Wednesday, 2 June 2010

Doctors will ask, and patients will lie

The National Institute for Clinical Excellence are now proposing that GPs should routinely quiz patients about their alcohol consumption during consultations. If you have gone to the doctor’s with a rash or a sprained wrist it will be very tempting simply to respond “none of your business!”

It has often been noted that men are much less likely to visit GPs than women, resulting in major health problems often being diagnosed too late. Surely if they are going to be subjected to intrusive and patronising inquisitions they will be even more inclined to grin and bear it and not bother making an appointment. Far from improving health, this is going to erect another barrier between doctors and patients.

This is not to say that some people do genuinely have alcohol-related health problems, but surely questions like this should only be asked if it is relevant to the condition being treated, and not as part of a general attempt to investigate and control individual lifestyles.

In the comments it is suggested that GPs routinely give patients annual checkups, something that in reality happens only in Cloud Cuckoo Land – back on the ground it is hard enough to get an appointment even if you are at death’s door.

The article also perpetuates one of the favourite Big Lies of the anti-drink lobby, that alcoholic drinks have become cheaper in real terms. How many more times does it have to be repeated that alcohol only appears cheaper in comparison with incomes because people have on average become better off?


  1. The way it works is, the doctor asks you "How much do you drink in a week?".

    You tell the truth, or lie, as you think fit.

    The doctor assumes you are lying, and makes up whatever number he feels like. The numbers the doctor invents are then used to generate statistics for alcohol consumption that show we are all going to die.

    GPs are then required to ask more questions about your drinking habits. The problem you went in with in the first place will be ignored, however dangerous it might be.

    All this is somehow thought to be healthy.

  2. I have been asked if my children smoke, not by a doctor but by a receptionist. I pointed out that they didn't as far as I know but that, if they did, they almost certainly wouldn't tell me. If I hadn't been taken aback by being asked, I would have told the receptionist to ask them. Or sod off.

  3. The last time I went to the doctor with a severe attack of sinusitis, the doctor took my blood pressure, saying it's routine now for people of my age, even though blood pressure had nothing to do with my nasal problems.

    Doctors' appointments are short enough as it is with barely enough time to describe what's wrong. If they're going to take tests and ask about drinking (and I assume smoking) when your problem is unrelated to these activities, we'll need longer appointments, which will increase costs. But they're cutting back on the NHS ~ I don't think NICE has taken that into account.

  4. Sit in the surgery Mudge, necking a can of lout. Let the doctor draw there own conclusions.

  5. And that's why I love reading Cooking Lager. :-)

  6. A few years ago, I was hospitalised with a particularly nasty bout of pneumonia. When I was moved to a ward, the sister took a lot of details, including how much I routinely drank. I told her 40-50 units a week, which was (and is) fairly accurate (although I tend to drink a bit less these days). She sucked a lot of air in and asked if I wanted to talk to someone about that. I looked surprised and told her that I didn't think it was a problem, and it wasn't mentioned again.

    What I also found out during that stay is that whatever you say you drink, medical staff assume you're trying to hide something and double your answer - which in my case certainly would have been cause for concern.

  7. Yes, ZakAvery. I had a similar experience; when asked how much I drank, I said "about 35 a week".

    Sharp intake of breath. "35 units a week?"

    "No, 35 pints."

    I got a liver function test for my trouble, and the quinsy I was suffering from was overlooked.

  8. Another pointless exercise as it's assumed you're lying anyway. Why? Because, as Dr House never tires of telling us "Everybody lies."

    Sounds like fun, though. I'm waiting for someone to ask me how much I drink in a week...

  9. Telling fibs to your doctor about your drinking and smoking even has a medical term too, misclassification. It is one of the problems with especially smoking. Asian women are particularly susceptible to sneaking in a porkie.

    This study from south east Asia suggests "..40.9% and 5.6% (claimed to be smokers) for males and females, respectively. After verification of the subjects' smoking status by saliva cotinine assay the rates of smoking were found to be greater, at 43.7% for males and 14.8% for females."

    So 2.8% for men and 8.2% for women. I have read papers as high as 40% for Japanese women. This study of Cork bar staff suggests 4% misled. "..Cork bar workers (n = 129) was 54% (58% using cotinine-validated measures).

    These were scientists just seeking information with no finger wagging at the end. Also smokers and drinkers also have amnesiatic memories on how they much they consume and when they gave up or cut down.

    Doctor's notes worldwide probably have more in common with The Brothers Grimm than sound science.


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