How bad does smoking look while on rotations?

[Small Cell Carcinoma]

I am currently a third year medical student on rotations and have been (unsuccessfully) trying to quit smoking for the past few years. I tend to go on smoke breaks with some of the nurses and have been kind of apprehensive about how this may look to my superiors. Do attendings generally look down on students/residents who smoke and could this sort of behavior affect evaluations and/or letters of recommendation in the future?

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[It's lupus!]

Not even on clinicals yet, but when I worked in the ED it wasn't a big deal that students smoked. It was more of have often they left and for how long. It put a bad taste in some of our attendings mouths if the student was gone and missing out on xyz or was taking longer to do xyz. Get a patch and chew on a straw or something? I quit smoking after 6 year. Been free of the habit for 8 years now. You can do it! Hope that helps?

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[Dr. Doctor MD]

I am currently a third year medical student on rotations and have been (unsuccessfully) trying to quit smoking for the past few years. I tend to go on smoke breaks with some of the nurses and have been kind of apprehensive about how this may look to my superiors. Do attendings generally look down on students/residents who smoke and could this sort of behavior affect evaluations and/or letters of recommendation in the future?

Responses will vary.

A tiny proportion may like you more, maybe if they also can't kick the habit themselves.

The rest of people either won't care or will judge you harshly for it, probably somewhere in the 50/50 range.

Personally I'd lose a lot of respect for a student that I found out smoked. We're doctors, we of all people know better, and I will judge myself and my peers 100x more harshly than I would a patient. We spend our entire lives watching people die horrible deaths from cigarettes (COPD, Cancer, MI/CVA), most patients don't get to see the end points from smoking directly, patients know it's bad but it's easy to block it out when you haven't directly seen these things.

I encourage you to quit if you can mainly for your long term health, and also because many doctors will think less of you if they find out you smoke.

 

[mw18]

Third year is difficult enough without putting a target on your back. I know quitting isn't easy, or else you'd have done it already. But you're not going to be able to duck out of the OR to go smoke. So if you can go that long on surgery, then you can go that long on other rotations. If a student came in smelling like smoke, I could see it rubbing people the wrong way. Third year is very subjective, as you already know.

 

[darknecrosforte]

I've been told by attendings at two sites that they have automatically failed students whose smoke smell triggered patient allergies/COPD. I don't know exactly how contributory that is to the actual exacerbation, but actively antagonizing the stability of admitted patients seems like a legit reason to get a fail on a rotation.

 

[akwho]

On surgery rotations there will be times when you are too busy to eat, go to bathroom or sleep. Don't think you will have time for a smoke break. Maybe that rotation will finally help you kick the habit.

 

[VincentAdultman]

Fair or not I’d judge the sh— out of a student who smoked.

 

[Oso]

Leaving your team to take smoke breaks is a ridiculously stupid idea. Smoking aside, I would write you a negative comment if you were repeatedly disappearing for a few minutes at a time. If you smelled like smoke, I would definitely give you ****.

Edit: I still can't believe you've been regularly leaving to take breaks.

 

[deleted645092]

I used to dip pretty heavily, so luckily I never had to deal with the logistics of smoking; I could run to the bathroom every couple hours and throw a lip in for a few minutes and nobody ever knew.

As for being judged for it, I'd say that the biggest issue you'll come across is the smell on your clothes. I used to manage fellow medical scribes and had to fire one because she came in smelling like smoke and would trigger the doctors and patients allergies. That on top of randomly leaving throughout the day won't look good to your attending. But as for smoking itself, you can drive to any hospital at the right time of day and see the healthcare staff across the street smoking.

Some hospitals have policies against it; where I'm rotating right now charges a monthly "smoking tax" to their employees that test positive for nicotine, I think $50.

 

[AnatomyGrey12]

Some hospital systems, and their residency programs, are testing for nicotine now and can actually deny you a spot at their program for it. I read that on a residency website last week. Just something to think about.

 

[It's lupus!]

Some hospital systems, and their residency programs, are testing for nicotine now and can actually deny you a spot at their program for it. I read that on a residency website last week. Just something to think about.

That sounds extreme. Do you have a link to that source? I'd like to read about it

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[NITRAS]

It’s very normal for many corporations. My hospital system has that policy. Realize that often time phycicians are not usually directly hired by the hospital, but it will limit your job opportunities.

 

[deleted480308]

That sounds extreme. Do you have a link to that source? I'd like to read about it

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Google brings up hundreds of hits, my hospital is no smoking on the grounds. I would have to leave the property to smoke

So yeah, op. You need to stop for your career prospects

 

[It's lupus!]

Google brings up hundreds of hits, my hospital is no smoking on the grounds. I would have to leave the property to smoke

So yeah, op. You need to stop for your career prospects

I know the hospital I worked for a had a nicotine penalty of sorts but straight refusing to hire someone on those grounds is something new to me

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[xffan624]

I know the hospital I worked for a had a nicotine penalty of sorts but straight refusing to hire someone on those grounds is something new to me

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A quick google will get you multiple hospitals across many states where this is the case and certain states where such policies are no longer legal. Cleveland Clinic was first major hospital that I'm aware of to do it.

 

[It's lupus!]

Pffff. Google search. You guys act like this is the internet. Tell me Google search...

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[WheezyBaby]

I know the hospital I worked for a had a nicotine penalty of sorts but straight refusing to hire someone on those grounds is something new to me

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Not uncommon

 

[Small Cell Carcinoma]

Some hospital systems, and their residency programs, are testing for nicotine now and can actually deny you a spot at their program for it. I read that on a residency website last week. Just something to think about.

That sounds pretty hard to believe. So I guess if someone is even trying to quit smoking (nicotine patches, gum, etc) they would also be screened out in this case? Also, what about all the staff who smoke at hospitals (attendings, nurses, PAs, etc)......are they under the same testing requirements or is it just for residents? Nicotine also wouldn't even have a high detectability on a drug test on account of the fact that it gets eliminated from the body so quickly after use, so that is another why this seems pretty outrageous.

 

[WheezyBaby]

That sounds pretty hard to believe. So I guess if someone is even trying to quit smoking (nicotine patches, gum, etc) they would also be screened out in this case? Also, what about all the staff who smoke at hospitals (attendings, nurses, PAs, etc)......are they under the same testing requirements or is it just for residents? Nicotine also wouldn't even have a high detectability on a drug test on account of the fact that it gets eliminated from the body so quickly after use, so that is another why this seems pretty outrageous.

All staff. The test is typically for cotinine

 

[deleted480308]

That sounds pretty hard to believe. So I guess if someone is even trying to quit smoking (nicotine patches, gum, etc) they would also be screened out in this case? Also, what about all the staff who smoke at hospitals (attendings, nurses, PAs, etc)......are they under the same testing requirements or is it just for residents? Nicotine also wouldn't even have a high detectability on a drug test on account of the fact that it gets eliminated from the body so quickly after use, so that is another why this seems pretty outrageous.

You have a year. Stop smoking

 

[Smurfette]

I am currently a third year medical student on rotations and have been (unsuccessfully) trying to quit smoking for the past few years. I tend to go on smoke breaks with some of the nurses and have been kind of apprehensive about how this may look to my superiors. Do attendings generally look down on students/residents who smoke and could this sort of behavior affect evaluations and/or letters of recommendation in the future?

What an ironic user name considering the question.

Hospitals testing for nicotine/cotinine is a real thing and is generally done for all employees across the board. It can take 2-3 weeks after quitting (depends on how much you smoke) for your cotinine level to drop to the level of a non-smoker. Whether reported as pos/neg or as an actual level depends on the institution.

 

[deleted707454]

Hallucinogen in 'magic mushrooms' helps longtime smokers quit in Hopkins trial

Fly somewhere for a psilocybin retreat and end that habit

 

[atomi]

Lots of docs in Asian countries smoke, even oncologists.

American medical students binge drink, which is encouraged by the schools with their parties. So their stance on smoking is a little hypocritical.

The smell is unacceptable to have on you around patients. Switch to vape immediately then work on quitting. It will seeiously impede your career.

 

[AnatomyGrey12]

That sounds pretty hard to believe. So I guess if someone is even trying to quit smoking (nicotine patches, gum, etc) they would also be screened out in this case? Also, what about all the staff who smoke at hospitals (attendings, nurses, PAs, etc)......are they under the same testing requirements or is it just for residents? Nicotine also wouldn't even have a high detectability on a drug test on account of the fact that it gets eliminated from the body so quickly after use, so that is another why this seems pretty outrageous.

It doesn't matter how hard you think it is to believe, it's a real thing and is easily seen on the websites of many residency programs. I suggest you start believing real quick.

 

[Peach Newport]

Start on a Juul or vape to cut down, try to get to 2-5 cigs a day. If you can quit by just switching over to vaping, great. If not, or if your hospital drug tests for nicotine, move on to the next steps.

Get a doctor to start you on varenicline or bupropion. Take as directed. Give it a full 4 weeks. If you fail one, try the other. I swear to god if I hear one more patient say they’d rather not “drug themselves” to quit smoking, the irony might actually give me a SAH.

If you fail both drugs, have your girlfriend or roommate handcuff you bed for a weekend, because a med student who smells like smoke is asking for a world of trouble.

 

[evilbooyaa]

There are multiple places that will check you, at least at new employment, for nicotine byproducts in your blood. How they deal with people chewing gum/patch to me is an unknown.

That is relatively rare. What is a lot more common, is that campuses are becoming smoke free. As a medical student, you do not have the time nor the luxury of a smoke break. If you can't live without it at work, consider nicotine gum.

I wouldn't care if somebody in medicine smoked outside of work, but I don't want them doing it at work, and I don't want them smelling like smoke, especially at the work place.

 

[Moose A Moose]

OP: I’ve always found if you have to ask if something’s a bad idea, it likely is.

 

[jrlob91]

Some hospital systems, and their residency programs, are testing for nicotine now and can actually deny you a spot at their program for it. I read that on a residency website last week. Just something to think about.

yep. The Henry ford medical system does this.

 

[ciestar]

yep. The Henry ford medical system does this.

As does Jefferson and UPMC.

 

[ortnakas]

Quit. You’re young enough and smart enough to know better. And hypocrisy aside, leaving your team for smoke breaks is a bad look.

Several places I interviewed at had a no-nicotine policy; people have lost their residency spot in the past for testing positive.

My current hospital has a huge discount on our health insurance if you’re tobacco-free.

 

[CherryRedDracul]

On surgery rotations there will be times when you are too busy to eat, go to bathroom or sleep. Don't think you will have time for a smoke break. Maybe that rotation will finally help you kick the habit.

That's why some neurosurgery residents who were smokers carried vapes for the nicotine hits.

 

[atomi]

There is NFW Nsgy residents are vaping in the bathroom. You would be fired for that. Nobody is that dumb.

 

[CherryRedDracul]

There is NFW Nsgy residents are vaping in the bathroom. You would be fired for that. Nobody is that dumb.

Perhaps things are different where I'm from.

 

[BabyDaddy]

Lol, this thread.

 

[TripleHBK]

Try a Juul


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[RNtoMD87]

Responses will vary.

A tiny proportion may like you more, maybe if they also can't kick the habit themselves.

The rest of people either won't care or will judge you harshly for it, probably somewhere in the 50/50 range.

Personally I'd lose a lot of respect for a student that I found out smoked. We're doctors, we of all people know better, and I will judge myself and my peers 100x more harshly than I would a patient. We spend our entire lives watching people die horrible deaths from cigarettes (COPD, Cancer, MI/CVA), most patients don't get to see the end points from smoking directly, patients know it's bad but it's easy to block it out when you haven't directly seen these things.

I encourage you to quit if you can mainly for your long term health, and also because many doctors will think less of you if they find out you smoke.

I agree. I have a hard time respecting any health care professional that is morbidly obese, eats large amounts of junk food, drinks alcohol in excess, uses recreational drugs (many do), or smokes. You should first of all set the example for healthy living, and secondly if you KNOW the effect these things have on your body, it seems like you would be very motivated to stop.

 

[NotAProgDirector]

Hospital systems (and employers) that refuse to hire for positive cotinine tests do so not because of some moral sense that smoking is bad, but simply because smoking great;ly increases health care costs.

In any case, many hospital systems are becoming smoke free -- at my place, the only location you can actually smoke is in your own car. Not outside, no smoking areas. Many sites now refuse to hire if your test is positive. You fail onboarding, they apply for a match waiver, and you're done.

 

[nimbus]

When I was a medical student in the late 1980s-early 1990s the chair of neurosurgery was a chain smoker. During grand rounds half the department would light up in the conference room even though the hospital had a no smoking policy. Things have really changed. OP was born 1-2 generations too late.

 

[DOFOSHO]

I am currently a third year medical student on rotations and have been (unsuccessfully) trying to quit smoking for the past few years. I tend to go on smoke breaks with some of the nurses and have been kind of apprehensive about how this may look to my superiors. Do attendings generally look down on students/residents who smoke and could this sort of behavior affect evaluations and/or letters of recommendation in the future?

everyone in health care will "look down" on you. Its one thing to disappoint a patient, its another thing to embarrass the profession.

 

[BabyDaddy]

I didn't have time to eat today, lol, much less time for smoke breaks. Must be nice to have that much time on rotations. I would look like crap if I bounced out like that on my rotations. Every minute counts.

 

[Redpancreas]

That sounds extreme. Do you have a link to that source? I'd like to read about it

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Very common practice and I applaud any program that enforces the nicotine policy. I strongly believe in an individual's personal choice, but not when it hurts the common good of society. I just don't think you should be a doctor if you're actively smoking. At least 50% of hospitalized patients (my guess) have COPD/Asthma and cigarette smoke lingers for days. I am a resident in a very large, respected health system and all medical staff whether they're secretaries in an outpatient setting that who check you in or MICU staff who deal with COPD'ers daily are required to be nicotine free.

 

[BigChief]

I love the self-righteous replies, everyone has their vices. Seriously though OP, get a vape, chew some gum, get the patch, don't smell like smoke, all it takes is that one person to complain about you smelling. Definitely plan on quitting because I'm sure more and more systems are going to go the way of the cleveland clinic and UPMC.

 

[Giovanotto]

I'm all for smoking, but you should not be smoking "on the job".

 

[FrkyBgStok]

I agree that everyone has their vices but to put in perspective how things are changing, I would say half the places that I interviewed for residency and another half now for fellowship explicitly state on their website that they are a smoke free campus and that new employees will be tested for tobacco free status. Whether you agree or disagree, that seems to be the norm anymore.

 

[Giovanotto]

I agree that everyone has their vices but to put in perspective how things are changing, I would say half the places that I interviewed for residency and another half now for fellowship explicitly state on their website that they are a smoke free campus and that new employees will be tested for tobacco free status. Whether you agree or disagree, that seems to be the norm anymore.

Why stop at tobacco though? Might as well check for alcohol, exercise levels, psychiatric visits, lipid levels, blood pressure, etc. This is an incredibly disturbing and frustrating trend. I hope some state legislature puts an end to this, it's such a slippery slope.

 

[Giovanotto]

Hospital systems (and employers) that refuse to hire for positive cotinine tests do so not because of some moral sense that smoking is bad, but simply because smoking great;ly increases health care costs.

In any case, many hospital systems are becoming smoke free -- at my place, the only location you can actually smoke is in your own car. Not outside, no smoking areas. Many sites now refuse to hire if your test is positive. You fail onboarding, they apply for a match waiver, and you're done.

Yet they have no qualms about serving fast food and absolutely disgusting hospital food either. The hypocrisy literally hurts me.

 

[deleted480308]

Why stop at tobacco though? Might as well check for alcohol, exercise levels, psychiatric visits, lipid levels, blood pressure, etc. This is an incredibly disturbing and frustrating trend. I hope some state legislature puts an end to this, it's such a slippery slope.

Another argument of govt not requiring an employer to buy health insurance

I do think we could eventually see soda free campuses or not hiring above certain bmis

 

[AnatomyGrey12]

I do think we could eventually see soda free campuses or not hiring above certain bmis

Intermountain Healthcare does not have sugared drinks/sodas, unhealthy snacks in any of the vending machines or cafeteria anymore. I think they are following what the Mayo Clinic did.

 

[AnatomyGrey12]

Why stop at tobacco though? Might as well check for alcohol, exercise levels, psychiatric visits, lipid levels, blood pressure, etc. This is an incredibly disturbing and frustrating trend. I hope some state legislature puts an end to this, it's such a slippery slope.

Nicotine is absolutely horrible for you.

 

[FrkyBgStok]

Why stop at tobacco though? Might as well check for alcohol, exercise levels, psychiatric visits, lipid levels, blood pressure, etc. This is an incredibly disturbing and frustrating trend. I hope some state legislature puts an end to this, it's such a slippery slope.

So they are starting that also. Most places I’ve interviewed usually have a certain rate for insurance and you get a significant decrease in your monthly bill if you regularly see the physician for well checks. I think this is the first step to exactly what you are talking about.

And don’t get me wrong. I’m a fatass so it is coming for me too. Not saying it is right or wrong, just saying that this is how it is.