When was the last time you spoke to your GP about alcohol?

“Has a GP ever asked how much alcohol you drink? For me, the answer was no.”

This week our Research Manager, Bianca Blanch, shares what she has learnt from a recent HSM project training GPs on how to compassionately discuss alcohol intake with their patients.

 


 

General practitioners (GPs) are our guides to better health and wellbeing. We often only see GPs when we are at our most vulnerable (and grumpy); we are sick, we tell them our secrets, let them examine us and wait anticipatingly for them to cure us. To expose ourselves in this way, we need to trust our GP which strengthens the unique bond that develops between doctor and patient.

When the best GPs look at us, they consider the whole picture (person), rather than just the brushstrokes (current symptoms). They may also act like our parent, caringly chastising us for our past behaviour, but also inspiring us by giving us the tools we need to do better in the future. Being a GP also involves having a lot of conversations most of us would find extremely awkward. Interestingly, I recently read several studies that GPs are reluctant to discuss their patient’s alcohol intake as they worry it may make the patient distressed or damage the relationship with their patient.

Upon learning this my initial reaction was surprise. I thought about the many awkward conversations I have had with GPs over the years, and thought doctors excelled at the awkward conversation. After my surprise passed, I felt concerned. As alcohol consumption is known as a modifiable lifestyle factor, meaning if we reduce our intake of alcohol it will improve our long-term health. (The other modifiable risk factors are regular exercise, healthy eating and not smoking).

But we shouldn’t judge GPs too harshly. From a patient’s perspective, alcohol consumption can be a sensitive subject to discuss, especially if we think we are indulging too much or too frequently. If a doctor asks “How much do you drink?” we may feel judged, defensive, or scared to admit to ourselves or others the amount we actually drink and react negatively by lashing out, ignoring the question, or getting angry. All of a sudden, I understood the hesitant GP.

I wanted to find out more.

In November 2019, HSM ran a training session for 11 GPs to teach them how to ask about their patient’s alcohol consumption in an open/non-threatening manner and, if necessary, to ask the patient to think of strategies to reduce their alcohol intake. (If you want to learn more about this approach it is called a screening and brief intervention [SBI]). The following week, the GPs asked all of their patient’s about their alcohol consumption. At the end of the week each GP spoke with me about their experiences.

When I spoke to the GPs, the most common reaction was surprise. Surprise at how often asking about alcohol opened up the conversation with their patient and elicited other important medical information like family history. Surprise that their patients liked their doctor being proactive and taking a holistic approach to their healthcare. Finally, surprise at how few patients reacted negatively when asked about their alcohol consumption.

For me personally I took away these four ideas:

 

This last point is really important, not just for alcohol intake but for all the modifiable lifestyle risk factors. At my next GP visit, I will discuss these factors with my GP to see if there is anything I should change in my lifestyle to promote better health. At a minimum, my doctor will know me better as a patient. Plus, if I ever need to discuss any of these issues, I have started the conversation and can pick it up anytime in the future. But there is a chance my doctor will respond insensitively, if so, I will likely find a new GP I trust to look after my long-term health. We owe it to our future self to look after ourselves the best we can!

There are many reasons why some of us do not routinely see our GP: we have had a bad past experience, only go when we are really sick; or, we are simply too busy to be sick. Each person needs to decide the best way to look after themselves and their health. But just consider your loved ones, they want you to be healthy, and they will benefit from any steps you take to be a healthier version of yourself.

What do you think? Will you visit your GP? Will you discuss your alcohol intake, or another modifiable risk factor, with your GP?

If not, what is stopping you? Have you already discussed alcohol intake with your GP? What was it like? Do you have any tips for making this conversation easier and more straightforward?

Please let me know by leaving a comment below.

 

My GP has assisted and supported me through my alcohol troubles for 10 years. He did ask me directly how much I was consuming, and was clear about how that would be affecting my health. A quality GP is so important. I treasure him.

Hi, my name is Trish and I am really interested in the information a GP will give if you have indicated there is an issue with alcohol. From my experience my GP has suggested AA as something to explore. This concerns me. I would like to do a survey of GP’s in Melbourne to explore the suggestions they give if a patient discloses an issue with regular drinking. For those struggling with having Alcohol Free Days there has to be more avenues than AA. Just my opinion. I believe this is a area of concern for a lot of patients and I am really keen to learn more. Patients might appear to be saying how much they drink but for many this may be embarrassing and challenging to disclose the truth.

I have discussed my alcohol consumption with my GP and other doctors if they ask, in a way it helps to say it out loud , they never react badly, they just usually suggest ….cutting back, which I do. It forces you to reflect on how much you consume and I feel guilty and ashamed, it’s dumb to drink every night it’s a waste of time. I have things under control at the moment and every day I wake up proud of the progress I have made. One day at a time and sometimes, one hour….

Thanks for the article and thanks to Liz, Trish, and Jennifer for your comments. For me, drinking had been a problem for a long time (10+ yrs) and every time I went to the docs or counselors I would stretch the truth about my alcohol consumption (lie ok, I lied). Even then, the general response was, ‘cut back’ or ‘meditate’. That’s fine and all, but doing those things didn’t stop the crazy train inside my head. It was only once I reached out via social media (using an anonymous account) that I got in touch with ‘like-minded’ people. I credit my sobriety to being able to talk to people anonymously, letting the truth out, but being responded to in an understanding way and hearing similar stories. I’ve also gone to AA, and it works in a similar way, the old school thinking that it’s just a religious bible bashing, big book thumping group isn’t accurate (not that I’ve experienced anyway). It’s just a group of people, just like me, wanting to know their not alone (and not unique). Finally, the only MP I related to and who seemed to understand me explained that he was a recovering alcoholic. I felt I was able to be truthful with him about my excessive alcohol consumption. He didn’t just tell me to cut back or meditate, he said that addressing alcohol use is like building a house, you need to use a bunch of tools and take your time. Since then, I’ve been sober, using mediation, positive thinking/mantras, talking to others, exercising and volunteering at rehabs.

It’s great when my GP raises the tricky or embarrassing issues such as alcohol consumption, weight or sexual health issues; it means I’m less likely to chicken out of an important conversation and makes me feel as if it’s just “business as usual”.

I actually had this conversation this week with a dietician ahead of meeting my GP. Up until 3 weeks ago I was consuming a bottle of wine per night I have cut out alcohol completely.

I have been alcohol-free for 6+ years now. During my heavy drinking days, I would always report my intake as about 50% of what it actually was when asked in a medical context. I was however receptive to any medical evidence given by a GP of the long-term health effects of heavy drinking. Such evidence, along with reading up and eventually HSM all added together to fuel my decision to quit.

I have the best GP. With her support and Daybreak I am now 1 year alcohol free. She is so proud of me. I feel I couldn’t have done it without her help. She quizzed me a few times about my drinking and I realized I was drinking too much and damaging my health. She now recommends people to join the Daybreakers on the App. It has been a life saver for me. GPs should be aware of all our health issues to help us to live well.

I have been concerned about asking my GP because of our health insurance. They may deny coverage for this diagnosis or may deny coverage for a related condition because of my history of alcohol abuse. In addition, I have concerns that a physician will not care to help me because of my misuse of alcohol. Felt that way before I quit smoking also. I’ve personally had encounters with physicians who just don’t want to take the time & dismiss my concerns – like I don’t know what I’m talking about or it’s just a situation of mind over matter.

I think doctors need to be more educated. My experience is that they can be dogmatic as to joining AA. I’ve tried AA and it’s not for me. Also, when I was going through severe detox, a GP would not prescribe any medication to help. Her advice was to commence controlled drinking to relieve the symptoms. One drink means a bender for me. I left humiliated and suffered a very frightening and dangerous alcohol withdrawal for days unassisted. Later I checked in to a clinic. That and this type of forum has helped me be almost alcohol free. My lapses are getter less frequent and for shorter periods.

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