Pulse
Anti-Smoking Prophet
David Warner believes anesthesiologists should help patients quit.
By Carmen Peota
Mayo Clinic anesthesiologist David Warner, M.D., has a message for his fellow physicians: Use the time just before surgery to encourage patients who smoke to quit.
Warner says his thinking about this began about 12 years ago when he started researching ways to reduce risk factors for lung problems in surgical patients. He quickly realized that stopping smoking before surgery was the single best thing they could do. He also learned something else: If a smoker underwent a major surgical procedure, his chances of successfully quitting were doubled, even without assistance. “There’s something very powerful about the surgical experience that motivates patients to take
Smoke Free for Surgery
In 2006, David Warner, M.D., convinced the American Society of Anesthesiologists (ASA) to encourage its members to talk to patients about quitting smoking before surgery. With the help of a task force led by Warner, the ASA has made a number of resources for patients available on its website including brochures and information cards, a PowerPoint presentation, and a video that explain the benefits of quitting smoking. There’s also a brochure for physicians that explains how to talk to patients about smoking. For more information, go to www.asahq.org/stopsmoking.
|
that step that most of them want to take anyway,” he says.
Just why that is isn’t entirely clear. But Warner thinks it’s probably because of a combination of factors, one of which is that people facing surgery are more aware of their health and willing to take steps to improve it. Also, his research has shown that smokers have fewer cravings and withdrawal symptoms when they quit around the time of surgery compared with when they quit at other times. He speculates this might be because they are removed from things in the environment that normally cue them to smoke or because they take other drugs such as opioids following surgery.
Warner says patients are motivated to abstain when they learn that it will speed their recovery. Research—the best of which comes from Scandinavia—has shown for some time that bones heal more slowly and wounds are more likely to become infected in people who smoke. “What’s relatively new is the knowledge that if you can get people to quit, the complication rate goes down,” he says, adding that even if they quit for a brief period, their outcomes can improve.
Warner is now working to convince fellow physicians to start talking to surgical patients about quitting smoking. He says anesthesiologists and surgeons often think discussing smoking is not their job; that they don’t have time for it; that they don’t know how to help; that what they say isn’t going to have an effect; and that patients will be offended if they try to bring it up. “I spend most of my time in my research trying to knock down those misconceptions,” he says.
What To Say
Anesthesiologist David Warner, M.D., knows that physicians sometimes struggle with how to talk to patients about quitting smoking. He starts by asking if they smoke, even if he already knows the answer. If they say yes, he advises them to quit for as long as possible before and after surgery, or to at least try to fast from cigarettes the morning of surgery and the week after. He explains that this will help them avoid complications such as infection and lung problems. Then he tells them, “If you’ve thought about quitting for good, surgery is an excellent time to do it because you may be more motivated to do things to improve your health, and you may even find it easier to quit.” He then hands patients a card with the telephone number 800/QUITNOW, which can connect them with free counseling. Warner says the conversation takes no more than a minute.—C.P.
|
His research has shown that patients aren’t offended when surgeons and anesthesiologists talk to them about smoking. “In fact,” he says, “if there’s something they can do to improve their chances of having a good outcome after surgery, they want us as physicians to tell them.” And he’s identified an approach that is effective and simple for busy physicians to do. You simply ask patients about smoking, advise them to quit for as long as possible (he recommends at least a week starting the night before surgery), and refer them to smoking-cessation services.
About five years ago, Warner took his ideas to the American Society of Anesthesiologists (ASA), which then launched the Be Smoke-Free for Surgery initiative. Although the ASA has embraced his ideas and a pilot study involving several private anesthesiology practices in Minnesota and around the country showed they were feasible, individual anesthesiologists haven’t necessarily adopted them. “I’m not the lone voice crying in the wilderness,” Warner says, but he acknowledges that the idea that anesthesiologists can help patients quit smoking is not widely accepted.
Yet Warner remains convinced that talking to patients is the right thing to do. And he’s hoping that he and others can spread this message within and beyond the anesthesiology community. He notes that patients have at least five points of contact with health care providers around the time of surgery. He’d like to see the nurses, primary care doctors, surgeons, and anesthesiologists who see them at those points all deliver the message about quitting. “It’s a matter of having an opportunity at a time when we know that people are more receptive to these messages,” he says. ■