Teaching doctors to take alcohol histories: a limited success story

Doctors often lack the knowledge and skills to identify and assess those who drink to excess and are unsure of what their preventive and educational role should be. As part of a prospective study of early identification and intervention with general hospital patients who drink to excess, we were interested to discover whether brief education about alcohol-related problems and training in the use of a quick and efficient alcohol screening questionnaire would improve doctors' alcohol history-taking and thus their identification of those at risk. The case notes of every fifth admission to orthopaedic and medical wards at the York District Hospital were studied before and after doctor education. Recorded information on both alcohol and tobacco increased over the period reviewed, reflecting perhaps doctors' growing awareness of the health-threatening aspects of these drugs. While there was no major change in doctors' alcohol history-taking, with two thirds of case notes making no mention, or only vague mention, of alcohol, there was a significant post-education increase in the number of patients for whom detailed drinking histories were recorded, but no significant changes in tobacco histories. Small but significant improvements such as these are important in view of the size of the medical problems arising from the use of alcohol.