Discussing the so-called 5 A’s of smoking cessation – ask, advise, assess, assist, and arrange – he noted that physicians do fairly well on the first two, but not so well on the others.
For example, a study of 246 community-based primary care physicians found that 67% asked their patients about smoking status and 74% gave advice, but just 35% assisted with smoking cessation efforts and merely 8% arranged for follow-up (Prev. Med. 1998;27:720-9).
It is important to understand that relapses are part of the cessation process, Dr. Talwar stressed; in fact, smokers who succeed in quitting make five to seven attempts, on average, before succeeding. Hence, "you have just to have to be patient with them."
It might also be possible to improve the odds of successful quitting by approaching patients at teachable moments, he further noted. For instance, "admission [to the hospital] is an opportunity to interact, to make the change. Maybe that’s the time when you need to approach them."
His own 800-bed hospital generates a list each day of inpatients who smoke. A smoking cessation therapist then visits these patients and invites them to the smoking cessation clinic.
A final barrier is that some physicians themselves are smokers. "It’s been shown that physicians who smoke have very little faith in their own ability to promote smoking cessation," Dr. Talwar commented (Prev. Med. 2005;40:595-601).
On the other hand, this group has greater insight into the difficulties of quitting and might be able to draw on their own experiences to assist patients in this endeavor, he added.
Dr. Talwar did not report any conflicts of interest.