Today I had to take a history from a patient who needed a repeat on her prescriptions. During the consultation, I dutifully took an alcohol and smoking history. The patient stated that she drinks 1-2 bottles of wine every Friday and Saturday both because it would help her sleep (she has recently had trouble sleeping) and because she “liked to drink wine”.
Alarm bells went off in my head.
I asked her more about this. She said that it was her only vice. She didn’t do it any other night of the week and she stayed home and went to sleep promptly. Her boyfriend didn’t like that she had this drinking culture, but she knew she was in control. She was aware that this was more than the recommended limit for drinking alcohol in a week, but she wasn’t interested in stopping or decreasing this amount because she was sure she was in control.
I have been trained in my last few years of med school to discuss risky alcohol drinking with patients and offer proper advice. There were numerous role-playing teachings and lectures that endlessly talked about the risks of over drinking and how to approach this with a patient.
But in this situation, I failed to do all of those things.
What I did was listen, explore as best as I could whether the patient was aware that she was drinking above the limit, but then when it came to the part where I should have asked her about cutting down and offer advice, I didn’t.
I cannot explain why. I don’t know why. But I am embarrassed. This woman was binge drinking. It was a substantial risk to her health. But being me, the little 5th year student in a GP practice, just seeing patients for my own learning, I felt grossly inadequate. I didn’t feel like I had the right or ability to offer advice on such things. I really don’t know why I felt like this. But I felt I seriously failed the patient. I shied away from offering advice. I knew it wouldn’t have mattered exactly what I said. Because studies show that just very brief advice is enough to get patients thinking about their behaviours in order to change them.
Then why didn’t I do it?
I have no idea.
I should have. My own view of myself. The fact that I felt too low in some invisible hierarchy, stopped me from helping a patient. I can’t explain why I felt this way. I wonder if lately I’ve decided that my voice isn’t good enough to help change anyone or anything. But even if that were the case, it doesn’t matter because, by focusing on whether or not my voice will be helpful, I essentially stopped the patient from receiving necessary advice to benefit her health. And for that, I am disappointed in myself.
I informed my GP about the patient’s drinking after she left, because from her notes, I could see that the GP had not addressed this either. But then again, GPs don’t have enough time during consults to explore all aspects of the patient’s health. I was there. I could have done something about it. I know this is a health risk, one that may be harmful for the patient and one that probably wouldn’t be addressed at all atleast until the next time she decided to visit the GP. By then, who knows what could have happened?
I hate this feeling. I hate thinking I may have failed a patient. I hate knowing that I had failed them because of some ‘view’ I have of myself that isn’t even true. I didn’t feel like I was the best person to offer advice to this patient. I was wrong. I was the person to offer advice in that situation. I was possibly the only person who could have offered advice. And I had all the tools to do so.
It probably isn’t as bad as I’m making it out to be, but it probably is. I feel guilty.
I hope that I always remember this situation with this patient. I need to be mindful of where I let my weaknesses hold me back from helping a patient.
I’m sorry if this post is rather morbid. But in the absence of having people to talk to about my thoughts, this blog serves as good avenue to share my thoughts and keep as a reminder of this day and what I have learnt. I can only hope I rise to the challenge next time and actually do what I am capable of doing and what needs to be done by me.
And I hope I have learnt my lesson.