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Doctors and their professional associations are in
a uniquely powerful position to take action on tobacco.
Doctors enjoy high credibility when speaking on matters
of health. They have the opportunity to give personalised
advice to their patients. Moreover, doctors often
enjoy a privileged social position and have access
to decision-makers.
This section outlines how doctors can take effective
action to reduce the burden of illness and death caused
by tobacco, whether as an individual or together with
colleagues.
Further pages include information on practical step-by-step
guidance to working with the public, media and politicians,
as well as a directory of relevant contacts.
Practical step-by-step guidance to working with
the public, media and politicians, as well as a directory
of relevant contacts.
Workshops on tobacco control especially designed
for the European medical profession, giving practical
guidance for both individual doctors and national
medical associations.
doctor to doctor
Professional development and continuing education,
as well as individual advocacy is of paramount importance
when tackling tobacco use within the profession.
To address this the tcrc will roll out a series of
training workshops
to National Medical Associations.
doctor to public
As an individual and as a member of a professional
association
You can make a difference by knowing what makes for
effective public health policy on tobacco, and by
speaking up for health at every available opportunity.
At the local level
You can get the message across by working with the
local community, media, politicians and decision-makers.
At the national level
Medical associations have a vital role to play in
campaigning for comprehensive tobacco control legislation
that is monitored and enforced. Key elements include
bans on tobacco promotion, increasing prices through
taxation, public education, health warnings, smoke-free
public places, bans on sales to children, product
regulation, and support for smoking cessation.
Ensure that action on tobacco is a priority for your
association. Ideas and guidance can be found in the
TCRC action manual
Doctors
and Tobacco: Medicine's Big Challenge
available free from this site in six languages
doctor to patient
This section outlines the ways in which individual
doctors can help their patients.
- be a non-smoker
- help your patients to quit
- make your premises smoke-free
- references
be a non-smoker
Our own smoking habits both reflect and influence
our attitudes to tobacco. As well as endangering their
own health, doctors who smoke risk sending a misleading
message to their patients and to the general public.
There is evidence that doctors who are smokers are
less likely to discuss tobacco use with their patients
and are less likely to be able to help their patients
who smoke to stop [1] Moreover, patients may give
less weight to advice on quitting when it comes from
a doctor who smokes. If you smoke, give serious thought
to stopping, for the sake both of your own health
and that of your patients.
help your patients to quit
One in every two smokers will eventually die from
a disease caused by tobacco. But while the risks for
those who continue to smoke are high, quitting smoking
at any age improves health and increases life expectancy.
Many smokers want to stop, but find it difficult to
succeed. Tobacco dependency is recognised as a behavioural
disorder in the World Health Organisation International
Classification of Diseases [2]. The nicotine in cigarette
smoke is highly addictive, acting through the same
physiological pathways as cocaine and heroin [3].
Smoking cessation and treatment of nicotine dependence
are crucial in curative medicine, preventive medicine
and public health.
As a doctor, you are in a unique position to help
your patients to stop smoking. The evidence shows
that even brief advice from a doctor significantly
increases the likelihood that a smoker will succeed
in quitting. An evidence-based protocol for a brief
smoking cessation intervention known as the ' Five
A's ' is recommended:
- ask whether the patient smokes and note
it on the patient record;
- assess
- advise of the dangers;
- assist those patients who are ready to
try to give up;
- arrange a follow-up visit.
This intervention takes only minutes of your time,
but increases the smoker's chance of quitting from
less than 3% for an unassisted attempt, to around
6% for smokers given brief advice. Nicotine replacement
therapy should be recommended wherever appropriate,
as it will double again the likelihood of success
[4].
From time to time, the doctor should review all patients'
smoking habits. It is important to realise that because
of the addictive nature of nicotine, many smokers
succeed in giving up only after several attempts.
Doctors need to persevere in helping these patients
to renew their efforts to stop smoking. Smokers who
try to quit but fail will need your reassurance, and
your encouragement to try again.
More intensive smoking cessation counselling has
been found to yield higher success rates per individual.
However, the same time spent making brief interventions
with a number of patients will result in a higher
number of quitters. The strategy you choose will depend
on the resources available and the needs of your patients.
make your premises smoke-free
Passive smoking has been established as a cause of
heart disease [5] and of lung cancer [6] in adults.
In children, passive smoking is known to cause lower
respiratory illness, reduced lung growth and middle
ear disease. In addition, second-hand smoke can cause
asthma, and increases the severity of the condition
in children who are already affected [7]. Both workers
and the public should be protected from the health
hazards of exposure to tobacco smoke, especially in
health care facilities. If smoking is currently allowed
on your premises, now is the time to introduce a smoke-free
policy, as a positive step towards a healthier environment
for both your patients and your staff.
references
1. Tessier JF, Thomas D, Nejjari C,
et al. Attitudes and opinions of French cardiologists
toward smoking. Eur J Epidemiol 1995;11:615-620.
2. International Classification of
Disease, 10th revision (ICD-10). Geneva: World Health
Organisation, 1975.
3. Pich EM, Pagliusi SR, Tessari M,
Talabot-Ayer D, Hooft van Huijsduijnen R, Chiamulera
C. Common neural substrates for the addictive properties
of nicotine and cocaine. Science 1997;275:83-86.
4. Raw M, McNeill A, West R. Smoking
cessation: evidence-based recommendations for the
healthcare system . BMJ 1999;318:182-185 ; Raw M,
McNeill A, West R. Smoking cessation guidelines for
health professionals. A guide to effective smoking
cessation interventions for the health care system.
Thorax 1998;53 Supplement 5
Part 1. (Available online at: http://www.bmj.com/cgi/content/full/318/7177/182)
5. Law MR, Morris JK, Wald NJ. Environmental
tobacco smoke and ischaemic heart disease: an evaluation
of the evidence. BMJ 1997;315:973-79. (Available online
at: http://www.bmj.com/cgi/content/full/315/7114/973)
6. Hackshaw AK, Law MR, Wald NJ. The
accumulated evidence on lung cancer and environmental
tobacco smoke. BMJ 1997;315:980-89.
(Available online at: http://www.bmj.com/cgi/content/full/315/7114/980)
7. International Consultation on Environmental
Tobacco Smoke and Child Health. Consultation Report.
World Health Organisation, 1999. WHO/NCD/TFI/99.10.
(Online version available at URL: http://tobacco.who.int/en.html)
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