Most families and health care professionals are very much aware of the negative health consequences of secondhand smoke. It is equally well known that significant numbers of children are exposed to this environmental hazard despite its widely known effects. The article by Perez-Stable et al1 is an intriguing effort to compare pediatricians and family physicians in terms of their counseling and incorporation of the major components of the program designed by the National Cancer Institute. Their conclusion in part states that education in smoking cessation counseling is needed for pediatricians and that data exist to support such a program for physicians in general. Its conclusion, however, raises several fundamental issues not resolved in the study. The authors contend that pediatricians are far less likely than family practitioners to prescribe nicotine replacement therapy, schedule follow-up visits, and set "quit dates" for parents. These data ignore fundamental differences between the specialties. The parents being counseled by the family practitioners are more than likely patients of these physicians and therefore prescribing and providing follow-up care for the parents separate from the children is expected. For pediatricians, such procedures touch on issues that are not distinctly viewed as clinical elements of pediatric practice. First, most pediatricians are not routinely comfortable prescribing for adult parents for legal and other reasons. Second, parents who are on another primary care provider panel list would probably not be willing to pay for follow-up visits not covered by their insurance. Finally, the authors fail to understand the nature of pediatric practice in the 21st century. Most pediatricians need to target messages and to utilize time efficiently and from an economic perspective (most unfortunately) to avoid the necessity of out-of-pocket payments from patients. Thus, I am not sure that the failure of pediatricians to match family practitioners on these outcome measures is meaningful.
Bradford BJ. Pediatric Counseling of Parents Who Smoke. Arch Pediatr Adolesc Med. 2001;155(7):857–858. doi:10.1001/archpedi.155.7.855
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