Why I Don't Advise Patients to Quit Smoking

I don’t advise patients to quit smoking.

I don’t exhort alcoholics to stop drinking.

I don’t preach to my obese clientele to slim down.

And I don’t lecture patients to get the COVID-19 vaccine.

This may be the point were some readers are wondering, “What kind of doctor are you?”

For the record, I do not endorse or advise cigarette smoking, alcohol addiction, obesity or careless behavior during the pandemic. I favor temperance in my own life. I exercise. I am attentive to my BMI. And I wear a mask and have received my COVID-19 injections with enthusiasm.

But it has never been my style, either professionally or beyond the office, to tell people what to do. Once folks reach a certain age, which for many are the teenage years, you just can’t make them do stuff. Every parent understands this. This does not mean that I don’t have influence over people who trust me. I do and I use it. However, it’s a process issue. How best can we help individuals make sound decisions? Are issuing edicts and threats our best weapons? Are lecturing and hectoring our most effective tools? Should we devise a reward incentive to motivate folks? Cash for pounds lost?

Who is stronger, the sun or the wind?

I am more comfortable laying out the facts – the cold hard truth without judgement – and allowing folks to make their own decisions. Sometimes, multiple conversations are necessary. When any of us ultimately makes our own decisions freely, they are more likely to be durable. It just works better if folks are vested with their own choices. Achieving ‘buy-in’ is critical to maximize the chance of success. Don’t you feel better when you have made a decision yourself rather than have been directed to act? I certainly do.

Do you really think that my smoking patients are not aware that this habit poses serious health risks? Do they not know that quitting would likely deliver major medical benefits? Will a finger-wagging doctor accomplish anything? Can you imagine a smoker who is advised to quit responding, "Really, doctor? I had no idea that cigarettes are bad for you!"

Recall Aesop’s fable when the sun and the wind competed as to which of them could separate a man from his cloak. The wind unleashed all of its strength and fury, but the traveler managed to hold on to his covering. Then the sun poured down heat to the point that the man removed his cloak and sought shade to get some relief.

Gentleness and persuasion win against force and coercion.

Comments

Becoming a Part-Time Physician

Next month my schedule will change. I will henceforth be off on Fridays with my work week truncated to Monday through Thursday. I am excited to be enjoying a long weekend every weekend. And while the schedule change is relatively minor, this event does feel like an important career moment for me. It is the first step on a journey that will ultimately lead beyond my professional career. It is this recognition that makes this modest schedule modification more significant than one would think it deserves. As some readers know, my current employed position has been a dream job for me. Prior to this, I was in a small private practice, which I loved, but was much more challenging professionally and personally. My partner and I ran the business. Working nights, weekends and holidays were routine for decades. On an on-call night, if I slept through until morning, I felt as if I had won the lottery. And w...

When Should Doctors Retire?

I am asked with some regularity whether I am aiming to retire in the near term. Years ago, I never received such inquiries. Why now? Might it be because my coiffure and goatee – although finely-manicured – has long entered the gray area? Could it be because many other even younger physicians have given up their stethoscopes for lives of leisure? (Hopefully, my inquiring patients are not suspecting me of professional performance lapses!) Interestingly, a nurse in my office recently approached me and asked me sotto voce that she heard I was retiring. “Interesting,” I remarked. Since I was unaware of this retirement news, I asked her when would be my last day at work. I have no idea where this erroneous rumor originated from. I requested that my nurse-friend contact her flawed intel source and set him or her straight. Retirement might seem tempting to me as I have so many other interests. Indeed, reading and ...

Will Smarter Lawyers End Frivolous Lawsuits?

How do you know if a lawyer is any good? Of course, they've all passed the bar, but now their profession is lowering it. While most of us strive for excellence, and raise our children to value this virtue, prominent legal educators are establishing a new quality intitiative for their profession. Who says that lawyers can't reform themselves? Perhaps, we physicians can follow their bold example and raise the credentials of our pre-medical students. I’ll present the facts. You be the judge. I have written a dozen posts on tort reform on this blog, which always generate spirited and adversarial retorts from attorneys and their supporters. They accuse me and other tort reform advocates of carrying water for insurance companies. They repeatedly point out that I know nothing about the legal system and are unqualified to opine on its flaws. They deride me when I argue that effective tort reform would reduce the practice of defensive medicine, despite the re...

MD Whistleblower

Search This Blog