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Giving up smoking

Unsolicited advice from health professionals, family and friends

Smokers usually know that smoking harms their health; they often go of their own accord to seek professional advice and help with quitting smoking or talk to their friends and family about quitting. In this section we discuss people’s reactions to unsolicited advice about smoking.

Routine advice from Doctors

When people go to the doctor for something other than asking about smoking cessation, they are sometimes offered advice on giving up smoking or told about the risks of continuing to smoke. This type of advice is called ‘opportunistic’ and the current recommendation from NICE (National Institute for Clinical Excellence) is that health professionals should check their patients’ current smoking status and that everyone who smokes should be advised to quit.

People were sometimes irritated when their GP initiated a conversation about smoking, or they thought that the advice they were given was predictable or irrelevant. Sometimes the advice seems to have been counterproductive.
 

Andy’s doctor asked about his smoking when he went with other issues. He was offered help with giving up but he wanted to do it on his own.

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Age at interview: 31
Sex: Male
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And so have you ever discussed smoking with your doctor?

No I never did. I mean I remember, not to any degree. I think I remember going in once with another complaint and he just asked me a couple of routine questions, things like you know, are you smoking, do you smoke? And I think I remember at one point saying, “oh yes, I do x’ amount a day.” And I remember him saying, “Do you want to quit. There are, you know, we can help you quit.” At the time I think I just said, ”No. it’s all right. Don’t worry.” I think I would have been relatively young at the time. I would have been in my teens I think at that point.

But I think, funnily enough, the next time I went to the doctors, it was actually in my ultimately failed attempts to give up. So he then said to me, “You know, do you smoke?” I said, “No I used to but I don’t anymore.” Even if it was about the third day, it probably was I had given up and which I wasn’t really failed. And I remember then going back, the next time I went to the doctors was a few years later and I was back into smoking quite heavily by then, and the doctor was saying, running through my, my file, he said, blah, blah, ex smoker, this that and the other. I thought you might have to update that actually, because I’m not an ex smoker any more. And again he just went through the whole process of, you know, asking me if there is any help that you want to get giving up and things like that, and I just, I think again I just dismissed it. Primarily because I always thought, which ultimately proved to be the case that I thought that if I ever wanted to give up I think I would be able to, and be capable of doing it on my own two feet and I think I would rather have done it that way.
 

When her GP asked Anna about her smoking and drinking habits during routine consultations it annoyed her and brought out a rebellious streak.

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Age at interview: 47
Sex: Female
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I don’t, I mean I don’t recall people really a) I just didn’t you know, when you’re younger you don’t go and see a doctor that much. And I don’t, I think people, I think they didn’t constant, they didn’t constantly ask you about it, in my recollection. I mean I don’t remember ever been asked about it at university or may be if they did ask me about it, I just thought that it’s… I have to be absolutely honest, I still have that. I still think I’ve come to see you about a medical problem, why are on do you feel that you’re entitled to talk to me about smoking? If I haven’t come up and said it’s a problem, why…? It actually it really bugs me when they ask me. So, “Are you still not smoking?” And I’m thinking you know, yes, no, is it any of your business. Just leave me alone, and maybe that’s also to do with the sort of, you know, it brings out the rebellious streak in me. I just if I want to smoke? Are you going to stop me smoking? [Laughs]. I guess that’s actually something that I do remember that I did associate smoking with being rebellious and I think that’s weirdly, I always look around and I think, I think younger kids don’t seem to feel that in quite the same way I used to think it was all about you know, being part of a sort of counter cultural rebellious sub group.

So you would... I’m just trying to think of other sort of health behaviours or something that you may think are a medical remit or not a medical remit in that sense. Would you ever say... I mean an equivalent would be talking about drinking?

I have a similar kind of thing. I think it’s, I mean in a way, I think it’s quite useful to have all this kind of information about units out there, but I keep looking at it and I keep thinking, well actually what they really saying is, don’t, don’t drink, well or only drink the amount that doesn’t, well really I think they’re really saying just don’t get more than the teeny weeniest bit tipsy. That’s really what they’re saying. And, yes, it’s probably, you know, you can measure it in units, but actually most people know anyway.
 

Laura replied honestly to her GPs questions about smoking but she avoided having a cigarette before visiting the practice for her regular blood pressure measurements.

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Age at interview: 32
Sex: Female
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Did you ever talk about smoking when you did smoke, to your doctor?

No only in the sense that they ask you don’t they before they prescribe or do anything, they said, “Do you smoke.” And I was always honest, I said, “Yes.” My blood pressure was always exactly the same as it is right now as well. It didn’t seem to have an effect on me particularly, which my doctor would tell me off about and say, “You shouldn’t smoke.” And I’d say, “Well my blood pressure’s fine.” He said, “I know, but that’s no reason to carry on.” But I must I used to, if I was going to the doctors I didn’t smoke until after I left [laughs]. And that was a conscious thing [laughs]. I don’t know. I didn’t want to smell of it. And yes, it probably would have changed my blood pressure if I’d have smoked as I was pulling into the car park.
 

Doctors irritated Val when they told her to give up smoking - she got sick of hearing about it.

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Age at interview: 71
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And did any health professional at any time talk to you about smoking?

Oh God every time you went the doctor’s, they’d say to you. “Do you smoke?” I think that’s what every doctor says to you. Or, “Are you a smoker? You really should try and pack up smoking.” So the time you get sick of hearing of it. But I never really had any illnesses.

So what would you think when doctors would say, you know, it’s time you should pack up smoking?

Just go in one ear and out the other.

Did you even used to feel irritated with the doctor and that?

Yeah, yeah, I used to think ‘oh that’s their answer to everything’. You know, ‘that’s the cause of everything ‘cause you’re a smoker’. And then you say one of my relatives lived till 90, smoked 40 cigarettes a day and he lived until he were 90. You get these examples of…

Yes.

…you know. So I don’t know. I don’t know what the answer is. I think somebody should come up with a magic pill.
Some people honestly told their doctors how much they smoked, others deliberately said that they smoked less than they did. Some people had felt as if the doctor was ‘telling them off’ whereas others like Chris can’t remember ever being advised by her doctor that she shouldn’t smoke. Sue’s doctor had suggested that the amount she smoked was not likely to cause health problems. Munir had felt that because he smoked only 10-15 cigarettes a day he didn’t smoke much but his GP disagreed. Roger can even remember that in the 1960s he was told by a GP that the “death rate from breathing fresh air was 100%”.

Advice in the context of a health problem

Doctors and nurses had often advised people about smoking when they had a health problem related to smoking, such as Chronic Obstructive Pulmonary Disease (COPD), Transient Ischaemic Attack (TIA –a brief stroke-like episode) or pulmonary embolism.
 

When Keith had a TIA, he appreciated the clarity with which a doctor told him about lifestyle changes that he needed to make, which included giving up smoking.

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Age at interview: 59
Sex: Male
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Can you remember how health professionals managed giving the information to you about the stroke and about changes in your life that you might want to think about?

Yes, they were absolutely clear. A series of people came to see me at various times. It’s all a bit jumbled, but I can remember my last meeting with the doctor who came and gave quite clear advice you need to stop smoking. I asked him the question what would be. Stop smoking, keep body weight... keeping decent, don’t get too overweight not too much drinking, but no need to stop altogether, but keep it within moderation, everything within moderation I suppose really. A good diet. We asked him about smoking. You shouldn’t smoke. But then it’s a daft question really because everybody knows that, well I knew that I shouldn’t smoke.

It was very, very interesting. He was very clear and concise and to the point. Hm.

And did he give you or anybody else give you advice about how to do a number of these things?

No. No. No. They didn’t.

And would you have wanted that or…?

I’ve stopped smoking without it. So no. As I say it’s a bit jumbled, so I can’t really remember if there was advice to hand really. I think probably I decided that that was it, so I didn’t look for it. It may have been there, because there was an array of information in written form and always, always nurses, well nurses in particular to ask advice.
 

Roger looked up COPD on the internet and was alarmed. His doctor explained that the damage could not be reversed but that if he stopped smoking it could be halted.

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Age at interview: 66
Sex: Male
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I went on I went on the internet and looked it up and the first place I went to, I don’t know what it was, I can’t remember the website now, but it freaked me out completely. So I went to the doctors’, and the doctor gave me a couple of places to have a look and sat me down and talked me through it. And it was great. Very helpful. And he told me what effect it was going to have on me, as it was at that moment, what effect it would have on me if I continued to smoke, and he didn’t beat around the bush, but he didn’t over dramatise it. He just told me clinically and in factual terms what would happen. And he told me what would happen if I quit now. That it wouldn’t get better, but it wouldn’t get worse. And there were some things that would help alleviate some of the symptoms, but it couldn’t, the damage that had been done up to that point wouldn’t be able to be reversed. But, I had it in my power to stop it getting any worse.
When Miles went to see the doctor about his asthma, he told him he was already giving up smoking. This was “music to [the doctor’s] ears”. The doctor was nice to him and didn’t pressurise him.

Sometimes specialists were very blunt about people’s smoking, with different consequences. Both Chris and Judith said that respiratory doctors had used rather shocking predictions about what would happen to them if they continued to smoke; they reacted very differently to this approach.
 

The respiratory doctor told Judith that she would be struggling for breath in three years if she carried on smoking, but that he knew she would not stop. This made her take notice.

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Age at interview: 36
Sex: Female
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So when I got the diagnosis, the respiratory doctor told me something that no other doctor had said, he said, “You’re not going to give up.” Whereas all the other doctors had been saying, “You need to give up. Here’s why it’s bad for you.” And they also told me that there was so many other things that were happening with me, like skin problems, and various other things that were essentially down to smoking. And I just got bored. I got bored hearing it. You switch off. You think surely everything can’t be down to smoking.

And I know that they generally have a job to do and that they have to tell you to stop smoking and it’s a really difficult one in that respect. But we, as smokers, we don’t listen. It’s like talking to a brick wall as if we haven’t heard it time and time again.

So this respiratory consultant saying, you won’t give up, was like a breath of fresh air. I just thought, you really know. You do know how difficult it is. And the likelihood of me being able to give up. And then he followed it by saying, “You’re going to be in the ward in three years, struggling for breath, and I could essentially book you a bed now. But as I say, I know you won’t give up, so that will be a certainty.”

That was a shock but I still appreciated the fact that he wasn’t trying to make me stop smoking against my, my ability at that point, I went away from that. I was really upset, because essentially what he was saying was, three years from now, you’re going to be struggling for breath, it’s a terminal disease, if I don’t change my lifestyle.

I then, I guess, I was looking to others to make me stop. And it wasn’t me who was giving up. I wanted other people to sort me out. I even started looking at rehab clinics for drugs, because I was so aware that to me, it was as devastating as being a heroin addict. I couldn’t, it was an addiction, it was completely an addiction and I so wanted to stop it, but just didn’t know how, I was going to stop it, because I tried so much and it had just been so draining.
 

Judith was frustrated by a surgeon’s dismissive reaction to the news that she had given up smoking, when it had been very hard for her.

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Age at interview: 36
Sex: Female
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And there was one incidence when I had given up, and it was one specific doctor that I was seeing for one specific problem, and he, I’d had a couple of operations, and he had said, “This will not stop until you give up smoking.” And after the second operation, it was probably about four or five months when I had given up smoking, I had to go for a review to check whether it had become a problem again. And I was so excited, because I was going to tell him I’d managed to give up. And I was really, really disappointed and upset because I went and I told him, and he said, “Right, okay. You do realise that this can happen in non smokers as well?” And that was really, really kind of crushed me at that moment. I wasn’t going to smoke again. But I thought that was really, that really undermined everything that you’ve said to suddenly turn round and tell me that smokers can get this as well. So, sorry non smokers can get this as well. It just, it really made me aware of how much [exhales] how much they put down to smoking. And how they really don’t give you all the facts and I just, it started to make me think, well how many of the other things that they’ve said is down to smoking, is actually down to smoking? And the medical profession at that point lost a lot of credibility for me. But touch wood, it has never reoccurred, but I feel duped, I did feel duped on that occasion and I also felt that he really just didn’t have a clue how hard it is to give up smoking. And how big an achievement it was when had I had give up smoking, given up smoking. Fair enough, people have bad days, but I would have felt that that might have cheered him up, the fact that somebody had come and actually been able to give up smoking. If that’s what he’s telling people to do, surely a success is worthy of at least a smile and a, really not even a well done, but a recognition of I didn’t expect you to do that, after the fact that I’ve been telling you this for goodness knows how long. So yes. Yes.
 

When Chris was first diagnosed with COPD it came as a shock. Her consultant upset her by describing, quite graphically, how her continued smoking might kill her.

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Age at interview: 65
Sex: Female
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What were you thinking and feeling during this whole process?

Disbelief I think more than anything. You know, they say the one doctor I was under right at the very, very beginning, he used to make me cry. He just used to shout at me every time because I smoked. You know, he said, “This is what it’s doing to you. You keep coming back in here. Your x-rays and that are showing that it’s worse, and you’re still smoking. What do you want me to do?” You know, “What do you keep coming back.” Okay they make the appointment and you have to go back, but it’s, whys, should we treat you, that was the attitude? When you’re not even trying to do anything yourself. Yes. Luckily then I had a different doctor, but he [small laugh] used to make me cry, he really did, because he said, “Not only will you have trouble to breath in, if you carry on smoking, you won’t be able to breathe out either. You will feel suffocated. You will actually drown in fluid in your own… Your lungs will just fill up, and you’ll just suffocate.” And still then it didn’t make no difference, still then I thought, if I want to smoke I’ll smoke. You know, you can’t tell me I can’t smoke. Although you don’t, they do know what they’re on about don’t they. You know, but that was my attitude, nobody can tell me I can’t smoke. If I want to smoke I’ll smoke. And I did.

And you know, this sort of attitude where people are sort of telling you something when you’re an adult and so on, did you feel like that there are any other areas of life where you’ve been told to do something you didn’t want to do, or …?

No, no, not really. Just smoking. I thought they can’t tell you can’t smoke. They can’t tell you know, me, I can’t smoke. If I want to smoke, I will smoke. Yes, no I’ve been a good person all my life, but I thought that was my only vice was having a cigarette you know. I mean, yes, I did go out socialising and smoking but nine times out of ten I was only drinking orange juice. I just wasn’t a drinker. In my young days before I had children who got married I did drink and I don’t know what stopped me. But I just stopped. I don’t, I think I don’t like the feeling of being drunk, that’s, that’s what stopped me drinking. I just hated that sinking feeling, and the room going round. So I just didn’t smoke, I didn’t drink. So somebody’s not going to turn round and tell me I can’t smoke, when that’s all I do, you know. So that’s how I felt at the time. But I wished I listened.
Sometimes the connection was less obvious: for example, Sarah had osteoporosis associated with an eating disorder; her doctor told her that smoking affected the amount of calcium she absorbed. But some people thought that doctors just tend to ‘put everything on smoking’ whether or not there was a real connection. Unsurprisingly, advice that was seen in this light wasn’t taken very seriously.
 

When Angela discussed having knee surgery, she was told it would be better if she didn’t smoke. She felt that, then and subsequently, smoking has been unfairly associated with other health conditions.

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Age at interview: 50
Sex: Female
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And you were saying some time ago when you were thinking about having a knee operation….

Hm.

That they don’t operate on people who are smokers. Did you say that or ..? Or is that just what you heard or …?

No, they don’t. I think I must have, when the surgeon said to me, “You know, you have to try and stop.” But I don’t think he said that he wouldn’t. I think he said, you know, it’s better for you to try and stop.

And what did you think about that?

Well to be honest what I thought were blooming heck they put everything on smoking, every condition is like eh smoking, smoking, they’re just making it as an excuse. That’s what I thought. And I would imagine that’s what a lot of people think is that. Oh God. Every time it comes down to smoking and I don’t whether it don’t, I don’t know whether people just say it.

Yes. I guess you got quite a bit of sort of health advice off him, can you remember getting any other sort of health advice and how you felt about it as a smoker?

No, not really. I know at one doctor’s. I’m not quite sure where it were, because I’ve had to move doctors since I’ve moved. It weren’t at this one, but they were doing a survey and I’m sure they weren’t going to accept as many people who smoked. Because they are running the risk of the… yes… Whether they were just doing this survey, and that’s what they were saying, whether they brought it in, I don’t know. But I suppose it’s like giving somebody a new, an alcoholic, a new liver and I’m still drinking. Its, you’ve got to take a bit of responsibility for yourself haven’t you.

And how did you feel about that as a smoker?

No. To me, it was just like ooh it’s another thing to do with smoking.

Did you even feel a bit resentful of it or…?

No. Because… [laughs]. No, because that’s it. It’s just like no matter what you do, it’s because you smoke. It’s not necessarily always that that is it?
Advice from family and friends

Giving up with someone else could be very helpful and supportive but many smokers had been highly irritated when non-smokers, or ex-smokers, in their social circle insisted on telling them about the risks of smoking, or nagged them not to smoke.
 

Raf’s wife and mother wanted him to give up smoking, but he tried to block it out as he wanted to continue.

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Age at interview: 40
Sex: Male
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Has anybody else ever played a role in your decision to give up smoking?

Well my wife, she would always nag me that it smells of cigarette smoke around the house, but apart from that, my Mum occasionally would give me a lecture. But apart from the two of them, no nobody else really.

And what went through your head whenever your Mum was giving you a lecture or your wife was complaining about the smell in the house?

I’d basically just blank it out, in through one ear straight out of the other, not let it register with me. ‘Cause I, basically I just didn’t want to stop, or I couldn’t stop. I think it was more a case of I didn’t want to stop, and I’d never really think much about it.

And why was it that you didn’t want to stop? What is it about it that you really liked?

I don’t know to be honest with you. It was just a case of like, if you’re ever feeling down or anything it was just the most easiest thing to fall back on, just for that comfort fact kind of thing, and I think that was the main reason, but it could be something else, but I’d personally say that that was actually the main reason; if I ever felt down, light a cigarette up, cheer me up straight away. Alright, if not cheer me up, it would take my mind off things.
 

Sue’s husband was a reformed smoker who wanted her to quit.

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Age at interview: 57
Sex: Female
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I mean you mentioned that you stopped for a while. Did you want to stop?

No I felt that I had to really. My husband is what you might call a reformed smoker, I supposed he used to smoke when he was young, and when I met him he would smoke the occasional cigarette when we were out or in company. And just occasionally he’d have one of mine at home as well. And then I think, I think, when I stopped when I was pregnant, he thought that was it, I’d stopped. And he would carry on having the odd cigarette whilst telling me how terrible it was to smoke. And I’d think you hypocrite, you know, just, and oh he would point out that you know, it costs money and it’s not good for you and it’s not good for the soft furnishings. This is a man who hates cushions. But you know, suddenly it was bad for the soft furnishings and the books and I think I just felt pressured by him, in a way that made me think, oh well I’m not giving up. You know, it was almost like no, actually I don’t care about the soft furnishings. And, it was almost, it’s like the young doctors telling you it’s bad for you to smoke. It’s just that sort of low level, constant pressure that makes you think, oh go away and leave me alone. So his, in fact, he probably had the opposite effect to the one he was hoping to [laughs]. As I told him quite a lot.
 

Jules’s Dad used to give him articles about the dangers of smoking which he tried to ignore.

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Age at interview: 41
Sex: Male
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My Dad was really disappointed. He lectured me he cut out all sorts of articles from various papers. Whenever there was an article highlighting the dangers of smoking, it would always end up on my place mat on the table. I think for my Dad he, being a vicar, he worked with a lot of, he gave a lot of pastoral care to people who were dying with cancer and terrible illnesses. So he saw what, he saw the results of smoking. And I think he tried to scare me but when you’re young you’ve got your whole life ahead you don’t think about those of things and if you do, you think it’s not going to happen to you.

I can understand why he did it why I continued I don’t know, people know it’s bad for you but they continue to do it.

So when you say you’d come to dinner and there’d be an article on your place mat. Can you remember sort of what you felt about that?

Oh God here we go again [laughs]. And I think, yes, part of me just didn’t want to read it, because I knew smoking was bad for you and although I didn’t understand the science of you know, I don’t know. I think it, when I was a teenager it was well accepted or well known, it was a well known medical fact that smoking contributed to early death. So, yes, I think, I just, I tried to ignore it. And I remember a couple of times, [laughs] sort of pretending to read it, and I was not even reading it, I was just like looking at it. Oh yes, and just put it down. Just to pacify my Dad, so that he felt that he’d done his bit, and then as soon as I’d finished by breakfast and off to school I’d be smoking my cigarette and it’s at the back of my mind. Yes, you’d ignore it.
(Also see ‘Help from pharmacists, GPs and Nicotine Replacement Therapies’, ‘Smoking related diseases’ and ‘The role of other people in the decision to quit’).

Last reviewed August 2018.
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