gkainz
Final Approach
I told my doc that I drink 2-3 beers a day ... but the days are Memorial Day, Independence Day and Labor Day.
Doggtyred
En-Route
All of that information actually has to be asked and documented (or in your case documented as refused)... but has to be addressed by the doc on your end with regards to billing.
Medicare 1995 and 1997 documentation standards require that level of detail for the higher levels of billing. Most of the insurance companies mirror those standards. Simply omitting that I addressed family history, or social history, is enough to knock an otherwise qualified higher level chart to a lower level.
Given that Medicare already pays on the cheap, and only 80% tops of that... you do what you can, legally, to maximize low reimbursement.
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Doggtyred
En-Route
I document what the patient tells me. I don't fudge it.
I'm more concerned about folks with higher average intakes, or people who admit that they drink "every day"... as this is a higher risk for DT's and alcohol withdrawal, which can have a direct impact on inpatient mortality and morbidity.
I watch those patients closer for agitation, fever, tremor, confusion that occurs 24-72 hours after the last stated drink...
If you've ever gotten the shakes and drink to calm them.... that's withdrawal.. and what I'm looking to avoid..
docmirror
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Dave, is daily, moderate drinking (defined as no more than 1/day for women and no more than 2/day for men) itself physiologically harmful, or is the concern that the patient will become dependent or begin drinking more?
It seems that the US and UK define moderation in terms of "X drinks/week" and "no more than Y in one sitting", and I get that, but I'm not aware of any guidance of the form "not every day" or "at most Z days/week".
It seems that the US and UK define moderation in terms of "X drinks/week" and "no more than Y in one sitting", and I get that, but I'm not aware of any guidance of the form "not every day" or "at most Z days/week".
RJM62
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One thing that has to be considered regarding definitions and guidelines for alcohol-related diagnoses in the United States is our Puritan heritage, part of the legacy of settlers who, in the words of Garrison Keillor, "arrived here in 1648 in the hope of finding greater restrictions than were permissible under English law at that time." Our standards for what is an "acceptable" amount of alcohol consumption are stricter, and our tendency to pathologize those who exceed those arbitrary definition much more pronounced, than those in other Western nations.
When I was studying for my CASAC certification years ago (which I obtained solely for purposes of volunteer work I was doing -- I never did it for a living), I realized that by the standards commonly used by the various agencies who write such standards, the alcohol consumption of everyone in my extended family, most of our friends, and close to the entire populations of every Mediterranean nation would be classified as "excessive."
In my Italian-American family, kids were (and still are) introduced to one glass of wine with dinner at age six. Of course, it's mainly water at that age, with the ratio of wine to water increasing each year until they turn 12 or 13, at which time the wine is no longer diluted.
For adults, having a glass of wine with dinner is simply assumed, and two glasses are not at all unusual. Wine glasses are as standard a part of table settings as forks and spoons. An additional glass or two during the day or evening are not unheard of, but not the norm.
And yet in my entire extended family, there has never been a DWI charged, job lost, marriage destroyed, liver ruined, house lost, bankruptcy filed, nor any other untoward event, either wholly or partially related to alcohol.
When I was in Europe, I noticed that the Italians in Italy (as well as people in most other countries I visited) drank even more. Having a glass of wine at one's work station raised not an eyebrow, and it was not uncommon for very old men playing briscola at tables on the sidewalk to go through an entire bottle each during a session -- often while their mothers and fathers watched them from upstairs windows, also sipping away.
And yet both in my own family and among the people I met overseas, both drunkenness and irresponsible drinking are very much frowned upon. I don't know if these statistics are still valid, but back when I was studying for the test, less than 2 percent of drivers tested at checkpoints in Europe were over the legal alcohol limits, compared to 2.7 percent in the United States. And mind you, European nations have drinking ages ranging from 14 to 18 as opposed to 21 in the United States.
I was also taught that clients almost always understate their alcohol consumption, which I doubted then and still doubt. I know that when I report my own alcohol consumption to a clinician -- really and truly a single glass of wine every day with dinner -- I usually detect a certain skepticism on the part of the person taking the information. Occasionally I've been further questioned about it. "Really? You can tell me the truth," and that sort of thing.
And yet for most people in my family, one glass of wine with dinner is in fact how much alcohol we consume, with the occasional exception of special events, when some may have two or three glasses -- almost never more than that. I suspect that's that's also true for many people of Mediterranean descent.
In summary, my opinion of the standards used to assess alcohol use in the United States has always been that they're a bit absurd. I was older and had seen more of the world than most of the students in the class, and such arbitrary and strict standards made no sense to me in that context. But I never said anything about it. I just took the course and answered the exam questions as expected. Why make waves? My goal was to get the certificate, not to change the profession. Maybe that made me a hypocrite. I just think it made me a pragmatist.
Nonetheless, my answer to your topic question is that I tell the truth, and to hell with whether or not they believe it. If further questioned, I'll tell the person taking the history that I've been having a glass of wine with dinner since I was 12, and with the exception of my years in the military and as an undergrad in college, I've rarely had more than that. Whether they believe it or not I don't know; and frankly, I care even less.
Rich
When I was studying for my CASAC certification years ago (which I obtained solely for purposes of volunteer work I was doing -- I never did it for a living), I realized that by the standards commonly used by the various agencies who write such standards, the alcohol consumption of everyone in my extended family, most of our friends, and close to the entire populations of every Mediterranean nation would be classified as "excessive."
In my Italian-American family, kids were (and still are) introduced to one glass of wine with dinner at age six. Of course, it's mainly water at that age, with the ratio of wine to water increasing each year until they turn 12 or 13, at which time the wine is no longer diluted.
For adults, having a glass of wine with dinner is simply assumed, and two glasses are not at all unusual. Wine glasses are as standard a part of table settings as forks and spoons. An additional glass or two during the day or evening are not unheard of, but not the norm.
And yet in my entire extended family, there has never been a DWI charged, job lost, marriage destroyed, liver ruined, house lost, bankruptcy filed, nor any other untoward event, either wholly or partially related to alcohol.
When I was in Europe, I noticed that the Italians in Italy (as well as people in most other countries I visited) drank even more. Having a glass of wine at one's work station raised not an eyebrow, and it was not uncommon for very old men playing briscola at tables on the sidewalk to go through an entire bottle each during a session -- often while their mothers and fathers watched them from upstairs windows, also sipping away.
And yet both in my own family and among the people I met overseas, both drunkenness and irresponsible drinking are very much frowned upon. I don't know if these statistics are still valid, but back when I was studying for the test, less than 2 percent of drivers tested at checkpoints in Europe were over the legal alcohol limits, compared to 2.7 percent in the United States. And mind you, European nations have drinking ages ranging from 14 to 18 as opposed to 21 in the United States.
I was also taught that clients almost always understate their alcohol consumption, which I doubted then and still doubt. I know that when I report my own alcohol consumption to a clinician -- really and truly a single glass of wine every day with dinner -- I usually detect a certain skepticism on the part of the person taking the information. Occasionally I've been further questioned about it. "Really? You can tell me the truth," and that sort of thing.
And yet for most people in my family, one glass of wine with dinner is in fact how much alcohol we consume, with the occasional exception of special events, when some may have two or three glasses -- almost never more than that. I suspect that's that's also true for many people of Mediterranean descent.
In summary, my opinion of the standards used to assess alcohol use in the United States has always been that they're a bit absurd. I was older and had seen more of the world than most of the students in the class, and such arbitrary and strict standards made no sense to me in that context. But I never said anything about it. I just took the course and answered the exam questions as expected. Why make waves? My goal was to get the certificate, not to change the profession. Maybe that made me a hypocrite. I just think it made me a pragmatist.
Nonetheless, my answer to your topic question is that I tell the truth, and to hell with whether or not they believe it. If further questioned, I'll tell the person taking the history that I've been having a glass of wine with dinner since I was 12, and with the exception of my years in the military and as an undergrad in college, I've rarely had more than that. Whether they believe it or not I don't know; and frankly, I care even less.
Rich
How, providing them cocktails? Does Medicare pay for Jack Daniels when prescribed to avoid DTs?
Stewartb
Final Approach
Most average guys would benefit from improving their eating habits more than their moderate drinking habits.
steingar
Taxi to Parking
Boy howdy. Problem is I suspect most average guys haven't a clue how to exactly do that.
pilot_dude
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pilot_dude
Only if they've lived under a rock the last few decades.
steingar
Taxi to Parking
Not at all. There is a ton of information available in the media, much of it contradictory, a lot of it bad. Not everyone has an advanced degree in biological science. Without one or some degree of science savvy I can see how someone might have a tough time working out a really healthy diet.
James331
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James331
Very well said
bflynn
Final Approach
Excessive alcohol use will impair insulin response over time, resulting in an inability to control blood glucose. Long term alcohol users are almost always T2 diabetic.
Stewartb
Final Approach
Isn't the only alcohol question on the FAA 8500-8 a yes/no regarding a history of alcohol dependence or abuse? Where does the number of drinks come into it?
pilot_dude
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pilot_dude
Really healthy I can see but there's no excuse for not knowing fruit is better than chips.
James331
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James331
BS
If you're in good shape and have a few beers or glasses of wine each day you're not going to always become a diabetic.
I'm more concerned with the 200lb purity who won't drink "the Devils juice" but eats crap and drinks mt dew all day.
Stewartb
Final Approach
Here's a good primer about eating right.
http://www.snagfilms.com/films/title/super_size_me
http://www.snagfilms.com/films/title/super_size_me
Doggtyred
En-Route
There are numerous studies that show that low level daily intake can have some benefits in the long term. Those benefits are said to be age dependent, and there is conflicting data from multiple sources. Some studies say wine.. some say liquor.. some think its the LIFESTYLE that wine drinkers lead that may be beneficial, lots of variables, correlation isn't causation, and I cant personally speak with authority on this subject. But I get something in my email feeds every couple weeks with a blurb about this or that was found to have a benefit, or not have a benefit, or the benefit disappeared after a certain age... Someone is always studying something.
Some folks have addictive personalities, and when they start, they just cant stop. Those folks are not good candidates for a low level daily alcohol regimen in search of a health benefit. It is much more likely to get out of hand and out of control in an addiction prone individual.
I am concerned with the daily drinker solely from a clinical aspect in a hospitalized patient who will not have access to alcohol during their stay, in that if they are a heavy daily drinker, sudden cessation can precipitate withdrawal, for which I need to be vigilant for. And given that every patient is an individual, an arbitrary definition of what is heavy and what is not doesn't always suffice. Particularly when the patient's pathology didn't bother to read or follow the arbitrary guidelines.
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Doggtyred
En-Route
Unsure, but I'm suspecting not. But they do pay for librium. And ativan.
We had a guy come into the ER in the 90's who was drunk on methanol (bad bad idea...) and we sent the resident home to get his stash of rum/vodka/whatever because we didn't have medicinal alcohol in the hospital...
Another time in the 2000's we had an old man who had like a 40-50 year 6-pack a day habit. Wasn't any point in trying to taper him off with librium as upon discharge he was going to be 6-packing it. Doc wrote he could have 2 beers with each meal, food service sent someone to the grocery store and he had a personalized supply for his stay. I think the hospital ate the cost.
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Doggtyred
En-Route
Have you ever looked at how many calories are in that beer you are moderately drinking? All carbs. No solutes. No nutrients.
I'd rather eat my calories than drink them.
Stewartb
Final Approach
No beer for me. No French fries or 30% fat fast food burgers, either. Now a filet mignon or similar lean protein with a steamed veg and a whiskey neat? That sounds excellent.
Stewartb
Final Approach
this has exceeded ridiculous. Good night.
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Snorting his way across the USA
Here's one for the experts: Let's say you drink, oh, say, 8-10 shots of whiskey a day on average, but over a 2-3 hour window in the evening. Are you an alcoholic?
RJM62
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Geek on the Hill
Insufficient information, in my opinion; but there are many who would say yes based solely on the amount consumed. I'd want to know about contexts and effects, and especially about what happens when the individual can't drink, for whatever reason.
If he had to be on a certain antibiotic for a month to cure a wasting disease, but a single drink would render the treatment ineffective, would he stop drinking? Would it be difficult for him? Would there be physiological or psychological withdrawal symptoms? Or would he simply shrug, say "Okey-doke," and not drink for a month?
Not all excessive use of a substance reflects an addiction. Sometimes it's just a choice.
Rich
Doggtyred
En-Route
Maybe.. Maybe not.. But I'd definitely call you a drunk... (assuming FAA standard body weight)
timwinters
Ejection Handle Pulled
Well, apparently this works both ways. I just got out of a follow up appointment for the appendectomy I had last week.
Doc "so you've avoided lifting anything over 10# like directed?"
Me "well, not really, I've probably been closer to twenty on occasion."
Doc "that's why we tell you men 10# when the limit is actually 20...we know you'll push it. Women we tell the truth to. Don't you dare lift anything heavier than that for the next week."
I couldn't help but to laugh and think about this thread. Was he serious about lying because most men will double it? I don't know but it certainly made me think of this thread.
Pretty damned funny.