The Family Physician.

Alcohol-related disorders are among the most common medical disorders family physicians encounter in their practices (Brown 1992). Family physicians have developed many of the skills practiced by internists, obstetricians, psychiatrists, pediatricians, and geriatricians and possess a breadth of expertise that gives them special abilities to detect and treat the alcohol and other drug problems they see in their practices. In addition, because these physicians often work with entire families, they are in a unique position to observe relationships among the family members and the effect that one person's alcoholism has on the family. The following case illustrates some of these opportunities. A family of four, after relocating in south central Wisconsin, chose a family physician as their primary care physician from a list of physicians provided by their health maintenance organization. The first family member to seek medical attention from the family physician was the 8-year-old boy, Paul, who had chronic headaches. A neurological examination was completed and revealed no structural lesion or other medical problems. His headaches continued, despite reassurances by the physician that there was no apparent medical reason for them. The second family member to seek medical attention was Paul's older sister, Mary. who was 16 years old and pregnant. During a prenatal examination that the family physician conducted, Mary revealed a history of sexual abuse as a child. The physician also noted that Mary was depressed and suicidal. The third family member to seek medical attention was Mary and Paul's mother, Margaret, who wanted something for her nerves. She was having difficulty sleeping. On further questioning, Margaret admitted to daily alcohol use and a family history of alcoholism. The last family member to seek medical attention from the family physician was Mary and Paul's father, John. He wanted a refill of his "stomach medication" that he had received from his previous physician. During the routine examination, the family physician also noted that John had hypertension and a history of alcohol withdrawal. Each of the family members was affected in some way by the alcohol abuse in the family. The family physician first became suspicious that the parents could have a problem with alcohol during the daughter's prenatal visit. Her suspicion was confirmed with the appearance of the mother. If the family practitioner had seen only one family member, as often occurs in a specialist's office, she would have been less likely to identify the primary issue affecting this family. It is easy to focus on an individual with a medical problem such as headaches, adolescent pregnancy, sleeping problems, or chronic abdominal pain and to overlook the relationship between these problems and an alcohol problem in the family. A further strength inherent in the role of the family physician is the opportunity to develop a trusting, supportive relationship with all the family members. Caring for patients over a long period of time allows family physicians more occasions to discuss sensitive issues and increases the likelihood of their being able to help patients change behaviors such as destructive alcohol use. Family physicians receive extensive training in public health issues of medical care during their residency training programs, which is essential for the primary and secondary prevention of alcohol problems. Primary prevention involves averting problems; secondary prevention involves early intervention before problems become unmanageable. The public health issues taught o family physicians are applied across diseases and include clinical experiences in community settings, screening asymptomatic individuals, and using brief and simple intervention techniques. The methods family physicians learn minimize the use of costly high-tech diagnostic and treatment methods, which helps to reduce overall health care costs while providing patients with earlier, more appropriate, and less invasive care options. …