Why do so many doctors smoke?

June 16, 2005 7:31 AM

Why do so many doctors smoke?

Doctors know better. They're exposed daily to the physical damage caused by smoking. One of the first responses to any medical issue (on AskMe, in medical publications, on TV, in their offices...) is "quit smoking." Yet lots of doctors still smoke.

This paper [pdf] tries to explain it from a clinical view, but what is your theory? I'm particularly interested to hear from 'the doctors of MeFi.'

posted by hsoltz to health & fitness (24 comments total)

I know an awful lot of doctors and do not know any who smoke or at least who admit to it. Perhaps twentysome years ago the percentage was higher, but from my anecdotal perspective their smoking rate is extremely low.
posted by caddis at 7:50 AM on June 16, 2005

My mother worked in the health industry for a long, long time, and I've met many of her doctor friends, none of which I ever knew to smoke.

I'm sure that the doctors who do smoke continue to do so for the same reason that non-doctors do: addiction.
posted by nitsuj at 7:54 AM on June 16, 2005

My wife is a medical student, and although very few of her fellow students smoke, a lot will do things that they advise their patients to stop, like drinking juice if you want to lose weight. I think it's the same reason that lots of intelligent people do that sort of thing: it's difficult to see your own faults. And with something as chemically addictive as smoking, it's even harder to stop. A high-pressure job like being a doctor probably makes a person more likely to smoke, too. Nicotine is a depressant.

(On preview, ditto nitsuj)
posted by Plutor at 7:55 AM on June 16, 2005

As far as I can tell, lots of doctors do not smoke as you presume. I don't, and neither do any of my close peers. I think it tends to be more prominent in older physicians who developed their addiction decades ago, but I would bet anything that age-matched and location-matched, doctors smoke far less than their counterparts in the general population.

That said, there's a difference between having a concrete understanding of how bad a behavior is, and actually discontinuing said behavior. There's more than a fair share of personality and mood disorders among physicians.
posted by drpynchon at 7:56 AM on June 16, 2005

Firstly, smoking is a habit and habits are hard to change.

I think the paper summed it up rather well. They probably started smoking when they were younger and like most smokers, find it incredibly difficult to quit and not worth the stress. My sister is a registered nurse who spends most of her days in intensive care facilities, but she smokes like a chimney.
posted by purephase at 8:01 AM on June 16, 2005

I know many doctors and many medical students. Of this large pool, I only know one who smokes, and he only does so in social situations, maybe once or twice a month.

I also smoke once or twice a month. The last time I went in for a checkup, I asked my doctor if that was a problem. He laughed and told me no, it was nothing to worry about.
posted by jdroth at 8:21 AM on June 16, 2005

Another thing to consider is that the process of becoming a doctor is very stressful and involves very long hours. I can see why a doctor would become a habitual user of a stimulant.

The inconsistency between what is known to be healthy and personal practice of doctors is similar with regards to weight: Many doctors advise their patients to lose weight, but they could stand to lose a few pounds themselves. As it turns out, my doctor's successful experience with Weight Watchers was a strong influence on my starting a diet myself.
posted by Doohickie at 8:21 AM on June 16, 2005

It's due to the bad influence of characters like Dr. Abby Lockhart on E.R.
posted by matildaben at 8:28 AM on June 16, 2005

most doctors I know (many in my family, many friends) who are smokers -- some of them, eerily, oncologists -- aren't heavy smokers (say, about 5 smokes a day on average, less than half a pack at maximum). the idea is, they know so much stuff can go wrong in the human body that a few cigarattes a day won't probably kill you by themselves. and they enjoy the smoking. what they seem to watch more than their diet (see: no saturated fats, no burnt food bits, keep weight under control, big helpings of fresh fruit and fiber, etc) than their light smoking
posted by matteo at 8:31 AM on June 16, 2005

As drpynchon idicates, cognitive dissonance.
posted by Pressed Rat at 8:32 AM on June 16, 2005

Some of the doctors I know echo matteo's sentiments. I remember one lung doctor saying that a few cigs a day will not harm a person whatsoever, so who cares?
posted by jmd82 at 8:35 AM on June 16, 2005

Many doctors advise their patients to lose weight, but they could stand to lose a few pounds themselves.

Ha!

I call my doctor Dr. Comic-Book-Guy. They're like identical twins.

Doctors are human, just like the rest of us, and they have weaknesses and they make mistakes. The key is to listen to what they say, not to watch the behavior they model. (The doctor I know best is an anorexic running freak!)
posted by jdroth at 8:37 AM on June 16, 2005

Stress and addiction. Pretty much everyone knows how bad smoking is for you, these days, not just doctors. Yet many still smoke. No reason doctors should be any different.

People do things that are bad for them in the long term because they feel good in the short term. And sometimes that's more important. Or at least, it can seem so until you're actually coughing up blood and rushing to get the will up to date, I guess.
posted by Decani at 8:42 AM on June 16, 2005

I can't give any insight into why these doctors started smoking but I can guess at why they don't stop.
Quitting smoking is an excruciating process. I've tried a couple times and the best I've ever done is 8 days without a cigarette. During withdrawal, I was more or less mentally incapacitated. Extreme confusion, irritability, and an inability to concentrate on much of anything. Compare it to the first 30 seconds of being awake, except much worse in a way that I can't quite describe.
Having tried to quit and knowing what the symptoms of withdrawal are, it makes me nervous to try to quit when I'm anticipating any kind of stressful event that's upcoming in my life.
In school, I didn't quit because I was afraid that I'd fail things, that I'd screw up projects or blow up in a rage during class. Now that I'm out of school, I'm planning my wedding and the stress of that keeps me smoking.
(Just a note: all of this could just be my addiction talking. It's powerful and insidious like that.)

I'm sure these doctors have tried to quit. But, if I were them, looking forward to days and days of difficult decisions and needing to be 110% all the time, I couldn't bring myself to quit. I'd be petrified of screwing something up. Quitting, in my experience, probably needs a month's worth of vacation time during which you do nothing but try to quit.
posted by Jon-o at 8:54 AM on June 16, 2005

A greater percentage of doctors smoke than the general population.

Many reasons:
* If you're constantly treating other people, your mind starts to assume that only other people get diseases, not you.
* Dealing with life and death can be very stressful.
* Others already mentioned here.
posted by gramcracker at 9:53 AM on June 16, 2005

A greater percentage of doctors smoke than the general population.

While googling brings up numbers for Arab countries, Russia, and China, I can't seem to find verification of this for, say, the US.

I did find a message board post that said "I read somewhere that the percentage of doctors who smoke went from around 25% to 3% in the past twenty years," which of course means very little, but makes intuitive sense.

So is this true at all in the US?
posted by frykitty at 10:25 AM on June 16, 2005

My mom has worked in the medical field for over 20 years, and she smoked for 30. My brother is a Paramedic / Firefighter and he smoked / chewed tobacco (also recently quit). From what I've seen, they know it's bad but their jobs are very stressful and they use it as stress relief. I imagine the same applies to doctors.
posted by geeky at 10:42 AM on June 16, 2005

For the same reason that there are so many fat nurses.
posted by crapulent at 10:49 AM on June 16, 2005

I remember one lung doctor saying that a few cigs a day will not harm a person whatsoever, so who cares?

whoa whoa -- can we get some outside confirmation for this? I'd love it if i had some medical backing to pursue my vices. So one day when my lungs are black I can call up this page on the wayback machine and curse long-dead mefi users.
posted by fishfucker at 11:35 AM on June 16, 2005

I e-mailed a doctor friend about this thread (specifically about the charred food thing), and she had this to add (relevant reading for us once-in-while smokers):

oral and liver cancers are the big ones, but again it is a quantity issue. these cancers are most commonly in alcoholics, but obviously carcinogeic potential is there.

A very simple way of thinking abut carcinogenic agents goes something like this: The agent irritates and damages the cell, including the cell's DNA. when the DNA is damaged one of two things can happen: the cell can repair it back to normal or a mutation can occur. if the cell gets enough mutations it no longer responds to the growth regulating factors in the body and it grows out of control (this is what cancer is). one mutation isn't enough to do it, it takes multiple "hits" so the more exposure you have to an agent the greater your chances are of getting a mutation. but don't despair, the body is very good at repairing itself and will make the right DNA repair 99.99% of the time. plus the mutations have to occur in genes related to cell growth (85% of your DNA does nothing -mutations there don't matter!).

say you sunburn a billion cells, maybe 1,000 will pick up a mutation, but only 150 or so will have a mutation in an important part of the DNA. if you get another sunburn, the chances are very, very small that one of these cells gets a critical mutation again, but everytime you get a sunburn, your chances go up. this is why a 5 yearold with one sunburn doesn't get melanoma, but a 40 year old surfer will (same with alcohol/alcoholics).

And smokers, one would think.
posted by jdroth at 11:45 AM on June 16, 2005

Most funeral directors I know are casual to habitual smokers.
posted by ColdChef at 12:05 PM on June 16, 2005

I worked in healthcare for 10 years and knew lots of respiratory therapists who smoked. They even had their own smoking section.....sorry but that's fucked up.
posted by mkelley at 5:12 AM on June 17, 2005

I worked in healthcare for 10 years and knew lots of respiratory therapists who smoked.

Maybe they wanted to keep themselves in business?
posted by dagnyscott at 6:39 AM on June 17, 2005

I think gramcracker's assertion about the percentage of doctors who smoke is wrong. It certainly lacks support.
posted by caddis at 7:18 AM on June 17, 2005