We had a workshop this afternoon about dealing with alcoholism-- identifying patients who may be alcoholics, guiding them toward treatment, etc. A recovering alcoholic spoke to the group, told us the lies he would tell his doctor, told us some signs to watch out for...
It's interesting to think about where the line is between what a doctor is expected to do and what he isn't, and a lot of it depends on the context. During my inpatient rotations, I've seen a lot of alcoholics come into the hospital, with all sorts of problems-- and never once did I see anyone talk to them about treatment. We treated the immediate medical issue, released the patient, and, as often as not, I'd see the same patient back again, after another drunken fall or other consequence of the alcohol. In the inpatient setting, the focus is on fixing and releasing.
But in the outpatient clinic, we do talk about treatment, we talk about addiction, and therapy, and I've heard people mention AA. The difference, I think, speaks a little bit to why I'm drawn to outpatient care more than inpatient. I don't just want to deal with the acute problems, I want to help the patients have better lives. I want to fix the big picture as much as the small. Not that the things they're coming to the ER with are small. But I don't know how to better articulate the difference.
Also, I think one of my friends is an alcoholic.