European Stars and Stripes (Newspaper) - May 16, 1989, Darmstadt, Hesse                                To your health is your doctor doing his Job physicians should help patients quit smoking by Victor Cohn Washington Post it s been said before but it s never Boon said with such  your doctor does t Lell you to quit smoking and does t help you quit to in t doing the Job. 1 Hir is the essence of a message irom a group of in dial and american cancer society of Licals. Led by surgeon general a Everel Koop and Harold Freeman a Harlem i Hospital physician and the cancer group s president they disclosed the results of i to now yearlong studios indicating that in a Doclot does the Job right a person May be several limes More Likely than other smokers to kick the habit most past efforts have generally achieved no More than a 4 or 5 percent quit rate succeeding thai is in getting no More than one smoker in 20 or 25 to quit Lor a year or More. In the most positive of he new studies at the University of Indiana and the Indianapolis veterans Hospital a medical team achieved a 15 percent Success rate by several simple Steps More on these below ii that sounds like a Small number said Joseph Cullen Deputy director of cancer prevention and control at the National cancer Institute remember thai we re talking about the possibility of helping millions of  and the would be quitter who tails in the first attempt often succeeds in the second or third. Quitting smoking make no mistake is not easy. When we non smokers see a smoker pulling away and say to ourselves How  we Well May to looking at an unhappy human being who has already gone through the agonies of attempted withdrawal from this True addiction and failed. Studies show that most smokers want to quit. A 1987 Survey showed that two thirds have made at least one serious try a third of them within he previous year. But these suffering smokers need help in psychological terms reinforcement. And Koop and others fast week said a Large part of the Job must be done by doctors Many Are not doing it now. Only Hall of All present smokers say that their doctors have Ever advised them to quit. Yel physicians themselves have shown Hal quilling is possible As recently Asho 50s and 60s, the air at medical meetings was heavy with smoke. Now in is Clear. It is estimated that Only 9 percent of doctors smoke loss than a third of the 29 percent who smoke in he general population. Among new medical students no More than 2 percent smoke and in some freshman classes none do. Koop who is leaving office july 13, spoke bluntly As usual now it s Lime for doctors to practice what they  he said. When i was in medical school to graduated in 1941 no one talked about smoking let alone How to Stop someone from smoking. When i took this Job Sovin years ago. F thought things might have changed a lot but they have not. Wilh some exceptions most medical schools have not taught younger doctors one More thing about smoking than what they aught me. I Don t believe there s any doubt that a patient listens when his doctor looks him in the Eye and says if you Don l Slop smoking you re going to be in serious trouble seventy percent of smokers see their doctors Al least once a year. That puts doctors Iri the top position of All educators. I would like to see them gel to the Point sphere they actually feel embarrassed in they Sec a patient and forget to inquire about smoking and fail to give the advice that might save the patient s  Why do medical schools fail to teach smoking prevention or teach it effectively Why Don t More doctors emphasize quitting to their patients in Large part because of old prejudices. Koop answered some doctors and medical professors fear la it they might be annoying patients or invading their privacy some see an older patient and think wrongly. What Good would in do for him or her to quit Al this Point in life Many doctors. Including medical professors Are also so Busy keeping up with and teaching and applying Medicine s advances now pharmacology is immunology molecular biology thai mention of smoking gets lost in the Shullie. Yel smoking Koop emphasized is responsible in whole or part for a sixth of All deaths and helping patients Stop May be the most important thing a doctor can do Lor their health. What specifically can a doctor do by Way of effective preaching and reinforcement based on recent and past experience say Sci and the cancer society in a new pamphlet Lor doctors a physician should ask about smoking habits. And Are you ready to quit clearly advise each smoker to quit and explain the hazards heart disease lung disease cancer of smoking and the benefits of quilting. Often health facts like these Don t get Home to us until our doctor relates them to each of us As an individual. Explain in a patient has tried to Slop smoking and failed that this is not unusual. According to Sci the average smoker has three or four relapses before quitting for Good. Sot an Early quit Dale. Then Olfer support. To quote an Sci pamphlet Lor doctors let patients know that you care enough to Monitor their Progress. Stress that you will be monitoring their commitment either to Stop by the quit Dale or consider quitting in the  this can mean phoning or having a nurse or assistant phone or write the patient periodically. Congratulate quitters encourage renewed efforts among relapses and avoid blaming patients Lor Lack of Success. Emphasize learning from past attempts and from stresses or situations that May make the new sex smoker search desperately for a cigarette. Give extra help or Lead the patient to it. For some this May mean a quit smoking program or class or the help of another therapist often a psychologist or counselling social worker. For some who Are highly nicotine dependent it May mean temporary use of nicotine gum. Past Ellerts have shown that for Many patients. Iho More measures or interventions the belter the help of a doctor the help of other health workers written materials or other educational tools classes close monitoring follow up. The efforts can work. Leif Solberg is a Minneapolis family doctor and teacher. With two University of Minnesota colleagues to practices Medicine in a residential neighbourhood. In the past trying to get patients to quit smoking was just frustrating he said. But our efforts tended to be hit or miss. In the past our years we be done it quite differently thanks Loci research. We re using a systematic structured approach involving everyone in the clinic physicians and nurses. First our nurses inquire and identify our smoking patients. Then we physicians give each one a Briel message lolling them Why they should quit and How to go about it. Then this still in t enough we follow up a nurse phones them within a week to ask How they re doing and Seo whether any additional measures Are needed. And they May be urged to come in for a follow up visit. The important thing is to let them know that we re  does this annoy or bother patients Quito the contrary he said. In Iho past four years we be seen 230 of our patients give up the habit that s Al least a 20 percent Success Rale and we re still working at  the entire Effort May be As healthy for the doctor As for the ," he said rarely go Homo Al the end of a work Day feeling they be saved a life Hal Day. Now i Leel i can do Al More often Page 16 the stars and stripes tuesday May 16,1989