I'm kind of a creature of habit. I can listen to the same songs on my iPod on repeat until I have exhausted all the enjoyment out of them. I often prepare the same meals over and over again. I have the same routine every morning. Most things that I do are planned. My husband is a good match for me because he encourages me to try new things, although my instinct is usually, "Why would I try new things when I already know that I like these things?" Occasionally he is right and I expand my tastes outside of the little circle I've created for myself.
I've never been a smoker. I don't really know what it's like to be addicted to a substance. Although comparing my tendency to eat the same food and listen to the same music to smoking seems quite inaccurate, it's the best example I have to relate to what my patients are feeling.
I talk to each of my patients about smoking. Many of them are current smokers; I'd estimate more than half confirm their smoking status. I review with them the risks of smoking and the benefits of quitting. Most nod and shake their heads emphatically and try to fast-forward our conversation. They've heard it before. They get it. Smoking is bad. Quitting is hard. Let's move on.
As I establish rapport throughout the course of treatment, I consistently ask my patients about their symptoms and I also briefly ask about their smoking status. Of all the patients I've treated, none have reduced their smoking or quit. They're all smoking the same amount of cigarettes every day. I again remind them of the smoking-cessation programs our clinic offers, which are included in their benefits and cost nothing.
I worked with a patient recently who smoked one pack per day (20 total cigarettes) but said he wanted to quit by the end of the summer. I suggested he take out one cigarette from the pack right when he opened it and try to smoke 19 cigarettes a day instead of 20. And when that step was complete, to try 18 instead of 19, and continue the process. I instructed him about medications and smoking aids he could utilize, as well as to try altering his routines that typically triggered smoking -- such as taking a shower before drinking coffee if having coffee triggered the need to smoke. He came back a few sessions later and told me he was down to 15 cigarettes! My first (known) victory in more than four years of practicing physical therapy and educating my patients on smoking.
I'm certainly not an addiction specialist nor do I know all of the components of smoking, but I feel good about helping one person work toward a healthier life. As healthcare providers, we have some responsibility in addressing the parts of our patients' lives outside of the musculoskeletal or neuromuscular area we treat, although without stepping on the toes of other specialists. What about you? Do you educate your patients on smoking?