When I am facing an alcoholic in the office, I do not advise him to stop drinking.
Other physicians may advocate a different approach. We live in a free society and individuals are free to make their own choices. I have decided, for example, not to own a firearm, ride a motorcycle or bungee jump as these activities are not only beyond my risk tolerance threshold, but are also activities that I have decided would not enrich my life. Many smokers, though addicted, enjoy the experience and are aware of the risks of this activity.
My responsibility as a physician is to inform and counsel, not to lecture or preach. I tell alcoholics with clear candor the medical risks they face if they decide to maintain this lifestyle. I advise them that if they wish to aspire to sobriety, that I will refer them to appropriate professionals for treatment. I further inform them that in my decades of experience, very few alcohol addicts can quit on their own, despite their vigorous declarations that they can do so.
Finally, I tell them that if they decide to venture on the difficult journey away from wine and spirits, that I will be there at every step to assist and encourage them. However, there is no hectoring or finger-wagging from me. No threats or intimidation — which never work anyway — just cold facts and honest predictions. The patient is then free to make his decision, as he is with any medical proposal.
Patients aren’t obligated to accept my advice. Indeed, the bedrock concept of informed consent places the authority of the decision where it properly resides, with the patient.
Alcoholism is an insidious disease whose tentacles slowly suffocate the addict and causes many friendly fire casualties. Yes, I am aware that there may be a genetic predisposition to the illness, but at some point, the decision to drink was still a choice. Ultimately, only the afflicted one can cast off the chains.
What do you think? Am I derelict by not delivering an energetic exhortation, “You’ve got to stop your drinking!” Is it my job to tell patients what to do, or to give them a fair presentation of their options so that they can choose for themselves?
Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.
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