This article in The New York Times asks why physicians so often fail to recognize and deal effectively with patients who have problems with alcohol– even when the problem is out in the open, and impossible to miss.
By the way, the article contains some good information as well as some that IMO isn’t so good. For instance, it lists disulfiram – Antabuse – along with acamprosate and naltrexone as a medication that “can blunt cravings and reduce the urge to drink.” I don’t think so. I’ve worked with dozens of patients who used Antabuse and never heard it described as anything more than a way to make people sick when they consume even small amounts of alcohol. It’s an aversion strategy. The patient may still crave a drink but is unlikely to risk it, knowing serious discomfort will result.
Although I have met a few, including one physician, who tried using disulfiram as a way to control their drinking. They’d take tiny sips until they felt the beginnings of a reaction. Then they’d stop until the symptoms were gone. And resume later. “It sort of works, but it’s not a lot of fun,” admitted one. I can imagine.
Back to today’s topic: Physician failure to address alcohol problems. Not a new issue, by any means. The field of medicine has struggled with it for generations. Progress has been made, largely through education. But there remain plenty of examples of cases where it still occurs.
Here’s a woman complaining about the night her husband was transported by ambulance to the Emergency Room for treatment of a gaping wound suffered during a drunken fall (he was trying to punch her, instead lost his balance and toppled down the stairs). “I was positive that this time the doctors would pick up on the drinking,” she reported. “He absolutely reeked of booze. It was on his breath, in his sweat, his clothes. He’d been soused for a solid week. No one could have missed it.”
Apparently somebody did, because the ER team simply patched him up, handed him a prescription for sedatives, and sent him off with a discharge note that described the injury and its treatment in detail, yet failed to mention… you guessed it..
They even paid for the taxi ride home.
My theory is they identified him as alcoholic as soon as he arrived but decided not to deal with it. Possible reasons, heard from other ER staff in similar situations:
- “The ER was busy. We didn’t have time to deal with it. Other patients needed attention.”
- “This is a medical service. Medically, he was ready for discharge. So we discharged him.”
- “We’re not here to deal with somebody’s psychological problems.”
- “Why doesn’t the family do something? It’s their job, not ours.”
- “I didn’t want to get into it. I’ve tried. It never goes anywhere.”
- “He’d just deny it. They always do.”
- “If we admit him, he just signs out AMA the next morning.”
- “It’s a waste of resources. We don’t need more people like that.”
And so forth. Excuses, sure. But from their perspective, legitimate ones. Maybe they really were pressed for time. There might well have been sicker patients who needed to be seen. They probably have had bad experiences with alcoholics who, as one head nurse put it, “woke up, threw up, and headed for the parking lot.” She wanted to know why they couldn’t at least have signed out before all the paperwork was done?
She felt that would be the considerate choice.
If there’s an underlying theme, it’s that dealing with resistance – that reluctant, sometimes downright uncooperative response — is just too much hassle.
I have to stop for now, but later on we can get back to discussing practical methods for dealing with the objections I’ve listed here plus others that come up. This being a complex issue, so easy solutions may be hard to come by.
At root, it’s about attitudes — the kind that, it’s been said, may not die until shortly after we do.