Your employer can tell you to smoke outside. Can they tell you not to smoke at all?

As a doctor, I’m pretty happy that many states and institutions have banned indoor smoking. With the patients I treat, there’s a drastic difference between smokers and non-smokers in terms of suffering and longevity. Smokers get lots more of the former, less of the latter.

They don't call 'em death sticks for nothing.

I wrote previously about e-cigarettes and their growing ubiquity in the para-smoking world. I also blogged from the Cleveland Clinic’s 2010 Patient Experience Summit, where I learned that Mike Roizen, the Clinic’s Chief Wellness Officer, had successfully banned all smoking in employees.

“Kind of par for the course for a hospital,” I remember thinking at first blush. Then he repeated his statement: he’d banned smoking entirely.

Translation: if you smoke, they don’t hire you. If you start smoking, they fire you (at the time I heard him the policy was three years old; two employees had been fired to that point under the policy).

“How can they know what you do on your own time?” you ask. Well, like life insurers, the Clinic tests prospective employees for nicotine metabolites in the urine. You can fib on the questionnaire, but if you’ve recently smoked tobacco, you can’t escape the test.

Now the NY Times is reporting that hospitals in eight states have adopted similar policies. Many have been consulting the Clinic for guidance, where the policy has been in place since 2007.

I’ve always been slightly amused when I walk by clusters of nurses, transporters, environmental service workers (janitors) or patients clustered near the exits of our medical center, getting their fix, usually in shirt sleeves, before heading back into the building. Sometimes I wish the designated smoking areas were a couple of miles away from the exits–then we’d be less likely to inhale a train of smoke as we walk the gauntlet. At least the employees should know better, I often think, stunned to see respiratory therapists in the mix. The same therapists whose job it is to suction pus from the lungs of asthmatics and emphysemics.

Though I find the article’s trend-spotting interesting and in line with my professional values, I think it goes a bit too far in the personal privacy realm. After all, cigarettes, though vilified, are still legal for adults. Will employers start the practice of not hiring other “health-risky” employees (e.g. obese, hypertensive, or diabetic patients)?

What do you think about this?

Clever incentive to make workers at health care institutions walk the walk, or trampling of a civil liberty? Let me have your comments.