WASHINGTON - A majority of Americans who smoke want to quit but get little help from their doctors, who often don't even ask whether they smoke or offer treatments, according to a report released Tuesday.

The report by the U.S. Public Health Service urges physicians to aggressively treat smoking just like any other chronic illness. The agency, which summarizes new guidelines for getting people to quit, said spending as little as 3 minutes talking to patients about their smoking habit can dramatically raise the chance that patients will eventually quit. ``A doctor isn't providing an appropriate standard of care for his or her patients if he or she doesn't ask two key questions - 'Do you smoke?' and 'Do you want to quit?' - and then work with that individual to make it happen,'' said Dr. Michael Fiore, a tobacco researcher at the University of Wisconsin Medical School who headed a panel of private and public health officials that created the guidelines. The American Medical Association said the report was a wakeup call for doctors, who need to do a better job treating smokers. ``We have to with every one of our patients inquire whether they are a smoker and spend some time with them to get them to be ex-smokers,'' said Corlin. ``Doctors have a duty to deal with this.'' Fiore said that 70 percent of the 50 million Americans who smoke have tried to quit at least once. Over 20 million Americans will try to kick the habit this year. Most will go cold turkey and only a million will succeed. The guidelines, which will go out to doctors, health clinics, hospitals and health plans, urge physicians to treat smoking no differently than other chronic disease such as diabetes and hypertension. They should prescribe nicotine gums, inhalers or patches and refer smokers for counseling. The combination of medicine and counseling - especially frequent counseling - is highly effective in getting people to quit, the report said. If doctors, nurses and other clinicians followed the guidelines, the number of people who quit annually would double to 2 million, said Fiore. President Clinton called the new guidelines ``an important tool to help...patients quit using tobacco products,'' and ordered federal agencies to use the new guidelines in updating their tobacco cessation programs. The guidelines also urged health insurance companies and government health programs to pay for tobacco cessation treatments and counseling. Only about half of all insurers currently do so; Medicare, the federal health program for seniors, doesn't cover anti-smoking treatments and only 22 states provided Medicaid coverage for tobacco dependence treatments. Medicaid is a state-federal health program for low-income people. Fiore said it only costs between $200 and $400 for patients to get a medication and one or two counseling sessions. Nearly 70 percent of Americans are in health plans sponsored by their employers. Managed care officials say that the decision to cover tobacco cessation programs is up to employers since they will have to pay for the programs or pass the costs on to their workers. ``We emphasize prevention but we don't decide what to pay for - the employers do,'' said Susan Pisano, spokeswoman for the American Association of Health Plans, which represents health maintenance organizations.

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