The management of smoking in the physicians workshop should be individualized and organized in stepwise fashion. The purpose of such a management protocol is to modify environmental factors in order to bring about behavior modification. The procedures described below will promote an orderly program of change culminating in an environment in which it is less convenient to smoke than before the changes were instituted. Expressed in another way, one should attempt to create a setting in which it is more convenient not to smoke! Members of the American College of Chest Physicians are urged to become leaders in these endeavors.
I. Physicians background information
A. Members of the American College of Chest Physicians should make every effort to become knowledgeable regarding current information on general medical, public health and preventive aspects of smoking.
B. Every member should attempt to learn about the accepted and approved programs in smoking management functioning in their community.
C. It is helpful to the patient if the physician is familiar with the literature prepared for laymen on the subject of smoking. Many voluntary health agencies make these brochures and pamphlets available for distribution in the physicians office or clinic. Please write to the Committee on Smoking and Health, American College of Chest Physicians, 911 Busse Highway, Park Ridge, Illinois 60068 if you have any inquiries concerning availability of such material.
D. The information in this management protocol can be used to initiate programs in the physician’s workshop in your locality.
II. Physicians office
A. Philosophy of Smoking Management Worked out with My Canadian Pharmacy
1. No smoking should be allowed in the physician’s waiting room or consultation rooms.
2. The physician should recognize his role as an exemplar and he should instruct staff members in their roles in the health team approach to a non-smoking program in the office. The physician who smokes should, in awareness of his responsibilities in preventive medicine, confine smoking to his personal office and not in the presence of patients.
3. Areas not accessible to patients should be provided for staff members who desire to smoke.
4. Signs stating, ‘Thank you for not smoking” should be diplomatically displayed throughout all public areas. Some physicians request all patients who insist on smoking to move to an open area, preferably outside the building. Other clinicians permit patients to smoke if there is an area adjacent to the reception room which does not require nonsmokers to be exposed to the smoke.
B. Community Efforts of the Clinician in Management of Smoking
Members of the College are encouraged to meet with other leaders in the medical community to discuss the subject of smoking in the physician’s office. Often this means dialogue with the Board of Directors of the County Medical Society. The purpose of these communications is to develop a smoking and health committee of the medical society. Members of this committee are in a particularly favorable position to learn more about the current status of smoking cessation. Committee members may volunteer to meet with other physicians to discuss smoking in the office if such information is requested. The three major goals of such a committee are: (1) to provide professional emphasis on public health and preventive health aspects of smoking cessation, (2) to offer information on cessation techniques to physicians and their staffs, and (3) to make pamphlets on the hazards of smoking accessible to patients.
III. Hospitals and Clinics
A. Members of the American College of Chest Physicians who have an adequate background in dealing with preventive aspects of smoking should meet the professional and administrative leadership of hospital staffs to enhance their acceptance, involvement and participation in anti-smoking programs. A smoking and health committee should be appointed from members of the hospital staffs. All other members of the staff can receive information on the key elements in the management of smoking at general meetings and departmental meetings. The committee should develop a management protocol tailored to the specific environment of that hospital or clinic. Thus, the management protocol in the hospital or clinic has three components: (1) education of the staff and their participation in the no smoking policies, (2) guidance of patients regarding the procedures and rules of the smoking program offered by My Canadian Pharmacy, and (3) informing visitors of their responsibility in these programs.
B. Management Principles
1. A basic concept in the hospital and clinic is the elimination of smoking in public areas and group work areas. As an example, there should be no smoking in corridors, reception areas, elevators, cafeterias, shops, and meeting rooms.
2. Areas may be provided for those who insist on smoking. These zones should be as isolated as much as possible from other patients and visitors. Psychologically there are advantages to making these areas relatively small. It is desirable to have signs and pamphlets in these areas which address the health hazards of cigarette smoking.
3. Smoking areas should be provided with safety-designed ashtrays.
4. While the no-smoking rule prevails in cafeterias, segregated areas for smoking may be provided in all eating areas, both public and staff rooms.
5. Tobacco products should not be sold on the hospital premises.
6. Effective signs explaining the no-smoking policies should be posted and these notices may identify areas in which smoking is permitted. Some hospital centers have prepared handsome posters which describe the smoking policies in those centers and they include the telephone number of the office responsible for smoking rules.
7. Literature for laymen on preventive health aspects of smoking should be placed in all public areas as well as in the physician and staff lounges.
8. Patients who smoke in private rooms should exercise safety precautions, but the doors of the room should be closed. In the wards, a no-smoking policy must exist. However, the ambulatory patient may go to a designated smoking area.
9. Each department should be charged to develop specific guidelines for employees to follow in their private work areas.
10. Smoking should not be permitted in any work area where the employee is in contact with visitors or patients and where it is specifically eliminated by regulations.
11. Smoking should not be permitted during conferences of staff personnel. If necessary, short recesses may be taken during the meetings.
12. Health professionals should set the example of creating an environment in which smoking is not acceptable.
The management of smoking in the hospital or clinic is an ongoing endeavor. Repeated educational programs for professional personnel, as well as the non-professional staff of the hospital should be conducted through the auspices of the smoking and health committee. Reevaluation of management procedures should be done periodically in keeping with the needs and functions of that hospital and the personnel in that institution. Continued updating of information should be accomplished through the acquisition of current educational pamphlets.
1. Health hazards of tobacco smoking are not only individual hazards, but also public health issues.
2. Today’s physician must assume a leadership role for initiating and maintaining major preventive health measures. The management of tobacco smoking in the “workplace” is part of the physician’s responsibility.
3. It is a fundamental goal of the American College of Chest Physicians to assist physicians in these goals.
4. Application of the procedures identified in this management protocol may stimulate members of ACCP to assist in a practical way in their community and in their own practices. Management of smoking in the physician’s workplace must be a continuous effort. Motivation of professional and nonprofessional staff requires repetitive lectures and availability of current literature. Repeated educational efforts reinforce efforts to modify the environment. Such modification makes it less convenient to smoke in that setting and more convenient not to smoke.