Stopping smoking: How the family doctor can help DAVID WOODS
Family physicians are ideally placed to wean people off cigarettes "because nothing else that we screen for has more than 40% of the population at risk," Dr. Walter W. Rosser told a recent Toronto symposium on smoking cessation. The symposium, sponsored by the College of Family Physicians of Canada and financially supported by Dow Chemicals, makers of a nicotine chewing gum, attracted 220 registrants. Dr. Rosser, who is director of the family medicine centre at Ottawa Civic Hospital, said that British and Canadian studies show that family doctors may be able to get 20% of smokers to quit. "A trusting relationship with a physician," he said, "has a significant effect on compliance. Rosser urged family doctors to ask all their patients whether they smoke, to have them complete a risk assessment form if they do and to spend even a minute or two counselling them about why they should stop. If the average Canadian general practice has 2000 patients, he said, it would be possible to persuade some 80 of the smokers to give up the habit each year. Rosser said fee schedules should be adjusted to encourage GPs to spend time counselling their patients about the health risks of smoking and the College of Family Physicians should press for more research into the doctor's role in getting people to abandon the habit. Psychiatrist Dr. Michael A.H. Russell of the Maudsley Hospital, London, England, agreed that the
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Rosser: Adjust fee schedule so GPs have counselling time.
Russell: Public is not really aware of smoking risks.
family physician has a pivotal role to play in smoking cessation. Russell, an internationally known researcher in this area, referred to a British survey showing that of four groups of smokers - a control group, a group given a questionnaire on smoking, a group advised by family doctors, and a final group given GP advice and a pamphlet on smoking hazards the last had a 5.1% rate of stopping smoking after 1 year. In the set receiving OP advice only, the rate was 3.3%; for the questionnaire group it was 1.6%, and for the control group 0.3%. Dr. Russell said one of the problems in getting smokers to stop is a hazy public awareness of the risks: another British survey, he said, showed that only half the population believes that smoking
"can help cause" heart disease and only 66% of smokers believe smoking is a cause of lung cancer. Pointing out that withdrawal clinics only attract those who are well-motivated to quit smoking, Russell cited a Philadelphia questionnaire that was mailed to 30 796 people. Of these, he said, 11 477 were smokers, 4775 of whom wanted to stop; 150 eventually attended a clinic, and 35 had given up cigarettes after 1 year. So the family physician's office, said Dr. Russell, is the most costeffective site for efforts to get people to abandon smoking. The nicotine chewing gum, he said, may be one method of helping the process if it's used properly. It at least enables the smoker to break the habit in two stages - off the smoke and then off the nicotine.E
CMA JOURNAL/AUGUST 4, 1979/VOL. 121 349
Family physicians are ideally placed to wean people off cigarettes "because nothing else that we screen for has more than 40% of the population at risk," Dr. Walter W. Rosser told a recent Toronto symposium on smoking cessation. The symposium, sponsored by the College of Family Physicians of Canada and financially supported by Dow Chemicals, makers of a nicotine chewing gum, attracted 220 registrants. Dr. Rosser, who is director of the family medicine centre at Ottawa Civic Hospital, said that British and Canadian studies show that family doctors may be able to get 20% of smokers to quit. "A trusting relationship with a physician," he said, "has a significant effect on compliance. Rosser urged family doctors to ask all their patients whether they smoke, to have them complete a risk assessment form if they do and to spend even a minute or two counselling them about why they should stop. If the average Canadian general practice has 2000 patients, he said, it would be possible to persuade some 80 of the smokers to give up the habit each year. Rosser said fee schedules should be adjusted to encourage GPs to spend time counselling their patients about the health risks of smoking and the College of Family Physicians should press for more research into the doctor's role in getting people to abandon the habit. Psychiatrist Dr. Michael A.H. Russell of the Maudsley Hospital, London, England, agreed that the
F
Rosser: Adjust fee schedule so GPs have counselling time.
Russell: Public is not really aware of smoking risks.
family physician has a pivotal role to play in smoking cessation. Russell, an internationally known researcher in this area, referred to a British survey showing that of four groups of smokers - a control group, a group given a questionnaire on smoking, a group advised by family doctors, and a final group given GP advice and a pamphlet on smoking hazards the last had a 5.1% rate of stopping smoking after 1 year. In the set receiving OP advice only, the rate was 3.3%; for the questionnaire group it was 1.6%, and for the control group 0.3%. Dr. Russell said one of the problems in getting smokers to stop is a hazy public awareness of the risks: another British survey, he said, showed that only half the population believes that smoking
"can help cause" heart disease and only 66% of smokers believe smoking is a cause of lung cancer. Pointing out that withdrawal clinics only attract those who are well-motivated to quit smoking, Russell cited a Philadelphia questionnaire that was mailed to 30 796 people. Of these, he said, 11 477 were smokers, 4775 of whom wanted to stop; 150 eventually attended a clinic, and 35 had given up cigarettes after 1 year. So the family physician's office, said Dr. Russell, is the most costeffective site for efforts to get people to abandon smoking. The nicotine chewing gum, he said, may be one method of helping the process if it's used properly. It at least enables the smoker to break the habit in two stages - off the smoke and then off the nicotine.E
CMA JOURNAL/AUGUST 4, 1979/VOL. 121 349
