Probing alcohol use poses ethical dilemmas for doctors

PRESS RELEASE

For immediate release: Wednesday, 23 January 2013

Assessing alcohol intake in patients is an essential element in clinical history taking and examination but it can also bring potential ethical dilemmas for doctors, says UK-wide medical defence organisation MDDUS.

Alcohol abuse is a major public health concern which causes thousands of deaths in the UK each year. The huge burden placed on the NHS as a result of alcohol-related illness is well recognised by government, prompting initiatives such as minimum pricing – already passed in Scotland but currently subject to a legal challenge by the whisky industry.

Alcohol Concern, meanwhile, is running a Dry January campaign this month in an attempt to highlight the problem and encourage a healthier lifestyle.

MDDUS medical adviser Dr Barry Parker says: “Doctors are well placed to identify excess alcohol intake in patients, either in the course of investigation of presenting illness or through opportunistic questioning during consultations. Once identified, appropriate advice, counselling and support can be offered to tackle the problem.”

But MDDUS has dealt with a number of situations where such intervention has led to conflict between doctors and patients, producing ethical dilemmas relating to confidentiality.

“It is extremely important that excess alcohol intake is identified in order to make patients aware of the risk,” says Dr Parker. “But patients may not always be aware of the consequences of such a disclosure.

“For example, insurance or occupation-related medical reports sent to the patient’s GP for completion may ask specifically about smoking and alcohol history and, under GMC guidance, the doctor must ensure that any such reports are accurate and do not omit relevant information or be misleading.

“Patients must consent to the release of reports, but they may wish the report completed but dispute the inclusion of the documented alcohol history, leading to disagreements.

“Furthermore, those with significant alcohol misuse may pose a risk to themselves or others, either in the workplace, if using firearms, or if continuing to drive when under the influence of alcohol.”

The GMC provides specific guidance to doctors in relation to any medical condition that may make driving unsafe. “Whilst it is the legal duty of the patient to report a condition of this kind to the DVLA, should they fail to do so and continue to drive contrary to the doctor’s advice, then the doctor should inform them that they will notify the DVLA medical officer and then confirm this has been done in writing to the patient,” adds Dr Parker.

“Another contentious issue relates to shotgun licences. Patients may feel that their history of alcohol excess is irrelevant to the holding of such a licence, arguing that they would only use a gun when sober. The GP must try to assess whether the reported pattern of use of alcohol poses a risk to the patient or others if he has access to gun use, and disagreements may arise.

“Doctors may have to breach patient confidentiality and must consider whether the actions of the person might pose a risk to himself or others and report that concern, with or without the patient’s consent.

“As there are clear lifestyle, occupational and economic consequences to such disclosures, it is unsurprising that patients may object. It is therefore important for the doctor to handle these situations sensitively, explaining in clear and consistent terms that these actions are often in the best interests of the patient.

“In addition, they are supported by the GMC in making public interest disclosures, where the risk of serious harm to the patient or others can be shown to outweigh the benefits to the doctor patient relationship of maintaining confidentiality.

“As with all ethical challenges, the key to managing these situations well is good communication throughout, so that there is at least a clear understanding of the reasons for actions taken.”

Ends

For further information contact Richard Hendry on 0845 270 2034 or 07976 272266, or email rihendry@mddus.com.

Note to editors

MDDUS (The Medical and Dental Defence Union of Scotland) is a medical and dental defence organisation providing access to professional indemnity and expert medico- and dento-legal advice for doctors, dentists and other healthcare professionals throughout the UK. For further information on MDDUS go to www.mddus.com.