Alcohol screening fulfills important duty to patients

Ethics Forum. March 6, 2006.

Why don't more physicians screen for alcohol problems?

What advice do you have on how to ask patients about their levels of alcohol use?

Reply:

What a lost opportunity! What may be the most blatant oversight in routine medical practice today is that while hundreds of thousands of patients enter health care settings every day with problems due to their overuse of alcohol, their physicians rarely ask them about drinking.

With alcohol abuse and dependence affecting 17.6 million adults in America, one would ask how this is reflected in medical settings.

Research shows that 7% to 20% of outpatients, 30% to 40% of patients in emergency departments and upwards of 50% of patients with trauma have significant alcohol problems. Despite these findings, most patients are not asked about alcohol problems, and even fewer receive professional advice about their drinking. In fact, in a recent study that examined the quality of health care in the United States for 25 health conditions, alcohol care ranked last.

Why is this? It may be that the stigma associated with problem drinking affects both the willingness of patients to seek medical advice and the willingness of physicians to address this public health problem head-on.

Given the medical complexities of the problem, the profound effects of avoiding it, the ease of clinical intervention, and evidence supporting positive outcomes, it seems to me that screening and brief intervention for alcohol problems is as much an ethical concern as a clinical responsibility for all physicians.