Great American Smokeout: a great day for clinicians to help patients quit.
But today I’d like to add a slightly different angle to Great American Smokeout. For over 20 years we have been encouraging clinicians to intervene with all of their smoking patients. Very simple mnemonics were developed to try to remind doctors to assess and treat tobacco dependence in their patients. We had the “4 As” then the “5 As”, and now some have realized that the last few A’s (Assist and Arrange) are usually not happening and so are pushing “2 As and an R” which basically means “Ask the patient if they use tobacco, Assess dependence and motivation and Refer to a specialist service”. There are many reasons why the 5As (Ask, Advise, Assess, Assist, Arrange) are only rarely implemented. These include lack of training, lack of financial reimbursement and lack of confidence in effectiveness. So my suggestion is that all clinicians make Great American Smokeout the one day of the year when they make a serious attempt to implement the 5 As with all their patients and try to help their smoking patients to quit.
Some colleagues and I recently wrote a short paper that is designed to remind clinicians to treat tobacco dependence like any other serious modifiable risk factor for disease. It points out that smoking is a unique risk factor in that it is causally related to diseases affecting every organ system, but also that we have relatively effective treatments. The paper is freely available online from today, and I hope it might encourage more clinicians to help their patients to quit, particularly on Great American Smokeout.
Foulds J, Schmelzer AC, Steinberg MB. Treating tobacco dependence as a chronic illness and a key modifiable predictor of disease. International Journal of Clinical Practice. (In press).
You can access the free preview version of the paper online at: