Why physicians should look beyond smoking cessation

It’s not only about smoking cessation.

As I entered the examination room, J.L., a new patient here for a well visit, was sitting comfortably on the examination table. In his mid thirties, tall, slim and with an athletic build, he had a relaxed, easygoing air about him.

Before entering the room, I had quickly scanned his chart, and noted that in the pre-examination questionnaire, my nurse had noted that J.L. was a current cigarette smoker; so after introducing myself, that was where we started off.

“So, I see here that you mention that you smoke cigarettes. How many cigarettes do you smoke daily?”

“Oh, about a pack to a pack and a half.”

“Are you at all interested in quitting, or at least cutting down?”

“To be honest doc, no, not really. I know that smoking is not great for my health; however, I thoroughly enjoy smoking. I know many people smoke because they are stressed out or because they are addicted, but I really only smoke because I like it!”

At this point in the visit, many of us would have some pre-conceived notions about J.L. We would likely assume that he doesn’t care much about his health. We would assume that he eats a poor diet, and that he probably does not exercise much. We may not even ask him about his vitamin and supplement intake.

As it turned out, J.L., aside from his smoking habit, was following a rather healthy lifestyle. He had joined a gym a few months back and was exercising there 3-4 times a week. In addition, he often went on walks with his wife in the evening. His wife was committed to following a healthy diet, and cooked healthy fare with plenty of vegetables and fish. He enquired about having his cholesterol checked, and asked me what I thought about him taking vitamin D supplements; he had read that they may have some purported health benefits.

Towards the end of the visit, I brought up the smoking issue once again. I mentioned to him that when he is ready to quit, I will be there to help him. I do plan to discuss smoking cessation with J.L at every subsequent visit (both sick and well visits), and I hope that he does eventually decide to quit. However, in the meantime, there are several other ways in which J.L., as well as many current smokers like him, can improve their health.

One of the biggest mistakes that we can make in our approach to our smoking patients is to limit the extent of our intervention into improving their health solely to smoking cessation. Of course, smoking cessation IS probably the single best thing a person can do to improve his or her health. Of course, we, as health care providers, should bring up smoking cessation at every visit. However, through our own erroneous assumption that all smokers who do not currently wish to quit are basically unhealthy people who do not care at all about improving their health, we miss opportunities to better other aspects of their lives. For example, encouraging regular exercise, a healthy diet, and stress reduction are all important ways in which we can make a positive difference.

Several studies have shown that in current smokers, frequent exercise and healthy food can mitigate some of the harmful effects of cigarette smoking. Exercise may help with smoking cessation as well. In addition, by discussing stress reduction in smokers who smoke because they are stressed out, we again may ultimately help them to quit.

The take home message is that next time you encounter a patient who smokes and does not wish to quit, instead of rolling your eyes back and brushing him or her off, actively pursue other positive lifestyle changes.