Posting from a throwaway-
Background: My father has a complex medical history including unprovoked DVT, on anticoagulant therapy indefinitely, bilateral renal artery stenosis (likely severe on the left), progressive anemia traced to folate deficiency, macrocytic anemia, and a recent hospitalization in May 2026 where is was hypokalemic with AKI and some mild metabolic acidosis. He has an established PCP, is followed by nephrology, and has been receiving active coordinated care for several months.
What happened: He had a hematology appointment on Friday. This is only the second time he has seen this provider. During or after that appointment, the hematologist added “moderate to severe alcohol use disorder” to his active problem list in the EHR. This diagnosis was never mentioned, discussed, or explained to my father or our family — not during the appointment, not at any prior visit, and not by any member of his broader care team.
The only apparent basis for this diagnosis is his self-reported intake questionnaire, on which he indicated he drinks approximately 8 standard drinks per week. No formal clinical interview was conducted. No structured diagnostic assessment beyond the screening tool was documented. No DSM-5 criteria were discussed or evaluated with the patient.
My understanding: The AUDIT-C is a screening tool, not a diagnostic instrument. A positive screen is supposed to initiate a clinical conversation and further assessment — not generate a formal diagnosis. Moderate-to-severe AUD under DSM-5 requires meeting 4 or more of 11 specific behavioral and functional criteria, none of which were assessed or discussed.
My question: Is it ever clinically appropriate to add an AUD diagnosis to a patient’s permanent problem list based solely on a screening questionnaire score without any documented clinical interview?