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10 September 2008 @ 09:45 pm
what dreams can my life imitate  
How far should you go when someone says they smoke and you're a doctor - in terms of 'Well, how 'bout that COPD; what say you give up now k?' I don't think most (qualified) doctors bother, but that means you end up with people going out for fag breaks the day before surgery. Guys, you're supposed to give up smoking the week before surgery. Waking up from general anaesthesia is traumatic enough without coughing up half a lung in the process. Not to mention how it increases your chances of, oh, DYING ON THE TABLE BECAUSE OF REDUCED RESPIRATORY RESERVE AND STUFF.

In other news, I probably shouldn't have told that guy he had rocking tats? But he did. Also, I've never palpated a ripped abdomen before. You're supposed to write 'soft and non-tender to palpation' if there's nothing wrong, but dude, it felt like a plate of rocks. A dilemma, i'faith.
 
 
Current Mood: exhaustedexhausted
Current Music: always in love (wilco)
 
 
 
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every Starbucks should have a polar bear: Art: hipposcoradh on September 11th, 2008 07:15 pm (UTC)
It's funny how cancer is pushed so hard as a reason to stop, when only 10% of smokers get cancer, but NINETY-FIVE PERCENT of them get COPD. AKA the way to die choking to death on air. (And yeah, I'd say 70% of resp and general wards are taken up with smokers who otherwise wouldn't be there.)
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mrsquizzical: greta pianomrsquizzical on September 10th, 2008 09:20 pm (UTC)
heee. that's great. i think you SHOULD say that about the tats. people are feeling judged left right and centre when a bunch of doctors are giving them the once over.

what you did was definitely great bedside manner!

but maybe leave the 'awesomely ripped' comment on the files. the patient doesn't get to see that anyway. :~P
Sereniaserenia on September 11th, 2008 03:08 am (UTC)
... unless the patient later gets a job as a filing clerk! XD
I got a job as a medical receptionist at my local doctors surgery some years ago, and was put in charge of reorganising the entire filing system. Of course I had to peek at mine!
I discovered that the psychologist I saw had filled three pages of notes with stuff about me clearly making up my mental problems to get attention! I might've felt more kindly toward her afterward if she'd also written that I was tremendously hot. ;p
mrsquizzical: boyhandsmrsquizzical on September 11th, 2008 05:28 am (UTC)
think how much nicer that would be.

'she seems to be wanting a lot of attention, but dude she's HAWT'.

:~)
every Starbucks should have a polar bear: Art: sunflowerscoradh on September 11th, 2008 07:16 pm (UTC)
Dude, I know so many doctors who don't even look at the patients.

Ha, I didn't write it down at all! Just thought it. (Besides, I'm doing surgical histories - they're like, five lines long. :D)
mrsquizzical: awesomespencermrsquizzical on September 11th, 2008 09:43 pm (UTC)
heeee. i didn't think you actually would...
Emila-Wan Kenobiemila_wan on September 10th, 2008 10:45 pm (UTC)
Had a doctor I absolutely loved whose first greeting to me EVAR was, "So, when are you going to lose weight?"
every Starbucks should have a polar bear: Attention bunnyscoradh on September 11th, 2008 07:18 pm (UTC)
Huh. Okay. I suppose that's warranted if you were in for a weight-related problem -? I'm not sure that'd be my style, though.
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Jiapajiapa on September 11th, 2008 03:43 am (UTC)
I vaguely remember reading a study that said it was harder to quit smoking than to quit heroin.

In a completely non-scientific survey, when I was working in the VA, I used to ask my patients who had used both which was easier to quit.

To a man, they said it was easier to quit heroin.

When I have a patient who smokes, what I say depends pretty heavily on them. I always tell them that it's bad for them to smoke and mention a few of the reasons it's bad (smell, cost, cancer risk, heart attack risk, not seeing their beloved child grow up risk, whatever seems most likely to matter to them), but I tend to stop after a sentence or two and evaluate whether they're actually interested.

On more than one occasion, when I've been talking with someone who was completely uninterested in quitting, I've said something like, "So, I'm sure you know all the reasons smoking is bad for you, including cancer, lung problems, etc. Shall I give you the whole spiel, or do you want to just say I did?"

OTOH, I've also spent oodles of time talking about triggers and planning for quitting and psychology of quitting and availability of various meds to help them quit with folks who were actually interested in quitting.

And I never take a history where the patient says, "I quit smoking x time_period ago." where I don't tell them congratulations.

And whenever I have a patient who has tried to quit and didn't succeed, I tell them that most people who succeed in quitting have tried to quit several times before, and that each time they didn't succeed in quitting, they learned a lesson for their next attempt, and ask them when they think they'll be ready to try again.
every Starbucks should have a polar bear: bands: Hush Sound: elegantscoradh on September 11th, 2008 07:25 pm (UTC)
I get you on the evaluation thing. That guy above said he'd no intention of quitting because he enjoyed it too much. (Okaaaay.)

When I'm qualified, I intend to spend a lot of time pushing - not just those interested, but all smokers. That's my intention. I don't know how it'll pan out in reality...

I always congratulate people who say they've never smoked, as well.
Jiapajiapa on September 11th, 2008 07:55 pm (UTC)
On the one hand, as a doc, my desire is for everyone to quit smoking cuz they'd be so much healthier.

On the other hand, if I start pushing quitting on someone who is completely uninterested in quitting, I _might_ get through to them, but I _might_ lose their cooperation completely, eg "All this doc cares about is my smoking. I came here for problem X and this doc doesn't even care about that."

For patients I don't know well, if they act like they're not interested in quitting, I give them the sentence or two and then ask if they want to just pretend I gave them the whole lecture. At least in my head, I've at least reminded them that another doctor thinks that quitting would be a good idea, and I've also left them with a feeling of empowerment, since I gave them the option of telling me to drop it, and then I did.

For patients I do know well, who know that I care about them and their concerns, I'll push a lot harder. "So, Mr. Jones. It's good to see you again. Are you ready to quit smoking yet?" I also need to prioritize. If they're coming to me because of an acute concern, I deal with the acute concern first. If they're just there for a checkup, then if they're otherwise healthy, their smoking may be my highest priority.

Have you covered stages of change yet? It sounds kinda hokey, and some of the divisions are a bit arbitrary, but as a conceptual structure, it really _really_ works. If someone is not ready to quit, all I can do is plant a seed and then not piss 'em off.
every Starbucks should have a polar bear: Art: Pretty shoesscoradh on September 11th, 2008 08:20 pm (UTC)
Yeah, see? It's going to break down differently when I'm actually on the scene, with twenty other patients to admit and etc etc etc.

We did the stages of change. It made sense to me on a lot of levels, not just for smoking - just general behaviour. It's depressing how easy it is to backslide, though. *sigh*
every Starbucks should have a polar bear: Art: Heart treescoradh on September 11th, 2008 07:23 pm (UTC)
Oh, I usually say 'Have you ever tried to quit?' But I'm not really supposed to discuss treatments or anything, mainly in case I get it wrong. I do usually mention Champex, if only because taking a pill sounds like a more successful mode of quitting than sticking plasters on yourself.

I was under a cardio consultant last year who, in clinics, would

a) pretend to strangle patients with his stethoscope
b) do the 'for your kids' line
c) tell them they were wasting his time
d) say 'you might as well get a gun and shoot yourself'
e) make people cry.

He was the most inspiring doctor I've seen. No lie.
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jehnt: sg1 - continuumjehnt on September 11th, 2008 02:31 am (UTC)
Not to mention how it increases your chances of, oh, DYING ON THE TABLE BECAUSE OF REDUCED RESPIRATORY RESERVE AND STUFF.

I would tell them that, lol. Sounds convincing to me!
every Starbucks should have a polar bear: bands: FOB: a little more touch mescoradh on September 11th, 2008 07:28 pm (UTC)
DUDE. YOU WOULD BE SURPRISED.

(Also, a lot of it has to do with how interested you are yourself, and most doctors ... ahem ... don't really give a shit if they quit or smoke until they turn into a chimney, and it shows.)
Sereniaserenia on September 11th, 2008 03:05 am (UTC)
Ironically, our family doctor when I was a kid, and the one who helped my mum quit smoking, was a heavy smoker himself. He retired a few years ago for personal health reasons, and I'll bet it was related!
I wish I could stop hating on smokers, but I get so pissed off at their "It's my right to smoke" being apparently more important than my own right to breathe comfortably and not stink of smoke just from walking past the doorway of the shopping centre!
I confess I have occasionally faked a mild asthma attack in front of them, but it doesn't faze them any.
every Starbucks should have a polar bear: bands: CS+TAI: stripey hoodie Gabescoradh on September 11th, 2008 07:34 pm (UTC)
Yeah ... smoking isn't a right in the same way murder isn't a right. Jeez.

A lot of doctors do mad things as a way of coping with everything there is to cope with - it's the one thing they forget to teach us.
de_facto_female on September 11th, 2008 01:19 pm (UTC)
Hah - that answers my what if? LOL. Glad to see Drs are humans as well - think this is more than enough reason to friend you.
every Starbucks should have a polar bear: bands: PATD: Brendon and his mouthscoradh on September 11th, 2008 07:36 pm (UTC)
But what is your what if?!