Viewpoint

Scared Straight

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

It may sound innocuous, but I hate the term “health care provider.” It's a garbage bag term that lumps everyone from neurosurgeons to chiropractors in the same group. I'd rather be called a physician. To paraphrase Judge Randolph toward the end of A Few Good Men, “The government will address me as physician. I'm quite certain I've earned it.”

Having said that, I actually do help care for my patients' general health. We've done a great job treating disease, but only recently have we spent much effort on prevention. I'd like to address one example in this column this month that we as ophthalmologists can affect: smoking.

I may be a little more anti-smoking than some, but I suspect many of you feel like I do. Steve Charles taught me years ago that smoking was the number one preventable cause of macular degeneration. We've all seen folks go blind from smoking-related diseases like retinal vascular occlusions. Smoking speeds up cataract formation, although we could see that as an opportunity to heal.

By the time this issue arrives, it should be mid-February — which means close to 95% of all New Year's resolutions will be history. Now it's your turn.

The primary care doctors try to get their patients to quit smoking by reminding them it will kill them. Everyone knows smoking will kill you! What's the typical smoker's response? “Doc, we all gotta die sometime.” They either ignore, or don't realize, just how badly a smoker's quality of life suffers in the years (even decades) before that. If they hear about some of the more gruesome treatments they might need one day — a tracheostomy tube, for instance, or a foot amputation — they can be “scared straight.”

So here's your chance to shine. When they shrug off the talk about smoking's mortality rates, tell them, “Yeah, but you don't have to go blind first.” They respond with shock that smoking could cause you to go blind — “No one's ever told me that!” I can't tell you how many people in our practice have quit smoking from that simple revelation. I often follow up by mentioning that since smokers die at an earlier age, they don't always live long enough to go blind.

Then, I back it up with a few other choice examples. I really hit them where it hurts. For men, I remind them of the high association of impotence with smoking. For women, two words: premature wrinkles. I even ask older patients if they have grandchildren and suggest they tape a photo of their grandchildren to the pack of cigarettes.

You might be reading this and think I'm kidding. I'm not. I use these and other examples to help folks get over this horrible addiction. Former Surgeon General C. Everett Koop equated the addictive power of cigarette smoking to that of heroin use. A great way to stop a bad habit or addiction is to be overwhelmed with its negative side effects, so I try to give them as many dark consequences as possible.

Oh, and amputations. Don't forget to tell them about the amputations. That's the kind of “health care” no one wants to “provide.”