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.

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