Hey buddy, can I bum a cigarette?

Issue: BCMJ, vol. 55, No. 2, March 2013, Page 69 Editorials

I guess this isn’t an unusual request from a stranger. However, I don’t smoke and have been told I am healthy-looking (liars). Also, when I was asked this question I was walking toward the physicians’ entrance at my local hospital. I could have been a visitor but I did have a stethoscope around my neck. The individual making this request was leaning against a No Smoking sign. 

One of my health authority’s initiatives was to make all of their facilities smoke-free zones. Admitted patients with nicotine addiction are now offered nicotine replacement, and staff who smoke are forced to go elsewhere. I applaud this health-driven decision, but unfortunately it hasn’t quite had the intended benefit. 

Previously, patients and staff would smoke in the designated smoking areas thereby keeping all of the smoking-related garbage and smell in one spot. Now, with no clear direction the smokers have to be more creative and sneak a ciggy wherever they can. This has led to the hospital grounds being littered with discarded cigarette butts, packages, and wrappers. Since the bus stop isn’t considered hospital property many of the truly addicted huddle together in this kiosk. Those wanting to actually catch the bus now must choose between secondhand smoke and standing in the rain. 

One of the less rule-oriented populations is the collection of unfortunate patients with psychosis admitted to the psychiatric ward. These nicotine-addicted unwell individuals escape out the nearest exit, which, you guessed it, is the physicians’ entrance. There they can linger under the No Smoking signs asking for handouts once their own supply is diminished. I have to admire their creativity, because they often fashion their own smoking area by pulling out wheelchairs and transport chairs, creating a nice comfy circle in which to socialize while they smoke. They mark their turf with garbage, blankets, chairs, and other items. As a result the arriving physicians are greeted by a cloud of smoke and patients requesting handouts.

It is reasonable for organizations to declare their properties smoke-free. However, most facilities don’t have visitors who are kept there for days on end without the opportunity to leave. Smoking isn’t illegal, and you could argue that for some nicotine-addicted psychotic individuals that removing their ability to smoke leads to conflict and interferes with their care. In contrast, narcotic addicts are offered risk reduction activities such as methadone maintenance, safe injection sites, and needle exchanges.

For the health of the non-smokers and care of our hospital, perhaps it is time to revisit having designated ventilated smoking areas. I’m not saying we should make it easy for people to smoke. Heck, we could make the room a giant treadmill, making patients walk while they get their fix. We could also cover the walls with anti-smoking slogans and have nicotine replacement dispensaries at the entrance. I am sure that better minds than mine can come up with some sort of compromise, as the current system isn’t working as intended. 

In the meantime, to cover my hospital parking fees, I have started selling packs of smokes at a 50% markup. If you can’t beat them—charge them.

David R. Richardson, MD. Hey buddy, can I bum a cigarette?. BCMJ, Vol. 55, No. 2, March, 2013, Page(s) 69 - Editorials.

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