References to alcohol consumption and alcoholism in medical records of a general hospital of Porto Alegre, Brazil--a comparison between samples with a 20 year gap.

Two samples of inpatients (493 and 158 subjects, respectively) of a large teaching hospital, collected using the same methodology and with a 20-year time frame, were analyzed aiming at finding information about alcohol consumption, abuse or dependence in the subjects' medical charts. Items reviewed were: the list of medical problems; hospital intake form; daily nursing review; medical anamnesis; pre-surgery records, and discharge forms. Only 54% and 50% of each sample, respectively, had some type of reference to alcohol consumption; when references were present, they were in most part incomplete, possibly reflecting distortions in the process of gathering information about alcohol consumption that involves the client and the health professionals. The authors discuss potential reasons for this, suggesting that lack of training of medical personnel in the identification of alcoholism, as well as prejudice towards its recovery, may be some of the underlying causes.