I can always tell when a parent of a child I'm treating is a smoker. The examination room is just filled with smoke - not too different from the experience you'd have if you walked into a bar or restaurant that still allows smoking. My style is to ignore it until the very end of the visit - sneaky, I know! I just forge ahead trying to not inhale too much air. I have to admit, there have been times I've had to find excuses to leave the room to get a few smoke-free breathes of air!! I talk to the child and parents about whatever sick or injury issue brings them in that day and give advice on that issue and then casually ask "By the way, any one at home smoke?" There's always a shocked look followed a pause before someone gives one of the following response:
2. Not in the house.
4. Not around the child.
5. We had relatives over who smoke.
6. His/her father/mother smokes but I don't.
Regardless of the answer, my reply is always the same. "I hope you are not offended by what I'm about to say but I could smell the smoke on you when I walked into the room. The level of smoke is the same level as an actual cigarette. That means that whoever is smoking is exposing me, your child and whoever else comes in contact with the smoke on your clothing with the same harmful effects of smoke as if the person smoking were actually smoking in this room. It turns out, second hand smoke is as bad for all of us as first hand smoke. Smoke is smoke - all of it is bad."
That seems to diffuse any defensiveness and even if the person I'm talking to still can't admit to being the smoker, we often, I'd say at least 90% of the time, get to a discussion of how to help the smoker quit. I talk about how it isn't easy and support groups help. I talk about the supports we have at our multi-specialty practice. I talk about the impact of smoking on the child's health for overall health, for recovery from sickness, for recovery from sports injuries, for sports performance, for school performance, for performance in the arts, for feeling good in general, and the list goes on.