The new vital sign: assessing and documenting smoking status

Article Abstract:

Vital signs (temperature, pulse rate, respiratory rate, and blood pressure) are an important component of clinical and diagnostic medicine; a new vital sign should be smoking status. By taking this into account, physicians can confront the main avoidable cause of illness and death today. Failure to confront this issue undermines the practice of medicine and prevents smoking from being treated. An article in the December 11, 1991 issue of The Journal of the American Medical Association shows that fewer than half of the smokers surveyed had been told by their doctors to cut down or quit. Physicians had helped smokers quit in only 4 percent of the cases. If smoking status were made a vital sign, the following steps would be taken by physicians in response to this problem: (1) assessment of smoking status as part of every clinical visit; (2) delivery of a brief intervention message to promote quitting; (3) recognition of smoking as a chronic disease and provision of appropriate help; (4) expectation of only modest success; (5) establishment of expertise in diagnosing and treating nicotine addiction (pharmacologically); and (6) playing a public health role in confronting cigarette smoking. A simple model for helping patients stop smoking is outlined in another article in the same Journal issue. Physicians can have an important impact toward the national goal of a smoke-free society by the year 2000. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Innovations, Medical examination, Smokers, Periodic health examinations

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Health law

Article Abstract:

Several new laws and Supreme Court decisions have had a significant impact on health care professionals and their patients In Rust v Sullivan, the court upheld a Department of Health and Human Services regulation prohibiting federally funded family planning clinics from counseling or referring women for abortions. Congress passed the Patient Self-determination Act of 1990 requiring hospitals receiving Medicare or Medicaid money to tell patients on admission about their rights to accept or refuse medical treatment, as well as their right to develop advance directives about their own care should they become terminally ill. The Americans With Disabilities Act of 1991 (ADA) prohibits health care personnel from discriminating, limits employer rights to preemployment medical screening and forbids discrimination by government agencies including public health departments. Both the Centers for Disease Control (CDC) and the Occupational Safety and Health Administration (OSHA) have addressed the problem of HIV-infected patients.

Laws, regulations and rules, Medical care

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Violence against women: relevance for medical practitioners

Article Abstract:

Physicians should routinely question their female patients about violence in their personal relationships. Physicians are often the first to see women who have been abused, and they are in a unique position to uncover the abusive relationship and refer the women to the appropriate social service agency. In some studies, 22% to 35% of the women seen in emergency departments had symptoms of abuse. Many of these women can be diagnosed with post-traumatic stress disorder. Physicians should be taught the types and consequences of violence against women, and should develop tools to diagnose abuse in their female patients. They should document the woman's history of abuse as well as her injuries. The hospital should also have staff members specifically trained to deal with abused women, and these individuals should be the patient's link to community agencies.

Care and treatment, Reports, Abused women, American Medical Association. Council on Scientific Affairs

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