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Hmmm ... The doctor might very well ask you to put two and two together.

But it has been shown time and time again that quitting smoking, quitting drinking, and changing eating habits are extremely difficult to do without medical/social/psychological support. It's a lot easier to pinpoint our bad habits on our own (I smoke, I drink, I eat too much, I eat too little, I do heroin, I'm afraid of commitment, I need tons of structure or I fall apart, I chafe under structure, etc.) than it is to implement change on our own. Would you suggest to the person you described above that she not seek out medical care, because with contemplation, she could figure out what her problems were? Just because she recognizes her culpability doesn't mean there are no current heart/lung/liver problems that need to be addressed, nor does it mean she is easily able to make those necessary changes. 

I think you are probably right -- we aren't as clueless to the machinations of our mind as we sometimes imagine/present ourselves to be. But I think a lot of times we are clueless as to how we can exact change, and that is where professional help can be of use to most people, I believe.