I saw a patient in Urgent Care for a wound caused by drunkenly walking into something the night before. He admitted to already having spent time in prison for endangering others by driving while intoxicated. He wasn’t driving this time, but obviously he has not stopped binge drinking. While his use did not suggest alcoholism, it certainly qualifies as an alcohol abuse disorder. I cleaned the wound and tried to make as big of an impact as I could about his abusive drinking. I asked questions. We discussed strategies. I told him stories.
Very early in my career, I did a physical on a young patient. He marked on his paperwork that he would consume 10 or more beers on a weekend night out with friends. I remember this so clearly because he died a horrific, binge drinking related death. Upon recognizing his name on the radio, I immediately pulled his chart and reviewed my notes. There I read that I did talk to him about the dangers of excessive drinking, but I still felt a little bit guilty. My speech obviously did not make a strong enough impact. Did I go into the standard, rote dialogue of don’t smoke, don’t drink to excess, don’t drink and drive, wear your seatbelt? Probably. Could I have spent more time and made more of an impact? Maybe. I’m sure I was rushed for I was seeing 25 patients at a time on most days. For years, I wanted to go back in time and deliver my message to him more thoughtfully.
Much later, a close friend of mine spent time in prison for a drunk driving accident that injured his friend. Everyone thought I was harsh by not feeling outraged by his sentence. I love him and didn’t want him to go to jail, but I also didn’t rage against the injustice of it because I thought the penalty was just. At least he didn’t kill his passenger. That would be the worst sentence. I guess I had been forever impacted by my patient’s story because it was his best friend that was driving. And, his best friend didn’t die. He lives and remembers.
Per the CDC, binge drinking is the most common, costly, and deadly pattern of excessive alcohol use in the United States. Drinking too much, including binge drinking, cost the United States $249 billion in 2010. These costs resulted from losses in workplace productivity, health care expenditures, criminal justice costs, and other expenses. Binge drinking was responsible for 77% of these costs. Binge drinking is when men consume 5 or more drinks or women consume 4 or more drinks in about 2 hours. Binge drinking is most common in men between ages of 18 and 34.
Do I think that taking the extra time to talk to the patient in Urgent Care about his drinking made a difference? Probably not. But, he wasn’t driving so maybe jail did make an overall difference. And, if I read about him in the news months from now, at least I won’t feel guilty for not giving it my all.