things like smoking, heart health and drug (ab)use - patients often understand that a doc is telling you what (s)he has to, and the best situation in terms of the goverrnment's health care dollars. But people also believe that you have to take that with a grain of salt to live the best balance of pleasure and health, so they look to those who know much more on the risks/benefits to help them decide "how much salt" to give their doctor's advice. So as a doctor you're actions end up speaking much louder than your words.

 

you are 100% right though that docs are just people too, who are going to live skewed lives like anyone else. I firmly believe that there should never be any negative reprocussions for smoking or drinking on a doctor outside of a professional setting. But docs should feel that responsibility of their profession though to lead by example, knowing for example, if they still smell of smoke from their break while councilling a teen on the "evils" of smoking, they may as well send they kid home and use that 10 mins of billed time to catch up on the soaps.

[Guest peachy]

But docs should feel that responsibility of their profession though to lead by example, knowing for example, if they still smell of smoke from their break while councilling a teen on the "evils" of smoking, they may as well send they kid home and use that 10 mins of billed time to catch up on the soaps.

I absolutely don't agree that whether or not the doctor smells like smoke is the main factor on how effective they will be at talking to that teen. Someone who comes in and says "Smoking is gross, it'll kill you, you shouldn't do it" is just as likely to be ineffective. Someone who comes in and says "I started smoking as a teen because I thought it'd never hurt me and I'd be able to quit once I finished school, but I haven't been able to, and the one thing I wish was that I hadn't started as a teenager" is just as likely to be effective.

[Guest nby]

you have a pretty good point there on addiction - just goes to show that resourcefulness in your pursuation is just as important as the main message.

 

Personally, I tend to think more about less addictive things, like say once a blue moon a doc getting high at a party or scarfing down three greasy burgers at the local MacD's, where the "I couldn't kick it" arguement won't be nearly as effective.

 

either way - I'm willing to agree to disagree

[Guest wattyjl]

peachy - you're right, on reading over what i wrote last night it doesn't come out sounding great. i was trying to paint a picture of someone who quite clearly didn't take care of their health; i don't remember using the word gross. the reason i stipulated all of those things in combination was because at that age and with those characteristics, it was supposed to say "heart attack candidate", that's all. i have nothing wrong with the number 50, it's much less far off than the number 0, for me.

 

i would think being told "quit smoking, eat better and lose weight" from an individual who clearly wasn't intertested in doing/trying the same wouldn't be very compelling, but perhaps you don't share that view (i would imagine you are in the minority in this case - but of course that is my assumption).

 

unfortunately or fortunately, depending on how you look at it, doctor's are in the public eye, and so like celebs, atheletes, and eminem, they are, to a degree, role models ('good', 'bad', whatever). are they parents, or even teachers? no. but they are role models for health, because they are supposed to represent, in general, health. i realize it's different than making the comparison: 'would you go to a broker whose just bankrupted himself on bad stock picks', but, it's at least a partially reasonable comparison.

 

i agree that i came off sounding paternalistic, and perhaps that is something i am going to have to work on getting out of my system over the next 3yrs. and perhaps the role model issue applies more to kids than to adults. but i think we are all subtley influenced by what we see and what is around us, kids or not. obviously i'm not saying a healthy doc spewing rhetoric on how to live a healthy life is going make all their patients sit up, listen and act on it - but don't you think *people* in general would be more likely to listen to that phenotype of individual rather than someone who obviously doesn't try to live that way themselves?

 

it's superficial, and i'd like to think that people would make the separation between what someone does, what they should do, and what the observer should do for themselves. however, monkey see, monkey do or maybe monkey don't see, monkey don't do, happens, to more or less extent, for most us.

 

james.

 

PS i am NOT comparing patients to monkey's!!