INTRODUCTION: General practitioners (GPs) have the potential to promote alcohol harm minimisation via discussion of alcohol use with patients, but knowledge of GPs’ current practice and attitudes on this matter is limited. Our aim was to assess GPs’ current practice and attitudes towards discussing alcohol use with their patients. METHODS: This qualitative study involved semi-structured, face-to-face interviews with 19 GPs by a group of medical students in primary care practices in Wellington, New Zealand. FINDINGS: Despite agreement amongst GPs about the importance of their role in alcohol harm minimisation, alcohol was not often raised in patient consultations. GPs’ usual practice included referral to drug and alcohol services and advice. GPs were also aware of national drinking guidelines and alcohol screening tools, but in practice these were rarely utilised. Key barriers to discussing alcohol use included its societal ‘taboo’ nature, time constraints, and perceptions of patient dishonesty. CONCLUSION: In this study there is a fundamental mismatch between the health community’s expectations of GPs to discuss alcohol with patients and the reality. Potential solutions to the most commonly identified barriers include screening outside the GP consultation, incorporating screening tools into existing software used by GPs, exploring with GPs the social stigma associated with alcohol misuse, and framing alcohol misuse as a health issue. As it is unclear if these approaches will change GP practice, there remains scope for the development and pilot testing of potential solutions identified in this research, together with an assessment of their efficacy in reducing hazardous alcohol consumption. KEYWORDS: Primary health care; general practice; alcohol drinking; alcohol-related disorders, attitude of health personnel

CASE REPORTA 59-year old male with no known chronic medical illnesses presented with a five-day history of constipation and not being able to walk. He reported no history of trauma, back pain, viral type symptoms, or nausea but gave a six-month history of shortness of breath. He denied cough, haemoptysis, palpitations, or chest pain. Of note, he had a 30-packyear smoking history and reported significant weight loss and anorexia over several months.On examination, the patient was tachycardic at 102 beats/minute, tachypnoeic at 32 breaths/minute and had an oxygen saturation of 84% on room air. He had right-sided ptosis and obvious anhydrosis on the right side of his face (Horner's syndrome) with distended neck veins on the right and fullness in the right supraclavicular region (Fig. 1). His right pupil was constricted (Fig. 2). Cranial nerve examination was otherwise unremarkable. Respiratory examination revealed decreased chest expansion on the right, with tracheal deviation to the left, dullness to percussion and absent breath sounds in the right upper-mid zones. He was fully alert with a Glasgow coma scale of 15/15.