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Smoking: When Doctors, Health Workers Don’t Lead By Example

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With their detailed knowledge of the risks of smoking, it is not surprising that most doctors and other medical professionals usually don’t smoke. But some do, despite many having first-hand experience of its dangers. VICTOR OKEKE asks why this is the case.

Doctor Nneoma Kalu (not his real name) owns a general hospital in Aba, Abia State. As the chief medical officer in charge, you will always see him under the canopy tree in front of the hospital drinking and smoking cigarette with friends as part of a leisure time.
Stories abound and mothers tell the narrative of how the doctor will wash off (detoxify) himself of all the harmful effects of cigarette smoking just because he is a medical doctor.
“He is a doctor. For them, smoking is nothing because they have the medicine to cleanse themselves of all the harmful effects of smoking. You that is not a medical doctor cannot try it, lest you will die,” my mother once told me.
For Ekanem Etim, a pharmacist with Mercy Hospital Abak in Akwa Ibom State, doctors smoke just because it is in the human nature to be stubborn and recalcitrant, the precautionary measures notwithstanding, for the same reasons why some doctors drink heavily and eat unhealthily.
“At the end of the day, they are human. They have the advantage of learning and seeing in great detail how destructive these habits are, but they’re also prone to making less than perfect decisions as well,” Etim said.
Cigarette smoking and tobacco use are important public health issues around the world, especially in developing countries. The World Health Organisation (WHO) has reported that 60 million people died between 1950 and 2000 due to smoking-related illnesses, more than the number of deaths in World War II.
A mortality study by researchers in some select African countries showed that smoking has decreased life expectancy by 16 years in all age groups and by 22 years in the 35–69 age groups. Recent studies link smoking with an increased risk of diseases such as coronary heart disease and cancers, as well as early death.
Half a billion people worldwide die due to cigarette use each year, and approximately half of those deaths are in the 35–69 age group. The danger of tobacco smoke is not limited to the smoker; environmental tobacco smoke increases the risk of lung cancer to 30% for nonsmokers.
In fact, tobacco products would not be sold legally if they were invented today—there is no other product on the market with such high levels of known toxins and carcinogens!

Given the overwhelming evidence of the health consequences of smoking and the documented detrimental effect that smoking physicians have on their ability to assist their smoking patients, a paramount question arises: Why do physicians smoke?
Is it because they do not know or do not believe that smoking is harmful?
Is it because they do not study this topic in their training as a regular course and thus they do not consider it important?
Or, perhaps they consider it important, but not a priority. They may think that helping a patient to quit smoking is doing prevention, and prevention is not promoted by most physicians who concentrate on treating their patients rather than helping them to avoid becoming ill. A study from Japan ‘found that 80 per cent of medical students did not consider counselling on smoking cessation necessary as long as patients did not have smoking-related diseases’.
But in reality, smokers are already sick; they are affected by nicotine dependence, which the WHO and the American Association of Psychiatry included, respectively, in the International Classification of Diseases and in the Diagnostic and Statistical Manual of Mental Disorders. Moreover, if they wait until they have a smoking-related disease before they stop, a huge amount of damage will already have been done, and they will have lost significant life expectancy.

In Turkey for example, despite the perception of medical doctors and other health workers as role models for teenagers and society as a whole, the smoking rate of doctors is greater than the average of the general population, the Turkish Health Ministry reported.
Meanwhile, some respondents on the issue like Emmanuel Arinze, a 400 Level medical student of the University of Nigeria Enugu Campus, said that health workers have a moral duty to abstain from cigarette smoking.
“Surely habits are stronger than rationality but I would like to add another aspect. People who see medical professionals, especially doctors, smoke, would conclude that if it is acceptable for doctors, why not for me? Or the other way. If even the doctors can’t give up smoking, I can excuse myself as well.”
“Therefore doctors betray their profession if they don’t follow what their profession recommends, be it smoking, eating or any other aspect rooted in one’s lifestyle,” he said.
Also, a medical doctor with the General Hospital, Arochukwu, Abia State, Bright Anwuacha, regretted that smoking is common in the medical profession.
According, Dr Anwuacha, “they do it primarily to relieve stress. It usually starts during medical school to relieve exam depression. While in school, we had a medical professor who was addicted to smoking. In fact, while in the ward, he will step out to smoke. The addiction hardly goes away.”

Dr Obinna Emeonye, an optometrist with the Abia State Ministry of Health also explained that most medical practitioners continue smoking because of the addictive effects of nicotine in their quest to relief of anxiety.
“Naturally, nicotine acts as stimulant that activates the brain. It gives them the momentary soothing effect, relaxing their nerves and helping them stay calm. At times before going into the theatre, some smoke just to relax and get control,” he added.
On whether disciplinary actions should be meted out for them, Etim said “the disciplinary action must be traced to hampering their job or the way they have treated a patient. You cannot combine people’s personal life with their professional life.”
But Uche Ogugua-Eze, an architect in New Haven Enugu, is of the view that cigarette smoking is never one of the habits that one develops on one’s own like masturbation. He said that it is a result of peer pressure.
“Cigarette smoking is a very social habit and almost everybody who smokes must have started smoking in the presence of smoking friends. It has nothing to do with medical school training and stress.”
“I have even jokingly told some of my smoking friends that I want to start smoking and they pleaded with me not to pick up the habit.”
“People who smoke hardly start it as a private affair. It is a social affair. It is a radical habit that you need people to start but unfortunately, people cannot help you to stop. Friends will aid you to start and at the end of the day, leave you with the burden of living as a smoker,” he noted.

From the preponderance of evidence, it is likely true that health workers often start smoking before undertaking their training, and do so for many of the same reasons other young people somoke. And being a medical practitioner can also be very stressful, so this likely has a role to play too.
The reason they don’t quit is also the same for the general population. Quitting smoking is very challenging, and combined with a stressful work environment, this explains why their medical education doesn’t lead all doctors and nurses to quit.
There are ethical and professional issues relating to smoking by doctors and other health workers. For ethical issues, the most obvious is that it could be seen as hypocritical.
A doctor smoking is seen by some people as undermining their credibility when telling patients about the dangers of smoking and why they should quit. It could also be seen as “sending the wrong message” to patients who see doctors or nurses smoking.
Whether for ethical reasons, professional reasons or for the multitude of health benefits that come from quitting smoking, doctors and health workers should be encouraged to quit smoking. Having first-hand experience with the quitting process also enables them to give more insight and advice to patients attempting to quit smoking.

Doctors can quit smoking using the same methods as everybody else, but they have the benefit of not only understanding the importance of quitting, but also having better access to medications to help with quitting smoking.
The more doctors and other health workers quit, the healthier medical professionals will be, and the more they will be encouraged to help their patients do the same.
The damage caused by tobacco is unacceptable and national and state support is needed to work towards a Nigeria, indeed, a world essentially free from the sale of tobacco products. A tobacco-free world where nearly nobody of the world’s adult population use tobacco, is socially desirable, technically feasible, and could become politically practical.



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