A reader, Neon, poses the question on how to define an alcoholic:
So, when you see a patient that admits to consuming a 6 pack of beer and 2-3 whiskey's per day, do you automatically label that individual an alcoholic? Where is the line drawn? Is a glass or two of wine acceptable? Is it ethical to label an individual an alcoholic in their medical file with the claim of drinking the above beverages without actually documenting other criteria of dependence?
In my documentation, I never document alcohol addiction. If they get admitted intoxicated, I label them as alcohol intoxication. Many folks suspected of drinking more than three drinks (my criteria) a day gets an automatic consultation from the alcohol nurse specialist?
Why? Because that's what they do for a living. Most of the time patients lie about their alcohol consumption anyway (in residency I was taught to take what ever number I am given by the patient and double it). That's what addicts do. They lie.
I let the alcohol nurse ask all the important questions about their alcohol history, legal, financial and marital problems related to their alcohol. And most of the time the alcohol nurse labels them as dependent, the patient refuses treatment and we all go on our merry way.
I once had a patient that I got called into to consult at 2 am for profuse sweating, tachycardia and fever and elevated blood pressure in a post operative patient. Hypertension causes me to act just as hypotension causes me to search for an answer. The patient swore up and down he didn't drink. I told him and his wife flat out that if they were lying to me he could die.
Sure enough, the wife comes of the room minutes after I left and told me her husband was drinking heavily. In less than two hours the patient was on a ventilator in the ICU.
I never believe how many drinks a drinker tells me they drink. I assume they will withdraw until they don't. And I let the alcohol nurse label them as alcohol dependence.
I agree that this person has problems and probably is an alcoholic. My concern was the fact of the provider using the alcoholism diagnosis code without true qualifying data to support this claim. Could this affect future insurance claims? What if he really wasn't an alcoholic and could stop at any time. Ok, so I probably stretching things a bit, but a label sticks.
ReplyDeleteI've often wondered why medical bloggers tend to gloss over alcoholism -- and can't believe that it all has to do with insurance concerns and coding. Where is the [disdainful] outrage that *you* direct toward smokers and fat suicidal people, that *others* direct toward rude and smelly crack/heroin addicts?
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