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Doctors Haven't Been Asking If You Vape. But They're About To Start

People who vape don't check the "smoker" box on forms, and doctors are realizing they haven't been tracking their patients' habits.

by Hannah Smothers
Sep 25 2019, 1:20pm

Stocksy/Colin Anderson

Unless you either come into your doctor’s office with a case of the mystery, vaping-associated illness, or waltz in taking a huge rip on your Juul, it’s unlikely that your physician will figure out whether or not you have a history of e-cigarette use. But that may (and probably should) soon change.

There is currently no formal way for doctors to report vaping behavior separate from smoking. That means these statistics have been falling through the cracks, even as people have started to fall ill apparently in connection with vaping. Until vaping gets medically codified, doctors have started to ask patients directly whether they vape, in hopes of heading off related health problems.

On Tuesday, Stat News reported that more and more physicians—particularly pulmonologists—are starting to ask patients specifically if they use e-cigarettes, vape, or use a Juul. This addition to their regular patient-intake process is inspired by the mystery illnesses, yes; but also by a realization that asking a vaper if they “smoke” (standard doctor intake form question) often doesn’t yield the correct information.

“That is the most important change over the last couple weeks for me… Do you vape? Do you Juul? Very bluntly. It’s part of what I ask now,” Dr. Pnina Weiss, a pediatric pulmonologist and professor at Yale School of Medicine, told Stat News. Weiss is one of several physicians Stat interviewed who are hoping that asking about vaping habits might help prevent whatever it is that’s making people sick.

The logic here of why vaping is not getting captured as a patient behavior is extremely simple to follow; vaping has been literally marketed as a healthier alternative to smoking traditional cigarettes. To vape is to not smoke (or at least that’s how Juul, with its soon-to-be-retired “Make The Switch” slogan, would prefer you to think about it).

“I have had patients who used to smoke tobacco and now are vaping e-cigarettes, and when I ask them if they're smoking, they say, ‘No, I was able to quit smoking cigarettes,’” Dr. Laura Crotty Alexander, a pulmonologist at the University of California San Diego Department of Medicine, tells VICE. “And then most of the time they'll go on to say, ‘Now I’m vaping e-cigarettes.’ You really do have to ask, because vaping e-cigarettes is not a continuation, in their mind, of smoking.”

But this also holds true for people who’ve never smoked cigarettes; and especially for many of the estimated one in four high school seniors who report using e-cigarettes in 2019. “They think smoking’s gross and they’re not going to do it,” Crotty Alexander says. “Vaping, in their minds, is a completely different entity.”

The difference in health effects between vaping and smoking has become abundantly clear over the past year, as more than 500 people (that we know of) have gotten sick with a mystery disease linked to e-cigarette use. Aside from the so-far furtive work that researchers are doing to figure out what the hell is killing people and infecting their lungs, one way to figure out what happens to someone who spends a decade vaping is to track e-cig use by how patients report their behavior to their doctorsin doctor’s office, the same way cigarette and drug use has been tracked for decades.

Dr. Laura Crotty Alexander tells VICE that the next version of the International Classification of Diseases (ICD-11), a giant manual of diagnostic codes health care providers use to track disease and symptoms, will include a code for e-cigarette use. So *if* your provider asks about e-cig use, they can then tap the code into your electronic health history, and other doctors and researchers can scan all of those records for health outcomes that may be correlated.

“That can be used to study what’s going on across, hopefully, thousands of people,” Crotty Alexander says. “Otherwise, it’s really hard to look for health signals when we can’t find those patients in the electronic records.”

Adding a code for e-cigarette use to ICD-11, which will come into effect on January 1, 2022, doesn’t necessarily mean all providers will start asking every patient if they use an e-cig, vape, or Juul (or whatever hellspun vapor-to-lung device exists by then). But it will hopefully prompt more providers to ask, because then they’ll actually be able to do something with that info.

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