Talking to your Doctor (PART I)

Dr Eric Britton is an NHS GP currently working in Student Health in London. He has had a 25 year career in medicine working as a GP partner, trainer and educator. He also has degrees in public health and education with certifications in alcohol and drug treatment and diabetes care. He is a supporter of Club Soda and sometime medical advisor when needed. In this first of two blogs, he talks us through how to go about approaching your GP, talking to your doctor about alcohol, and how they’re human and non-judgemental.

Talking to your doctor about alcohol

Many patients have difficulty being honest about behaviours that they think their doctor would consider bad for them. This includes drinking, smoking, other drugs, as well as poor diet and food choices.

Aside from smoking, most “bad behaviours” can at times have some beneficial benefits – if done in moderation. That piece of birthday cake isn’t necessarily bad for you… but if you eat the whole cake, well that’s a different story! There is some evidence that drinking in moderation may have beneficial effects on a population level. However, persistent alcohol intake for an individual may be problematic and affect their health even at low daily amounts.

Your GP can’t help you with your drinking if you don’t share the information with them. GP’s have a lot of tools to quantify how much you are drinking and if you are at risk of your drinking impacting on your health. GP’s are there to help you, not judge you, so it is important to answer questions honestly and as exactly as possible. If you feel that you may have a problem with drinking alcohol or using any other drug (including caffeine) it doesn’t hurt to ask.

GP’s are human too; their job is to help you figure out how to make your life better by giving you information about the possible consequences of your behaviours. If you don’t share with them honestly they won’t be able to figure out the answers with you.

Be honest about your drinking

There are medical reasons for being honest about your drinking with your GP.

Honesty is the best policy

Even if you don’t feel you have a problem with drinking, it is important to share your use of drugs with your doctor openly and honestly. This includes alcohol use as well as other recreational drugs, anabolic steroids, herbal supplements and over the counter medications. This is because these drugs can affect the treatments your GP suggests. Moreover, some conditions are specifically linked to certain behaviours and if the GP does not know that you are a regular drinker, or using steroids, or eating a dozen doughnuts a day, the medications they are prescribing may be useless or even worse there may lead to adverse effects.

Should I discuss my drinking if I am talking about a different health condition?

Some antibiotics will make you physically sick if you take them with alcohol in your system. If you have a seizure disorder (epilepsy) your fits may occur more often or your medication may not work as well if you are drinking. Some conditions, such as high blood pressure or depression are worsened by regular drinking. Additionally, if you stop drinking suddenly before you see the doctor your blood pressure may be higher than normal. Your GP may try to treat high blood pressure causing your blood pressure to fall too low.

Of course, these are extreme cases but they illustrate why it is important to be honest. GP’s are busy and they don’t always ask about your health habits. If you think it is relevant you should always ask.

Getting help

What will happen if I raise my drinking with my doctor?

They are likely to first try to quantify how much you drink and in what circumstances. They may use a questionnaire such as the AUDIT or FAST to get an idea of how much and how often you drink. They will explore with you how much of a problem you feel it is and the reasons why. Depending on the answers, they may give simple advice or refer you to the local alcohol advice service. If they have experience themselves with learning to control drink (GPs have a higher rate of alcohol abuse than the general population) they may share their own perspective and tools that they used.

If they feel your drinking may compromise your physical health, they may suggest a few tests as well. Whatever they suggest will be just that — a suggestion. You will have to be willing to engage with their suggestions and follow through on the plan the doctor and you agree.

I am embarrassed and my doctor would judge me so I lie

Doctors are human beings and they do have opinions but you will be surprised how good they are at not being judgmental when it comes to drinking. First of all, they are trained to leave their own opinions at the door and focus on your concerns. GP’s have your best interest at heart and they will work with you if you want help. Of course, all GP’s have bad days or personalities don’t match. If you are not satisfied with the interaction you have with your GP you can and should see another. However, if you are getting the same answers from different GP’s you may need to look at who is the constant in the interaction and take the advice on board. It is important to find a doctor you can trust and be truthful about all your health care concerns; this includes alcohol.

How do I raise the subject if I am worried about my drinking?

If a patient wants to discuss something embarrassing or difficult they usually start a consultation with something else that is minor to gauge if it is “safe” to discuss the more difficult topic. However, it is important to be clear about what is worrying you as doctors only have a limited amount of time per patient. The best way to raise the subject is to be open and honest about your concerns at the start of the consultation. It would be best if you booked the appointment specifically to discuss the problem so that you have to address it. If you do this, your doctor will be able to afford you the time and understanding this difficult discussion deserves.

If I discuss my drinking, will my doctor think I am an alcoholic?

“Alcoholic” is a word that is loaded with meaning and doctors have stopped using it as a clinical term. Your GP will be concerned about how alcohol is affecting your health and relationships, and will want to help you to either control or stop drinking depending on the circumstances and your own goals.

I don’t want to go to AA, what should I do?

AA is a good institution that works well for some people. They use the term “alcoholic” to describe themselves and OWN the term. But there are other organizations that are helpful to those who want to control or stop their drinking. Every area has an alcohol advisory service that provides counseling to people who want help controlling or stopping drinking. Your GP may refer you to one of those services in your area. There are also self-help communities, such as Club Soda, that are alternatives to AA if you don’t feel it is the right organisation for you.

I have heard there is a drug to help me reduce my drinking. How do I ask for it?

There are a few medications that are used by GP’s to help patients to stop drinking. They have interactions with other medications and cannot be used by people with certain conditions. Although they can be useful to help people remain abstinent from drinking, they still require the patient to make a commitment to stop drinking.

The second part of Eric’s blog looks at medical records and health insurance, as well as explaining how exactly drinking affects your health.