Substance abuse in the elderly
I was pleased to see the inclusion of alcohol abuse as a cause of potentially reversible cognitive defects in elderly patients. ("Alzheimer's or age? Some tips to make the right diagnosis," September ACP Observer, page 1.)
I would stress, however, that physicians have problems dealing with these patients because they do not ask the right questions—or ask any questions at all—about alcohol and other substance use, including benzodiazepines, which also have important effects on cognition in elderly patients. Too many physicians also fail to obtain information from collateral sources or refer to physicians with experience in treating older substance abusing patients.
I was also distressed by the use of the term "get them off the sauce" by one of the physicians. I doubt that any disrespect was intended, but the use of unprofessional language when dealing with chemically dependent patients represents one of our attitudinal blocks in trying to help them. Pejorative and loaded terms neither help communication nor development of a therapeutic alliance.
There is no area in medicine, in my opinion, where there are more patients with a problem and fewer health care workers with adequate knowledge to treat them. Our negative attitudes towards those with chemical dependency contribute to the lack of focus on addiction in training programs, CME courses and other educational venues.
Alan A. Wartenberg, FACP
The "Practice Rx" column from the September ACP Observer ("The new ICD-9 codes that every internist should know," page 4) should have been entitled "55 more useless codes to make our lives more miserable." Not a single one of these codes will enhance the care I provide to patients, and none will increase my reimbursement for the services I provide—or the extra time it takes to look up the new code.
These codes do force me, at my expense, to buy new coding books for the physicians and staff in my office, and to reprint my superbills with these new codes. They will also certainly increase rejections, as insurers follow their own timeline in adopting new codes.
The International Classification of Diseases is clearly a system run amok that serves no purpose but to make the AMA money from licensing fees.
Ronald Hirsch, FACP
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