I had a patient today, overweight, long-time smoker, really not taking good care of his health at all, hadn't seen a doctor for years but came in today with stomach pain, worried it was appendicitis but actually turned out to be gas.
"You really should try and quit smoking," I said. "I can give you information about smoking cessation classes, or we could try a nicotine patch...."
"I've never tried to quit. But don't worry, I go outside when I smoke."
"Uh... well, that's good for anyone else in the house, but it's not any better for you...."
"Oh, I live alone."
"Then why do you go outside to smoke?"
"I have two birds, and I don't want to expose them to it."
"Well, that's great for the birds. But, still, not good for you."
"I cook for the birds every day. Organic bird feed, pesticide-free, healthy stuff, they love it."
"But what are you eating?"
"McDonalds, Burger King..."
"You should try and treat yourself as well as you treat your birds."
"I'm too tired after cooking for the birds to worry about myself."
"Maybe you should think about what will happen to the birds if you get sick and can't take care of them."
"I don't take care of them. They take care of me."
"Then they should tell you to stop smoking."
So... psych consultation, or what?