Gathering Collateral Information

Many patients may be reluctant to acknowledge their excessive alcohol use and its consequences because of the stigma attached to such behaviour. Collateral interviews can, therefore, play a central role where the patient does not self-report their problem with alcohol. Collateral information is particularly needed where a discrepancy appears likely; for example, a patient may say he has reduced his drinking but his liver tests remain elevated. The patient’s spouse or other close family members are often aware of drinking and may be more aware of alcohol-related problems than the patient. Work colleagues may provide evidence of impairment or intoxication while on duty. Reports from other clinicians or hospital records may also be revealing. 

Significant barriers limit access to collateral reports. Privacy legislation limits the distribution of personal information without consent. It may also be unethical to pursue such enquiries without patient consent. Even if legally, ethically and clinically appropriate, the patient may object to such enquiries. In such cases, the therapeutic relationship may be disrupted.  

Many people freely acknowledge their use of alcohol and its consequences; in which case, there may be little to be gained from interviewing others. Indeed, unnecessary collateral interviews in this setting can undermine an evolving therapeutic relationship. 

Collateral information may also include information recorded elsewhere, for example in the referral letter, discharge summary or in notes from earlier presentations to the general practice or hospital. Such sources are often a valuable source of diagnostic information.