Preventative Medicine 
Are hospitals going up in smoke?

Dalia Hasan talks about the need for preventative medicine in Britain's hospitals

Smoker outside of a hospital. Photo by Olivia Harris via Reuters

A smoker outside of a hospital. Photo by Olivia Harris via Reuters

As a final year medical student I have travelled to many different parts of the world on various medical rotations. Common to many of the hospitals that I’ve worked at, however, is a disturbing paradox. Picture a patient draped in their gown, standing outside a hospital with an IV drip in one arm, healing them back to health, whilst a cigarette is held in their other hand, simultaneously undermining this effort being made to heal them. Sometimes smokers come out in masses, found at the footsteps of the doors that lead into the place of healing and recovery. The hospital, just as the patient, becomes devitalized with a plume of smoke blown in its face. Surely something must be done to keep the integrity and purpose of the hospital alive?

Until now, the NHS trust has aimed to solve this problem by building smoking shelters for patients and visitors at several hospitals in the UK. Professor Mike Kelly who works for the National Institute for Health and Care Excellence (NICE) believes it “sends completely the wrong messages. Smoking is not OK, it is deadly”. Indeed, allowing people to smoke on hospital grounds not only goes against the hospitals efforts of promoting and protecting good health, but also encourages patients to continue smoking despite being given medical care. As the World Health Organization identifies, tobacco is the world’s leading cause of premature death, contributing to mortality in 1 in 10 adults. To help prevent the adverse effects of smoking, the underlying causes need to be addressed, which is perhaps through the way we practice medicine itself.

The need for preventive medicine

If a patient comes to the hospital with a fever, we don’t just give them paracetamol, we look for the underlying cause and treat it. Why should smoking-related illnesses be treated differently? “It’s senseless for the NHS to be spending so much time and resources dealing with the consequence of smoking and not addressing the cause in the first place”, says Professor John Britton, chair of NICE guidance development group. As smoking has addictive properties and countless health consequences, it should be considered as a disease and, more importantly, treated as one.

In an ideal world, preventive medicine would be at the forefront of how physicians care for patients. As it stands, simply put, hospital treatment currently consists of medications and surgery. A third element needs to be incorporated into the system of treatment to enable patient recovery to succeed outside of the medical system. Preventive medicine has had much success with the advent of vaccines and screening tools to impede the advancement of disease. Patient-approach smoking interventions could work in tandem with these innovations, thereby preventing patients from further exacerbating their illnesses or becoming ill in the first place.

One way that preventive medicine can be applied is by reaching vulnerable patients within the hospital itself. For example, patients being treated for tobacco-related illness could receive personalised counseling alongside the pharmacologic treatments that are available, such as Bupropion tablets and nicotine replacement therapy. The Centre for Disease Control has published that almost fifty percent of smokers have tried quitting in the past and therefore have the ability to do so again. Asking patients open-ended questions regarding their smoking history and what methods of quitting they have previously found useful empowers patients to do so again with additional supportive methods tailored to their experiences. Identifying the patients that actively smoke should therefore be a basic task of health care staff in order to help and support smokers to quit.

Turning smoking breaks into social breaks

From speaking to family physicians in Canada, it is clear that a more empathetic approach needs to be applied in order to make smoking cessation programs more comprehensive and therefore successful. Indeed, some general practitioners propose meaningful social contact, emotional support and companionship to be offered by health care providers.

Dr. Cathy Faulds, Canada’s family physician of the year (2010) and incoming President of the Ontario College of Family Physicians, illustrates the analogy: “We do not give our alcoholics a place to drink but rather, with compassion, we help them with withdrawal and offer addiction programs.  We should offer the same approach to all patients with addictions including smokers. Lack of readiness to quit should not be the reason we facilitate addictions in the hospital setting”.

One solution could be to offer a friendly room inside the hospital where patients can go at times when they are craving to smoke. By leaving a cigarette at the door, one could be rewarded with a place to socialize. Here patients can distract their hands from the habit of smoking by playing games or crosswords, or pass their craving sensation with a yoga session in order to enter into a more relaxed state of mind. More research into what activities can help to divert patient’s attention away from their smoking withdrawal symptoms would be of great benefit in this regard.

Although smokers have a right to smoke if they wish, clean air is a basic need around the hospital grounds. At the grassroots, there is opportunity for improvement in the delivery of healthcare by focusing on a more holistic approach to prevent the sequelae of smoking. Providing guidance to quit smoking through the use of pharmacological therapy, counseling and support groups could save health care expenditures and ameliorate quality of life. It is about time the medical community extinguishes the hospital’s smoky reception.