Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Should doctors stop prescribing inhalers for smokers?

Deep Ramachandran, MD
Meds
September 18, 2012
Share
Tweet
Share

I’ve always had a tough relationship with cigarettes and the people who love them. As a lung doctor I hate cigarettes, and I hate that patients I see everyday continue to use them. But I also understand that vilifying smokers seems to be in vogue right now. I figure that if someone does something that is not considered socially palatable, and that does them harm, even as they strive to take treatment for it … well it must be a pretty powerful addiction.

Recently I was hanging out with a few physician friends, when the topic of conversation came to treating patients who are smokers. Some contemplated whether patients who smoke should even be prescribed inhalers for breathing disorders. Furthermore, we wondered about whether such patients should be followed up for breathing problems unless and until they quit smoking.

This made me wonder about my current approach. As I mentioned above, I have always been accommodating to smokers, particularly considering how little is done to help them quit or prevent them from starting. So is treating smokers a practice I should continue? I do discuss smoking at every visit, as well as the  importance of quitting. I use my usual analogies of using inhalers while continuing to smoke;  “you’re hitting the accelerator and the brake at the same time” or “you’re pouring gas and water on the flame at the same time.” Sometimes I even tell them they would not need the inhalers and probably wouldn’t need to see me anymore if they quit smoking. Unfortunately these approaches rarely work.

Perhaps I’m even acting as an enabler and tacitly endorsing their behavior by inviting them back for another appointment. One could even say that I’m benefiting by continuing to see a patient who is smoker, profiting from their continued behavior.

However, while I said that smokers rarely quit, some actually do respond to my constant pestering. It would be interesting to know whether refusing to see a smoker is a better cessation tool than a cessation intervention itself. However, as it stands now, the questionable ethics of conducting such a study would make it highly unlikely that it would be conducted in the U.S., or anywhere, for that matter. Those same ethics would make some physicians somewhat uncertain about  using such an approach in their own practices. Could I reasonably withhold an inhaler  which may benefit someone? Can I also withhold a cessation intervention (which in this case would be the smoking cessation discussion)  when I know it might help some people, albeit very few?

We must also remember also that we can only have this discussion because of the current negative view of smoking by society. For example, would it be acceptable for my doctor to tell me that they are not going to prescribe me Lipitor because I’m fat and I need to lose weight, first? Certainly not! If they did, would it make me lose weight? Maybe.  Yet still it would not be considered ethical to do such a thing. Should we deny insulin to chocoholics? Tell people with GERD to come back for Nexium post fried chicken cessation? Explain that we prescribe STD treatments only after people stop practicing unsafe sex? No, we don’t do that, at least not that I’ve heard of.

And so I guess I’ll keep seeing smokers, and keep talking about smoking cessation until I’m blue. But maybe I’ll push back a little harder when they ask what I can prescribe that will help their breathing.

Deep Ramachandran is a pulmonary and critical care physician who blogs at CaduceusBlog.

Prev

Physicians need to embrace change to fix heathcare

September 18, 2012 Kevin 12
…
Next

Both sides are spewing nonsense when they talk Medicare

September 19, 2012 Kevin 2
…

Tagged as: Primary Care

Post navigation

< Previous Post
Physicians need to embrace change to fix heathcare
Next Post >
Both sides are spewing nonsense when they talk Medicare

ADVERTISEMENT

More by Deep Ramachandran, MD

  • We can’t build our way out of the ventilator shortage. But there is a solution.

    Deep Ramachandran, MD
  • When someone is not dead but not alive

    Deep Ramachandran, MD
  • The hurricane in Puerto Rico is leading a shortage in saline bags

    Deep Ramachandran, MD

More in Meds

  • How drugmakers manipulate your health from diagnosis to prescription

    Martha Rosenberg
  • The food-drug interaction risks your doctor may be missing

    Frank Jumbe
  • Why retail pharmacies are the future of diverse clinical trials

    Shelli Pavone
  • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

    Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO
  • A world without antidepressants: What could possibly go wrong?

    Tomi Mitchell, MD
  • The truth about GLP-1 medications for weight loss: What every patient should know

    Nisha Kuruvadi, DO
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why perinatal mental health is the top cause of maternal death in the U.S.

      Sheila Noon | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 8 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why perinatal mental health is the top cause of maternal death in the U.S.

      Sheila Noon | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Should doctors stop prescribing inhalers for smokers?
8 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...