The recently published guidelines on Smoking Cessation for Health
Professionals are directed primarily at general practitioners with whom
the majority of doctor-patient encounters in the NHS take place.1 The
guidelines encourage GPs to advise smoking cessation "at every
opportunity".
The average GP consultation now lasts about eight minutes during
which GPs are expected to deal with the patient's presenting problem as
well as considering health promotion of which smoking is an important
element.2 In addition to smoking cessation GPs are encouraged to promote
a healthy diet, exercise, moderate alcohol consumption and sexual health
to name a few. In this time we are also expected to detect underlying
disorders including depression, diabetes mellitus, hyperlipidaemia and
hypertension. GPs do not have time to ask about smoking "at every
opportunity", and exhorting them to do so is simply impractical and
inappropriate. It would be more realistic and pragmatic to give advice
about smoking when it is relevant to the patient's presenting complaint or
when it arises in the consultation. The message would then have more
impact on the patient and be a more efficient use of limited time. Smoking
advice unrelated to the issues presented at the consultation may be seen
as paternalistic and intrusive by some patients, and may adversely affect
the consultation dynamics.
We believe that while cigarette cessation should remain a priority
for health care professionals it needs to be tackled in context. The new
guidelines will be welcomed for the clarity they bring to the management
of this difficult subject. However the failure of the guidelines to
emphasise the importance of targeting individuals and situations in which
smoking advice is likely to be most effective represents a barrier to
their introduction in general practice.
Dermot Nolan MRCGP, General Practice Researcher.
David Whooley MRCGP, General Practitioner.
Patrick White FRCGP, Senior Lecturer in General Practice.
Department of General Practice and Primary Care,
Guy's, King's and St Thomas' Medical School,
Weston Education Centre,
Bessemer Rd,
London SE5 9PJ.
Conflict of interest- none
References
1 Raw M, Mc Neill A, West R. Smoking cessation: evidence based
recommendations for the healthcare system. BMJ 1999; 318:182-5.
2 Wilson A. Consultation length in general practice: a review. Br J
Gen. Pract 1991; 41: 119-22.
Rapid Response:
Smoking cessation guidelines
Dear Sir
The recently published guidelines on Smoking Cessation for Health
Professionals are directed primarily at general practitioners with whom
the majority of doctor-patient encounters in the NHS take place.1 The
guidelines encourage GPs to advise smoking cessation "at every
opportunity".
The average GP consultation now lasts about eight minutes during
which GPs are expected to deal with the patient's presenting problem as
well as considering health promotion of which smoking is an important
element.2 In addition to smoking cessation GPs are encouraged to promote
a healthy diet, exercise, moderate alcohol consumption and sexual health
to name a few. In this time we are also expected to detect underlying
disorders including depression, diabetes mellitus, hyperlipidaemia and
hypertension. GPs do not have time to ask about smoking "at every
opportunity", and exhorting them to do so is simply impractical and
inappropriate. It would be more realistic and pragmatic to give advice
about smoking when it is relevant to the patient's presenting complaint or
when it arises in the consultation. The message would then have more
impact on the patient and be a more efficient use of limited time. Smoking
advice unrelated to the issues presented at the consultation may be seen
as paternalistic and intrusive by some patients, and may adversely affect
the consultation dynamics.
We believe that while cigarette cessation should remain a priority
for health care professionals it needs to be tackled in context. The new
guidelines will be welcomed for the clarity they bring to the management
of this difficult subject. However the failure of the guidelines to
emphasise the importance of targeting individuals and situations in which
smoking advice is likely to be most effective represents a barrier to
their introduction in general practice.
Dermot Nolan MRCGP, General Practice Researcher.
David Whooley MRCGP, General Practitioner.
Patrick White FRCGP, Senior Lecturer in General Practice.
Department of General Practice and Primary Care,
Guy's, King's and St Thomas' Medical School,
Weston Education Centre,
Bessemer Rd,
London SE5 9PJ.
Conflict of interest- none
References
1 Raw M, Mc Neill A, West R. Smoking cessation: evidence based
recommendations for the healthcare system. BMJ 1999; 318:182-5.
2 Wilson A. Consultation length in general practice: a review. Br J
Gen. Pract 1991; 41: 119-22.
Competing interests: No competing interests