Wonderful article Claudio. CoSTED embodies what healthcare is - grab the opportunity, no matter how brief, unplanned, messy. Have the chat. Here. Now. Get the connection started.
How I wish for the ‘luxury’ of CoSTED’s 15-30 mins! My reality in engaging smokers at the primary care level is more like: I’m running behind. They’re new to clinic. Haven’t seen a GP for ages, life and kids come first. Ambitious list of topics to cover in 15mins. They’re sizing me up. What can they trust me with? How do I reset expectations that we can’t really get through all topics today, without making them feel dismissed and unheard? I get the sense they smoke, or their ‘ex smoker’ official status on intake is less than ex. Should I even bring it up? If not know, will they return? What about all the stuff they actually came in for?
Somehow I’ve worked out a 30 second spiel, it engages them, they relax, barriers come down. It happens quickly. Maybe while I’m typing a referral, or waiting for printer to have a think. I make sure to shove a quick script for a pharmacy vape their way, no pressure, encourage a follow up Telehealth. It’s not refined but it seems to work. They’re interested and often relieved. We joke a bit.
This is tobacco harm reduction at the primary care coalface.
Hi Carolyn, I came to see you quite a few years ago now. I came specifically to get a script for nicotine, I had heard you you were among the few doctors willing to do so. Anyway, it was I think, the last time I have ever got a script for nicotine lol. No reflection on you, it's just easy to get if you know how. But I have watched your career and involvement with admiration ever since. Keep up the good work.
Yes I remember you Paul! Argh the script system …. No comment is my safest response. Glad to hear you’re still smokefree. Hopefully your e liquids are good quality :)
Brilliant account. That’s exactly it: daily practice rarely offers the “ideal time,” yet it’s still possible to create meaningful moments, even in seconds. Your approach is realistic, humane, and effective; truly the essence of harm reduction in primary care.
These quick moments, often between one click and the next, can be pivotal. It’s not about perfection, it’s about presence. And you know that. You’re there, planting a seed, opening a door — even if just a small one. What you said about resetting expectations with the patient without causing frustration is powerful. Showing we care, even when we can’t solve everything today, is already therapeutic.
Thank you for sharing. Exchanges like this remind us we’re on the right path, even if it’s a narrow one, with tight deadlines, impossible demands, and slow, temperamental printers.
Great article, which spells out the need to explore this trial further. However, it is also essential to consider a person's daily life, including their daily stressors and routines. The mere cost of a vape kit and a half-hour conversation could save countless lives. Not including the thousands saved on later health care concerns by helping someone quit smoking. Giving people honest conversations, allowing them "choices," and allowing them to choose what flavour they want too. So many countries that ban vape flavors don't understand that those who smoke, who are seeking to quit, don't need reminding of the "cigarette" taste. They are trying to escape it. These trials need to be done within primary care clinics, with family doctors who know more about the person and their daily life. Great article, as always. :)
Wonderful article Claudio. CoSTED embodies what healthcare is - grab the opportunity, no matter how brief, unplanned, messy. Have the chat. Here. Now. Get the connection started.
How I wish for the ‘luxury’ of CoSTED’s 15-30 mins! My reality in engaging smokers at the primary care level is more like: I’m running behind. They’re new to clinic. Haven’t seen a GP for ages, life and kids come first. Ambitious list of topics to cover in 15mins. They’re sizing me up. What can they trust me with? How do I reset expectations that we can’t really get through all topics today, without making them feel dismissed and unheard? I get the sense they smoke, or their ‘ex smoker’ official status on intake is less than ex. Should I even bring it up? If not know, will they return? What about all the stuff they actually came in for?
Somehow I’ve worked out a 30 second spiel, it engages them, they relax, barriers come down. It happens quickly. Maybe while I’m typing a referral, or waiting for printer to have a think. I make sure to shove a quick script for a pharmacy vape their way, no pressure, encourage a follow up Telehealth. It’s not refined but it seems to work. They’re interested and often relieved. We joke a bit.
This is tobacco harm reduction at the primary care coalface.
Next patient.
Hi Carolyn, I came to see you quite a few years ago now. I came specifically to get a script for nicotine, I had heard you you were among the few doctors willing to do so. Anyway, it was I think, the last time I have ever got a script for nicotine lol. No reflection on you, it's just easy to get if you know how. But I have watched your career and involvement with admiration ever since. Keep up the good work.
Yes I remember you Paul! Argh the script system …. No comment is my safest response. Glad to hear you’re still smokefree. Hopefully your e liquids are good quality :)
Brilliant account. That’s exactly it: daily practice rarely offers the “ideal time,” yet it’s still possible to create meaningful moments, even in seconds. Your approach is realistic, humane, and effective; truly the essence of harm reduction in primary care.
These quick moments, often between one click and the next, can be pivotal. It’s not about perfection, it’s about presence. And you know that. You’re there, planting a seed, opening a door — even if just a small one. What you said about resetting expectations with the patient without causing frustration is powerful. Showing we care, even when we can’t solve everything today, is already therapeutic.
Thank you for sharing. Exchanges like this remind us we’re on the right path, even if it’s a narrow one, with tight deadlines, impossible demands, and slow, temperamental printers.
Claudio, I don’t know how you do it, but I love how you capture the essence of any topic in as few words as possible. ‘Presence not perfection’. Gold.
Damned printers.
Great article, which spells out the need to explore this trial further. However, it is also essential to consider a person's daily life, including their daily stressors and routines. The mere cost of a vape kit and a half-hour conversation could save countless lives. Not including the thousands saved on later health care concerns by helping someone quit smoking. Giving people honest conversations, allowing them "choices," and allowing them to choose what flavour they want too. So many countries that ban vape flavors don't understand that those who smoke, who are seeking to quit, don't need reminding of the "cigarette" taste. They are trying to escape it. These trials need to be done within primary care clinics, with family doctors who know more about the person and their daily life. Great article, as always. :)