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To the Editor: In his Grand Rounds, Dr Schroeder¹ discussed smoking cessation options but did not consider the role of physician as coach. With each office visit, a physician should come up with a simple goal for the smoker to achieve, aiming toward cessation. For example, a patient may aim for a reduction of tobacco use by 50% in the subsequent 3 months, with the physician working with the patient to develop a formal schedule of gradual rationing that will allow some satisfaction from nicotine while reducing overall consumption. At the same time, patients should be encouraged to exercise more as a means of diverting them from tobacco use and to consume raw vegetables such as celery, broccoli, or cucumbers to avoid weight gain.

Financial Disclosures: None reported.

Jeffrey L. Kaufman, MD
kaufman@massmed.org
Vascular Services of Western New England
Springfield, Mass

1. Schroeder SA. What to do with a patient who smokes. JAMA. 2005;294:482-487. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;294:2434.

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