Examining the Role of the Health Care Professional in Controlling the Tobacco Epidemic: Individual, Organizational and Institutional Responsibilities

Abstract

Despite a historical inclination to view tobacco use as a defect in character or reason, advances in the neurobiological understanding of human behavior and the associated disturbances in behavior patterns produced by exposure to nicotine lead to a conceptualization of tobacco dependence as a chronic disease of the brain. Far from being ineffective, the health care practitioner is in a supremely enabled position to effect change, given the enormous access health care has to dependent patients and the established models of longitudinal care of chronic illness. Our understanding of the biology of addiction, as well as the availability of effective methods of treatment, create a fiduciary responsibility to patients suffering from the addiction -a responsibility which is difficult to ignore given the magnitude of the problem. Until recently, the focus of change within health care has been on promoting new individual and organizational roles for the health care professional caring for tobacco-dependent patients. This chapter explores those roles more fully and suggests new ways of imagining these responsibilities. In addition, this chapter will explore the nature of the institutional role of health care in establishing cultural norms and expectations that are most likely to influence the future trajectory of the epidemic.

Integrating Tobacco Use Treatment Into Practice

“…The magnitude of impact might be expected to be quite high after providers fully integrate tobacco dependence into their personal, organizational, and institutional roles, but system pressures are likely to produce suboptimal change unless significant barriers to engagement have been removed. 27,28 Clarity regarding coding and documentation requirements relevant to the problem are a necessary prerequisite to full adoption. Several key points are important to recognize-primary among them is the distinction between counseling and E/M services.…”

Implicit attribution of culpability and impact on experience of treating tobacco dependence.

“…(Park et al, 2001; Vogt, Hall, & Marteau, 2005) Others have suggested that the institutional responsibility to treat tobacco dependence has not yet been firmly established within the culture of medicine. (Fiore & Baker, 1995; Leone & Evers-Casey, 2015) In addition, several cognitive biases have recently been proposed as possible barriers to effective tobacco dependence treatment by virtue of their influence on perception of treatment success probability. (Leone, Evers-Casey, Graden, & Schnoll, 2015; Leone, Evers-Casey, Graden, Schnoll, & Mallya, 2015) If true, static patterns of physician behavior in the face of well-organized and widely disseminated clinical guidelines may in fact be a function of complex social motivations rather than simple lack of interest or training.…”