Why is it so difficult for general practitioners to discuss alcohol with patients?

Abstract

If general practitioners are to take an active role in the secondary prevention of problems connected with alcohol, they must be able to discuss the subject in an adequate fashion. Interviews from a trial study showed that the greatest difficulties were lack of time and fear of spoiling the relationship with the patient. Earlier studies indicate that the latter problem may have several causes, in part arising from a desire not to infringe upon the integrity of the patient, and partly due to condemnation of excessive drinkers. In other words, the root cause is often contradictory conceptions of alcohol problems on the part of the physician. In order to ensure effective alcohol counselling in primary care, such conceptions must be dealt with in future training courses.

Readiness to Change in Primary Care Patients Who Screened Positive for Alcohol Misuse

“…11 Further, clinicians have reported concern that primary care patients who screen positive for alcohol misuse will deny that they misuse alcohol or will not be interested in discussing or changing their drinking when the issue is raised. [13][14][15][16] Denial of alcohol misuse is sometimes assumed to be a characteristic of alcohol dependence. 14 Despite its clinical utility, little research has addressed the prevalence of denial or readiness to change among primary care patients who misuse alcohol.…”

“…[13][14][15][16] Denial of alcohol misuse is sometimes assumed to be a characteristic of alcohol dependence. 14 Despite its clinical utility, little research has addressed the prevalence of denial or readiness to change among primary care patients who misuse alcohol. 11,17,18 No study has described readiness to change in a large sample of primary care patients who screened positive for alcohol misuse but were not recruited into a study focused exclusively on alcohol misuse.…”

Número Completo/Full Number

“…Esto es coherente con los resultados de otros estudios donde la negación de un consumo problemático o la no intención de realizar cambios en el patrón de consumo se menciona como una característica propia de aquellas personas a los que se le detecta un consumo problemático o dependencia de alcohol, actuando como barreras para la búsqueda de tratamiento o inicio de cambios (Aira, Kauhanen, Larivaara, & Rautio, 2003;Arborelius & Damström Thakker, 1995;Beich, Gannik, & Malterud, 2002;Grant, 1997;Morse & Flavin, 1992;Wells et al, 2007). En este sentido, la negación es un factor cognitivo en los pacientes con dependencia teniendo un papel defensivo para éstos, tal y como referencian Sawayama et al (2012), pudiendo ser a su vez un indicador de falta de motivación para el cambio (Miller, 1983).…”

Older adult patient--doctor communication regarding alcohol use: A qualitative study

“…Thus far, research has primarily focused on physician factors that influence alcohol communication including attitudes (Arborelius & Thakker, 1995;Sharp & Vacha-Haase, 2010), biases (Sorocco & Ferrell, 2006), and diagnostic difficulties (Sattar, Petty, & Burke, 2003).…”

“…Sharp and Vacha-Haase (2010) found that physicians who held negative perceptions of their alcohol management skills with older adults (i.e., ability to diagnose and treat alcohol use problems) were less likely to screen their older adult patients for alcohol. Many physicians fear that discussing alcohol use with their older adult patients would spoil the relationship (Arborelius & Thakker, 1995). Some physicians have a condemning attitude towards "excessive drinkers," which can be related to previous negative experiences of treating patients, or a stereotyped view of what would constitute an "excessive drinker" (Arborelius & Thakker, 1995, p. 421).…”