Louisville Medicine Volume 69, Issue 6 - Page 6


love to help people quit smoking . As a family medicine physician , it is one of my passions . I witnessed firsthand the pain and effects that the addiction to nicotine has had on my family and close friends .
There are a myriad of ways and factors involved in helping people to quit smoking ; however , I have developed my own system which includes using five rules of smoking cessation . They are :
1 . The patient must have the desire to quit .
2 . The patient should be ready to set a quit date within the next two weeks .
3 . Provide as much help as possible to the patient , including smoking cessation counseling and other tools such as smoking cessation aids ( nicotine patch gum , medication , etc .).
4 . Encourage exercise ( 15-minute daily walk ) as this increases the success rate of quitting and reduces the chances of gaining weight simultaneously .
5 . Encourage follow-up with physician within two weeks of the quit date which increases likeliness of quitting successfully .
I am a firm believer that no one quits smoking who is not truly ready . Ascertaining whether a patient truly wants to quit is what I believe to be the first and most critical key to helping a patient quit smoking . One way that I determine if the patient is ready to quit smoking is to partner with them on a “ set quit date ” which is established within the next two weeks after their appointment with me . I ask the patient if they are ready to quit and watch closely for their response . If they say they want to quit but appear to have hesitation or uncertainty , then we discuss whether they are truly


ready or not . If they seem genuinely interested and ready to make a quit attempt , we move on to step 2 .
In the words of Mark Twain , “ The secret of getting ahead is getting started .” Patients seek out their primary care provider for help in overcoming their nicotine addiction . The idea of getting started on their own can be daunting . Sometimes the patient will ask me what I can do or what medication I can prescribe that will “ make ” them quit . I explain to the patient that the journey to overcoming a nicotine addiction is accepting that they must truly have the desire to quit before there is any real chance of a well thought out plan to be successful .
Setting a quit date is the next step for those patients who are determined to quit smoking . I explain that in my experience , people who are not ready to set a quit date within the next two weeks are not likely to be ready to quit . There are some exceptions which may impact a patient ’ s decision to set a quit date two weeks from our visit . The patient may have a holiday or upcoming birthday and state that they may fail if the start date is set on or around that festivity . I have had some patients who ask to proceed with developing a plan without setting a specific date . There are times when the patient names a life stressor which may affect their success . At that point , I reassure the patient there is no time like the present and that there will never be an ideal time to quit with little or no stress .
The trajectory of the conversation about stressors leads us to have a meaningful conversation about dealing with anxiety , worry and fear , which underlies most addiction . Most patients are open to follow me down this path and learn how to reduce or eliminate anxiety , worry and fear from their lives .
I teach them a little about focusing their attention on the present moment instead of ruminating about the past or worrying about the future , to observe the uselessness of most of our thoughts , and