Posts Tagged ‘Chantix’

How did those samples find me?

May 11, 2017

The samples can help people quit
Without the nicotine fit
Tobacco detox
In a little brown box
Came free, and it made quite a hit.


Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and short jobs in western Iowa and Alaska, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.


About ten days ago I found a box on my desk, sturdy cardboard, about 6 inches on a side. It held Chantix samples from Glaxo, Smith, Kline.
I hadn’t asked for the samples, I’d signed no papers for them, and I have no idea how GSK knew where I am. After all, I’ve only been here since February.
And they were the right samples to treat exactly one patient: a starter pack, because abruptly starting full dose Chantix risks major side effects, and two months follow-up therapy. Chantix turns out to work better in real life than it did in the lab; it works more consistently than anything besides quitting cold turkey.
The first patient of the day came in for other things (and gave me permission to write what I’ve written). But just like I do for everyone else, I asked if he smoked.
And, indeed he does.
I used to lecture people on the evils of smoking. By now, though, everyone already knows all the bad things about tobacco. Lecturing only brings antagonism into the relationship; “educating” the patient can thinly mask judging the patient.
These days I use a script from Motivational Interviewing, a technique that capitalizes on ambivalence. I hold my two forefingers a foot apart, and I ask, “On a scale of 1 to 10, where 1 means you’re not ready to quit, and 10 means you’re ready right now, how ready are you to quit?” If they say 1 or 10, I stop. For any other number, I ask, “Why not 2?” Mostly the smokers don’t get the question, and will tell me the bad things about tobacco. I interrupt them, explain that they weren’t ready for the question, and ask them the 3 best things about tobacco. When the patient understands what I’m asking, they mostly talk about stress relief, anxiety, and habit. A few talk about taste. One said “Breakfast, lunch, and dinner.” After they tell me their favorite things about tobacco, I give them a blank stare for 3 seconds, then change the subject. The idea of Motivational Interviewing is to get the patient to think.
But this patient gave me an enthusiastic 10. I don’t get many of those, just like I don’t get many 1s. And he’d done well with Chantix in the past. In fact, he wanted me to give him a prescription for Chantix. “I’ll do better than that,” I said, “I will give you the Chantix.” And 90 second later I reappeared with the samples.
He already knew how to use them, and he already knew about side effects.
I couldn’t think of a more appropriate way to use the samples. Tobacco makes any other medical problem worse.
I enjoy helping people, but certain parts of my work bring me disproportionate pleasure. A low B12, a high TSH, or curing someone by stopping their statin makes my day.
This one came close.


A hasty trip to the plastic surgeon, grocery shopping at the Hispanic market, the impact of a plant closing.

March 1, 2010

Grocery shopping and advising for free

To soon get a biopsy

            On a trip to the store,

            For a chile or four,

It’s the way that I like it to be

The morning starts OK, but I bog down explaining to people the bandage on my forehead and my upcoming career move.  Before things get hectic a drug rep suggests that I say that I am graduating rather than retiring.  I like the turn of phrase.

I learn that I’m going to lose 316 patients when the John Morrell meat-packing plant closes.  A fixture in Sioux City for more than a century, that packing house employed successive waves of immigrants, slaughtering pigs and packing the meat.  I attracted a lot of the workers who came from Mexico, Guatemala, Honduras and El Salvador because I speak Spanish.  I suspect a gross underestimate of the number of patients I’ll lose. 

One more reason that my move comes at the right time.

Lulled into thinking I’m running ahead, suddenly I find myself three patients behind.  I finish my 10:30 patient at 11:06, jump into the car, and arrive late for my appointment with the plastic surgeon to get my stitches removed.

I drive aggressively, rushing.  I lose the pleasure of watching the snow banks melting. 

My incision is healing well.  The stitches slide out easily, and I look at the efficiency of Dr. Formosa’s office between her two exam rooms.  I eye the dimensions and make a mental note. 

Getting back to the office takes thirty seconds longer than getting away but I perceive a much more leisurely drive.

A patient with a lot of stress, a history of bipolar illness, and tobacco addiction comes to discuss an abnormal chest CAT scan.  The patient, understandably, worries about the implications of the report and the possibility of cancer.  We decide that Chantix would be a bad idea, despite the desirability of smoking cessation, because of the patient’s ease of slipping into psychosis.  I go to my second choice for tobacco addiction, the clonidine patch.  We then discuss roommate stress.

Occasionally it happens that I get a clear picture of a situation without having actual knowledge.  I shut my eyes and I describe the roommate’s character.  I make twelve points and I hit eleven of them correctly.

I am not a psychic, and I don’t believe in psychics.  In retrospect I can give an analysis of what lead me to come to the correct conclusions.  I call it holistic data retrieval, a term I borrowed from Time Considered As A Helix of Semi-Precious Stones, a science fiction story from the ‘60’s.  Given the correct student, I can teach the techniques. It’s fun to use, it gives credibility, but it creeps people out. HDR made an appearance in one of my novels. 

I receive with approval the announcement that the roommate’s days in the apartment are numbered.

A Hispanic mother brings her two children in for well child checks; in both cases I diagnosed pregnancy and attended the delivery.  They know me so well that we play our way through the exam.  When the core of the visit finishes, I tell the family that I am leaving for a year.  The bitter mixes with the sweet.  I have so much enjoyed the integrated process of seeing couples become families, watching the children grow up, while relationships and groups mature. I get to see the whole thing from a front row seat for the best reality drama in the world. 

My explanation in Spanish rolls at the same speed my explanation in English did four years ago.

I get out of clinic early, and at five I stride into the gym.  I sweat for an hour, stride out and drive home.

One of our friends had a surgery and till he can stay by himself he’s staying with us.  We make a run to my favorite Mexican grocery store, Plaza Latina.

I know five of the nine people present in the store when I walk in.  I pick out some poblano chiles and avocados.  My friends and acquaintances make comments on my forehead wound, and I talk about my ‘graduation’.

A person whom I don’t know points to a 6 millimeter purplish lesion on her face.  It’s been present for less than a year, she says, and it’s growing.  I touch it and tell her she really needs a biopsy. 

As we walk out my friend observes that few doctors would give a definitive recommendation without making the patient schedule a visit.  I shrug.  It’s part of who I am in the community. 

It’s one of the reasons that, even if I want to travel, I want to come home here.