Confessions of a GP

Smoking

Regardless of why a patient comes to see me, I am required to ask them if they smoke and if they say yes to give them ‘smoking cessation advice’. I do this because it is probably a good idea that my smoking patients give up. I also do it because it earns the practice points and we all know what points mean.

Personally, I’ve never been that convinced about giving smoking cessation advice. I have tried various techniques and am not sure any of them really work. Here are a few of my best efforts:

• ‘Smoking is bad for you’ (patient probably knows this).

• ‘Smoking will kill you’ (patient probably knows this, too, and now I’ll have put their blood pressure up, which will mess up my hypertension targets).

• ‘Smoke if you want to, I really couldn’t give a monkey’s’ (reverse psychology – maybe they’ll give up to spite me).

• ‘Stop smoking right now!’ said in an authoritative paternal doctortype way (patient would probably laugh because I’m not very good at being authoritative – ask my cat).

As with all addictions, beating them is only possible when the addict is really ready to give up, hence I only give smoking cessation advice when it is the patient’s idea. Sometimes I’ll give my smokers a bit of unsubtle prompting: ‘Hmm, you’ve had a fair few chesty coughs this winter. Why do you think that is?’ If the 40 per day smoker insists that it is because of an allergy to the neighbour’s rabbit or the office’s air-conditioning system, I don’t bother with stop-smoking advice. If they recognise that smoking is harming them and genuinely want to give up, I am only too happy to give as much help, encouragement and nicotine patches as humanly possible.