Postgraduate medicine
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Tobacco use is the leading attributable health risk in the United States today, and smoking cessation by patients should be a major concern of all practicing physicians. A history and physical examination with emphasis on the consequences of tobacco use can open up the subject, while the nonsmoking behavior of physician and office personnel and the office setting itself reinforce the nonsmoking advice. When a patient has decided to quit, the physician can implement several strategies: provide a positive orientation toward quitting, discuss the pros and cons of gradual versus sudden cessation, identify triggers to smoking, anticipate withdrawal symptoms, and set up a reinforcement system.
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The hospice is a physician-directed, multidisciplinary program of care for terminally ill patients designed to meet their emotional and spiritual as well as their physical needs. Services are provided in the patient's home for as long as possible and then at the hospital, if necessary. ⋯ Recent enthusiasm for the hospice concept in this country reflects deficiencies in the care of terminally ill patients that can be attributed in large part to inadequacies in the training physicians receive. By including instruction on the enormous psychologic consequences of illness and impending death, medical schools would better equip future physicians to serve their patients.