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February 1989

Smoking Counseling and Preventive MedicineA Survey of Internists in Private Practices and a Health Maintenance Organization

Author Affiliations

From the Division of General Internal Medicine, Department of Medicine (Drs Cummings and Coates and Mr Richard), the Department of Epidemiology and International Health (Dr Cummings), and the Department of Dental Health and Public Hygiene (Dr Gerbert), University of California, San Francisco; the Department of Medicine, Kaiser-Permanente Medical Group, San Francisco (Dr Stein); and the Department of Psychiatry, KaiserPermanente Medical Group, Oakland, Calif (Dr Hansen).

Arch Intern Med. 1989;149(2):345-349. doi:10.1001/archinte.1989.00390020069014

• Physicians could help a large number of patients quit smoking by taking time to advise them about quitting, helping them plan a date to quit, giving them self-help materials, following up, and referring some to smoking cessation programs. To determine the attitudes and practices of internists concerning smoking cessation and selected preventive medical practices, we surveyed a random sample of internists in private practice and in a large health maintenance organization (Kaiser-Permanente Medical Group) in the San Francisco Bay area. Overall, internists consider counseling about smoking to be at least as worthwhile as many other practices, such as screening for breast cancer, and more worthwhile than periodic physical examinations. Despite these beliefs, 57% to 65% of internists reported that they spend two minutes or less counseling smokers during new patient visits. Many internists never use recommended strategies for counseling about smoking: 33% to 44% never help patients plan dates to quit, 68% to 75% never make follow-up appointments with patients primarily about smoking, and 27% to 48% never give smokers self-help pamphlets about quitting. Although they believe that counseling about smoking is worthwhile, internists are not doing as much as they could to help their patients quit.

(Arch Intern Med 1989;149:345-349)