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No Deeper Commitment to a Patient

Few conditions demand more of patients and their physicans than the journey, the odyssey, to becoming a former smoker.

The neurochemicals in tobacco, particularly nicotine, affect numerous sections of the brain, producing profound chemical dependency. This overpowering habituation calls forth the broadest and deepest commitment by the patient’s physician. Over the years, I’ve found it helpful to adopt a bio-psycho-social-ecological and spiritual approach to the patient. And, to enlist a total commitment on the patient’s part.

Among other things, this involves: explaining the effect of smoking on the brain; understanding the various ways humans deal with anger and other negative emotions; convincing the patient to forgo routine activities; changing the environment; increasing exercise. I often ask the patient to study the 12-Step Program of Alcoholics Anonymous and consider applying it to smoking cessation.

When a patient asks for help in quitting smoking, I make plans in my schedule to commit additional time with the patient, and to schedule repeat visits. Often this involves voluntary, uncompensated time. The notion that this can be accomplished in one or two visits that insurance will pay is specious and counterproductive.

When treating patients who are trying to quit smoking, I often think of the words of Dr. Francis Peabody, nearly one century ago: “The secret of the care of the patient is in caring for the patient.” This quotation reminds me that caring for the patient demands time, patience and commitment.

Our profession is called upon to make many sacrifices in the name of service. This is one that has a built-in and profound payoff.

Joseph Fennelly
Madison, New Jersey

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