Why don’t we detect at-risk drinkers? A qualitative study of GP beliefs and attitudes

This presentation was reported by Byron Kaye on 21 October 2013 in Medical Observer: http://www.medicalobserver.com.au/news/gps-reluctant-to-screen-patients-for-atrisk-drinking

GPs reluctant to screen patients for at-risk drinking

TWO-thirds of at-risk drinkers presenting to GPs do not have their habit picked up partly because their doctor fears straining the relationship, research presented at the RACGP’s annual conference suggests.

The study of four groups of Sydney GPs found that three in 10 adults who see a GP are classified as at-risk drinkers. But the lead researcher, University of NSW public health lecturer Dr Michael Tam, said that only one in 10 patients was detected as being at risk.

The study identified four key complaints from GPs when explaining their reluctance to use existing alcohol screening tools such as the Alcohol Use Disorders Identification Test (AUDIT) and its shorter version, the AUDIT-C: social and cultural attitudes to drinking; the importance of doctor-patient relationships; the difficulty of alcohol screening in general practice; and the ineffectiveness of existing screening tools.

GPs were unwilling to screen because of “the sense that at-risk drinking is not only normal but also desirable”, Dr Tam told the conference.

GPs were also careful to “avoid conflict” when discussing alcohol use with patients, he said.

Even when GPs used screening questionnaires, they were seen as ineffective because of doctors’ concerns that the information patients gave may be unreliable and because of concerns that their relationship would be affected.

“Although detecting at-risk drinking was considered important, alcohol screening questionnaires were not perceived as part of routine practice by our participants,” the authors said.

“Universal screening was seen as impractical and the AUDIT-C in particular was considered to have poor practical utility. It seems unlikely that approaches that focus on GP use of these tools will be successful at improving detection of at-risk drinking.”

BMC Family Practice 2013; 14:121