The alcoholic who goes to his general practitioner and asks specifically for treatment can pose his doctor with a demand which neither his medical-school training nor his professional experience has equipped him to meet. The doctor’s response, therefore, may be to indicate that this is not a matter for him, or he may selectively attend to the physical aspects of the disorder, or he may refer the patient to a specialist. Many patients report that their general practitioners do not seem to have taken their alcoholism seriously.
If the general practitioner also attends the wife, the patient may feel, sometimes correctly, that the doctor is more concerned with her point of view than his own. The patient will be dismayed if the doctor seems to hold him responsible for the wife’s unhappiness, especially if his strictures are accompanied by ineffectual advice to give it up. ‘Just do your best ’, a general practitioner had urged an alcoholic we heard speak at an AA meeting. When they refer patients to specialist care few practitioners seem to do so with an air of confidence in the outcome, thereby conveying to the patient that he was right to come to the doctor and is now being sent to get the treatment that will help him recover. The alcoholic is more likely to get the impression that the doctor is passing him on and is not prepared to maintain a continuing interest.
If the general practitioner does not appreciate the problem of alcoholism this is because of lack of knowledge about the nature and treatment of the disorder. The subject is likely to have been ignored in his medical-student training unless he qualified fairly recently, and opportunities for postgraduate instruction are meagre. Not all teachers are persuaded that the subject merits emphasis; some are opposed to any teaching about alcoholism being given in a general-practitioner postgraduate psychiatry course. Yet a joint committee of the Medical Association and the Magistrates’ Association1 stressed that the problem in Britain was ‘of the size to merit urgent attention’. They stated clearly that few doctors have a training which enables them to manage a case of alcoholism and pointed out that neither general nor psychiatric hospitals do much to meet the special needs of the alcoholic. The committee urged more training for doctors in the recognition and treatment of alcoholism.
In the meantime, until there is wider professional understanding about alcoholism, the alcoholic needs to ascertain for himself whether his family doctor will approach his problem with understanding and sympathy.
We consider that, ideally, general practitioners should possess sufficient knowledge of the illness of alcoholism to understand that patients cannot recover by their own efforts. Therefore they should know what treatment facilities are available in their own area and if necessary be prepared to press for better ones. They should take an active part in the after-care of patients who have received specialist treatment. What they know about the patient and his family could be of the greatest value. Above all, the single contribution which they could most easily make to the problem of alcoholism is to respond to all the vicissitudes of an alcoholic’s illness with the same calm professional concern that they show towards other illnesses.