Alcoholics remaining anonymous: resident diagnosis of alcoholism in a family practice center.

Family practice residents rarely detect more than one half of the alcoholic patients they see. This study examines detection rates in terms of the patient's presenting complaint, the clinical encounter, and the resident's attitudes. Over four months 218 patients of the family practice center of a large community hospital completed a survey that included the Short Michigan Alcoholism Screening Test (SMAST). Chart audits of each patient's visit assessed each resident's behavior in recording questions about the patient's use of alcohol. After the first four months, each resident completed a survey of his or her experiences and attitudes concerning alcoholism. Using the SMAST scores and chart audits, 25 of the 218 patients were identified as alcoholic. The residents detected only 12 of the 25 alcoholics. Of 51 patients who presented for physical examinations, the residents recorded asking only 28 about their drinking; of 157 patients who presented for more limited visits, the residents recorded asking only six about their drinking. Residents rated the alcoholic patient as less motivated, more dangerous, less hopeful, and much sicker than the average person. First-year residents rated alcoholics much more negatively than did upper-level residents. The SMAST again proved to be much more effective than clinical interviews in detecting alcoholism in patients.