Health Secretary Otis Bowen said this week physicians should not overlook the drinking problems of patients or try to protect families by under-reporting alcohol abuse as contributing causes of death.

Bowen said doctors play a key role in combating alcohol abuse and alcoholism problems because "it's usually a primary care provider who makes the initial diagnosis for all of a patient's health problems."The health secretary testified at the first of four hearings on alcohol abuse and alcoholism by the Senate Governmental Affairs Committee.

"We hear of underreporting by physicians of alcoholism and alcohol abuse as contributing causes of death," said Bowen. "There are many reasons for this, but it in great part stems from a concern for the feelings for the family left behind.

"I was and still am troubled when I hear reports of the tendency on the part of some of my colleagues in the medical community to overlook a patient's alcohol problem when seeing the patient for other reasons, some of which are probably related," he said.

"I think members of the medical community have a unique opportunity to educate their patients about alcohol abuse," he added.

Thomas Burke, chief of staff at the Department of Health and Human Services, said alcohol-related problems were estimated in 1983 to cost the nation about $117 billion a year for everything from health care to unemployment. The annual costs are expected to grow to $136 billion by 1990 and $150 billion by 1995, he said.

By contrast, Burke said the estimated cost of illicit drug use and abuse in 1983 was $60 billion.

Other societal costs, Bowen said, include an estimated one to three cases of Fetal Alcohol Syndrome for every 1,000 live births and about 4.6 million teenagers in America with serious alcohol problems each year.

Bowen added, "I've seen studies that indicate that for nearly half of all teen pregnancies one or both of the teenagers involved had been drinking alcohol at the time of conception."

However, Bowen said a 1982 study found that 70 of 271 problem drinkers had been seeing a physician for various illnesses when the drinking problem was first noticed. Only 45 percent of those seen, however, were asked by their doctor about the drinking, and only one-fourth were either encouraged to cut back or warned about the health hazards of drinking.

Only 3 percent of heavy drinkers were referred to treatment by the doctor.