Thursday, 3 December 2009

Big Brother

We've had a new healthcare initiative added to our remit this year. The idea is to screen as many of our patients as possible for alcohol misuse, with the aim of making people more aware as to what constitutes dangerous drinking, and helping them to make changes before it is too late.

According to the Department of Health, 23% of adults aged between 16 and 64 years are thought to drink at hazardous or harmful levels. This includes a massive 32% of men (15% of women), and equates to approximately 7.1 million people in England.

Some definitions are needed here. The World Health Organization divides alcohol problems into three main categories; hazardous drinking, harmful drinking and alcohol dependence. Hazardous drinking describes drinking above safe levels, 14 units a week for women and 21 for men. Harmful drinking is the same but with evidence of alcohol related problems. Alcohol dependence has a much more complicated definition but basically describes the group that we would know as alcoholics.

So what's interesting about the 23% statistic is that it isn't talking about alcoholics, but about people who drink in excess of what the medical profession considers safe. It's referring to anyone you know who drinks more than a couple of glasses of wine a night, and according to the stats that's nearly one in four of us - in reality, it's probably more.

The problem of course, is that this group of drinkers doesn't think there is a problem. The government and the NHS do however, and in fairness, rightly so. Any sort of prolonged hazardous drinking can lead to liver disease, heart disease, even some cancers, and that's before you look at the social problems of relationship breakdown, financial problems and alcohol related crime.

So I do understand this drive to identify problem drinkers, and there's evidence to show that some brief advice from your GP can make all the difference. On the other hand, actually performing this mass screening is pretty uncomfortable. It's understandably difficult to launch into questioning someone about their alcohol intake when they've come to ask you about a toenail infection. It hasn't happened yet, but I'm just waiting to be told to mind my own business, an attitude that I would sympathize with completely.

So the point is, is it our business? The powers that be would say that anything that impacts on the nation's health should be, but as individuals surely we must be allowed to make at least some of our own lifestyle choices. I feel pretty strongly that what we eat and drink should be one of them. However that then leaves the question of where to draw the line; is smoking a lifestyle choice? Is injecting heroin?

It all comes back to that age old conflict between wanting to help and interfering, trying to protect and smothering. I have no desire to play the role of nanny, and yet I have seen the desolation that problem drinking can bring. So I do my best to follow this new initiative where I can, apart from anything else we will lose out financially if I don't. I try hard not to be too intrusive. As for how much the toenail guy drinks though, I didn't ask.

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