"I'll give up smoking when you get me better": patients' resistance to attempts to problematise smoking in general practice (GP) consultations

Soc Sci Med. 2003 Jul;57(1):135-45. doi: 10.1016/s0277-9536(02)00336-2.


This paper focuses on general practice consultations where the issue of patients' smoking is raised and problematised by general practitioners (GPs) by linking it to their presenting or ongoing medical conditions. The data are taken from a larger study in one country of the UK, of the factors influencing discussion of smoking between GPs and patients who smoke. Consultations have been examined informed by the conversation analysis literature, with a focus on patients' resistance to doctors' problematisation of smoking. It is argued that, despite evidence from other areas of health care that advice is most effective when it is personalised, and despite GPs' expressed views that a preferred way of topicalising smoking is to make links to a patient's current medical problems, this is not generally the case in these consultations. Linking smoking to current problems commonly results in explicit resistance from patients of a kind that is rarely seen in other medical consultations. It is postulated that this results from the moral implications of linking a person's health status with their own behaviour, thereby undermining their claim to legitimate illness and to medical help.

MeSH terms

  • Family Practice / organization & administration*
  • Health Services Research
  • Humans
  • Physician-Patient Relations*
  • Referral and Consultation
  • Smoking Cessation / psychology*
  • Social Problems
  • Treatment Refusal / psychology*
  • United Kingdom