What better time to quit smoking than during the pandemic?

Hester Wilson

13/04/2020 9:17:05 AM

Dr Hester Wilson reflects on a patient who was moved to quit amid the ongoing coronavirus outbreak.

Woman smoking
Dr Wilson found helping her patient quit smoking allowed her ‘to focus on something other than the direct danger of the coronavirus’.

The last few weeks have been crazy for all of us. We’re all under pressure and our patients are stressed in the strange, ever-shifting new normal in which we find ourselves. 
Trying to get our heads around COVID-19 testing and keeping ourselves, our staff and our patients safe, while continuing to provide our usual good-quality care, has taken considerable effort. 
It can be easy to get lost in the deluge of information. For me, that’s meant I have had to think through the unfolding characteristics of the SARS CoV-2 coronavirus and how we can protect those who are high risk, including older Australians those with hypertension or other chronic diseases – and people who smoke. 
This came to the fore recently when one of my patients – let’s call her Jay – came to me.
‘Okay, doc, I need to give up smoking now,’ she said. ‘You’ve been gently prompting me forever to change this, but with the coronavirus and the risk my smoking puts me at, I need to do this now.’
Of course, I think. It makes total sense.
But I have to ask the question.
‘Is this a good time? You’re stressed and worried and the world is in turmoil.’
What I’m really asking is whether it’s possible, given all the other stresses she might experiencing, from financial to anxiety around older parents. Rapidly quitting smoking isn’t for the feint if heart.
My patient is definite.
‘Doc, there’s never going to be a good time. I’ve always made excuses but this feels right. It feels right to do this now.’ 
I hear my own words in Jay’s mouth, the gentle prompting I’d done over years to change her habit.
Jay is in her 50s. She’s been smoking for 30 years, at least a pack a day, with her first cigarette 15 minutes after waking.
She stopped when she was pregnant but started up again later. So it’s safe to say she’s fairly dependent.
Jay also has a family history of hypertension and cardiovascular disease. All in all, she fits a similar profile to many of my patients. They all know smoking is risky, but ending the habit is hard.
Jay tells me she’s now working from home, that her family has never liked her smoking and her grown-up kids are nudging her to stop.
I ask and find she has lots of support, people who will help her when it gets tough.
I think she’s right. This is the time to quit.
For me, it feels good to focus on something other than the direct danger of the coronavirus. It feels good to be able to help someone to take an action that will have long-lasting benefit for their health and wellbeing – and will decrease their risk from the current virus.
So we discuss options, everything from going cold turkey to nicotine replacement therapy (NRT) to combined NRT to varenicline to Quitline to techniques to help change the habit (delay, distract, surf the urge).
After this, Jay makes a choice to continue the journey towards a new identity: becoming an ex-smoker.  
As for me, I’m planning to follow up via phone over the next few weeks. I know my ongoing support and the treatment I can provide is important, as is that of her family.
I don’t know if she’ll totally kick the habit of a lifetime, but every cigarette Jay doesn’t smoke will do her good.
As she leaves, I’m reminded of how much I enjoy helping patients change behaviours. I love this role of being a cheerleader, a bit player in the story they will tell themselves about how they made that significant change for the better.
I don’t yet know how her journey will go this time around, but I know I’m in for the long haul if she needs me.
I’m happy with that.
The RACGP has more information on coronavirus available on its website.
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Dr Christopher Charles Davis   14/04/2020 7:10:42 AM

Another great article Hester. Demonstrates that our 'gentle prompting' is really important in preventative health and 'being there for the long haul' is the beauty of General Practice. Let's all keep on prompting gently!

Dr Hester Hannah Katherine Wilson   18/04/2020 10:08:58 AM

Hi Chris,

yep, sometimes it feels like the gentle prompting goes nowhere but it leaves the door open so the person can come on in when they're ready