Clinical reasoning, clinical trials and risky drinkers in everyday primary care: A qualitative study of British general practitioners

Abstract

Alcohol and other substance misuse problems have historically been seen as refractory in primary care, but in the past 20 years Brief Interventions have come to be seen as an important and effective response to a range of problems around ‘risky drinking’. Proponents of brief interventions have argued that these interventions are best accomplished in the community, but that primary health care professionals resist using them. This qualitative study investigated responses to alcohol problems in a maximum variation sample of 28 primary care professionals in and around a northern English city. We found clinicians negotiating alcohol problems using interactional techniques that integrated elements of brief interventions, and which fitted these to the interactional and temporal order of clinical encounters and physician–patient relationships in primary care. Central to these accounts was the problem of finding an interactional solution that drew together notions of what was both ethically and practically possible in any given encounter.