Physicians Are Talking About…

Do Patients Deserve to Know if You Drink?

Brandon Cohen

Disclosures

April 02, 2018

In a recent article on Medscape, Dr Harpreet S. Bajaj wrestled with a two-part question:

  • What to do when patients cite studies that suggest alcohol consumption may have positive effects; and

  • How to respond to patients' queries into their doctor's drinking habits.

Bajaj felt comfortable both owning up to his own moderate drinking but still advising teetotaling patients to remain dry. This led to animated discussion in the comments on both the questions and Bajaj's responses.

Many respondents had a strong reaction to the question of disclosing personal information. Most saw it as unnecessary or counterproductive.

One gastroenterologist was adamant: "I do not reveal my alcohol consumption, as I do not reveal my DNA profile, my medical history, my age, my IQ, my legal history, my sexual history, my political views, or whether I ever smoked cigarettes."

A primary care physician was also against sharing:

Regardless of approach, I believe there is little benefit in confessing to patients... Advising positive lifestyle changes does not warrant crossing the professional line... Our beliefs and practices should not be a factor in our professional ethics and demeanor.

An ob/gyn agreed: "I am in a professional relationship with a patient, so what could possibly justify their asking or me answering questions about my personal life?"

An emergency department physician also advised colleagues that revealing personal information might have unintended repercussions: "In this litigious society, saying anything personal to any patient could come back around and bite you."

A surgeon was a little taken aback at the idea of disclosing personal habits to patients: "The patient comes to the physician for advisement and treatment, not vice versa. As long as we show up for work sober and competent, our personal lives are none of their business."

But an emergency department physician saw a little wiggle room: "If they are a patient I have known a long time, then perhaps I'd say I have an occasional glass of red with pasta—which is all truth."

When it came to advising patients on alcohol consumption, there was a broader range of responses and recommendations. An internist agreed largely with the advice of Bajaj:

When asked [whether a patient should begin drinking], I advise patients to remain teetotaler if they already are. If I am unable to convince my patients who drink heavily to quit, I recommend switching to moderate quantity of red wine because of antioxidants.

A psychiatrist believed in playing it safe: "Overall, with the current rate of morbidity and mortality from alcohol, I believe that we should always err on the side of caution."

A pathologist advocated caution and the need to look at many facets of the question: "In considering advice to use alcohol, I would suggest thinking about whether the patient is among those with a genetic predilection to alcoholism or other addiction."

An ophthalmologist, however, saw much physician-led discussion of drinking as futile:

There is very little likelihood that office advice alone about alcohol risks and benefits will have any impact on the behavior of a full-blown alcoholic. An alcohol abuser might process the pros and cons, but human nature being what it is, will most likely justify current patterns by emphasizing any evidence of benefits.

But a psychiatrist felt that it was important to discuss all the potential problems:

One additional risk, obvious but needing to be discussed, is alcohol use disorder. The social ramifications of alcohol use can be worse than the medical comorbidities: disinhibition, marital discord, spousal abuse, child abuse, job/career loss, alcohol access in the home for children/teens, serious injuries, traffic fatalities and suicide, to name a few.

A psychiatrist practicing in Spain felt that the answers to these questions depended in part on the customs of a nation: "[Alcohol use] forms part of our Latin culture. Understanding the role of culture and society in an abuse or dependent disorder is crucial to understand the relationship that this particular individual has with alcohol."

An ob/gyn sought to avoid the issue: "If this specialty does not include expertise in the areas in question—nutrition, and alcohol consumption and its benefits/consequences—what qualifies me to give any advice?"

But another healthcare professional challenged this attitude:

I wonder how many of your patients are using you as their primary care provider. This is common, particularly for women of childbearing age... At minimum, you should have some familiarity with the topic, some idea how to begin the conversation, some ability to gracefully refer a patient to an appropriate provider.

And an emergency department physician blamed society for at least some of the abuse: "All we have on TV is drinking, drinking, drinking, and in many medical shows all they do after work—drink! It has been ingrained into the population as a regular thing."

The final word goes to a wry internist who had a unique response to patients' questions about his personal use of alcohol: "I would tell them I have to go home and have a drink and think about whether to disclose that information."

The full discussion of this topic is available at Advising Under the Influence: Alcohol Guidance Demands Full Disclosure .

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