Why talk to a patient when you can breathalyse one?

26 June, 2010 | By Victoria Thompson

As I’m sure you’re aware, Beyond the Bedpan loves nothing more than to look down our nose at people. We’re naturally suspicious. So the recommendation that nurses and midwives give breath tests to pregnant women to check if they’re lying about smoking seems highly sensible to us.

Some people seemed concerned that this might make the women feel “guilty” but we think rightly so. Women know that smoking while pregnant will harm their baby but do it anyway. They should be made to feel bad about it. And if they’re going to lie to the midwife about it then they must be found out.

Actually, we’re not sure that this guidance goes far enough. If they’re lying about smoking then who knows what else they’re up to in the privacy of their own homes? Drinking? Eating prawns? Wearing high heels? We need tests for all of these things immediately if not sooner.

In fact why stop at testing pregnant women. Why not test everyone for everything. Having trouble losing weight despite that diet? We’ll check your pie consumption and send you away red-faced when our results show you cracked and ate half a steak and kidney last Tuesday. Want a hip replacement? We’ll make sure you’re going to use it properly by fitting you with a pedometer for a year.

After all, why talk to patients about their health when you can check for yourself? Sod offering advice, support and looking at the root causes of the problem first; we’ve got a breathalyser and we’re not afraid to use it.

Readers' comments (28)

mike | 25-Jun-2010 4:25 pm
Forgive me for repeating myself as I wrote this in a simialar article, but why shouldn't they be made to feel guilty?

They should be put in stocks and ridiculed in my opinion!

Smoking is a nasty, selfish and disgusting habit, if people want to go and poison themselves, fine. Go off in a corner and do it. But if you are pregnant that is a whole different matter.

I remember my parents smoking heavily around me from the day I was born (and probably before) all through my childhood until I was big enough to force them to keep it away from me.

I hated it, I stank, the house stank, and more importantly I suffered really seriously all throughout my childhood with asthma and chest problems because my parents were too selfish too not keep their disgusting selfish habit away from me.

People who smoke when they are pregnant really wind me up, and damn right they should be challenged!

I know this article was written with a massive dose of sarcasm, and I agree that Nurses are not supposed to be the moral police of society. This isn't 1984, despite what Labour's Socialism tried to do.

However, there are some areas where we can legitimately and justifiably say 'you are wrong for doing this, pack it in!'

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Anonymous | 26-Jun-2010 0:31 am
Calm down Mike. I'm sure you're mum n dad didnt set out to deliberately harm you. What decent parent would? My mum also smoked all her life (and still does despite numerous ops due to it). I believe that was the generation thing..when fags were cool...etc. These days it's different I agree,people are more educated,they know they shouldn't be smoking at all,(never mind when pregnant). But how do you stop it? we're not the fag police. We're nurses and midwifes. Should we stop treating people because they eat too many fried foods? Should orthopaedics stop treating sports injuries? 'cos lets face it nobody really has to play football or for heavens sake rugby or something equally as evil like Karate as I do and I even ride a motorbike..shock, horror. I think we have enough to worry about with Mr Clegg asking us how to make cuts. We could start by asking the government to ban tobacco.How much would that save the NHS? But they can't 'cos they're public school chums own the stuff..thats how they got there. I totally agree with you mate but I have no Idea how it would ever work, do you?
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mike | 26-Jun-2010 4:34 am
Anonymous | 26-Jun-2010 0:31 am, I make no apologies for passionate beliefs. Maybe they didn't set out to deliberately harm me physically, but they willfully and selfishly carried on with their nasty habit despite knowing I despised it at a time when I was too young to do anything about it.

You are right about the generational thing, but it is still no excuse. Like you said people have NO excuse at all now to even start smoking, nevermind continuing to do so when pregnant.

As for your question, there are many ways to stop it.

First on my list would be to make all tobacco illegal, and stigmatise the disgusting drug in the same way as other drugs. I agree that it is unrealistic as the government gets a lot of money from tobacco, but greed by those in power is not and can never be justified as an excuse to allow the legal sale of tobacco. In any case it is a false economy as the idiots spend far more than they gain in treating the illnesses caused by it.

Or how about to actually withdraw treatment? Lets think about that for a minute.

At the moment it is fine to offer smoking cessation, as you said there are many people who started due to a generational thing. However, due to the vast cost of treating illnesses caused by or exacerbated by smoking, if they refuse this or consistently relapse (for lack of a better term) after taking the help, then they should have treatment withdrawn or charged the full amount for that treatment.

And yes, I agree this should be extended to alchohol and drug abuse too, and obesity to a slightly lesser extent.

Now sports injuries are a different matter and a bit of a false argument in my opinion. I too have trained in Karate and Judo since I was 6 years old, and other Martial Arts to a lesser extent. And I believe the health benefits of training in such pursuits far outweigh the risk of the occassional injury (I myself have never had any injury serious enough to require treatment). Furthermore the savings to the NHS in the future due to my health being pretty in damn good shape will far outweigh any costs undertaken to treat say a broken bone or whatever.

But even if none of that is done, then what is wrong with stigmatising those who do smoke? Pointing the finger at those who smoke when pregnant in particular?
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jennie lynch | 26-Jun-2010 11:27 am
Pregnant women should be challenged on their smoking and any other unhealthy behaviours and offered support to stop; but trying to force them is counterproductive. As for breathylisers; well, most midwives have functioning noses and it is pretty easy to spot a regular smoker without any sophisticated technology!
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Anonymous | 26-Jun-2010 11:30 am
Well I gotta say breathalising women whatever next ? Are we going to do the same for COPD patients and do that "Oh you are naughty" look you give to your kids when they have just pinched the last biscuit without asking? Are we going to insist every obese person is weighed every week just to make sure they havent been scoffing more crap food, or we could even stand outside the local takaway and target the punters or stand outside pubs and lecture all the smokers sat under the heaters having a fag polluting the air. As an EX smoker who gave up when she was pregnant, it was one of the hardest things I have had to do and stay free from cigarettes. Only after 12 years am I truly not bothered by them. Unless you have ever been addicted to them you can not know how difficult it is to stop, not that I advocate smoking in pregnency or ever. The only way smoking will not become a problem is if A they remove nicotine from ciggaretts or B ban the death sticks neither of which owill happen cause the governement and some rich drug dealers ( which they are really!!) are making far too much money out of it!! Sorry about that rant I feel better now!
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Anonymous | 26-Jun-2010 1:49 pm
I think that all we can do in these kinds of situations is make people aware of the damage that can occur as a result of smoking in pregnancy and unfortunately if they choose to ignore the advice then it is a dam shame for the child. We cannot force people to stop, and I do not feel that a breathalyser test will have much of an effect on people quitting smoking, i feel that they have to want to quit to start off with.
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Anonymous | 26-Jun-2010 7:09 pm
There are always reasons why people smoke in the same way there are reasons why people self medicate in other ways.

Stopping unhelpful habits only happens when someone feels inspired, safe and supported in ways to make it manageable and do-able.

I've never witnessed anyone stopping by being either terrorised or tyrranised by someone who apparently knows whats best for them.

I've also noticed people who are passionate in knowing what's best for other people always have their own story to tell and yet find it difficult to acknowledge or recognise their own underlying agendas.

It worries me that the current trend and descent into rules and regulations, and the apparent safety they would have us lulled to sleep by, we are missing the relationship with ourselves and people volunteered into our care.
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mike | 26-Jun-2010 8:16 pm
Anonymous | 26-Jun-2010 7:09 pm, to be perfectly frank the reaons why don't matter any more. The fact of the matter is it is still a choice, and there is no excuse for smoking when pregnant. Simple as that.

I have got no great wish to terrorise or tyrannise anyone. Nor have I any wish to mollycoddle them and give them a big hug.

If people choose to poison themselves that is one thing, in my opinion we should just take away treatment and force them to take the responsibility for and consequences of their piss poor lifestyle choices.

However these selfish 'people' are choosing to poison not only themselves, but others too, and that is wrong. Perhaps they should be done for child abuse or neglect or something?

Something harsh needs doing.
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Anonymous | 26-Jun-2010 8:45 pm
mike | 26-Jun-2010 8:16 pm

Let he without sin cast the first stone. Are you really so perfect and without fault in your own lifestyle choices Mike? Have a think about it.
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Peter Goble | 26-Jun-2010 9:02 pm
Mike has a point. Children do need to be protected from harmful influences that may blight their future lives.

I'm the father of six and I behaved in ways that have had damaging effects on my children, all grown adults now. How do I know? Because they've told me. I wish I could have my time over again, and I'm sure they do.

But I also wish I had been put right at the time. I might have resented it, but not so much as my children have had occasion to resent my carelessness when they were innocently at risk.

Mike's character is not in question. No nurse's character is. It's what she does that is right professionally that matters. That's what concerns Mike, and I admire him for having the courage to say so.
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Anonymous | 26-Jun-2010 11:53 pm
I completely disagree with smoking when pregnant, I think all women should be asked about smoking, given information and support to stop. So the breathalyser proves they smoke, and they still don't stop - then what? What exactly are you then going to do about it? It's not going to be a threshold for social services.

If they have lied about smoking, 'catching them out' with a breathalyser isn't going to achieve anything and isn't going to endear them to an open therapeutic relationship.

My parents smoked - because they were of that generation and I hated it too, but actually that didn't make them bad parents, there are 100's of worse things they could have done! Sadly the reality is that some parents do do things so much worse.

Also (Mike), whilst personal experience is valid and inevitably colour us, it is not how we primarily inform our practice.

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Anonymous | 26-Jun-2010 11:57 pm
Mike - if you are going to 'take treatment away' from a pregnant mother - because of her 'piss poor lifestyle choices' - what you are actually removing is care for the unborn child - you want to punish them too?
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Anonymous | 27-Jun-2010 2:30 am
Mike, "In any case it is a false economy as the idiots spend far more than they gain in treating the illnesses caused by it." - where did you glean that nugget of truth from mate?

Because your wrong. Not even anywhere close.
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Anonymous | 27-Jun-2010 2:35 am
There is little 'choice' about addiction.
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mike | 27-Jun-2010 9:19 am
Okay, there are a lot of responses here to me personally so I will respond to them one at a time. I do want to state however (as some forums have descended into some people insulting others) that I am simply debating here, I may be passionate about things and I may disagree with some people, that does not mean I am having a go personally.

Anonymous | 26-Jun-2010 8:45 pm, actually yes I am. I don't smoke, never have. I have never taken drugs (and can't remember the last time I even had medication), I rarely drink and when I do I'll never have more than 2 or 3 before switching back to juice or coke, I eat very healthily whilst allowing myself treats such as chocolate without going overboard, perhaps the only vice I have is I drink a little too much diet coke, but the rest of my diet compensates. I also excercise very regularly in the gym as well as training in numerous Martial Arts. Is that perfect enough for you?

And it is not the personal choice I am arguing about (that is a seperate issue for me) as much as the fact that people who smoke when pregnant are harming the children due to pathetically selfish reasons.

Peter Goble, thank you for the compliment. My own dad now says pretty much exactly what you have just said too.

Anonymous | 26-Jun-2010 11:53 pm, I don't think I ever said that personal experience would be how we primarily inform practice, I was offering an opinion based on experience which is different.

I see what you are saying about catching them out, but I am not trying to endear them to a therapeutic relationship, that way is clearly failing as so many pregnant women continue to smoke. I am suggesting that maybe it is about time we get a little tougher in our approach.

Anonymous | 26-Jun-2010 11:57 pm, please read my previous post again. What I actually advocate is removing personal free treatment for those who CHOOSE to continue with piss poor lifestyle choices unless they pay. I seperated that group from pregnant women due to the fact that there is now a child involved too, as you rightly point out. What I advocated is tougher measures, maybe punitive, for women who smoke when pregnant. I don't want to punish the unborn child, I want to protect it.

Anonymous | 27-Jun-2010 2:30 am, it is basic common sense, and an easy fact to look up. The so called taxes that smokers pay in and always bleat on that they 'pay for the NHS with' is miniscule in comparison to the money spent on acute and LCT care. COPD, Asthma, lung diseases, Cancer, etc etc etc. Add up the costs of treating all of the diseases that are directly caused by, or severely exacerbated by smoking, and you will get a far greater number.

Anonymous | 27-Jun-2010 2:35 am. Of course there is a choice. You CHOOSE to start the habit, you CHOOSE to continue with it, and you can CHOOSE to end it. I am not saying it is easy, it isn't, but it is still a choice. Weakness does not constitute a lack of choice. Simple as that.

And I want to reiterate here that it is not the personal lifestyle choice of a single person I am arguing about, I have passionate views on that too, but it is a seperate issue. I am arguing against women who smoke when pregnant.
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Anonymous | 27-Jun-2010 4:35 pm
Friedrich Nietzsche:

"He who fights with monsters might take care lest he thereby become a monster. And if you gaze for long into an abyss, the abyss gazes also into you."

Projection

Psychological projection (or projection bias) is a defence mechanism in which one attributes ("projects") to others, one?s own unacceptable or unwanted thoughts or/and emotions. Projection reduces anxiety by allowing the expression of the unwanted subconscious impulses/desires without letting the ego recognize them.

Transference

Transference is a phenomenon in psychology characterized by unconscious redirection of feelings of one person to another. For instance, one could mistrust somebody who resembles a parent, an ex-spouse in manners, voice or external appearance; or be overly compliant to someone who resembles a childhood friend.

Also helpful to consider:

http://www.mental-health-today.com/articles/drama.htm
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Anonymous | 29-Jun-2010 11:52 am
Anonymous | 27-Jun-2010 4:35 pm, what is your point?
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Anonymous | 30-Jun-2010 0:33 am
Leaving aside the pycho-drama for a moment

http://www.ecancermedicalscience.com/news-insider-news.asp?itemId=311

Quick search on the Inter-Pipe says your wrong Michael. It's not as obvious as you assume is it?

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mike | 30-Jun-2010 1:50 pm
Anonymous | 30-Jun-2010 0:33 am, I have just read that article and there is nothing in there that says I am wrong. In fact there is a lot in there that actually supports what I have been saying? So what exactly IS your point?
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Anonymous | 30-Jun-2010 3:04 pm
Tax revenues from tobacco 10 billion, cost of treating smoking related disease in the NHS 2.7 Billion. Which bit of that supports your argument?
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