The Medical Dilemma
There appears to be a lack of education in the medical community concerning alcoholism. Whether you believe it is a disease or a lack of self-control. The need exists for doctors to be trained just as they would for any other medical specialty. In my research I have found that while in medical school, doctors only receive between 24-30 hours of instruction on alcoholism. There are outside programs that focus on alcoholism but they are in the form of conferences, seminars and workshops. But these programs are most often for practicing medical professionals who have completed medical school.
Since medical specialties are based upon different systems and organs in the body rather than a specific disease, finding a doctor who is well versed in all aspects of alcoholism is extremely difficult. Most doctors don’t have the time to devote to such a time-consuming effort when the odds of complete recovery and relapse are not in their favor.
Most spouses or care-takers of the alcoholic put high expectations on their primary care physicians. It’s hard to understand that the medical doctor can only treat the physical body, and not the addiction. To complicate the situation, the alcoholic cannot always relate to the doctor what are his real physical complaints.
For several months Riley had complained to me about his back pain, stomach aches, headaches – a myriad of aches and pains. When I got him in to see a doctor, the doctor asked him why he came to see him. Riley stated that he felt fine, he was just there for a regular six-month checkup. Instead of asking ME what had been going on – the doctor did a cursory exam and asked Riley if he wanted to detox. Of course the answer was no. And the appointment was over.
In the earlier stages of alcoholism, it is reasonable to expect a medical professional to do everything possible to get the alcoholic into detox and rehab. But it seems that when that fails the doctor is at a loss as to what to do next. The family is still expecting the doctor to do something. They still believe that in this 21st century there must be something.
The truth is there is not much the physician can do. The only thing left is to monitor vital statistics and be brutally honest as to where the alcoholic stands in the scale between survival and death. The doctor can prescribe vitamins, minerals and supplements to replenish nutrients the alcohol deletes. He can also suggest the alcoholic begin a regimen of medication designed to reduce the craving for alcohol. The most important thing a doctor can do is be brutally honest about the issue of impending death as a result of excessive drinking.
It is my experience that the alcoholic will only hear from the doctor what he wants to hear. Because of that it becomes more important for the searing truth to be told over and over again. One of the by- products of alcoholism is selective memory, so the words – “you’re dying” – cannot be said often enough.
I have found few doctors are willing to be that honest with the alcoholic or the alcoholic’s family. Most doctors don’t want to say how long of a life expectancy is anticipated. The usual response when asked the question directly is a vague – “no one knows when a person's time will run out.”
I’ve been told that this has become an issue of legality. Doctors are being sued for saying a person will die and the patient ends up living. It seems like a crazy thing, but I have seen a recent news article that reinforces that theory. How sad that a patient is so angry that they didn’t die rather than rejoicing in the fact that they are still alive.
Alcoholism is a terminal disease just as cancer is a terminal disease. It seems doctors have no issue telling a cancer patient how much life he can expect. If vitals and lab results are monitored, I see no reason why a prediction cannot be made as to what to expect just as a cancer patient. The same formulas used to determine a patient’s standing on the UNOS List for a liver transplant can be used to determine an approximation of how much time an alcoholic has left.
It is at this point that physicians should turn their attention to the people who are caring for the alcoholic. In most cases these caretakers have an intimate knowledge of the alcoholic’s modus operandi than anyone else. Because they are bombarded with the insanity on a daily basis they can tell where the alcoholic is physically and mentally more than any health professional could ever determine in a 15-minute office visit.
I was shocked and dismayed when I was told that Riley was an adult and was perfectly capable of making his own decisions and that he could live on his own. On most days, Riley did not know the difference between his daughter and granddaughter. He did not remember that we had moved across country. He did not know how to work the TV remote. He did not remember to turn off the burners on the stove after cooking. To me these were vital factors to have a life of living alone, but one particular doctor did not agree.
There were four questions asked to determine his ability to live on his own:
1. What year is it;
2. Who is the current president of the
; United States
3. Where do you live; and
4. Do you feel you can live by yourself?
Riley answered all four questions to the satisfaction of the doctor. Because of those answers, Riley was deemed phsycially and mentally competent. Add to that, the fact that he has enough monetary income to provide a means of financial support, and the doctor was in agreement that he could live alone.
Contrary to this doctor’s determination, Riley’s family knew that he could NOT function – or function for very long – if he were not provided with supervision and support. This fact was supported by the next doctor who treated Riley who told him he could not possibly live in his own apartment without supervision.
This contradiction is frustrating for the family because the alcoholic will only hear what he wants to hear and will dismiss anything thing said before or after the desired answer.
That is why alcoholics need to be told the naked, gut-wrenching truth when it comes to their physical status as often as possible. Because medical doctors are persons of authority, having a doctor tell the alcoholic that he will be dead in 3 months is far more eye-opening than hearing it from a spouse.