{"id":18828,"date":"2020-09-08T12:25:41","date_gmt":"2020-09-08T17:25:41","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=18828"},"modified":"2023-03-06T09:49:33","modified_gmt":"2023-03-06T14:49:33","slug":"no-your-doctor-probably-doesnt-double-the-amount-you-drink","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/patient-stories\/no-your-doctor-probably-doesnt-double-the-amount-you-drink\/","title":{"rendered":"No, Your Doctor (Probably) Doesn\u2019t Double the Amount You Drink"},"content":{"rendered":"

The last time I went in for a routine physical, I decided to be honest with my doctor about my drinking habits.<\/span><\/p>\n

I’ve read the guidelines; I know the <\/span>Centers for Disease Control and Prevention<\/a> says <\/span>women should consume no more than seven alcoholic drinks per week. Nonetheless, my weekly number often falls a few drinks higher, especially if I\u2019m on vacation or attending lots of social events.\u00a0<\/span><\/p>\n

When I admitted this to my doctor, I was ready for a raised eyebrow and a reminder to keep my revelry in check. Instead, her reaction was explosive: \u201cWhy do you drink so much?!?\u201d She quickly announced she was ordering a test of my liver function (it came back fine) and told me that anything more than the occasional glass of champagne was harmful and unnecessary.<\/span><\/p>\n

Her response freaked me out. When I told a friend about my experience, she sympathized with my frustration over my doc\u2019s judgmental tone. Then she said, matter-of-factly, \u201cYou know that doctors always double the number of drinks you tell them, right?\u201d<\/span><\/p>\n

The idea that doctors automatically double a patient\u2019s self-reported alcohol intake <\/span>made headlines<\/span><\/a> in 2018.<\/span><\/p><\/blockquote>\n

No, I did not know that. But it made sense \u2014 patients probably downplay how much they drink all the time. <\/span>Plus, during the pandemic, alcohol sales have spiked and many adults have reported their drinking is up<\/a>. And I\u2019m sure some people underestimate their weekly total without meaning to. It\u2019s easy to forget that a generous pour equals more than one glass of wine, or to omit half-finished cocktails from your drink count. <\/span><\/p>\n

Did some unspoken doubling rule explain why my doctor reacted so strongly to my confession? Did she think I was actually imbibing upwards of 20 or 30 drinks a week?<\/p>\n

\u201cThat seems like a bad rap we get,\u201d says Dr. Allison L. Ruff, a general medicine physician. Ruff says the only people who cite the drink-doubling rule are patients.<\/p>\n

\u201cI\u2019ve heard patients tell me all these things like, \u2018Oh, you\u2019ll double what I say,\u2019 \u201d she says. \u201cI don\u2019t think doctors really do that. Patients are surprised to hear that, but I really do take what people say at face value, especially with alcohol intake.\u201d<\/span><\/p>\n

A common myth<\/h3>\n

The idea that doctors automatically double a patient\u2019s self-reported alcohol intake <\/span>made headlines<\/span><\/a> in 2018 when<\/span> British<\/span><\/a> media<\/span><\/a> reported on a survey of fewer than 200 general practitioners. Many said they used an \u201calcohol multiplier\u201d to assess patients\u2019 drinking habits, assuming that patients only admit to about half of their actual consumption.<\/span><\/p>\n

Ruff, who also teaches the \u201cIntroduction to Doctoring\u201d course at the University of Michigan medical school, says this might<\/span> be the case for some old-school doctors. But in her experience, and in her role educating medical students, \u201cI promise nowhere in the course does it say \u2018Double the amount of drinks someone tells you,\u2019\u201d she says.<\/span><\/p>\n

Dr. Giuseppe Aragona, a general practitioner based in the UK, says he personally doesn\u2019t double his patients\u2019 numbers.<\/span><\/p>\n

\u201c’When people self-report, I think you can usually believe them, unless there are telltale signs that [indicate] otherwise,\u201d he says. \u201cIf you have evidence, then press them on this.\u201d<\/span><\/p>\n

Downplaying your \u201cbad habits\u201d or exaggerating your virtuous ones isn\u2019t going to do you any favors \u2014 in fact, it ultimately makes your doctor\u2019s job more difficult. <\/span><\/p><\/blockquote>\n

Curious for more insight, but not equipped to execute a formal study of my own, I texted a few friends in their late 20s and early 30s who are medical residents across the US. Two out of three were emphatic: They always take patients\u2019 self-reported number of drinks at face value, unless a patient\u2019s test results indicate liver damage or other signs of excessive drinking.<\/span><\/p>\n

But one friend did<\/span> tell me she\u2019d been told to round up the number of drinks that patients report, and she assumed this practice was widespread. So it\u2019s possible that this happens sometimes, even with younger providers.\u00a0<\/span><\/p>\n

Tempted to underreport? Don\u2019t.<\/h3>\n

Regardless, it\u2019s important to have<\/span> honest conversations with your provider<\/span><\/a> about your habits, whether you\u2019re talking about your diet choices or discussing how much you drink, smoke or use drugs.<\/span><\/p>\n

Downplaying your \u201cbad habits\u201d or exaggerating your virtuous ones isn\u2019t going to do you any favors \u2014 in fact, it ultimately makes your doctor\u2019s job more difficult. Ruff points out that these behaviors contribute to other medical conditions: \u201cIf you tell me you\u2019re only drinking two drinks a week because you think I\u2019m going to inflate that, and then your liver tests come back a little bit elevated, I might start looking for other causes, when in actuality it\u2019s because you had a beer last night.\u201d<\/span><\/p>\n

Withholding information or fudging the truth also makes it harder for your doctor to create an effective treatment plan. One example is a patient that\u2019s trying to quit smoking.<\/span><\/p>\n

\u201cIf you\u2019re underestimating how much you\u2019re smoking, then I\u2019m going to give you the nicotine replacement for that amount,\u201d Ruff says. \u201cThen you\u2019re going to come back to me and it\u2019s not going to work.\u201d<\/span><\/p>\n

\u201cIntervention\u201d doesn\u2019t have to be scary<\/h3>\n

What should it look like when your doctor wants to have a conversation about habits that create cause for concern?<\/span><\/p>\n

For conversations about drinking, there\u2019s \u201ca fairly particular framework around how that conversation happens rooted in the framework around <\/span>motivational interviewing<\/span><\/a>,\u201d says Randy Brown, associate professor at the University of Wisconsin School of Medicine and Public Health. \u201cThe idea is to get a sense of where the patient is in terms of their own desires around behavior changes, providing concrete feedback around why the provider is concerned about it, and then negotiating a set of goals around what might happen.\u201d<\/span><\/p>\n

Those goals may or may not include going cold turkey.<\/span><\/p>\n

\u201cHistorically, a lot of the treatment around the US was pretty firmly rooted in 12-step approaches that are abstinence-focused,\u201d says Brown, who also directs the Center for Addictive Disorders at UW Hospital and Clinics. \u201cNot everyone is going to feel comfortable with the idea of being told that abstinence is the answer and they need to start doing that right now.\u201d<\/span><\/p>\n

Your doctor should meet you where you are, Brown says. That doesn\u2019t mean sugarcoating the situation or validating your decisions, but it does mean evaluating your drinking habits in context, not just zeroing in on the number of drinks you report.<\/span><\/p>\n

\u201cWhere it is important for patients to be reflective is not necessarily a pure focus on the quantity [of drinks],\u201d he says, \u201cbut whether or not they have some idea that a pattern of use may be contributing to a hazard in their lives.\u201d<\/span><\/p>\n

When I talked to my doctor about how much I was drinking, I didn\u2019t get the feeling she was looking at my full health picture or curious about my alcohol use in context. I felt chastised and ashamed, and I haven\u2019t been back to see her since. Does that mean it\u2019s time to find a new primary care provider?<\/span><\/p>\n

You shouldn\u2019t feel like you need to lie about your own [drinking] habits just to appease [your doctor].<\/span><\/p><\/blockquote>\n

\u201cI think that\u2019s totally valid,\u201d Brown says. What it doesn\u2019t mean, though, is that I should go with the first doctor who tells me it\u2019s fine to throw back more than seven drinks a week. It also doesn\u2019t mean I\u2019ll be able to avoid uncomfortable conversations completely.<\/span><\/p>\n

As telehealth becomes more widespread, conversations about drinking and taboo subjects can also become trickier.<\/span><\/p>\n

\u201cIt\u2019s so much easier to have these difficult conversations in person,\u201d Ruff says. \u201cBecause there\u2019s less small talk virtually, I find it harder to assess some of the social behaviors that are much easier to assess in person.\u201d Ruff says most of her virtual visits address a specific concern rather than a general health check, which doesn\u2019t create an opening to discuss drinking habits, for example.<\/span><\/p>\n

\u201cThat may change as the pandemic goes on,\u201d she says. \u201cFolks might do more general wellness via virtual visits once it becomes more and more clear that this is the way of the future.\u201d<\/span><\/p>\n

Considerations when switching providers<\/h3>\n

Traditionally, \u201cfor your primary care doctor, the idea is this person is going to be with you for years, if not decades,\u201d Ruff says. \u201cIt\u2019s reasonable to find someone who fits with you.\u201d In her own practice, Ruff says her colleagues all have \u201cdifferent flavors\u201d: Some are paternalistic and stern, others are more casual and laid back.<\/span><\/p>\n

Brown notes that patients should feel empowered to steer conversations about drinking and other touchy topics in the exam room. If you know your doctor\u2019s style is to condemn any level of alcohol use, you shouldn\u2019t feel like you need to lie about your own habits just to appease them.<\/span><\/p>\n

\u201cIdeally the patient would be able to say, \u2018I\u2019m drinking beyond what I know is recommended. I\u2019d appreciate us not taking up a lot of our visit talking about it; if it is an issue, I will talk to you about it,\u2019\u201d he says.<\/span><\/p>\n

However, even if you\u2019re not experiencing any immediate consequences from your habit, it\u2019s still your doctor\u2019s job to inform you about the risks.<\/span><\/p>\n

\u201cEven lower levels of [alcohol] consumption can increase risk for breast cancer and may have some impact on cognition later in life,\u201d Brown says. Alcohol can also interfere with management of hypertension, diabetes, depression and mental health issues.<\/span><\/p>\n

Unfortunately, there\u2019s no hack for finding the doctor that fits you best. Landing on the right one might take trial and error. But both Ruff and Brown agree that your doctor\u2019s role is ultimately to help you lead a healthier life, and sometimes difficult discussions are part of the equation.\u00a0<\/span><\/p>\n

If you\u2019re switching providers, you might be tempted to avoid sensitive topics altogether if you had an unpleasant experience in the past. But Brown suggests getting ahead of the issue and addressing it with your new provider at the first appointment.<\/span><\/p>\n

The conversation can be simple, he says: Consider saying something like, \u201cI\u2019m switching providers because there is this issue, and the relationship between [us] was a bit challenging. I\u2019d like to hear more about your approach.\u201d<\/span><\/p>\n

As for whether your doctor is secretly rounding up your number of drinks, cigarettes or sexual partners? It\u2019s unlikely, unless your test results contradict your story. But even if you question your doctor\u2019s assumptions, your best bet is to be forthcoming.\u00a0<\/span><\/p>\n

\u201cAs much as my patients expect me to be honest about what I think is going on with them, I really do expect that my patients value our relationship enough to be honest with me,\u201d Ruff says.<\/span><\/p>\n

This makes your doctor\u2019s job easier, and frankly, it makes yours easier too: no mental math, no fudging the truth, no stories to keep straight \u2014 just unfiltered conversations that help your doctor see the full picture of your health.<\/span><\/p>\n

\n

Ready to book a doctor’s appointment? Visit Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

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