Editorial

How the Times Have Changed: Smoking Cessation

This Editorial is a personal reflection on an article from the Consultant archives and was written by a Consultant Editorial Board member.

 

By Dean Gianakos, MD

Lefebvre RC. Helping patients prevent weight gain and relapse. Consultant. 1990;30(4):35-38. https://www.consultant360.com/article/helping-patients-prevent-weight-gain-relapse.

 

When R. Craig Lefebvre’s article “Helping Patients Prevent Weight Gain and Relapse”1 was published in 1990, I was a pulmonary fellow. I do not recall counseling patients on smoking cessation. There are several reasons for this: (1) my clinical experience focused on caring for critically ill patients, (2) smoking prevention was considered a primary care responsibility, (3) there were few therapies to offer patients, and (4) many patients I cared for had already suffered the devastating consequences of smoking (such as lung cancer and chronic obstructive pulmonary disease).  

In the mid-1990s, I switched careers and became a general internist in a family medicine residency, where I frequently advised smokers. I usually started with a question: “Have you thought about quitting cigarettes?” I don’t Smoking cessation original article 1990remember weight gain being the biggest reason for a patient’s reluctance to quit smoking.

I would remind patients: “You’re in charge, not me. I’m not going to nag you to quit, unless you want me to. That usually doesn’t work. I will gently nudge you from time to time, and you can tell me when you’re ready to quit. When you decide you’re ready, then we can work out a plan together. How does that sound?”

According to Lefebvre, the foundation for a successful smoking cessation program includes: “constant monitoring, increased physical activity, development of a support system, coping with relapse situations, and regular follow-up.”1 In the last 28 years, this foundation has been buttressed by (1) national evidence-based smoking cessation guidelines, (2) health care system changes to address smoking in all patients, (3) at least 7 first-line medications (nicotine products and medications like bupropion extended-release and varenicline, (4) individual, group, and telephone counseling, and (5) online applications.2

Maybe most importantly, if physicians use questions and motivational interviewing techniques to engage their patients (eg, “Do you really want to quit smoking? Okay, what is getting in your way? Would you like for me to share the health benefits of smoking cessation? How do you think I can I help you to quit?”), I believe they will be more successful in helping patients stop smoking.3

Dean Gianakos, MD, is the director of Medical Education at Centra Health in Lynchburg, Virginia. He has been an active member of Consultant’s Editorial Board since 2013.

References:

  1. Lefebvre RC. Helping patients prevent weight gain and relapse. Consultant. 1990;30(4):35-38. https://www.consultant360.com/article/helping-patients-prevent-weight-gain-relapse.
  2. Treating Tobacco Use and Dependence: Quick Reference Guide for Clinicians. 2008 Update. Washington, DC: National Institutes of Health; 2009. US Dept of Health and Human Services, Public Health Service. https://www.healthquality.va.gov/tuc/phs_2008_quickguide.pdf.
  3. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. New York, NY: The Guilford Press; 2013.