“Has a GP ever asked how much alcohol you drink? For me, the answer was no.”
This week, Bianca Blanch shares what she has learnt from a 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:
- GPs should ask their patients about their alcohol consumption (even if it’s scary), it may sometimes go badly, but overall, it will likely strengthen the doctor-patient relationship in the short-term and enhance their patient’s health long-term.
- Most patients are not as sensitive to discussing their alcohol as the academic literature suggests.
- If my GP hasn’t asked me about my alcohol consumption it is likely because it has never been relevant to my current health concerns (as I also learned, even if the GP is busy, they do want to know about alcohol intake).
- Finally, I need to be the champion of my health and raise any issues with my GP that may improve my long-term health and wellbeing.
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.