Talking to your Doctor (PART II)

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 second of Eric’s two blogs, he explains the deal with drinking and medical records and health insurance, as well as explaining how exactly drinking affects your health. Read the first part, on how to talk to your GP about alcohol here.

What should you do if you’re concerned about talking to your doctor, and what appears on your medical records?

Drinking and medical records

Can my workplace find out about my drinking if it is in my medical records?

Your records and all consultations are confidential. Except in certain circumstances related to public safety, your GP is forbidden by the General Medical Council (GMC) from breaking that confidence without your permission. If you are in a profession where your drinking may put the public in danger, your GP would be obliged to try to persuade you to tell your employer, otherwise, they would be required by the GMC to divulge that information to the appropriate authorities, e.g. a bus driver who drinks while on duty.

In general, your employer would not have access to your medical records without your expressed consent. This would usually occur if there were an occupational health assessment being undertaken. Your employer would commission an occupational health specialist to compile a report after reviewing your medical records and consulting with you. The report to your employer would make recommendations for your workplace based on those enquiries. She need not explain why she was making the recommendations or give general details that are not pertinent to your job. This process is done to protect your confidentiality. Your boss needs to know that you can’t lift a certain amount or need a special computer screen, she does not need to know your diagnosis or your alcohol intake. Of course, if you are an airline pilot or firefighter, your boss does need to know if your doctor feels you have a physiological dependence on alcohol.

If my private health insurance asks for my records, will they find out I have discussed drinking with my GP? Could this affect my premium?

Again your medical records are confidential and will not be shared with your insurance companies without your consent. Usually they are shared when you apply for life insurance or similar products. They will ask for your permission for your GP to prepare a standard report. They also ask you to complete a health questionnaire that includes behaviours that affect your health. You have a right to see the report prior to the GP sending it to the insurance company. The insurance company needs to know details that allow them to make judgments about how risky your policy will be for them and charge a premium appropriately.

Although you may be charged a higher premium if you are a heavy drinker, if you lie on your health questionnaire and the insurance company discovers this, they will not honour the policy and all your “lower premiums” will be forfeited. Many insurance companies will reward you for changing your lifestyle and reducing your risk to them. If you have been charged a higher premium because you are a drinker or a smoker, it would not hurt to discuss with them what discounts they may give you if you cut down or stop drinking or smoking. This is true for private health insurance as well.

Alcohol and your health

How does alcohol actually affect my health? I have heard there are some benefits to drinking?

There is some evidence that regular moderate drinking of wine may contribute to lower cholesterol and subsequently lower risk of heart attacks and stroke. Drinking does allow people to relax and be more social. The problems are when drinking is immoderate and not structured in social contexts. Evidence is arising that the cultures that exist around alcohol have a great influence on the health benefits. Southern European countries tend to drink with meals, and public drunkenness is greatly discouraged. Whereas in northern European countries like the UK, drinking is more separate from meals and more likely to be to excess.

How is drinking bad for my health?

Alcohol leads to poor judgment, accidents and aggressiveness, resulting in large numbers of visits to A&E and intervention by the police. But alcohol can also have more subtle effects on the body over time.

Alcohol is in the class of drugs known as depressants. These drugs lower the activity of the body, lower the blood pressure and sedate the brain. In order to prevent you from passing out when you drink, your body releases adrenaline to wake you up and support your blood pressure. This emergency response causes your fat tissue to release fatty acids into the bloodstream as food for your muscles and brain to keep them alive. Your body’s response to the alcohol tends to be an over-response; it releases too much adrenaline and too much fat. Your liver needs to process that excess fat to send it back to your fat tissue, and your liver becomes engorged with fat.

Over time, if you are a regular drinker your body will habitually overproduce adrenaline to support your blood pressure, leading to high blood pressure, your liver will become inflamed from chronically being engorged with fatty acids, and your mood will likely be lower. Your memory may also be affected. In addition, as a carbohydrate, alcohol is fattening and you are likely to gain weight. You may become malnourished as well because you need certain vitamins to process the alcohol in your liver. These changes are slow and insidious, most heavy drinkers attribute then to causes such as getting older, or low levels of physical activity. Given that most drinkers’ friends are also drinkers and they age together, most don’t recognize that the heavy drinking is the cause of the changes in their bodies.

As a GP, I meet people of the same age who appear to be of vastly different ages. Some of these differences can be attributed to genetics, but it is the behaviours of the individuals in question that really contribute to their health. Smoking is the number one cause of poor health but alcohol intake is a close second.