Docs Miss Alcohol Abuse -- Almost Always
That problem would be at least partly relieved by the passage of so-called parity legislation that would require insurance companies to cover addictions like other diseases, says the report. However, since most doctors are involved in cost-cutting managed care plans, there still may not be enough time to figure out that a patient is suffering from a substance abuse issue.
"Particularly, if they [primary care doctors] haven't been taught that there are places to refer, that there are treatments that do work ... if it seems to them as if this is a hopeless thing anyway, why bring it up?" asks June Osborn, MD, president of the Josiah Macy Jr., Foundation, which funded the study.
The study could just as easily have come to the same conclusion about all physicians, not just those in primary care, according to Sam Cullison, MD, a Seattle family physician who's also a specialist in addiction medicine. He agrees that more training in addiction and substance abuse is desirable, but he tells WebMD the study's recommendation that doctors be held liable for missing such a diagnosis a "crazy" attempt at punishing physicians.
Cullison, a clinical associate professor of family medicine in a residency program affiliated with the University of Washington School of Medicine, says that if a patient came in for a sore throat, Cullison wouldn't necessarily ask questions about alcohol or drugs unless there were obvious signs -- such as alcohol on one's breath or a deviated septum from cocaine use. However, substance abuse and addiction questions would come up in detail on an annual physical.