Emergency Medicine

Emergency physicians ask over half of female patients if they smoke, but don't counsel or advise them to quit

Emergency departments (EDs) treat 25 million smokers each year, which provides an opportunity to identify smokers and encourage them to quit. ED physicians are likely to ask female patients about smoking, but are not likely to counsel or advise them to quit, according to a new study supported in part by the Agency for Healthcare Research and Quality (HS11096).

Researchers found that physicians spent little time discussing smoking with their patients beyond the initial screening. They rarely assessed patients' readiness to change, provided advice to quit, or provided referrals for tobacco cessation resources. Physicians tended to screen and discuss smoking when patients had a health condition that could be aggravated by smoking.

Researchers analyzed 871 audiotapes of emergency physician-female patient interaction during visits to 2 socioeconomically diverse EDs, an urban academic ED and a suburban community hospital ED. They found that emergency physicians asked 56 percent of female patients if they smoked.

One-third of women said they did, but only slightly more than half of the women who smoked (56 percent) were advised to quit, and 13 percent received a referral, most often to primary care physicians. About 16 percent of smoking discussions included an assessment of readiness to quit. Physician empathy and encouragement was associated with patients' detailing their attempts to quit smoking.

Tobacco screening was twice as high at the urban ED than at the suburban ED, even though smoking prevalence at the urban site was only slightly higher. However, rates of smoking-related discussions at the urban ED were 59 percent lower.

See "'Should I give you my smoking lecture now or later?' Characterizing emergency physician smoking discussions and cessation counseling," by Natalie I. Vokes, Jeannine M. Bailey, M.A., and Karin V. Rhodes, M.D., M.S., in the October 2006 Annals of Emergency Medicine 48(4), pp. 406-414.

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