Dr Phil Hammond, broadcaster and GP returner in Bristol

Why won’t GPs help their patients to stop smoking?
 

Have you jumped on the bandwagon of the smoking ban to help your patients quit? I suspect not. Two-thirds of smokers say they want to stop, and intervention works but only a fraction get the best treatment. Yet helping people who want to stop smoking is one of the most useful things a GP can do. We see each patient who smokes around five times a year. We are paid to know who smokes and to give advice, and there are treatments that work and patients who want our help. So why are we so bad at giving it?

Most GPs only refer a fraction of their patients to stop smoking services and often give bad advice on how to stop. That is according to Dr Alex Bobak, who claims to be the first, and possibly only, GP with a special interest in smoking cessation. According to Bobak, 63% of GPs did not have time to offer treatments, 61% did not think the treatments worked, and 23% did not think it was their job.1

And it gets worse. Doctors are not trained in smoking cessation. In one study that looked into incorrect beliefs about nicotine in cigarettes, some GPs thought nicotine caused:2

  • cardiovascular disease—51%
  • strokes—49%
  • cancer—41%.

Even 6% thought replacement therapy was as harmful as cigarettes.2 Do they not teach us anything at medical school?

As for smokers, they thought nicotine caused:2

  • cardiovascular disease—62%
  • strokes—63%
  • cancer—71%.

Also, 37% thought nicotine replacement therapy was as harmful as cigarettes. So, they are marginally less well-informed than GPs.

A good smoking cessation service gets 20% of people off cigarettes in the long term. Half of all long-term smokers die prematurely from a smoking-related death. So you need to treat ten smokers to save one life.

Compare that to prescribing cholesterol-lowering drugs, where you have to treat 107 low-risk patients over 5 years to stop one death. You have to treat 700 people with mildly raised blood pressure for 1 year to prevent a single stroke, heart attack, or death. And you have to screen 1140 women over 10 years to prevent one death from cervical cancer.1

Smoking cessation is one of the most effective treatments around. It is also quite boring and repetitive, which I suspect is why GPs do not want to do it and, therefore, do not turn up to what little training there is. But receptionists, nurses, and healthcare assistants love it and are really good at it. There are now plenty of smoking cessation clinics that could take on far more smokers if only they were referred. The least we could do is brush up, show an interest, and enthusiastically point people in the right direction.

Another reason for the lack of enthusiasm on the part of GPs is that maybe we are too world weary to become enthused about anything. I was taught by an old-fashioned GP who felt his job was to help people through their short time on the planet in some sort of harmony with their environment. He hated telling people what to do or how to live their lives. He would have hated the obsession with ‘outcomes’ and constant change. He used to say, ‘People just want to be well enough to do the things that made them ill in the first place.’ But some people want to kick the habit, and we are killing them through apathy.

  1. McRobbie H, Bobak A. How to engage GPs in smoking cessation. UK National Smoking Cessation Conference, June 26/27, 2006. www.uknscc.org/2006_UKNSCC/presentations/alex_bobak_1.html.
  2. Bobak A. Perceived safety of nicotine replacement products among GPs and current smokers in the UK: impact on utilisation. UK National Smoking Cessation Conference, June 9, 2005. www.uknscc.org/2005_UKNSCC/speakers/alex_bobak.html.G

 

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