A young man out partying with his
friends has too much to drink. Leaving the party, he wrecks his truck. An
ambulance picks him up. At the hospital, routine tests show that he is
drunk. Doctors put him in the hallway to die. Fact or fiction? Just ask Mr. Thompson.
On his first visit to a Florida
health clinic, the staff required Mr. Thompson to watch a video and complete a
new patient questionnaire. Three questions dealt with alcohol use. The
first asked how often in the past year he had a drink containing alcohol. The
second question asked how many drinks containing alcohol were consumed "on
a typical day" in the past year. The third question asked how often 6 or
more drinks were consumed on "one occasion" in the past year.
Mr. Thompson came to the clinic in
March of 2009. It isn't clear whether the term "year" in all three
questions referred to 2009, 2008, or whether it meant in the past 365 days. In
any case, very few people record each alcoholic drink consumed. Obviously,
someone who never drinks can easily answer such questions. Or a person with an
obsessive compulsive disorder might be able to respond accurately. Otherwise
the only honest answer to the question would be "unknown."
None of the questions asks about the
type of alcohol, the amount of alcohol in the drink, or the size of the drink.
Should the patient include the number of times he has taken communion with
watered-down wine? Is there a significant difference between a drink of
O'Doul's beer and a jar of grain alcohol? What if the patient took a sip of
grain alcohol and didn't like it? Is that a "drink"? Do you include
the day you got a notice of an IRS audit as a "typical day"? What if
you're always in trouble with the IRS? What is an "occasion"? Some
celebrations can last several days.
When presented with vague questions
like these, the patient has few choices. First, he can try to answer truthfully
by saying, "I don't know." I tried this option when my physician's
questionnaire asked obscure questions about my grandmothers' health. I didn't
know the answers to most of those questions; however, "I don't know"
wasn't a choice. I asked the receptionist what to do about those questions. She
told me to "do the best you can." She also said that the doctor
wouldn't see me if I didn't answer every question.
The second option - and the one
chosen by Mr. Thompson - was to guess at the meaning of the questions and
answer as well as he could. The result was catastrophic. His attending
physician determined that, "as per VA outline criteria" more than 14
drinks per week "constitutes alcoholism." Because Mr. Thompson
admitted to 3-4 "drinks" a day, the doctor labeled him an
"alcoholic." Since alcohol can adversely impact Mr. Thompson's pain
medications, the doctor revised those prescriptions. Disputing the diagnosis,
Mr. Thompson filed suit.
Defendants offered no evidence that
Mr. Thompson had experienced any legal problems related to his
"drinking." There were no arrests for drunk driving, public
drunkenness, or any other behavior related to drinking. In fact there is no
reported history of any criminal behavior at all. We also have no record of Mr.
Thompson's employment history. Has he ever lost a job because of
alcohol-related behavior? Was he a reliable employee or did he have a history
of chronic absenteeism? There was no evidence that alcohol had impacted his
social relationships. Did his wife divorce him because of his drinking? Did he
loose custody or visitation rights with his children because of his "alcoholism"?
Was he ever injured in an accident where alcohol was a factor? Finally, there
is no indication of physical or mental problems often seen in alcoholic
patients. There is no report of liver disease, hypoglycemia, hypertension,
brain damage, heart damage, chronic gastritis, or pancreatitis. There is no
record of blackouts, hallucinations, or cravings for alcohol. Despite the
shoddy diagnostic criteria relied upon by his doctor, the court refused to
strike the "alcoholic" label from Mr. Thompson's records.
A few weeks ago, the CDC strongly
urged physicians to begin screening patients for potential alcohol problems. It
acknowledged that, "Doctors are busy and have lots of things to do"
but it urged doctors to begin screening every patient for alcoholism.
Doctors should ignore this advice
until the CDC provides them with reliable screening tools. Labeling a patient
as an "alcoholic" can have severe consequences. Employers can fire
"alcoholics." Licensing boards can take away professional licenses of
substance abusers. Judges have taken away children and have terminated
visitation rights in cases involving claims of a parent's alcoholism. Courts
have even allowed health insurance companies to refuse to pay for medical care
of a patient who was injured when "intoxicated." Finally, many
doctors would refuse to consider an "alcoholic" for a life-saving
liver transplant.
Patients faced with obscure,
invasive, and potentially dangerous questions on doctor's surveys should also
realize that their answers will be permanently stored in an electronic data
base. Without the patient's knowledge or consent, the law allows that record to
be shared with other health care providers, law enforcement, and certain
government authorities. In addition, hackers routinely steal information from
"confidential" data bases. Just ask the National Security Agency,
Target, and Edward Snowden.
As for me, when threatened with
denial of medical care, I decided to provide safe answers to my doctor's
questions. According to my survey, neither I nor my parents, grandparents or
other ancestors have ever had any diseases or mental disorders. In fact, I have
always led a happy, joyful life. I'm not a suspicious person and rarely find
fault in anyone. I've never had a drink of alcohol nor smoked a cigarette. I've
had sex only three times and that was with my husband, the father of my three
children. (This may account for the divorce after 28 years of marriage.) I
brush and floss three times a day and I get 8 hours of sleep each night. I meditate
and exercise regularly and only eat organic foods. Finally, I have no idea
how I got this horrible rash. Now may I see the doctor?
