The Referral Process
Mr. Logan comes to the office for his 3-month follow-up appointment. At his last visit, you and he discussed his alcohol intake and the possibility that his poorly controlled blood pressure may be related to his drinking. He agreed to cut down but declined to discuss any formal treatment for his drinking as he felt that he didn’t have “a problem with it.” Today, when you ask if you can revisit his drinking habits, he says that it has been harder than he thought it would be to cut down. You tell him that it is commonly very hard to make such changes and remind him that help with these changes is available and that he might be surprised by the variety of programs and services available. He agrees that hearing more about such services is the next best step to get him toward his personal goal of cutting down and, maybe, quitting drinking altogether. You call your substance abuse counselor to see if she is available to talk with Mr. Logan right now.
Miss Stark comes to your clinic for a new patient appointment following a hospitalization for cellulitis. During the hospitalization, she was noted to have methicillin-sensitive Staphylococcus aureus bacteremia that was thought to be due to a spider bite*. She had a transesophageal echocardiogram to rule out endocarditis and was treated with 2 weeks of antibiotics which she has nearly finished. As you interview her, you bring up the issue of alcohol and drug use. She begins to tear up when she describes her belief that her infection was probably due to her drug use. You inquire further to discover that she has been using hydrocodone orally or nasally off and on for the past couple of years but recently, she has tried injecting it. She is really scared about this, her first, complication of her drug use and wants to quit but doesn’t know how. You congratulate her for her decisions and drive and suggest that she discuss what type of inpatient or outpatient therapy that may be available with your substance use counselor.