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Thu Aug 17 15:57:02 BST 2006

Tim,
I know exactly what you are talking about - our hospital had the same
social worker to ward ration for the longest time, and they actually
thought that was too many social workers.  it just took a whole lot of
pressure on a whole lot of levels to move the rock.....
As to the issue of violating the rights of the entitled (you know - "I
am entitled to do what ever I want whenever I want to do it - regardless
of who I hurt, maim or kill in the process"), we here in the States have
the ACLU.  
As my Daddy once said, tongue in cheek,  "It just don't get no better
than that, do it!"

Be well,
Ron

>>> "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za> 8/17/2006
10:42 AM >>>
Ron

At least you have ready access to social workers - in the South African
scenario we are lucky if we have once dedicated SW for entire unit which
sees in excess of 20K trauma cases per year. For us also the government
would close the hospital if we screened for ETOH on every patient as
this would use up the entire lab budget, not to mention be in breach of
the "rights" of the citizen to privacy and lifestyle choice (no matter
who else is injured because of it, mind you!!!!)

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
Program Manager: Emergency Medicine (SU)
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Department of Surgery Room 4064
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za 
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Ronald Gross
Sent: Thursday, August 17, 2006 4:26 PM
To: trauma-list at trauma.org 
Subject: Re: Alcohol Screening

I don't think anyone is going to argue with you on anything but the
presumptuous part.  True, the information we gather is important as it
will assist us in managing a patient and help clarify the reason(s)
behind altered states of consciousness.  True, too, that we are not
enforcers, and that the results of drug and alcohol screening/testing
must remain a part of the medical record and not the purview of the
law
UNTIL subpoenaed.  And true again that the primary diagnosis might
just
be EtOH intoxication, with MCC or MVC as the second in the list, for
without the EtOH it could be argued that the crash just might have
never
occurred to begin with!  

However, the longer we say that we cannot successfully intervene or
have any effect on the lives of "those already befallen", the longer
those lives will remain wasted, and the longer we will allow those
wasted lives to waste and destroy the lives of the innocent people who
happen to be in the wrong place at the wrong time - right in the path
of
the befallen bent on continuing his/her wasted ways 'cause no one gave
a
damn enough to make the effort to redirect!  And lastly, true yet
again
that success here will require "significant social resources" that we,
as clinicians are obliged to find and engage.

OK, I will put away my soap box and go back to work.  Heavy
sigh.......

Ron

>>> <bensonblues at comcast.net> 8/17/2006 10:06 AM >>>
I feel that screening trauma victims for alcohol and drugs of abuse is
medically necessary to give the provider information necessary for
optimum care. Drugs and alcohol can complicate diagnosis and
management.
However, it is rather presumptuous to believe that the
emergency/trauma
team can 'intervene' with any real degree of success. Although
sentinel
events in the life of addicts/alcoholics are opportunities for
intervention, success in this area usually requires significant social
resources that are lacking in the lives of many people (family
support,
etc). Further, physicians must avoid becoming involved in the role of
enforcement, lest we loose the trust of our patients. Patient
information about drug/alcohol use acquired by physicians to assist in
providing medical care should remain part of the medical record, and
should not be available to insurance companies and law enforcement to
further destroy the lives of those already befallen. State laws which
provide for the a
 cquisi
tion of evidence when officials are investigating a crime have been in
place for years, and have been successful. DB
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