According to the World Health Organization, "Health professionals are encouraged to personally exhibit and promote a tobacco free lifestyle. The advice and treatment given by health professionals can be a major factor in whether or not a person tries and succeeds in quitting smoking".
The Tobacco Free Initiative of WHO states that "Health workers function as exemplars and educators for their patients, and consequently should set an example by abstaining from tobacco. When this point is emphasized in professional organizations and through the education system that trains professionals, their tobacco use rates decline.
If health professionals and researchers focus as much on efforts to prompt attempts at tobacco cessation as on creating new approaches to treatment, many additional tobacco users will be motivated to quit... physician advice does increase both immediate and more distant attempts to quit."
We need to persuade doctors themselves and those who most influence them. Also those who have the most professional influence with doctors, including deans of medical schools, professors of medicine, and other respected, award winning doctors and medical scientists should be motivated.
It also includes those with institutional and economic influence including health ministers and senior public health officials, hospital administrators, boards of directors, hospital medical department heads, nursing directors and inspectors of hospital hygiene and safety.
Most of the doctors do not recognise that their professional responsibility extends beyond the treatment and cure of tobacco caused disease to include prevention and cessation. This lack of recognition is reinforced by medical compensation systems that rarely pay for counselling or cessation services.
Several leading health authorities have issued strong statements encouraging medical professionals to give up smoking and to embrace the key role that they play in helping others to curtail their tobacco use.
Doctors need to hear that their interventions can have a powerful impact, not only in cessation counselling and treatment, but also in policy advocacy. Professor David Simpson, the eminent tobacco control advocate in the world says; "such messages are empowering - there is something they can do to alleviate the suffering from tobacco caused disease."
Doctors who have already become tobacco control advocates are perhaps the most powerful messengers to convey the message of tobacco prevention to doctors.
Medical school professors have a prime opportunity to educate young doctors about the hazards of tobacco use. Their curricula can introduce prospective doctors to tobacco control activities and make them aware of their obligation to participate as members of the medical profession.
In some countries, leading physicians have access to the mass media as great experts on news programmes and talk shows or with their own health guidance programmes. They can use these media opportunities to encourage their colleagues to get involved in tobacco control.
Doctors have the every possibility of helping and protecting their patients and their families by giving timely warning of the dangers of smoking. They can advise patients to stop smoking when they are suffering from tobacco-related illnesses. They can also use their immense influence to encourage tobacco control measures.
Most people regard doctors as the most reliable source of knowledge and advice on matters related to health. The example of doctors has an important influence on the rest of the community. Therefore doctors should not smoke themselves. If doctors smoke they make smokers think that smoking cannot be as dangerous as they have been told.
However, fortunately in many countries only a low number of doctors now smoke. This particular factor should be publicized more and more as a reason for social marketing and then to promote tobacco control.
In Doctors and Tobacco: Medicine's Big Challenge, by Professor David Simpson, it is mentioned that medical professionals probably have "the greatest potential of any group in society to promote a reduction in tobacco use, and thus in due course, a reduction in tobacco induced mortality and morbidity." They have a unique potential to contribute to tobacco control in several complementary ways:
* As role models in not smoking, or quitting smoking
* In counselling patients not to smoke
* In providing smoking cessation treatment
* In organising and speaking out publicly and lobbying for comprehensive public policies to control tobacco use
As a routine, whatever the health problem of all patients, doctors should ask whether they smoke. The details should be recorded in the notes. Smoking may well be related to the medical problem or to treating it, for instance, post-operative complications are more common in smokers.
Doctors should raise the possibility of quitting with all smokers, particularly if symptoms may be related to smoking. If the patient does not wish to consider quitting, note it and raise the matter again at later interviews. If the patient might consider quitting, give a preliminary counselling, and perhaps a pamphlet if available, and arrange to see again.
If the patient does seem really motivated and is a light or moderate smoker, suggest temporarily avoiding routine occasions associated with smoking, substituting other routines, arrange a follow up appointment about a week after the quit date etc. If the patient is a heavy smoker, may need additional counselling, follow-up and group support.
Many children start smoking in their teens. The doctors should raise the problem with every teenage patient and give appropriate advice - to consider stopping or, if a non smoker, not to start.
Doctors should aim at making all medical environments smoke free. It is better to initiate with a survey of staff and ask both about their smoking habits and their attitude towards having smoke free premises. Opinion in favour of smoke free premises is often more widespread than expected. It is important to provide help for staff members who wish to stop.
Convince the value of a smoke free atmosphere, it may help smokers to withdraw the habit.
All students and particularly medical students should have training in counselling.Counselling patients on tobacco can provide a convenient introduction to counselling methods. Also tobacco should be a component in all relevant postgraduate education.
There should be sessions at meetings of all relevant specialist societies. Similar policies should apply to dentists and dental students. All scientific meetings should be smoke free and there should be regular reviews of national statistics, policy and progress on tobacco and tobacco related illnesses in relevant medical journals.
Using their high prestige in health matters, doctors can give valuable support to action in local communities by conducting campaigns for smoke free clinics, hospitals, schools, restaurants, offices, public transport, leisure areas and workplaces.
