Okay, and how’s that working for you (or us, as a society) at getting addicts to quit? Decades of telling people the health risks hasn’t worked for getting the 20% of people still smoking (number derived from a recent newscast, so I don’t know how accurate it is) to quit, that’s for sure.
Like I said, *smokers *see benefits to smoking, and they can even list them for you. Telling them that those benefits don’t exist isn’t going to establish patient rapport or formulate a quitting plan that works for them. Acknowledging those “benefits”, whether they come from feeding the addiction or the chemical nature of the cigarettes (and I still argue that it’s some of both, but whatever), or psychological habit, allows you to A) build rapport and trust and B) discuss other coping strategies to meet those same needs, to provide those same benefits without the risks of tobacco use - and that’s what builds a quitting plan that may actually work. It’s the foundation of behavioral modification therapy - smoke a cigarette because you need something to do with your hands? Twiddle this pencil instead. Need a cigarette because it relaxes you? Try some deep breathing or meditation for 10 minutes.
Pretty damn good as that’s about 1/3 of the smoking rates just in my liftime, or a 2/3rd reduction
You’re absolutely wrong here. Allowing them to continue with the delusion that there are benefits will allow them to continue rationalizing their addiction “I need to smoke to reduce stress”.
You do make a point about suggesting specific behaviour modifications, but they can’t be based upon “benefits” as again- there are no benefits and allowing dudes to saty in denial about them won;t help. Now sure, saying to a smoker “Well, you feel you need to do something with your hands, so try these pencil manauvers. Feel like you need the oral gratification? Carrot sticks and Wwrigleys Doublemint gum.”. But telling someone that a cigarette relaxes you feeds right into their rationalizations. You can explain how smoking actually increases stress, and here are some real stress relievers.
Because YES, that’s step one in medical relationships. Not by “lies” but by recognizing and accepting a patient’s point of view and accepting them as a worthwhile person, while not condoning their actions, and moving them towards more healthful actions.
My sig isn’t a clue? (and you are a MD, right?) :rolleyes:
You have a cite that accepting the patients *false assumptions *is “step one” or even any step at all? There’s a huge difference in accepting someone as a worthwhile person, versus accepting their delusions as facts. You are not promoing accepting the patient-you are condoning accepting their false and harmful delusions and falsehood, the very delusions and falsehoods that are feeing their rationalization of their addiction.
Of course. But none of those are killing me, or those around me.
Unemployed? No
Overweight? Somewhat, but my MD has no concerns. He sez it’s not adversly affecting my health, although we both agree that I could lose a few pound, and in fact, I have modified my eating behavior and am losing weight slowly but surely.
Bad breath? No. Well, after eating garlic, which I love…divorced? no
Sloppy housekeeper? I could use improvement.
Text while driving? Never. Or even call while driving unless it’s to 911.
I have a graduate degree, and in fact work in what some might call the public health field as a inspector/investigator of sorts. My dept oversees Stop Smoking programs.
Exactly, I have provied solid cites from peer reviewed medical journals, your cites are badly out of context wikipedia quotes. *You can’t be arsed. *You got caught making shit up by using out of context quotes and are now trying to cover your falsehoods by changing the subject.
Tell ya what, if our real MD, **Qadgop the Mercotan **(who works with addiction) come in here and agrees that a MD should lie to his patients and validate their delusions, then you win.
My ‘shoot from the hip’ comments on my dealings with nicotine addicts:
Present the facts but don’t hit them over the head with 'em.
Don’t lie to patients. Nor dramatize the data.
Spell out that while smoking/nicotine use may have short-term pleasurable effects, these effects are not benefits.
Present the real risks in context. Don’t maximize or minimize them.
Minimize use of emotionally loaded terms.
Saying nicotine is addictive, or that a nicotine user is a dosing themselves to avoid withdrawal is usually appropriate; calling them addicts may be very counterproductive.
Point out that while they’re in prison, tobacco is a contraband item which will result in loss of privileges and time in the segregation unit if they’re caught with it (one of the most effective tools in my ‘stop using tobacco’ toolkit, I must admit).
But overall, I tend to lean a bit more towards DrDeth’s approach, save with less bombast.
Theoretically, let’s say I’m a smoker. And let’s take for granted as well that I know smoking is harmful, but do it anyway. If I’m not at the doctor to quit smoking, and am barraged with a speech on quitting smoking, I’m not coming back.
This doesn’t just go for smoking. If I’m at the doctor to get an STD test, and get lectured for being promiscuous, I’m not going back. Nor am I going back to an OB who criticizes me for considering abortion. In all of these scenarios, I won’t put up with being solicited to make a change simply because you (the doctor) disapprove of it.
You could argue, I suppose, that you don’t want a stubborn patient anyway, don’t let the door hit my ass on the way out. But keeping the irrelevant opinions to yourself will go a long way to improving your overall bedside manner. And if you like having my business, you could view it as a cost/benefit analysis. Treat what I’m asking you to treat. The end.
Of course, if you are asked by a patient how or why to quit smoking, then that would be a good time to launch into the speech. But I’ve never understood why doctors live in some fantasy world where a patient will quit smoking/getting abortions/fucking strangers on command. Real people don’t work like that.
Is that really relevant? It seems like every time we have a thread about smoking, at least one smoker will defensively pop up with, “Oh yeah, but other people ____.” Which may be true, but doesn’t really have anything to do with smoking. And if that’s the best argument you can make–that other people do bad stuff, too–it doesn’t really seem like a very good one.
Sadly. Most of them are older, so it’s not entirely their fault. Mostly they’re in the high-risk (and high stress) specialties. Rare is the family doc who smokes, but many surgeons and ER ones do. But if you look outside an ER in a major city, you’ll see ones under 40. Even outside of women’s hospitals.
I’ve told this story before, but it’s fairly relevant: my mom was an immigrant, didn’t speak English when she came to the US, finished med school in 3 years, was one of only 3 women in her class…and she swear up and down that the hardest thing she’s ever done was quit smoking. :eek:
I have known Heroin addicts from NA swear quitting cigs is tougher than heroin. Mind you, of course the addiction and withdrawel is harder, but it’s easy to avoid people shooting up.
No, but he’s in denial. Dudes come up with very strange rationalizations when they’re addicted, this thread is a good example, with people talking about the “benefits of smoking”, the idea that the fact that some people are overweight justifies your addiction, and the ever popular “this sort of thing makes me want to light up a cig to spite them”.:rolleyes:
What’s amazing is that the people talking about the benefits of smoking are the people being rational: obviously there must be something in the pro column that gets people to start smoking in the first place. That’s basic psychology: you have to perceive value in something.
As for rationalizations of addiction–it’s not really that amazing when you realize that everyone rationalizes everything they do, and the smarter they are, the more they do it. If you enjoy something, you always try to figure out a way that it is logical for you to do it.
Finally, the fact other people have other addictions doesn’t justify you having one, but it does get to the heart of the matter: often people talking about addicts are doing so for the purpose of insulting someone, because they view someone with an addiction as less than them. Pointing out that they also have addictions to helps deflate this, so that they realize they aren’t any better, and legitimate help can be offered.
It is very relevant in this case, as you are clearly biased in trying to insult rather than help. It’s funny to point and laugh at behaviors, rather than try to fix them. It is better to laugh about how you aren’t getting through than to change your tactics so you can. It’s better to refuse to accept someone’s beliefs, and thus push them away, than it is to accept them as they are and then slowly show them where they are wrong.
How can you separate the two? What is his approach without the bombast, and with everything you identified as being proper, but a completely different approach? He’s taking an antagonistic approach, as evidenced by people in this thread getting defensive, and him doing nothing to calm that defensiveness.
