Despite the accumulation of evidence about the risks of tobacco use in recent decades, smoking remains an important public health problem. Although significant advances for its control have been achieved, the role of health care workers, especially physicians, is still less than ideal, as smoking cessation could provide great benefits to their patients. In many countries, these professionals fail to be proactive in promoting smoking cessation: they do not motivate their patients, offer options for quitting smoking or help prevent smoking initiation among adolescents. This reluctance clearly signifies lost opportunities in the fight against smoking, much as in the days before the harmful effects of smoking were well-defined. Given that about 70% of smokers seek medical assistance over the course of a year due to problems both related and unrelated to smoking, the percentage of wasted possibilities remains significant. This may occur because physicians feel insecure in addressing the various problems when communicating with smokers. The aim of this article is to review the reasons for insufficient commitment of some physicians to this fight. We attribute part of the problem to deficiencies in medical school education, insufficient training, not adapting medical school curricula to the rapid changes occurring in this area and a lack of transdisciplinary vision regarding smoking. All are possibilities that can explain such lost opportunities in treating smokers.