The Practices of General and Subspecialty Internists in Counseling About Smoking and Exercise

Published in: American Journal of Public Health, v. 76, no. 8, Aug. 1986, p. 1009-1013

Posted on RAND.org on January 01, 1986

by Kenneth B. Wells, Charles Lewis, Barbara Leake, Mary Kay Schleiter, Robert H. Brook

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The authors compared the practices of subspecialists and general internists in counseling about smoking and exercise, using data from a study of recent graduates of United States training programs in internal medicine. Information on the characteristics of physicians and their clinical practices was obtained from self-report questionnaires. The internists most likely to counsel smokers regardless of the presence or absence of diseases associated with smoking are cardiologists, pulmonary specialists, nephrologists, and generalists trained in a primary care residency funded by the Robert Wood Johnson Foundation or Health Resources Administration. Most internists practice tertiary prevention by counseling a high percentage of smokers with heart or lung disease. Rheumatologists counsel a higher percentage of all patients with poor exercise habits but a lower percentage of such patients with heart disease than do other internists. The differences in counseling related to training are not explained by different levels of involvement as a primary care physician. Rather, these differences appear to reflect training and subspecialty-specific priorities for counseling.

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