GPs turn a deaf ear to quit-smoking line

By MARTIN JOHNSTON health reporter

Only a third of GPs have heeded the call to ask all adult patients if they smoke.

The Government's National Health Committee directed doctors in August last year to encourage all smoking patients to quit. Guidelines told doctors to ask every adult patient if he or she smoked and to record the answer.

Smokers should be advised to quit at nearly every consultation. Those interested should be told about the Quitline and nicotine-replacement therapy and follow-up help arranged.

Shortly after the guidelines went out, the Wellington Medical School surveyed 283 GPs.

Only a third said they asked all patients aged over 17; a further 41 per cent asked most patients in that age-group. With children and youths, only 20 per cent of GPs asked every patient.

In each of those categories, an even smaller proportion of GPs recorded the answers.

Fewer than 60 per cent had read or looked through the guidelines.

A quarter of New Zealanders - and 5 per cent of doctors - smoke, a habit which kills 4700 people a year.

"There is good evidence that advice from health professionals increases quit rates by a small but measurable amount," the researchers say in the latest Medical Journal.

Former Heart Foundation medical director Dr Boyd Swinburn, who headed the team that wrote the guidelines, said yesterday that while there was room for improvement in GPs' performance, the survey showed it was "not too bad."

He suspected that it would have improved since the survey as many doctors had attended seminars on the guidelines.

But he was concerned about the follow-up - only 16 per cent of GPs in the survey reported following up patients' progress on quitting at all consultations.

Their perceptions of the telephone Quitline - only 2.3 per cent thought it "very useful" - would be because in August last year it was still quite new as a national service, he said.

The authors wrote that time pressures on GPs restricted how much stop-smoking and other preventive advice they could give.

Patients' resistance to the quit-smoking message was also a major limiting factor on GPs. Doctors in New Zealand might be more sensitive to that resistance, mainly because of the "fee-for-service" system, in which doctors were mostly paid per consultation.

"In a fee-for-service system, it is unlikely that patients would attend appointments made specifically for follow-up," the researchers said.

But practice nurses could do telephone follow-ups, with GPs making a further check at the next consultation.