Intended for healthcare professionals

Rapid response to:

General Practice

Qualitative study of patients' perceptions of doctors' advice to quit smoking: implications for opportunistic health promotion

BMJ 1998; 316 doi: (Published 20 June 1998) Cite this as: BMJ 1998;316:1878

Rapid Response:

Improved advice to quit smoking

After 5 years of developing and utilising a programme of advice about smoking I concur with many of the findings of Butler, Pill and Stott. I am acutely aware of the criticism that many General Practitioners are dictatorial, and demanding of immediate smoking cessation. I adopt a sympathetic and supportive stance, helping patients understand more about the addictive nature of nicotine, the importance of support from family and friends, and the need for long-term effort. Increasing a smoker’s awareness and changing their attitude are of paramount importance.

Smokers may be aware of the dangers of smoking, but has anybody explained why smoking causes hardening of the arteries, why it causes babies to be born small. It’s no wonder that denial and under-reporting of smoking is a problem. If smoking-related diseases are to be treated effectively accurate information about smoking is required. Laboratory tests to verify and quantify smoking are available, and a near-patient test to measure nicotine and its breakdown products is currently being developed1. This correctly identifies smokers, and quickly assesses nicotine intake. The medical profession, as well as the general public, need to be educated about the variability of smoking behaviour, which includs the range of cigarettes available, the manner of smoking - the number, duration and frequency of puffs from a cigarette, and the variability of nicotine metabolism.

Smokers often cite their enjoyment of smoking, and its ability to induce relaxation as the reason for continuing to smoke. Attitudes quickly change if it is explained that nicotine, and the craving for it during periods of deprivation, is the cause of the anxiety and enjoyment is simply a relief of the yearning. To achieve smoking cessation a person, must progress through a series of psychological stages. Their ‘readiness’ to quit can be manipulated with an understanding, individualistic approach with long-term support. Complete cessation is too demanding for many patients, but a gradual concerted effort to cut down, with a view to cessation when the time is right is more acceptable. Also taking into account ‘life factors’ which may be impeding change, and delaying action until the time is right, shows compassion and understanding.

As the paper in question highlights current advice to smokers is inadequate and new approaches are needed. The message to quit smoking needs modification, moving away from the negative effects of smoking on health, towards a positive attitude that behaviour can be changed to the benefit of health and general well-being. The patient should be set achievable targets, which will encourage progress towards the goal of smoking cessation.

1. Cope G, Nayyar P, Holder R, Gibbons J, Bunce R. A simple near-patient test for nicotine and its metabolites in urine to assess smoking habit. Clin Chim Acta 1996; 256: 135-49.

Competing interests: No competing interests

24 June 1998
Graham F Cope
Research Fellow
University of Birmingham