The medical degree isn’t a vaccine against addiction. “If you don’t drink as much as your GP, you don’t drink too much,” an old saying goes. When it comes to doctors’ own lifestyle habits and patient-related alcohol counselling, the science remains silent.
Personal Experience
Surveys of physicians’ attitudes towards drugs or drinking are multitude. They are relatively easy to do – doctors answer them by circling numbers or ticking the boxes in research questionnaires. While sometimes it’s easy to figure out the purpose of the survey and adjust one’s answers accordingly, other times the survey doesn’t give clues about its underlying goals.
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| Photocredit: wisequacks.org |
A Boston surveyasked over a hundred family doctors whether they knew someone (other than a patient) with an alcohol or drug problem. Up to 85% knew someone with these problems and about a third of them said this person was “family, a close friend or themselves.” Compared to the rest of the survey, they were more confident in asking patients about alcohol and advising on low-risk drinking. This positive effect did not translate to the other parts of their job, such as “perceived responsibility, attitudes, professional satisfaction, and practices”, though.
When faced with a “human face” of addiction, some medical doctors change their preconceptions:
“I found the workshop really eye opening. It changed my preconceptions of what I thought a ‘drunk Doctor’ would be like; when we were all sat around the table I was wondering to myself when the Doctor would be coming to speak to us and why he wasn’t there already, so I was taken by surprise when it turned out he was sitting right opposite me! I think that shows that this really is an issue that needs to be put in front of medical students as most like me will only have come into contact with alcoholism through seeing patients on wards, or seeing people in the street.”
The Example comments made by students who attended an addictions workshop were taken from http://www.sgul.ac.uk/research/projects/icdp/pdf/smugprojectreport.pdf The doctor was a member of the Sick Doctors Trust http://sick-doctors-trust.co.uk/
The measurement problem
Two measurement problems hinder research on this topic. How to measure doctors’ drinking? How to measure the alcohol treatment they provide to patients with addiction?
Objective measures of alcohol consumption would be best. The measures we normally use are unreliable – Breathalyzers or ETG (Ethyl Glucuronide) tests. Apart from being perhaps somewhat intrusive for docs, they it pick up recent drinking only. Similar to other alcohol research, we would have to rely on what the doctors tell us.
Actual measures of practice are less worrying than objective measures of drinking. Again, measuring success of doctors’ approach by the number of abstaining patients is extremely difficult. Our best shots are proxy measures, such as number of prescribed medications or number of referrals to specialists. Although audits of doctors’ practice have been found to underestimate the actual care delivered by doctors, the Self-reports of practice seem to inflate the figures.
Other lifestyle habits
A previously published blog post and an article in the Irish Psychologist described two studies that illustrated how doctors’ lifestyle habits matter and how their ambivalence can be boosted. Research at the University of Michigan, cardiovascular centre demonstrated how doctors’ confidence in their ability to advise patients on diet and exercise correspond with their own personal health and fitness levels. Maybe lifestyle habits influence health care (in one paper) for a different issue (diet/exercise), but does that relate in some way to alcohol?
Another team supervised by Hettema and Sorensen used Motivational enhancement therapy (MET) to help medical trainees to resolve their ambivalence around managing alcohol and drug problems. They’ve put a group of nine medical residents through a brief MET therapy before they learned more about alcohol consulting and advice-giving. Five weeks later, their consulting and advice-giving went up, but due to the small numbers, the researchers called for caution with interpretation of their results.
No one is immune from addiction. While we know that doctors do get it too, we see little, if any, literature that specifically supports a statistically significant association between physician drinking and physician screening or counselling. In another words, we don’t know whether their own drinking or drug taking influences how they treat addictions. Can you find a paper?