How alert are hospital doctors to alcohol misuse among acute orthopaedic patients?

The notes of 100 acute orthopaedic admissions were examined to discover the number of cases in which doctors considered, identified or addressed problems of alcohol misuse. The adequacy with which routine drinking histories were recorded was also examined. Overall, 17.5% of male and 4% of female patients were identified as misusing alcohol; however action was taken in only 36% of these identified cases. Action tended to be taken in cases of chronic alcohol dependency (withdrawal management) or concomitant psychiatric illness (referral to specialist). No action was taken in other cases even when the admission was identified as alcohol related. Admissions identified as alcohol related were significantly more likely (chi 2, p = 0.0002) to have had a previous adult hospital stay compared with admissions not identified as alcohol related. Only 37% of all patients had an adequate routine drinking history recorded. These results corroborate previous research findings and suggest that New Zealand hospital doctors are inconsistent in identifying and addressing alcohol misuse. The results are discussed in the light of current societal norms which condone alcohol misuse. Possible changes in medical school teaching on alcohol are suggested.