Smoking cessation, deprescribing, and more
Stories on Leadership Day, career building, and iron deficiency are also featured.
Addition by subtraction is one of our themes in this issue, with two cover features focusing on how to help patients stop doing things, namely smoking and taking too many medications.
Our story on smoking cessation takes a close look at just how difficult it is. If you wait to begin treatment until your patients tell you they're ready to quit, you may be waiting forever, as the experts we spoke to explain. A better approach may be to implement "pre-quitting" by, for example, prescribing varenicline before patients have set a quit date. Viewing quitting as a continuum rather than a hard stopping point, finding out the reasons why patients smoke, trying various cessation strategies, and providing behavioral support and counseling are also key strategies for success.
Deprescribing is another tricky area where it can be difficult to convince patients that less is more. Older patients who have relied on a medication for years may be unwilling to give it up even if it may now be increasing their fall risk, and sometimes patients (and their families) may not even realize they've crossed into the category of polypharmacy, defined as taking at least five prescription drugs. The first step in addressing this problem is finding out exactly what patients are taking by conducting a full medication review, then stratifying drugs according to risk, our story explains. The STOPP/START criteria, the 2023 American Geriatrics Society Beers Update, and disease-specific algorithms from the US Deprescribing Research Network can help you decide what to taper, stop, or switch. Read our story for more, including tips on the importance of shared decision making.
This issue also features a report from ACP's 2025 Leadership Day, held in May in Washington, D.C. Nearly 500 ACP members visited Capitol Hill to advocate for their patients and for ACP's priorities, including cosponsoring and passing the Medicare Patient Access and Practice Stabilization Act, protecting Medicaid, and protecting and investing in public health initiatives, research, and workforce.
I.M. Ready offers coverage from Converge 2025, the annual meeting of the Society of Hospital Medicine, which features a method used by a former U.S. president to categorize to-do lists. Divide your tasks into four quadrants—urgent and important, nonurgent but important, urgent but unimportant, and nonurgent and unimportant—as an exercise to help you determine whether your job might actually be getting in the way of your career, a physician expert explained.
Our Pearls from I.M. Peers column delves into the different values that may indicate iron deficiency and how best to apply them, and the Washington Perspective looks at 60 years of Medicare and Medicaid. ACP's President, Jason M. Goldman, MD, MACP, discusses recent changes to the CDC's Advisory Committee on Immunization Practices (ACIP) and the ongoing importance of vaccination.
What are your thoughts on the changes to ACIP? How do you handle smoking cessation and deprescribing in your practice? Let us know.
Sincerely,
Jennifer Kearney-Strouse
Executive Editor
