How much is medically acceptable?

[mattd2]

Yes, as I mentioned a few posts up.



It's really hard to know what to think of the "gasp" or "hmmmm" bit. Even the op doesn't seem to remember exactly what it was, and a "hmmmm" is not necessarily judgmental... it could simply be her thinking of whether or not to do a follow up test. And I seriously doubt she was gasping out of shock that someone drinks about a beer a day. We weren't there, so none of us know the possible nuances of what happened. Only the op does, but even that is open to misinterpreting.

The fact that this whole thing rests on a particular interpretation of a very brief vocalization says it all, IMO. She really did everything she should have. Can it get a patient on the defensive? Absolutely. But a wounded ego is nothing compared to what can happen if she errs on the side of making sure she doesn't ruffle anybody's feathers.

But what happens if the wounded ego or ruffled feathers in turn causes someone to lie about an even more critical item on the checklist - do you use drugs? "oh crap I'm a freaking junky but if I don't want to tell her that, I don't even want to tell her that I use occasionally soooo... No maim, I'm a clean as a whistle "
The person taking the phone interview should be practice enough that they can make that call to follow up on a answer without having to umm and arrr about it. Instinct should kick in - ...6-8 beers a week => "are they all in one sitting? / do you drink more than xx a night? / etc." => all in one sitting => "Do you feel like you are dependent on alcohol or that you could not stop drinking if required?"
As little emotion as possible should be "shown" by the interviewer otherwise it is human nature to feel judged and start calmming up.

 

[bottlebomber]

If you have a serious medical condition that you are concealing for whatever reason, in my mind that should constitute a clear release of liability for anyone that has to treat you without knowledge of this condition. Most addicts are ashamed of their habits, that's nothing new.

 

[huhwha]

Not to muddy the water, but your two beers a night could be 4% BMC beers, or 12% imperial whatevers. Does it matter? Logic tells me yes, but I'm not a medical professional.

 

[907_fellow]

So is 2-6 twelve ouncers a night (depending on the amount of **** I had to put up with during the day) to much for a 26 year old? I am pretty physically active taking advantage of Alaskas resources and I make it to work every day at 7. Don't feel like it's a problem...

 

[mattd2]

So is 2-6 twelve ouncers a night (depending on the amount of **** I had to put up with during the day) to much for a 26 year old? I am pretty physically active taking advantage of Alaskas resources and I make it to work every day at 7. Don't feel like it's a problem...

Can you stop on any given day, any given time. If yes you are not an alcoholic. Or do you depend on those beers to calm you down?
This is not the medical definition but I see alcoholism as the dependence on alcohol such that you either cannot stop drinking if required or cannot fuction if made to stop.
Drinking 6 beers a night, every night would not be good for your body though even if you can stop when you feel like.

 

[JonM]

6 a week is a lot? I think we use a different measuring stick where I live.

 

[kroach01]

I think I need to clear up my stance on this. I have no issue with the questions, further questions with regards to previuos answers and in general the person trying to get as much information as possible with the means they have (phone, person to person).
My issue with the OPs experience is with her reaction to his answer that he drinks 6-8 beers a week - the gasp or "hmmmmm". A reaction like this is likely to get anyone at least a little defensive and is totally unproductive in this sort of situation where you want the person to be as open as possible.

Well the interview was on the phone. Aside form the fact that observing and diagnosing a patient over the phone is a terrible way to do medicine, it's really hard to gauge the reaction of the doctor by voice only. It could just have been interpreted as an offensive disbelief reaction by the OP but in reality the nurse jumped into the room to tell him a crazy drug seeker was back in his/her clinic.
Ultimately bad and judgemental doctors do exist. But you're free to pick whoever you want. If you don't like how your doctor treats you, get another one.

 

[Bedlam]

6 a week is a lot? I think we use a different measuring stick where I live.

That's part of the issue: there are too many measuring sticks! Check this out:

http://www.slate.com/articles/healt..._can_help_us_think_clearly_about_alcohol.html


Different organizations use differing standards to quantify what determines alcoholism. As a physician, being on the side of caution when someone is having a procedure or going into the hospital is a service to the patient. DT's are serious and life-threatening. If I'm suspicious that ANYONE might have some withdrawal symptoms, I'm putting them on detox precautions...be it a homeless tattooed bald guy with a beer gut or a 78-year old woman who's been taking Xanax as prescribed by her personal doctor for 15 years. The danger is too great and I don't care who gets all butt-hurt over it. It IS judgmental....CLINICAL judgement, which patients pay for and expect.

But, insofar as a "label" is concerned...it isn't how much someone uses, but the effect it has upon that individual. Beyond the screening for acute withdrawal or DT's, the "how much" question for what I do is only secondary. It is the "how does your drinking affect you (occupationally, socially, legally, in your relationships)" that matters.

 

[907_fellow]

6 a week is a lot? I think we use a different measuring stick where I live.

Ya well it's probably not -11F at 2:45 pm and getting dark where you live is it??? Ha

I got mono an strep throat at the same time this summer. I didn't drink for 3 weeks and I didn't feel like the "not drinking" effected me. Seems kinda lame to try and stop drinking when I got 25 gallons fermenting right now and 6 cornies on tap I'm just trying to keep up with my pipeline!!

No one has yet discussed the "functioning alcoholic" to my knowledge. I guess maybe I fall into that category..... Or it's just winter in Alaska, there Is no snow, and it's cold as **** outside.

 

[kroach01]

But what happens if the wounded ego or ruffled feathers in turn causes someone to lie about an even more critical item on the checklist - do you use drugs? "oh crap I'm a freaking junky but if I don't want to tell her that, I don't even want to tell her that I use occasionally soooo... No maim, I'm a clean as a whistle "
The person taking the phone interview should be practice enough that they can make that call to follow up on a answer without having to umm and arrr about it. Instinct should kick in - ...6-8 beers a week => "are they all in one sitting? / do you drink more than xx a night? / etc." => all in one sitting => "Do you feel like you are dependent on alcohol or that you could not stop drinking if required?"
As little emotion as possible should be "shown" by the interviewer otherwise it is human nature to feel judged and start calmming up.

The problem with this is that questioning alcoholics and addicts in general causes them to become very defensive regardless of the inflection of the interviewer. I've interviewed alcoholics and drug seekers who fly into a fit of pure rage at any question about using drugs or alcohol.
If you have strong suspicion of alcohol abuse, for instance, we ask the standardized CAGE questionnaire - fell the need to Cut back? Anger when asked about their habits? Guilty about drinking? Eye-openers?
Some people would interpret asking these questions as assumption of guilt and some sort of judgement. In reality its a simple standardized and widely used method. In fact an adverse emotional reaction to these questions in itself is an indication they may be addicted.

 

[kroach01]

Not to muddy the water, but your two beers a night could be 4% BMC beers, or 12% imperial whatevers. Does it matter? Logic tells me yes, but I'm not a medical professional.

Alcoholism is characterized by:

- a prolonged period of frequent, heavy alcohol use.

- the inability to control drinking once it has begun.

- physical dependence manifested by withdrawal symptoms when the individual stops using alcohol.

- tolerance, or the need to use more and more alcohol to achieve the same effects.

- a variety of social and/or legal problems arising from alcohol use.

The definition doesn't include an amount. There are so many factors involved -- body weight, metabolic capacity, rate of drinking, drinking on an empty stomach.... Putting numbers on it is useless.

 

[kroach01]

that's part of the issue: There are too many measuring sticks! Check this out:

http://www.slate.com/articles/healt..._can_help_us_think_clearly_about_alcohol.html


different organizations use differing standards to quantify what determines alcoholism. As a physician, being on the side of caution when someone is having a procedure or going into the hospital is a service to the patient. Dt's are serious and life-threatening. If i'm suspicious that anyone might have some withdrawal symptoms, i'm putting them on detox precautions...be it a homeless tattooed bald guy with a beer gut or a 78-year old woman who's been taking xanax as prescribed by her personal doctor for 15 years. The danger is too great and i don't care who gets all butt-hurt over it. It is judgmental....clinical judgement, which patients pay for and expect.

But, insofar as a "label" is concerned...it isn't how much someone uses, but the effect it has upon that individual. Beyond the screening for acute withdrawal or dt's, the "how much" question for what i do is only secondary. It is the "how does your drinking affect you (occupationally, socially, legally, in your relationships)" that matters.

+1

 

[Dr. Francois]

6 a week is a lot? I think we use a different measuring stick where I live.

Ha! One of my favorite things about living where I do is that doctors think I'm awesome.

Don't snort meth? Awesome! Good for you, buddy!

Only 3 beers a night? What self-control you have!

Only 15 pounds overweight? Skinniest guy I've seen today!

All of your original teeth and no cavities? What demon did you make a deal with and can I have his number?


Then I go back to Colorado or California to visit and everyone makes me feel like a fat, drunk slob.

So I go back to Michigan and hit up the local WalMart. Hey! I'm okay again!

 

[jakenbacon]

Ha! One of my favorite things about living where I do is that doctors think I'm awesome.

Don't snort meth? Awesome! Good for you, buddy!

Only 3 beers a night? What self-control you have!

Only 15 pounds overweight? Skinniest guy I've seen today!

All of your original teeth and no cavities? What demon did you make a deal with and can I have his number?


Then I go back to Colorado or California to visit and everyone makes me feel like a fat, drunk slob.

So I go back to Michigan and hit up the local WalMart. Hey! I'm okay again!

Lol, freakin hilarious

 

[Ryush806]

I don't care who gets all butt-hurt over it.

Haha. Butt-hurt...

 

[TxBrew]

I lie.

Do you smoke? Like a chimney.

Do you drink? Like to stay alive? That's a silly question.

 

[AMonkey]

Alcoholism is characterized by:

- a variety of social and/or legal problems arising from alcohol use.

Uh-oh. Looks like I was an alcoholic in college.

 

[JonM]

So I get a call from the preadmission nurse regarding a procedure I have scheduled next month. One of she says that the real concern is whether I might start experiencing withdrawal before I am released from the hospital.[/ZZFsb2eA]

 

[JonM]

she says that the real concern is whether I might start experiencing withdrawal before I am released from the hospital.

I have an enormous amount of respect for nurses, and I know that they put up with a LOT of crap, and that their patients sometimes aren't truthful with them, but If a nurse said that to me, I'd start looking around for Allen Funt.

 

[ChuckO]

Again, there is no reason to lie to your doctor. Everything is 100% confidential.

Confidential? Most doctors offices require you to sign a waiver allowing them to release information to insurance companies and Medicare. There goes any semblance of confidentiality. Most releases that I have seen for any type of communication mention "or any reason ALLOWED by law", not just reasons REQUIRED by law.

 

[Bensiff]

I smoke an occassional cigar and I get crap for it from my doctor and every time he asks me about it I ask him to produce research that shows that smoking once a week, once a month, once quarter is actually bad for your health or is it just assumed based on other research?

But, to the point of alcohol question. There have been some significant studies done on alcohol consumption which are pretty interesting. For instance the life expectency of a teetotaller is equal to someone who averages 6 drinks a day. Maximium life expectency is at 1-2 drinks a day. The research makes a nice bell curve. So, don't drink 6 or more and you will live as long as someone who doesn't drink at all. I stick to one or two a day for the most part unless I don't feel well then I don't drink or if my Huskies screw the pooch to the Cougs then I might have a few extra .

 

[NuclearRich]

Confidential? Most doctors offices require you to sign a waiver allowing them to release information to insurance companies and Medicare. There goes any semblance of confidentiality. Most releases that I have seen for any type of communication mention "or any reason ALLOWED by law", not just reasons REQUIRED by law.

Slightly off topic but I'll bite. Those waivers do not allow indiscretion for who sees your private info. Whoever is ALLOWED by the law, such as insurance companies for the sake of reimbursement. HIPAA is no joke, if you give out info even by accident when you aren't supposed to, you get fined/fired/jailed. Seriously.