Dr Dean Eggitt
GP | Teacher | Politician | Speaker
- March 4, 2026
- 8:52 am
- 6 Comments
🩺 Clinical Reflection Case: Mr. Khan’s Persistent Cough
Mr. Khan, a 58-year-old man, attends his GP with a persistent cough and hoarseness. He’s noticed a change in his voice over the past few months and occasional difficulty swallowing. He smokes 20 cigarettes a day and has done so since his early twenties.
He’s polite, humorous, and insists he’s “not one to fuss.” He’s here because his wife insisted.
Examination reveals inflamed vocal cords and signs of chronic laryngitis. Referral to ENT confirms early-stage laryngeal changes consistent with tobacco-related damage. There is no malignancy, but the consultant warns that continued smoking will accelerate deterioration.
Mr. Khan listens quietly. Then he says:
“I’ve smoked all my life. It’s the only thing that calms me down.”
The ENT team explains the risks clearly. Mr. Khan nods, thanks them, and lights a cigarette outside the clinic.
At the follow-up, the GP gently revisits the topic. Mr. Khan shrugs:
“I know it’s bad. But I’ve lost too many things already. This is mine.”
He’s recently retired, lost two close friends, and feels isolated. Smoking is his ritual, his comfort, his identity.
The GP doesn’t push. Instead, she asks:
“What does smoking give you that you feel you’d lose without it?”
Mr. Khan pauses. Then he talks – about grief, loneliness, and the fear of change.
They agree to explore support options, not just for smoking cessation, but for rebuilding connection and routine. No ultimatums. Just partnership.
Diseases of the ear, nose and throat commonly occur because of smoking. How would you demonstrate patience and understanding with a patient who wishes to continue to consume tobacco when you know that this is contributing to their illness?
Approach the conversation with patience and kindness, explain the ways that continued smoking may contribute to their illness, and explore what role smoking currently plays in their life while making sure to actually listen to understand their point of view. I’d do my best to view my patient holistically, as a human first, and openly discuss with them what alternative options they believe are realistic for them to strive towards.
I think if he knows the dangers and is persistent about continuing we could try to reduce the amount that he smokes gradually at first and try to get him to exercise more. Realistically it will kill him eventually but this will slow down the process and hopefully make him feel better about himself in the process. It sound like his mental health isn’t the best at the moment and it would be good to try and get him support and friends to help him get though whatever he’s going through with the recent losses. Hopefully having that support at home may cause him to stop smoking and prolonging his life. Just need to make sure he is fully aware of the dangers how and why it’s affecting him.
Listening to the patient with care and understanding, offering support networks for them to reach out to. Also making sure that the patient fully knows the risks, but telling them in a way that doesn’t seem targeted, judging or insulting.
I would take a non-judgemental and patient-centred approach. First, I would listen to the patient’s reasons for continuing to smoke and acknowledge their perspective to build trust. I would then clearly and sensitively explain how smoking is contributing to their ENT symptoms and the potential risks. While encouraging them to consider reducing or quitting, I would respect their autonomy if they are not ready. I would offer support and resources for smoking cessation and reassure them that the topic can be revisited in future consultations.
I think that it is very important to approach the patient calmly, and explain the importance of quitting smoking and to also give alternatives to improve his lifestyle. As his doctor, it is essential to understand that the patient does not want to quit, but to thoroughly inform him of possible further complications, so the patient can make an informed decision.
I would take an approach that is understanding but also include the acknowledgment that this is negatively impacting their health. I would then listen to the patient with empathy to understand why they consume tabacco. As well as trying to see if there could be any alternatives that could help the patient with addiction and also to improve their health.