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Tobacco use has been identified as an increasingly popular phenomenon in the People’s Republic of China, and Chinese physicians have been found to exhibit high smoking rates as well. The practice is controversial because some believe that medical professionals should serve as role models of healthy behavior to their patients, while others believe that doctors should have the right to smoke because it is a personal matter.

Prevalence
A 2004 study conducted among 3,500 Chinese physicians found that 23% were regular smokers. There was a significant gender difference, with 41% of male physicians reporting to be smokers but only 1% of female physicians. More than one third of current smokers had smoked in front of their patients and nearly all had smoked during their work shift.

Male surgeons were found to smoke more than any other specialty. A study conducted among 800 Chinese male surgeons in 2004 found that 45.2% were smokers and 42.5% had smoked in front of their patients.

The smoking rates from these independent studies are lower than those reported by China's state-run newspaper. An article published in 2009 interviewed a source who claimed that 60% of Chinese male doctors were smokers, a percentage higher than any other country's doctors in the world.

Comparison to other populations
Smoking rates among Chinese male physicians are comparable to the country's general population, although overall physician rates are lower. Chinese physicians have a substantially higher smoking prevalence than doctors in the United States (3.3%) or United Kingdom (6.8%). They have a slightly higher rate than Japanese physicians (20.2%) and Japanese physicians have a smaller gender discrepancy with 27% male and 7% of female doctors smoking.

Causes and influences
High tobacco use among physicians may be attributed to several factors. In Chinese culture, smoking is connected to masculine identity as a social activity that is practiced among men to promote feelings of acceptance and brotherhood, which explains why more Chinese male doctors smoke than females. Furthermore, physicians in particular may resort to tobacco as a coping mechanism to deal with the day-to-day stress that is associated with long work hours and difficult patient interactions. One surgeon in Kunming (Yunnan province) described smoking as a phenomenon that is an integral part of Chinese medical culture and one that improves job performance: Smoking is such a big part of being a doctor here. The director of our hospital smokes. The party-secretary smokes. The chair of my department smokes. And whenever I walk into the duty office, most of my colleagues are smoking. And to tell you the truth, with such a pressure-filled job, smoking is extremely helpful, at times soothing, at times energizing, at times helping me focus my attention when preparing for a complex surgery or facing a stack of paperwork 10:30 at night.

Effect on patient care
A physician’s personal smoking habits have been shown to influence his or her attitudes toward the dangers of tobacco. Doctors who smoked were less likely to believe that smoking has a harmful effect on health compared to nonsmokers. Fewer smokers also believed that physicians should serve as role models for their patients and that indoor smoking in hospitals should be prohibited. Nearly all Chinese physicians (95%) believed that active smoking causes lung cancer and most believed that passive smoking causes lung cancer (89%), but current smokers were less likely to hold these health beliefs than nonsmokers were.

Arguments in favor of physicians' choice to smoke
It may be argued that as responsible and informed adults, Chinese physicians should be given the choice of whether or not to smoke. Their backgrounds in science and medicine enable them to know more about the effects of smoking on the body compared to the general public, so a decision they make about tobacco may be more educated.

Furthermore, smoking can be considered a personal matter that should not be relevant to the workplace. Some have suggested that so long as a cigarette does not interfere with a physician’s ability to diagnose and treat patients, smoking should be permitted among health care practitioners. In fact, Chinese physicians who smoke may be able to form closer relationships with patients because of tobacco’s role in the local culture as a commodity that promotes unity and friendship.

Arguments against physicians' choice to smoke
Others may argue that since physicians influence the well-being of the general population, their high smoking rates serve as an unhealthy role model to Chinese citizens. Many believe that doctors should serve as exemplars, as sources of information about quitting, and as providers of support and encouragement for those who are trying to live healthier lives by giving up cigarettes.

Physicians who smoke may also have a bias that prevents them from giving accurate information regarding the negative health effects of tobacco to patients. Alternatively, smoking cessation advice offered by a doctor who smokes may seem hypocritical to the patient trying to quit.

An economic motivation against physician smoking may be the societal loss that is caused by tobacco use. The resources that are spent on medical school and hospital training might not be realized fully if physicians die prematurely from higher smoking rates.