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No smoke without fire

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Interesting juxtaposition of stories. On the one hand we have NICE suggesting that we should ‘adopt a harm reduction approach’ by prescribing NRT to smokers who aren’t actually interested in stopping smoking. And on the other, we have Clare Gerada pointing out that we’re booked up to our eyeballs and regularly working 15 hour days.

As Private Eye would say, do you think they might be in any way related? I think maybe yes. Let’s look at that NICE guidance in a little more detail. What it requires of us is to

  • Identify people who smoke but aren’t willing/able to give up.
  • Ask these people if they would like to consider a harm-reduction approach.
  • If they agree, ‘Help them to identify why they smoke, their smoking triggers and their smoking behaviour. Use this information to work through the harm-reduction approaches.’
  • Discuss the pros and cons of these approaches.
  • Explain that NRT may help them reduce the amount they smoke.
  • Recommend and prescribe NRT.
  • About 16 other steps I can’t be arsed to describe.
  • Froth at the mouth.
  • Die.

Let’s put to one side the fact that there are times when evidence, facts and authoritative guidance just smell completely wrong, and this is one of them. And that, if there’s one thing more tedious than nagging people to stop things they’ve no intention of doing, it’s prolonging that conversation when they’ve already made that fact as crystal clear as it can be through the cloud of tobacco smoke. And that the nation’s repeat prescribing systems will, within a year or two, be clogged up with every form of NRT known to man as we end up subsidising the nicotine habit of around 20% of the population.

Instead, let’s focus on the key points, specifically that

a)     This will generate more consultations.

b)     This will generate longer consultations.

c)     Yesterday there was another thing we ought to be doing that will generate more and longer consultations, and tomorrow there will be something else.

Clare Gerada, in her GPs are overwhelmed story, commenting on the comments, comments that WE NEED MORE GPs. Maybe. But more, much more than this, WE NEED LESS WORK.

Readers' comments (7)

  • I'm not convinced of the validity of 'harm reduction' anyway - Does QRisk ask how many they smoke? Do we write "light smoker so lung cancer unlikely" on chest X-Ray forms? No we don't. Giving smokers the idea that actually, just the odd 10 a day is OK, seems like a daft message - I'm with Copperfield on this one!

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  • I agree entirely.
    However , the most important issue here is that the patient DOES NOT WANT TO STOP SMOKING and have made that clear. I am totally against the whole drive to try and force patients to conform against their will and know it affects the doctor/patient relationship.
    I am overweight... recent conversation with GP while in for sx of renal colic....
    " Do you know how much you weigh?
    "yes"
    "How much?"
    "Too much"
    " Are you going to tell me?"
    "No"
    " Would you like to get on the scales?"
    "No"
    Interestingly, I later discovered that she had claimed a health check fee for me!!!
    I am not stupid, know that I am overweight, and did not go to talk about it. I will never see that doctor again!

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  • And I am sure that doctor doesnt want to see you again but s/he may have no choice when you become diabetic and have your MI/CVA....all treated for 'free'.

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  • Does the term Nanny State ring a bell?Anyways the DoH can't be all that broke then to recommend this crud

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  • Anonymous, 12.20 pm. You're right to be annoyed, but maybe not so much at the GP you saw. He clearly wasn't too enthusiastic about it either. We think these checks are as useless as you do and the onus to perform these checks are imposed upon us. Nobody "claims for a health check" on you ,although it may account for a tiny part of a public health Enhanced Service that GPs are put under enormous pressure to sign up to.

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  • The only argument for risk reduction in smokers is an attempt to reduce the financial burden of their smoking on the NHS ( and do we have the evidence that it works?) Smokers are not working the streets, catching HIV or breaking into your car for a hit.

    What a pointless and stupid idea.

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  • If govt really very keen on reducing smokers - try increasing cost per pack of cigarette or impose more bans on them. I am sick and tired of being forced to refer babies and young children to a " proper doctor " in the hospital because cough does not settle when whole family smokes and mum smoked throughout pregnancy - with no future intension of stopping!!!

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder