Are doctors taught about nicotine recovery?

Sometimes the response people get from their doctors upon finding out that they had quit smoking is less than enthusiastic, often expressing great skeptisism that the people will be able to sustain their quits over the long-term. The former smokers are often left discouraged and at times begin to question their own ability to stay off. Video explains why physicians are often pessimistic of people’s ability to quit smoking and stay smoke free over the long term.

Related resources:

“Whatever you do don’t quit smoking cold turkey!”
When you may really need to talk to your doctor about quitting smoking
Talk to your doctor about quitting smoking
Resources to pass along to health professionals
How to help your patients quit smoking
How did the former smokers you know quit smoking?
Are people doomed to fail if they don’t get professional help to quit smoking?
Who should you believe?
Is cold turkey the only way to quit?
A smoking cessation expert?
“The Surgeon General says…”
“40 years of progress?”
When did people start to take your quit seriously?
I’d rather be a little overweight and not smoking than underweight and dead!
Resources for doctors to help their patients

A study of smoking and smoking cessation
on the curricula of UK medical schools.
Tobacco Control 2004 March ;13(1):74-77.
Roddy E, Rubin P, Britton J.Division of Respiratory Medicine, School of Medical and Surgical  Sciences, University of Nottingham, Nottingham, UK. Faculty of Medicine and Health Sciences, University of Nottingham. Division of Epidemiology and Public Health, School of Community Health Sciences, University of Nottingham.OBJECTIVES: To identify current practice in teaching on smoking and smoking cessation in UK medical schools, and establish whether newly qualified UK doctors feel prepared to deliver smoking cessation interventions.
DESIGN: Search of published curricula from all UK medical schools; questionnaire surveys of all UK medical school deans and UK qualified pre-registration house officers (PRHOs).
PARTICIPANTS: Deans or nominated representatives from all 24 UK medical schools with current undergraduates, and all UK qualified PRHOs.
MAIN OUTCOME MEASURES: Inclusion and organisation in curriculum of 15 predefined core topics related to smoking (deans); perceived readiness to deliver smoking cessation interventions (PRHOs).
RESULTS: There was no mention of smoking or smoking cessation in the published curriculum material of 10 (42%) medical schools. Deans reported compulsory teaching on a mean (SD) of 9.5 (2.8) core topics, while PRHOs recalled compulsory teaching in only 6.6 (3.2). Training in clinical aspects of smoking cessation was particularly neglected, with 60% of PRHOs reporting that they graduated unable to deliver smoking cessation interventions in accordance with national guidelines. Only 17% of PRHOs felt well prepared to deliver advice on using nicotine replacement therapy, and 5% on bupropion.

CONCLUSIONS: Teaching on smoking cessation in UK medical schools is inadequate.

PMID: 14985601 [PubMed – as supplied by publisher]


WhyQuit’s Patient Resources
Joel’s Library as a .PDF Book
Sadly, the odds are that your physician’s nicotine dependency recovery understanding is primarily comprised of what the NRT pharmaceutical industry want him to know. Even then it’s only what the industry wants them to know.
How many know that when all over-the-counter patch and gum studies are combined and averaged that only 7% of study participants are not smoking at six months?[1] How many physicians actually know that two different studies have now shown that the six-month smoking cessation rate for second time and subsequent nicotine patch users drops to almost 0%?[2][3] How many know that 36.6% of all nicotine gum users are chronic long term users?[4]
Imagine the number of minds and lives that could be touched if your physician’s nicotine dependency understanding matched yours. There was always only one rule, no nicotine today, Never Take Another Puff!
1. Hughes JR, Shiffman S. et al, A meta-analysis of the efficacy of over-the-counter nicotine replacement, Tobacco Control 2003 March;12(1):21 -7. Full text link – http://tc.bmjjournals.com/cgi/content/f … o5/Oz4yutI
2. Tonnesen P, et al., Recycling with nicotine patches in smoking cessation. Addiction. 1993 Apr;88(4):533-9. Abstract – http://www.ncbi.nlm.nih.gov/entrez/quer … t=Abstract
3. Gourlay, S.G., et al., Double blind trail of repeated treatment with transdermal nicotine for relapsed smokers, BMJ 1995;311:363-366 (5 August) http://bmj.bmjjournals.com/cgi/content/ … 1/7001/363
4. Shiffman S, Hughes JR, et al., Persistent use of nicotine replacement therapy: an analysis of actual purchase patterns in a population based sample, Tobacco Control 2003 November; 12: 310-316. Abstract – http://tc.bmjjournals.com/cgi/content/abstract/12/3/310
Other related commentary:

I’ve had a few discussions recently with people who have encountered doctors who were encouraging members of their families or their friends to consider taking NRTs to help deal with occasional smoking thoughts even though the people were totally off smoking and nicotine for very significant time periods. Again, some of these people assumed the doctors understood something because they were trained medical professionals. As this article discusses, training in smoking cessation for medical professionals is usually inadequate to almost non-existant.

All of our members and lurkers have an opportunity to help their doctors to be better able to help their patients. It is not even by just referring them to Freedom, or WhyQuit.com or to any online support. It is by helping them see that for you what made quitting possible was simply getting nicotine out of your system and the one thing that is making this quit stick is the fact that you recognize that you cannot put nicotine back into your system ever again.

If physicians, dentists and other health care professionals see and hear this enough they will start to recognize what message they can give to really help their other patients break free from nicotine. The message is oh so simple, to get and then stay nicotine free just never deliver nicotine again from any replacement source and as far as the smoked form goes, to stay nicotine free is as simple as just knowing to never take another puff!

Joel

Other related information: WhyQuit’s patient resources

February 2008 commentary from John Polito from WhyQuit.com

Physicians Missing Golden Opportunity to Teach, Heal and Save Lives

In June, my oldest daughter Carmen graduated as an M.D. from the  Medical University of South Carolina. We’re extremely proud of Carmen as she graduated #3, 4 or 5 (the exact finish was kept secret) and was the top female grad. But what’s shocking is that her class received no formal instruction time in how to counsel patients regarding our nation’s leading cause of premature death. What students were instead exposed to was watching doctors advising patients during clinical rotations, primarily in how to prescribe pharmaceutical “cessation” products, very much in line with what the 2004 UK study above seeks to achieve.

I’m about to complete presenting two hour cessation seminars to thousands of inmates in 28 prisons. Not only does each inmate have in hand WhyQuit’s quitting tips sheet, they now have access to library copies of “Never Take Another Puff” by Joel. Yes, sadly, many of these inmates will soon be better prepared, knowledge wise, to counsel friends and family regarding cessation, than their own doctors. Why?
What medical students and physicians need to ask themselves is, what dependency recovery learning takes place by slapping on a patch, swallowing a pill, chewing nicotine gum, being hypnotized or when stuck with needles? None, absolutely none. Knowledge truly is a quitting method but that knowledge can never be shared unless known.

Yes, practicing physicians are short for actual patient contact time but if the doctor has a smoking patient sitting and waiting in a patient examination room, they have before them a captive audience and golden opportunity to dim the lights and treat the patient with a dose of education. Short 15 to 30 minute video clips played upon an exposed wall could teach patients: (1) the price their body is paying, (2) how and why their mind became nicotine’s slave (3) how to arrest their dependency, or (4) relapse prevention clips at follow-up appointments.

The enslaved mind’s priorities teacher was long ago fooled into believing that arriving nicotine was a species survival event, every bit as real and important as eating. This isn’t some “nasty little habit” but nicotine’s presence or absence causing brain neuro-chemicals to flow or not flow, rewarding anticipation or compliance with dopamine pathway “aaah” sensations and punishing abstinence with insula generated anxieties and craves. These amazing behavior control pathways are believed to generate the most vivid or powerful memories the mind can record, memories that quickly over-write and bury nearly all remaining memory of life without nicotine. The new drug addict is compelled to believe that nicotine use defines who they are, gives them their edge, helps them cope and that life without it would be horrible. If the physician isn’t going to tell the patient the truth about what’s happened to their brain then who will?

Every physician encountering chemically enslaved patients must have some means of instructing patients regarding the time needed to rid the mind of all nicotine and achieve peak withdrawal, and the law of addiction, the fact that they are not fighting a whole pack or even a whole cigarette but just that one powerful puff of nicotine that would, within 8-10 seconds, cause roughly 40% of their brain’s nicotinic-type acetylcholine receptors to be occupied, creating a powerful dopamine explosion that their mind’s priorities teacher would find nearly impossible, in the short term, to ignore.

Patients need to understand how nicotine was their spoon and the importance of again learning to eat regular meals now that nicotine, via fight or flight pathways, is no longer pumping stores fats and sugars into their bloodstream with each puff. They need to realize that encountering and extinguishing their mind’s conditioned feeding cues, their crave triggers, is good not bad, as with each extinguishment they are rewarded with the return of another aspect of life, a time, place, location, person or emotion during which their brain once expected the arrival of a new supply of nicotine.

They need to be taught not to run and hide from smoking thoughts rattling about inside the conscious thinking mind but to grab hold of each and closely examine it for truth. You want “one”? For the true drug addict, there’s no such thing as one as one is too many and a thousand never enough. You miss the taste? There are zero taste buds in human lungs, the place you’ll instantly such the smoke. You’re bored? Your brain is not addicted because it’s bored, it’s bored because smoking one pack-a-day consumed roughly 5 minutes per cigarette or 11.5 hours per week, and when quitting you notice all the extra time you wasted while the cigarette’s 4,000 chemicals slowly destroyed your body. You “loved” smoking? Stop and think about the beauty of your pre-addiction mind, before nicotine took control, and going months and years without once craving nicotine. If you can no longer remember the beauty of that mind then what basis exists for honest comparison? None.

Increasingly, both health insurance and government treatment programs are showing greater willingness to compensate physicians for nicotine dependency recovery counseling. Just one or two wires running from an existing office computer to a less than $300 examining room LCD or DLP projector and a less than $50 speaker could instantly deliver your personalized slide show cessation presentation to your smoking patients, a presentation that can sequence automatically with your voice on recorded audio clips explaining exactly what they are seeing and why it’s important. Imagine $350 and a few hours recording time actually helping save a patient’s life.

What’s stopping you? Need help putting it together? Here at Freedom you’ll find hundreds of the most knowledgeable ex-smokers on earth and I’m sure any one of them would be delighted to assist. Knowledge truly is power, but only if put to work!

Breathe deep, hug hard, live long,

John