Editorial: Passive doctors risk to 'quit' campaign

In theory, it sounded among the more sensible of the many and varied attempts to get people to stop smoking. Under guidelines set by the publicly-funded National Health Committee, doctors were to keep records of every patient's smoking status.

Then, at "nearly every encounter," they would encourage smokers to stop, and give them information on ways to achieve this. Patients would be asked to set a "quit date" and doctors would monitor them around the time they intended quitting.

If this approach had a flaw, it seemed most likely to be the likelihood of patient resistance. Some will never be receptive to the anti-smoking message, perhaps in the case of youngsters because they think the habit is cool or perhaps because they are comfortable with their addiction. Yet the blame for the move barely getting out of first gear lies not with such stubborn attitudes, but with the lassitude of doctors.

Almost 18 months after the directive was issued, a survey of GPs has revealed that only a third had checked the smoking status of every patient over 17. A further 41 per cent had asked most patients in that age group. With children and youths, a particularly susceptible group, only 20 per cent of GPs had asked every patient.

Following up patients' progress on quitting was an even rarer occurrence. Less than 60 per cent of GPs had even read or looked through the guidelines. So much for the logical thought that doctors should be the first line of defence against smoking, for the good of both the individual and society.

In their defence, doctors may cite pressures on their time which restrict the amount of advice they can dispense. And practical difficulties can arise in following up patient progress.

But the survey suggests a lack of endeavour totally at odds with the clout which doctors could bring to the anti-smoking message.

Doctors enjoy a particular power because of the respect in which they and their advice are held. Obviously, the National Health Committee believed they could give patients a bigger fright than that delivered by advertisements or cigarette-box messages. Certainly, doctors have become distinctly more direct in their dealings with patients in recent years. Diagnosis, for example, is no longer delivered in non-specifics. Why not use that praiseworthy openness to deliver blunt messages about the dangers of smoking?

Doctors' inactivity is the more regrettable because another initiative suggests many smokers are receptive to quit messages. There has been a fervent demand for subsidised nicotine patches and gum through the Quitline since that programme began at the start of last month. About 10,000 calls a month were expected; so far more than 40,000 people have phoned.

This heavy demand flies in the face of doctors' views on the value of the national telephone service. Only 2.3 per cent of those surveyed thought it would be "very useful." The National Health Committee guidelines suggested that doctors should direct patients to the Quitline and its offer to heavy and moderate smokers of nicotine-replacement therapy. Obviously, however, the impulse to take advantage of the Government's $65.8 million programme - and to stop smoking - has come largely from patients, not their GPs.

If that programme is to be a long-term success, it is best in some ways that the urge to stop comes from the smoker. An inner determination supplies greater fortitude than the quick, easy and cheap fix seen in a subsidised programme. The response to Quitline suggests that as many as 40 per cent of the country's 750,000 smokers may be interested in nicotine replacement therapy.

Too often, however, smokers attracted by such a convenient device can be just as easily distracted. The most effective means of stopping people smoking lies not in swingeing bans or messages on cigarette boxes but in education.

That is where doctors have a crucial role to play. Each hospital bed occupied by a smoker is one that cannot be occupied by a patient whose illness is not self-inflicted. Doctors, therefore, owe it to each of their patients to hound smokers methodically.