One day his wife, who also smoked, phoned him at work to tell him she had signed them up to attend a smokers' clinic at Rochester Methodist Hospital. “Had it not been for her calling me that day, I don't think I would have ever stopped smoking,” he said. “More than that, I would probably not be here today. She was the motivation.”
The group support there, “made it so I was able to focus attention on me and what I was doing,” Dr. Hurt said. “There was no pharmacotherapy at that time. I was focusing my energy and attention in a way I had never done before.”
For him, the hardest part was dealing with the constant urges to smoke. “I took it in time increments that were manageable,” he said. “I knew I could stop smoking for an hour, but I wasn't sure about 2 hours.”
After a group session on Nov. 22, 1975, he drove home and quit smoking for good.
“There's an old adage in the alcoholism treatment world: Take it one day at a time,” he said. “Some people take it in smaller increments than that. I certainly did [in] the beginning. The urges to smoke can be very powerful and intense, but they don't last very long. Finally figuring that out was helpful.”
He returned to the smokers' clinic, this time as a counselor for the group sessions. This role helped to “focus attention on preventing relapse and maintaining my abstinence from smoking,” he said.
Today, when he counsels smokers at Mayo's nicotine dependence center, Dr. Hurt points out that smoking “brings an end-of-life experience that none of us want. The end-of-life experience all of us want is to live to be 85 or 90 and die in our sleep after having had a good meal, a couple of drinks, and sex,” he said.
“None of us want to die in a hospital, in an ICU, or in a nursing home with a protracted end of life. The message is that nonsmokers and ex-smokers have compressed morbidity. That means that nonsmokers live longer and die shorter. Smokers live shorter and die longer. All of us have had firsthand experience with that,” Dr. Hurt said.
Dr. Richard D. Hurt and his wife Mary, shown here with their grandchildren, both quit smoking with the help of a clinic. Courtesy Dr. Richard D. Hurt
For Many, Dependence Runs Deep
If Dr. Hurt could speak to the estimated 6%–7% of physicians in America who currently smoke, he'd start by asking: “What can we do to help you?”
Physicians who smoke “should be treated, because they obviously have a degree of tobacco dependence that a casual smoker does not have,” declared Dr. Hurt, who smoked heavily for 13 years before quitting. “If you could measure the degree of dependence in physicians, I bet it would be much higher than the run-of-the-mill smoker's.”
He also noted that most physician smokers will need help beyond that of traditional treatments such as a nicotine patch, nicotine lozenges, or bupropion. “I think they need to see someone who specializes in treating tobacco dependence,” Dr. Hurt said. “They may need to be in a place where they have very specialized treatment, even to the point where they come into a residential program and spend 8 days in intensive treatment. That sounds like a huge commitment in order to stop smoking, but that's what a lot of people need.”
Physicians who use smoking cessation medications properly “should be able to minimize the cravings, urges, and disruption to their practice,” he said. “But it takes some creativity. So if you have a smoker who's smoking a pack and a half or two packs a day, [you may need to] use more than one nicotine patch at a time or use more than just one medication at a time.”
Ultimately, efficacy depends on the intensity of the treatment. “If you have counseling by a physician or by a tobacco treatment specialist and use proven effective medications, you can expect 20%–25% 1-year stop rates,” Dr. Hurt said. “If you go into a residential treatment program, the outcome is closer to 50% at 1 year. We can maximize the chances of stopping smoking by bringing the forces to bear.”
Ready to Quit? Resources to Help
American Cancer Society's quit smoking page:
www.cancer.org/docroot/PED/content/PED_10_13X_Guide_for_Quit ting_Smoking.asp
800-227-2345
American Lung Association's quit smoking page:
Centers for Disease Control and Prevention's quit materials: