Physician Gregory Bratton relates a recent experience he had with two young patients with a bad smoking habit:
I saw two patients recently that really made me scratch my head.
The first was a 15-year-old girl who was smoking a pack of cigarettes daily and had been for 3 years; the other was a 26-year-old man who smoked 1.5 packs daily for 10 years and had recurrent oral ulcers and bleeding gums. In sitting and talking with these two patients, it became blatantly obvious that the risks of tobacco use – such as developing emphysema or lung cancer – didn’t scare them. Both said, matter-of-factly and without hesitation, “I’ll worry about that when I have symptoms.”
As you might imagine, I was at a loss for words. For years, schools, billboards, doctors, and the government have been trying to educate Americans about the ills that tobacco use can bring. Smoking has gone from being the cool thing to do to being socially unacceptable. Restaurants have banned indoor smoking sections, and ballparks, office buildings, and public venues have designated smoking areas that are far removed from the main flow. Society has recognized that smoking is bad, but, as evidenced by my patients, our youth are still struggling with the concept.
How did Dr. Bratton respond?
Thus, when discussing smoking habits with my patients, I informed the teenage girl that her heavy smoking not only leads to lung cancer, bladder cancer, and other well known side effects, but also to bad breath, odor in her clothes, wrinkling of the skin on her face, staining of her teeth, infertility, and menstrual problems including irregular bleeding.
With the “too-cool-for-school” 26-year-old, I mentioned that he should have his oral lesions biopsied to rule out cancer, because if the lesions were malignant he could lose his tongue and lower jaw. Plus, I told him that he could be facing a future of impotence if he continues smoking at his current pace.
It’s a sad day when physicians need to resort to instilling fear in apathetic patients to discourage them from unhealthy activities, but this story does demonstrate the limits of the pay for performance model touted by so-called health policy experts.
Doctors can only go far in lecturing a patient on living a healthy lifestyle. It’s ultimately the decision of the patient to adhere to such advice. As a result, bad health outcomes occur and should not necessarily reflect negatively on the physician.
At any rate, kudos to Dr. Bratton for going a little further in his practice of preventive medicine.
