There is perhaps no more striking contradiction in modern healthcare than the image of a physician in a white coat, stethoscope draped around the neck, stepping outside the hospital to light a cigarette. These are individuals who have devoted years of rigorous study to understanding human physiology, pathology, and the mechanisms of disease. They counsel patients daily on the dangers of tobacco, recounting the well-established links between smoking and lung cancer, cardiovascular disease, chronic obstructive pulmonary disease, and premature mortality. Yet, a substantial proportion of these same healthcare providers continue to smoke.

The phenomenon is not limited to practicing physicians. Medical students, those still in the formative stages of their professional identity, also exhibit smoking rates that rival or even exceed those of the general population in certain regions. This narrative review explores the multifaceted reasons behind this paradoxical behavior, examining the prevalence of tobacco use among doctors and medical students worldwide, the psychological and social forces that drive initiation and maintenance of smoking in these populations, the unique occupational stressors that contribute to tobacco dependence, and the broader implications for public health and medical education.

Physician smoking; medical student tobacco use; healthcare professional substance use; smoking prevalence among doctors; occupational stress and smoking; knowledge-behavior gap; tobacco cessation in medical education; burnout and coping mechanisms; physician health behaviors; tobacco control policies.

Smith, D. R., & Leggat, P. A. An international review of tobacco smoking among medical students. Journal of Postgraduate Medicine, 2007. (Classic global review)

World Health Organization. Tobacco Free Initiative: Health Professionals. Various reports on physician smoking rates globally.

Centers for Disease Control and Prevention (CDC). Current Cigarette Smoking Among Adults — United States, 2005–2015. MMWR, 2016. (For U.S. physician smoking trends)

Aveyard, P., et al. Does the stage of change model predict smoking cessation in UK general practice? Addiction, 2001. (On the "knowing-doing" gap in healthcare settings)

Baccouche, R., et al. Patterns and associated factors of cigarette smoking among medical students in 2020: a cross-sectional study from a North African country. BMC Public Health, 2025