Doctors Routinely Miss Signs of Problem Drinking
Primary care doctors who rely on instinct alone fail to spot 70% of problem drinkers among their patients.
When it comes to diagnosing problem drinking, doctors should by no means go with their gut, a new study indicates. Researchers led by Dr. Daniel Vinson of the University of Missouri screened around 1,700 patients. They found that doctors failed to diagnose over 70% of those patients with drinking problems when they relied merely on suspicion, rather than using screening tools. Although 235 of the patients screened positive for hazardous or harmful drinking, primary care doctors suspected drinking problems in just 81 of them. They do spot the most obvious cases, however: When they did suspect that a patient had a drinking problem, they were correct 98% of the time. "[Primary care doctors] are uniquely positioned to screen and assess all patients' patterns of alcohol and drug use," says Bruce Goldman, director of Substance Abuse Services at the Zucker Hillside Hospital, NY. "A few standardized screening questions, consistently asked of all patients, could quickly identify those who would benefit from either education or referral to specialized care." But some doctors argue that, while screenings are the best way to identify drinking problems, it's not feasible to perform them in every medical setting. "Most practices do not have the ability to deal with the conditions that are being detected," says Dr. Neil Calman, chairman of Family Medicine and Community Health at the Icahn School of Medicine at Mount Sinai. "Second, they identify many patients who do not choose to seek help for the detected issues and resources may be wasted on people who do not see the problem as something that needs to be addressed or that they want to have addressed." Calman adds that conducting such screenings could also alienate some from receiving care for other critical conditions because they don't want to be asked about issues they feel are irrelevant to their visit.