So, About Your Smoking...

[blas]

My coworker has been in a lot of inexplainable pain lately. But, because she's stubborn and poor like the rest of us (and did I mention stubborn?), she put off going to the doctor as long as she could, until it got too bad to handle.

She set up a normal appointment with her doc when the pain wasn't as bad. She had tests done and all the fun stuff, but the doc said they wouldn't know anything until at least the end of the month.

And, as customary, and as what happens to me and so many others who smoke, any time you go to the doctor, you get some kind of rigomorole about quitting smoking, cessation classes, blah blah blah blah.

Coworker was blunt, "I am not worried about that right now."

The pain is getting worse. So much so, she went home early the other night. She wanted to work through the pain, but she could barely walk.

She came back to work the other night and told me that her dumb bitch of a doctor called her that morning, and she figured maybe the results came back sooner or something. No.

The doctor called her to ask her if she was interested in signing up for the smoking cessation classes she'd attempted to foist on her when she'd been in the office. *Might I note here these classes are never free or covered by insurance or anything like that*

Coworker pretty much told her off, and is switching doctors.

I can't believe that either. She ended up getting a different doctor and was given a better medication that wasn't making her want to sleep at work, so it's a happy ending of sorts. I just hope her doctor learned a lesson. Good way to lose a patient, there.

[teh_blumchenkinder]

How insensitive! :wtf: And isn't smoking cessation help considered preventative care or addictive care? :headscratch: arg.
Glad your coworker got some relief, even if the problem isn't fixed. :( I hope it is fixed soon.

[blas]

This place charges you for walking in their door and breathing their air.

I've had "preventive" care stuff that is supposed to be covered at 100% not be covered, because they worked around it by charging for the medical instruments.

[Sapphire Silk]

Smoking cessation is generally covered by insurance. They want you to quit: anything to reduce the risk of them having to pay out on a heart attack or lung cancer.

You didn't say what kind of pain your friend was having. If it was chest pain, nicotine is a vasoconstrictor. It narrows blood vessels and can cause angina (heart pain) or pain in other parts of the body suffering from a depleted oxygen supply.

That they called her at home is a bit surprising, but pushing it in the doctor's office is actually part of the job. It's your right to say no . . . and I'm gonna document it so you can't come back later and complain, "but no one eeevvverrr toooollld meeee about smoking cessation."

I realize some folks get very defensive about their smoking. When we offer smoking cessation or tell you that you should quit, we are not judging you. We're trying to help you. Smoking is the number one factor in so many preventable illnesses.

[bainsidhe]

When you said your coworker could barely walk, that reminded me of my days of foot pain. Molded shoe inserts were a blessing, I suffer from plantar fascia and being on one's feet all day (without my custom inserts) is torture. It's interesting how we each interpret a post. :)

[blas]

Her pain was in her back and feet.

She had every right to be defensive of her smoking, and her doctor had no right to call her at home and try to sign her up for that nonsense when she was barely able to go to work in pain, and was hoping that call was answers that she desperately wanted to know.

[teh_blumchenkinder]

<snip> [...]and her doctor had no right to call her at home and try to sign her up for that nonsense when she was barely able to go to work in pain, and was hoping that call was answers that she desperately wanted to know.
Exactly. Which is where the suck is. :( Being pushy at a very bad time-- an obviously bad time, however smoking is (or isn't) related to the problem, when it's apparently not the problem (ie if you were coughing, smoking cessitation would be a bit more pertinent/immediate)... and then calling? And saying nothing else? yeah.
I do understand that medical professionals (as a rule) want to help... but this smacks of cluelessness or... something. arg.

[telecom_goddess]

My insurance doesn't pay for smoking cessation any damn thing.....and I don't understand why. You would think they would fall all over themselves to pay for that and lower costs in the long run.

[Sapphire Silk]

Exactly. Which is where the suck is. :( Being pushy at a very bad time-- an obviously bad time, however smoking is (or isn't) related to the problem, when it's apparently not the problem (ie if you were coughing, smoking cessitation would be a bit more pertinent/immediate)... and then calling? And saying nothing else? yeah.
I do understand that medical professionals (as a rule) want to help... but this smacks of cluelessness or... something. arg.

I acknowledged that the call at home was out of the norm. In the office, routine and more and more required. Unless the person is literally writing on the bed, we're supposed to use the opportunity of you being in the office to discuss it. It doesn't matter whether it is related or not since very few people see a doctor unless they are sick, and even fewer come in specifically for smoking cessation.

I'm not downplaying the friend's pain, which I'm sure was severe. The only suck was the call at home, and truth is it is not even that sucky. The caller had no way to know how the person was feeling at the moment of the call; she could have been feeling much better for all the caller knew. It only elevates to the level of suck if the caller persists in maintaining the call when the patient says, "Not today, thanks." (How the patient feels is really irrelevant, no is no).

The only thing about this call that is really sucky is that the call was made after the patient said no in the office.

[Seshat]

In the office, routine and more and more required. Unless the person is literally writing on the bed, we're supposed to use the opportunity of you being in the office to discuss it. It doesn't matter whether it is related or not since very few people see a doctor unless they are sick, and even fewer come in specifically for smoking cessation.

Is this also the case for fat/other tissue ratio?

[Sapphire Silk]

Is this also the case for fat/other tissue ratio?

It's not etched in stone . . . yet. Smoking cessation is a huge thing, and a JCAHO requirement in the hospitals. So is screening for domestic violence.

Talking about weight is getting that way what with the epidemic of obesity, and the fact soooooo many conditions and problems would get better if people would just lose weight.

And believe me, I know how hard that is. I've been working on mine since January and I've only been able to lose 30lbs. I've plateaued and I'm having trouble breaking past it.

I'm in pain most of the time. Before I started losing weight it was the headaches, neck and back pain that was killing me.

Now that I'm working out, it's primarily knee and foot pain, and general muscle aches for which I can no longer take anti-inflammatories because they were causing my blood pressure to go up. Tylenol helps a little, thankfully. And it's a good pain, a sign that my body is getting stronger, so it is much easier to live with than the pain I had before. The frequency of my migraines has dropped to next to zero, and my mood is much improved. My blood sugar is back to normal (I am pre-diabetic as well), and my blood pressure is coming down (though I am taking medication for that now, I hope to be able to stop at some point). The edema I was starting to develop in my feet, legs, and hands is a lot better, but still there. I may be stuck with it for life.

If I had started my exercise program a couple of years ago, before I was pre-diabetic and had high blood pressure, I would probably not have to take medication at all, and I would have less weight to lose (I need to lose a total of 76 pounds to reach my goal, so I have another 45 or so to go), and I might not have developed the edema at all.

[Seshat]

In that case I'm kind of glad my doctor's office is tracking my weight. It means I have an official record. :)

My wonderful GP hasn't been talking to me about it lately, probably because he knows what I'm doing and achieving.

Panacea, if you're having any pain crashes from the exercise, grab a pain-specialising physiotherapist and get some advice. Or PM me, but with all the usual caveats (I'm a patient, not a physio, yadda yadda yadda).

[Sapphire Silk]

In that case I'm kind of glad my doctor's office is tracking my weight. It means I have an official record. :)

My wonderful GP hasn't been talking to me about it lately, probably because he knows what I'm doing and achieving.

Panacea, if you're having any pain crashes from the exercise, grab a pain-specialising physiotherapist and get some advice. Or PM me, but with all the usual caveats (I'm a patient, not a physio, yadda yadda yadda).

Every patient should have the weight tracked; it's a part of good routine care :) And if you are on a plan to improve your health and following it, your doc will likely not bug you as long as you are making progress.

Last time I saw mine, he looked at my records and said, "Well, looks like your weight loss plan is coming along, you've lost X pounds and your blood pressure is a bit better. If you can keep bringing your weight down, we can look at your blood pressure and see if we can get you off the medication." That was music to my ears: I don't like taking the medication.

My knees are a lot better. I got physical therapy for awhile, and now I do the exercises on my own. My ankle problems are partly healing from that bad sprain I had last April, and partly a failure to stretch properly. I re-examined my routines and started working on better stretches, and it seems to be helping. Icing my joints after my work out also helps.

It's the next morning that kills me. I wake up very stiff, especially in my feet. I'm going to try doing stretches before I go to bed for awhile and see if that helps. If it doesn't, I'll PM you or check out a physio :)

[Seshat]

Hm. Try heat packs on the ankles before going to bed, or wearing bedsocks to keep the joints warm and flexible.

Or both. :)

[dalesys]

...wearing bedsocks to keep the joints warm and flexible.
Bedsocks go on feet?:eek: :p

[Pagan]

And what it is lately that they seemed to be concerned about my drinking? It seems to be some big concern that I'm a woman and a moderate drinker. C'mon, I'm Scots-Irish. My blood is half Scotch, half Guinness, and half tea.

The only suck was the call at home, and truth is it is not even that sucky.

She said "no" in the office and it should have been dropped then. Calling to badger her at home about that, and only that, when that wasn't what she was in for and was waiting for test results, is a little beyond the pale.

[blas]

I've gotten smoking cessation junk from the eye doctor and the dentist as well. I wish they'd just effing drop it.

In fact, the last time I had my teeth cleaned, the dental assistant said "If you don't quit smoking, I guarantee you're going to get gum disease!"

Really? Anything else you can forecast for me so I can be ready for it?

Next time I have a flat tire, I'm blaming it on my smoking.

[ShootMePlease]

This is where I disagree.

I always heard about my smoking and need to lose weight from nearly every medical professional I have come in contact with.

And I am grateful for it.

I finally did quit smoking 5 years ago, and I absolutely notice the difference. I'm still working on my weight, but those 2 things were definitely exacerbators for some of the problems I had. Would I have had a many upper respiratory infections if I didn't smoke ? Probably not. Would my back and feet feel better if I took some of the weight off of them ? Absolutely.

I know all about being in back and foot pain and wanting to know why. But to berate a doctor for caring about your health is a little much. Last time I checked, it was their job to do so.

[Captain Trips]

As to why insurance won't pay for the cessation programs, I think I have an idea. It's the same reason why dental insurance won't pay for implants.

Once upon a time, in a nation not too far away, it was actually expected that a person would end up working for the same company for decades, possibly all their life. In those days, you would of course have the same insurance plan all that time, and insurance companies cared about the long-term health of their subscribers as better health meant less payouts.

Those days are gone. Now, the average length of time most people stay working at one employer is about five years. Insurance companies know this, so are not really concerned any more about a subscriber's long-term health. So, they don't care if you quit smoking - your emphysema will be another insurance companies concern. (Dental insurance is the same way with dentures vs. implants - implants last longer than a lifetime, but by the time your dentures need replacing [which are far cheaper than implants] it will be another insurance company that has to pay. So they make more money if they don't cover implants.)

It's been said before - by President Clinton, I believe: We don't have a health-care crisis in this country. We have a health-care-PAYMENT crisis.

[Ree]

OK...this thread has touched on fratching territory numerous times.

I realize this is "Sickbay" and the original intent of this thread was that a doctor was so fixated on the fact that the patient smoked that he ignored the real reason for the visit, but I'm thinking this thread would have been more suited to fratching right from the start because of the potential to go down the road that it has.

CS is for discussing what is, and fratching is for discussing what should be.

CS is not to debate whether physicians have a duty to monitor their patients' smoking habits (or drinking, or weight), nor to debate when concern for a patient's health crosses to fanaticism over smoking, and it's certainly not the place to debate whether smoking contributes to long term health issues.

CS is not the place to question why insurance companies act as they do, nor to question why some things are not covered on health insurance plans.

I totally sympathize with the OP's friend, and feel that the questions raised are valid, but as I said, the issue is slightly contentious, and is really better suited to fratching.