Alcoholism: Heartsink or microcosm?
By Dr Jonathan Shapiro, Associate of Health Services Management Centre, University of Birmingham
"Few GPs get excited by seeing known alcoholics walk into their surgery; they are the classic ‘heartsink’ patients, with a host of problems, often insoluble. They range from the physical (you really do destroy your body with long term drinking), through the underlying psychology (there are often personality disorders and depression), to the day to day consequences, such as social isolation, unemployment, and homelessness.
Dealing with all these issues is difficult, as it entails the interaction of many different people, each with their own rules, cultures, and bureaucracies: alcoholism is perceived in very different ways by say, policemen, social workers, and nurses. Moreover, the patients themselves are often unwilling or unable to take control of their own destinies, and this makes the oversight and management of alcoholism all the more difficult...."
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