Sir: Kareem & Ashby (Psychiatric Bulletin, March 2000, 24, 109-110) moot the possibility of a definite Mental State Examination (MSE) format in order to decrease the chances of important items being unexamined or unrecorded. This seems reasonable, but there may be difficulties as our experience auditing alcohol history-taking in the elderly shows.

We audited the alcohol histories recorded for all the elderly patients in Fair Mile Hospital. We found 147 new assessments. Of these, 81 (55%) failed to record an alcohol history, 37 (25%) recorded a qualitative history and only 29 (20%) recorded the number of units drunk. Where a history proforma was used the alcohol histories were better. We developed a pro forma for the history and MSE, which included a reminder to record units of alcohol. Having piloted the pro forma, it was introduced for general use and, following educational sessions devoted to alcohol problems in the elderly, notes were re-audited six months later.

In the second audit, when the pro forma was used, only 11% failed to record an alcohol history, whereas 33% recorded qualitative and 55% quantitative histories. This was a statistically significant improvement (P<0.02; χ² test with Yates's correction, d.f.=1). But the pro forma was used in only nine out of 74 new assessments! Overall the alcohol history-taking had not improved (P<0.5; χ² test, d.f.=2).

Part of the problem was simply logistical: the pro forma was not readily available. But there was also a reluctance to use it. There was a concern that it made history-taking and the MSE less natural. Of course, such a pro forma does not have to be slavishly completed at the time of the history and MSE. Nevertheless, there are important issues involved in the use of such a pro forma which are worthy of further consideration.