The Rational Clinical Examination
David L. Simel, Drummond Rennie
James M. Kitchens
alcohol abuse, alcohol dependence
"A 58-year-old man was admitted to the hospital for an elective
cholecystectomy. At the time of admission, he smelled of alcohol,
although he was not obviously intoxicated. On questioning, he said that
he had come from a business lunch where he had "a drink." When
questioned about his alcohol history, he became angry and defensive.
He said that he was "offended by the implications of these questions." On
the day after the surgery, he was found to be diaphoretic, tremulous,
and hallucinating and was judged to be in alcohol withdrawal. Could
other interviewing techniques have identified this man as one who
was alcohol dependent and at risk of withdrawal? ..."
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