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LETTERS: Joseph L Y Liu and Jin-Ling Tang Doctors are ethically obliged to advise patients to quit smoking BMJ 1998; 317: 1588 [Full text]

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Delivering the non-smoking message

Alon Duby   (10 December 1998)

Delivering the non-smoking message 10 December 1998
Alon Duby, Registrar, Accident & Emergency St Thomas, London Send response to journal: Re: Delivering the non-smoking message	A possible solution to please both sides1 is to allow the patient to decide whether or not he/she should be advised regarding the cessation of smoking. Working in an Accident & Emergency department, one is often confronted by patients who seem to be self-harming with cigarettes and other products. When these habits are probably related to the presenting complaint, one is faced with the dilemma of deciding whether an unknown patient should receive the relevant advice or not. My own personal method is to ask the patient whether he/she is aware of the dangers of smoking and its probable relationship to the current complaint, or whether he/she would like to discuss it. If the patient claims ignorance then instruction follows. If the patient claims to be aware of the information about to be given, then I do not repeat it. Whenever I do give advice regarding unhealthy habits, I do my best to avoid telling the patient what to do (e.g. stop smoking). Instead, I clearly state that the habit is the cause of a condition or an obstacle in its treatment and enlighten the patient on how he/she is harming him/herself. I do not tell a patient to stop a habit unless I am specifically asked for my advice about stopping. The patient has the choice. Alon Duby Specialist Registrar Accident & Emergency Department, St Thomas Hospital, Lambeth Palace Road, London, SE1. 1. Liu JLY, Tang J. Doctors are ethically obliged to advise patients to quit smoking. BMJ 1998; 317: 1588. (5 December.)