As a family physician for over forty years, I’ve dedicated enormous time and effort to ending tobacco use through a non-finger-wagging approach to patients in the clinic and the hospital, as well as through the use of humor and parody to students in middle schools and high schools. I’ve now helped teach two generations of medical students and residents to shift patients’ focus away from fear and guilt about their smoking and instead to direct patients’ wrath to the cigarette makers. And I’ve coached physicians to help “laugh the pushers out of town” when they’re asked to speak at schools, civic groups or the city council.
In medical school at Emory, our class only received a single lecture on smoking in four years–by Dr. Brigitte Nahmias, an occupational medicine specialist, who wryly commented that the rugged models in the Winston and Marlboro ads would one day become the “pulmonary cripples” she would care for in her clinic. A comment by one of my professors on the internal medicine ward also stayed with me: “You take away cigarettes and alcohol, you take away eighty percent of your patients.”
But almost everything I’ve learned about helping patients stop smoking has been from listening to their own stories and tips. “It was either my leg or my cigarettes,” one patient poignantly told me. “I quit so I could get my kids Happy Meals,” said one young mother.
“You cut back on your cigarettes when you get grandbabies,” related one woman. “I finally realized it when my grandson said, ‘Grandma, I want a cigarette, too.’ When the grandbaby who’s only four wants to smoke, it’s time to quit.”
One of the most rewarding comments I ever heard from a patient was related to my preferred non-pharmacological approach to smoking cessation that includes using Dr. Herbert Benson’s relaxation response twice a day–a few minutes of slow, controlled breathing in a quiet place. “Oh, I did some exhaling the other day,” she said, “and I thought of you.”
Crisscrossing the country speaking on smoking to medical groups and lay audiences alike all these years, I realized I’d gotten pretty good when, after a talk to a Rotary Club in Houston, one man told me, “I enjoyed your presentation. I’m not a smoker, but I wanted to stop smoking something when I heard you.”