Is Smoking Part of Medical History?

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Mike Mathers

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I got into a debate with a colleague of mine. He says that he doesn't including smoking cigarettes as part of a patient medical history. He gave me a bunch of reason why but they all didn't seem to make any logical sense to me.

Since am new to the organization I didn't want to create a big argument but it's definitely something I would include. What do you guys think? Also, is there a medical-like term for cigarette smoking?

Thanks.
 
Smoking is not medical history or a medical condition. Smoking is social history along with drinking alcohol (unless they are an alcoholic).

I usually don't ask about smoking because I have yet to find that piece of information useful. The hospitals will ask it and include it in their reports usually labeled as pack years (packs per day x years of smoking)
 
I generally do not ask unless it is to explain why somebody has an acutely high CO level


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Smoking is ALWAYS a part of social history.

It CAN BE a part of medical history. If they are acutely short of breath, do they smoke? Have they smoked more than in the past? Are they smoking more? If my Rad 57 starts yelling at me, then Smoking Hx also turns into part of the Pertinent PMHx. There are lots of other examples as to how it can be medical history, so I would say both of you are right depending on the circumstance.
 
How is smoking not part of a medical history? It has a direct impact on the health of the individual and predicts many health problems that could complicate your assessment and management. It is a risk factor for vascular disease, heart disease, hypertension, stroke, MI, COPD, CHF, cancers, etc. It can have a significant impact on airway management - smokers desat faster and are at higher risk for laryngospasm, bronchospasm, and barotrauma.

I can see how it may not be relevant in the field, where assessment is generally focused on the immediate complaint or presenting problem, and we generally aren't that concerned with overall health status as much as we are the immediate problem. I probably wouldn't include it on a run report unless it was directly relevant to the presenting problem. But as part of a comprehensive medical history, it is definitely pertinent.
 
Use your discretion, and sound clinical judgment. Not every patient will be asked whether or not they have a previous history of smoking.

The 15 y/o panic attack who is otherwise stable with no other indications to make me ask? I probably don't care.

The 50 y/o COPD with an acute exacerbation flare up? You bet it's pertinent, and I want to know how long they have smoked, and/ or how many packs per day, etc.

Not much in this field is either black or white, but prudent detective work is a key component to a thorough assessment that a proactive prehospital providers approach should include.
 
Every time I'm scrolling and I see the title to this thread, I think is says:
"Blah blah SMOKING POT blah blah blah"


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Wishful thinking perhaps? Lol.
 
Remi said:
It is a risk factor for vascular disease, heart disease, hypertension, stroke, MI, COPD, CHF, cancers, etc. It can have a significant impact on airway management - smokers desat faster and are at higher risk for laryngospasm, bronchospasm, and barotrauma.
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^ This, and it is also why questions about social habits are asked in a hospital environment. It's a part of predictive diagnostics, which have little to none to do with prehospital care.
 
Routinely asking about smoking, unprotected sex, drinking, eating sushi or other tar-tar, are their parents alive and if not what did they die from at what age,... generally not. It has been included when it was relevant but not on 99% of my calls.

...that, and lets face it, at 2am in their house when they are complaining of difficulty breathing - you see and smell the ash trays and butts...
 
Yes it is, but it isnt a question i would ask every patient, just like drug or alcohol abuse, obesity ect
 
Ask if you think it's relevant. It's part of the social Hx (which is an aspect of medical Hx) just like martial status, employment, and alcohol.
 
Smoking is absolutely part of Medical history just as much as alcoholism is. The fact that someone was a heavy smoker for most of their life explains Health conditions if they were a former smoker. Once you quit your body does not return back to normal

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I don't think it really matters what you classify it as (social history, medical history, etc). I do think it's important to know, though.
 
If EMS starts treating and releasing more, or making community health calls, I think you will see it fall more into our verbal and documented assessment. For a standard 911 call and a tick box ePCR, not so much in most circumstances. The same can be said for many lifestyle choices and risk factors such as Smoking, Alcohol, Unprotected Sex, Sedentary Lifestyle, Unhealthy Diet, ect ect In fact, I would be hard pressed to find it in a Paramedic or EMT main textbook.
 
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Docs/RN's can bill an additional code for smoking cessation education...little trick to increase revenue. Primary use is in risk factor analysis for cardiac/neuro event...or as a risk factor analysis for another type of med complaint, should you want to try and Dr. House-it
 
Bullets said:
Yes it is, but it isnt a question i would ask every patient, just like drug or alcohol abuse, obesity ect
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My experience with 911/ALS providers around here is that at some point during the assessment they will inevitably ask about drug/social history. It makes sense in many circumstances--doesn't cocaine use increase the risk of MI, and can lead one to suspect it in younger patients?

(Also, I'm curious, in what circumstance would you "ask" about obesity? Do you mean bariatric surgery etc?)

Phrased correctly, it is a nonjudgmental question that accepts the patient regardless of whether she/he uses the drug in question, showing compassion in both cases--so I perhaps don't feel as many qualms as you do about asking.

(I have my own social anxieties and awkwardness with patients, but thankfully this is one I've navigated around).

What really annoys me is when phrases like "illegal drugs" and "illicit substances" are uses, not so much the vocabulary, but the tone, that almost implies that the patient is being judged by the provider as "bad" for his/her life choices.

In terms of tobacco, it's not the first thing I'll think of, but if it seems relevant, or if the patient offers the information, I'll record it and include it in the handoff.
 
RedAirplane said:
My experience with 911/ALS providers around here is that at some point during the assessment they will inevitably ask about drug/social history. It makes sense in many circumstances--doesn't cocaine use increase the risk of MI, and can lead one to suspect it in younger patients?

(Also, I'm curious, in what circumstance would you "ask" about obesity? Do you mean bariatric surgery etc?)

Phrased correctly, it is a nonjudgmental question that accepts the patient regardless of whether she/he uses the drug in question, showing compassion in both cases--so I perhaps don't feel as many qualms as you do about asking.

(I have my own social anxieties and awkwardness with patients, but thankfully this is one I've navigated around).

What really annoys me is when phrases like "illegal drugs" and "illicit substances" are uses, not so much the vocabulary, but the tone, that almost implies that the patient is being judged by the provider as "bad" for his/her life choices.

In terms of tobacco, it's not the first thing I'll think of, but if it seems relevant, or if the patient offers the information, I'll record it and include it in the handoff.
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I wouldnt ask about obesity, but in the patients PMH section i would put "obese" when relevant. Like you said, social history is history. Its one of the many things my staff doesnt note that annoys me.
 
If they just have a broken leg, then smoking is irrelevant.

If they fell and broke their leg because they suddenly felt short of breath and got dizzy...then, yes, smoking is a relevant question.

Smoking is not a social question. It is a question about chemicals in the body and conditions resulting from damage to the body. I don't ask every patient to detail what vitamins they take, but I do ask some, because sometimes it's relevant. The catch is that we don't always know when it is or isn't relevant until we often already have the information.
 
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