Wednesday, February 04, 2009

How would you have handled this one?

My long-time patient has struggled with alcohol abuse in the last two years. She's been in and out of rehab plus had several hospitalizations with serious illnesses indirectly linked to her addiction. Now she's back to work and looking the best I've seen her in ages. She came in alone yesterday regarding a mild skin ailment--her daughter usually accompanies her-- and walked slowly and a little unsteadily into the exam room due to a 'minor ankle sprain'.

After our pleasant visit, I gave her a hug and realized she smelled of alcohol.

11 comments:

Anonymous said...

Honestly if she had driven I probably would have called the police, or at the very least taken her keys and called a cab.

Then I would have refused treatment for anything intended solely to relieve symptoms of alcoholism (depending on what the skin ailment was it could be directly related), because to make an alcoholic feel better is to enable her addiction by taking away the consequences of the addiction.

And then I would have called her substance abuse counselor and made sure right then and there that she had an appointment. Even people well down the road to recovery hit pot holes. Or she could be totally off the wagon again. In either case her substance abuse counselor needs to know, especially if she is on court ordered treatment.

Anonymous said...

Ugh. This is very sad. I know because I've been in your patient's shoes. I would say going to the doctor's office drunk was something I was able to stave off for at least a decade into my addiction, so I would bet your patient is in a lot more trouble right now than she realizes. I sometimes wonder if going to a physician/dentist drunk (I did both)wasn't just a clumsy and indirect way for me to try to hand off the problem to someone else and have them "force" me to deal with it. I always "got away" with this behavior, and in the end, the only thing that forced me to quit drinking was finding myself in a hospital with two fractures and a head injury from a drunken fall. I also had a blood alcohol level of
over .400. So, do I wish a doctor had called me out sooner? Maybe, but I wasn't going to get sober until I was good and ready. It's a truly horrifying disease that puts everyone around the alcoholic in a no-win situation. So, what did you do?

kenju said...

I think she wanted you to know. I would have been disgusted with her, so I'm not sure how I would have handled it. I'm sure you did fine.

Cilicious said...

Oh jeez, what an awkward situation.
I too wonder if this patient wanted you to know, but then again, my mom used to enter into similar situations, and I truly believe she just brazenly assumed that nobody would notice.
That's a tough one.

femail doc said...

Thank you all for your thoughts on this one. I actually did nothing right then--I was behind in my schedule, disgusted both with her and myself (for being so gullible), and truly clueless as to the right approach. I called her the next day, fortified by the comments from both Anonymous readers, and "called her out", cut her off from a medication I was giving her to help with her anxiety, pledged my unfailing support to her rehab efforts, and she was off with a friend to an AA meeting. Next week I meet with her and the daughter. The meeting was originally meant for me to support her in her increasing independence from familial surveillance, but the nature of the discussion will be quite different now.

BC Cook said...

Too many references to being "disgusted" with her. What happened to the disease paradigm?

I'm thoroughly disgusted with professionals who don't grasp that this woman has an addiction problem and not a character flaw.

femail doc said...

BCC: I agree with you totally. And that is why I chose not to say anything to her when I realized she'd been drinking the day of her appt., because my disappointment in her had no place in the ongoing plan to help her overcome her addiction. I have enormous compassion for her, especially knowing the difficulties of her personal circumstances, and was also disappointed in my wishful thinking that her animation in the waiting room and exam room was a sign that everything would now be okay for her.

Anonymous said...

As the anonymous with the BAC over .400 on my last drunk, I can totally understand the disgust I engendered in many people, including medical/psych professionals. Just because I have a disease doesn't mean that people who are affected by it aren't entitled to their reactions. I'm sure "disgust" wasn't conveyed to this patient, but I can understand the feeling and I know for a fact that everyone who knew me in my drinking days felt disgusted by my behavior. Being fed up and just plain confused over alcoholic behavior isn't inconsistent with the disease paradigm. It's a confusing and vexing disease, accompanied in my case by an incomprehensible level of risky conduct, dishonesty and manipulation. So, I say nonalcoholics are entitled to their reactions and everyone who is so inclined should say a prayer for the still suffering alcoholics that they may find their way out.

Mauigirl said...

Probably she thought since she'd had success quitting that she could handle it now and thought she'd just have "a couple" - and immediately fell off the wagon. I sympathize with you - it's a very difficult situation. Sounds as if you handled it very well.

Anne Morley said...

I'm kind of late coming in on this one Judy. You did a great job of handling it though. I think exactly right. You took some time to assess your own reaction and figure out what to say to your patient. You followed up. You did good.

I have a little experience dealing with alcoholism having grown up in a family affected by the disease..both grandfathers were "drunks" by their own definition. Then I married an active alcoholic who entered a rehab after drinking nearly daily for 35 years. That's when I began to learn about alcholism and other addictions. The worst thing one can do is ignore the problem.

Jules said...

I'm kind of confused as to why you rx'ed her the benzos if you knew she has an alcohol problem. I think cutting her off like that was unfair, especially considering the seizure risk plus the DT's she will inevitably go through.