Obstacles to Identification

Doctors' willingness or ability to identify alcohol problems may be impaired by internal or external factors. 15

Individual factors are characteristics of individual doctors such as knowledge levels, skills, attitudes, beliefs and expectations. Theoretically, these are acquired or modified by education and training.

Structural features refer to the external circumstances in which doctors work and include factors such as organisational priorities, financial reimbursement, lack of standardisation and quality control.

Emphasis is sometimes given to the supposed failings of individual doctors in regard to identifying alcohol problems and problem drinkers, and, indeed, there is evidence that doctors often possess ambivalent if not downright unfavourable attitudes to such patients. In the words of a UK commentator, 'some doctors are wary of getting involved because of an image of alcohol misusers as time consuming, difficult to manage, manipulative and, by and large, incurable.' 16

It is, however, as pointless as it is easy to engage in simplistic blaming exercises - blaming the patient for having the problem and the doctor for failing to recognise it.

Alcohol problems, particularly in their early stages, are not always easy to detect. The signs and symptoms of alcohol problems often mimic those of other conditions; patients may be resistant to discussing their drinking and may not understand the connections between their drinking and the problems they are experiencing.

As far as the doctor is concerned, his or her efficiency in identifying and treating alcohol problems cannot be considered in isolation from the resources with which they are provided. This includes the structure of the health service in which they work and its relationships if any to specialist alcohol treatment services. Unfortunately, a common theme to emerge from European countries is the often fragmentary nature of the treatment process and insufficient inter-disciplinary cooperation. 17

References:

15 R. A. Walsh: Medical Education about Alcohol: Review of its rule and effectiveness. Alcohol and Alcoholism Vol 30 No6. 1995.
16 A. Paton. ABC of Alcohol. BMJ Publishing Group 1994.
17 Dr C Ansoms Psychiatrische Kliniek This volume.