MBChB Curriculum Map

Liz King, a 72 year-old widow, is brought to A&E at lunchtime after hurting her hip following a fall. On examination, John Gould, the on-call Medicine specialist registrar to whom she is referred by the A&E senior house officer, finds Mrs King smelling of alcohol. Dr Gould can find no evidence of serious injury. Despite the large amount of bruising Liz says her hip doesn’t hurt, she just wants to go to the toilet again. When questioned about her alcohol consumption, Liz is evasive and becomes mildly abusive and aggressive.

Liz lives alone. Dr Gould and the medical team wish to admit her to hospital for observation, but she refuses. She did however agree to have an ultrasound, that was reported as showing an echo bright liver suggestive of difuse fatty change. Liz then goes home with some arrangements made for follow-up.

One morning, in the following week, Anne Finnigan, a social worker, visits Mrs King at home. Liz is sitting watching television in her dressing-gown. Discussing how she is coping after her fall, Ms Finnigan also notices the smell of alcohol on Mrs King’s breath. Ms Finnigan contacts Mrs King’s GP, Dr Ken Wall, and raises the issue of a drink problem.

Dr Wall realises that he has not seen Mrs King since her husband, Fred, died. He reviews her case with his colleagues in the practice. He learns from his partners, and the GP registrar, that Mrs King’s son William recently lost his job after being prosecuted for drink driving. William King was referred by the practice to the same alcohol treatment centre attended by Dr Wall’s senior partner, Dr Stoke, when he had his ‘liver problem’. The practice team is proud of its professional approach to these problems. All are now well aware of the DVLA guidelines for doctors with patients with alcohol problems. The team discusses the wider issues of trying to work out normal versus abnormal alcohol use, the rising alcohol consumption in the young, women especially, and the mixed messages they get, particularly from the media about the role of alcohol. “The licensing laws are supposed to protect the young”, Dr Wall observes. “Alcohol costs society a lot more than the Government takes in tax and duty…we could do with knowing the cost-effectiveness of some of these government policies”. He recalls reading a correlation study about average alcohol consumption versus cost to industry in days off work.

At home, Liz King sits down to watch people passing by her window, but quickly puts the bottle of sherry away when she sees Ms Finnigan arriving again.