SerpApi.Org
They say that alcohol makes you tell the truth. But when it comes to admitting to your doctor just how much you drink, it seems that more than a third of us cross our fingers behind our backs.
A recent study shows that 38 per cent of patients lie about their drinking habits to their healthcare professional. Two in five will even fib about how much alcohol they drink when filling out medical forms.
Meanwhile, 27 per cent make up the number of units they consume simply because they have no clue how many they are drinking. But with the NHS recommended limit of 14 units per week, most of us who like a drink can easily overtake this in a sociable weekend. A pint of strong lager contains three units while a medium 175ml glass of prosecco contains more than two units.
Here, two healthcare professionals reveal whether it’s a case of in vino veritas with patients in their clinics…
The doctor: ‘I can tell when a patient might be fibbing ’
Dr Nikki Ramskill is a GP based in Milton Keynes and the founder of The Female Health Doctor Clinic. She can be found on doctify.com
A few years ago, I worked for a private health company doing healthcare assessments where I had to ask patients about their lifestyle – including how much they drank. I noticed that around 70 per cent said they didn’t drink at all.
I found it so puzzling that it got to the point where I started worrying about my own drinking habits. I don’t overdo it, but I even asked a couple of my colleagues: “Is it me? Do I drink too much? Because surely, I can’t be in the minority here?”
What I’ve realised is that these patients were probably lying.
I put my hands up completely. I’m also one of those people who will stretch the truth slightly and say “only 14 units a week” when in reality, sometimes, it’s more.
Because, let’s face it, when you see your GP you don’t want to sit there discussing your drinking habit. No one wants to feel judged. It’s like when a patient is overweight. The last thing they want to talk about is losing a few pounds, they just want to talk about their specific medical issue.
Today, in my GP’s surgery and clinic, I find that some patients don’t lie to me outright about their alcohol consumption but will often downplay the figure, or be “honest” only about their “14 units a week”.
But I can tell when a patient might be fibbing because there are nervous giggles, usually from the women. Men tend to be more matter-of-fact and admit to being economical with the truth, saying: “Everyone does it, it’s normal.”
Sometimes the “miscalculations” are simply down to a lack of knowledge, however. I ask patients to break down those 14 units drink by drink and it turns out they are drinking about 14 pints a week or “two or three bottles of prosecco a week”. Then I tell them that that’s actually more like 28 units. You can see their surprise.
The Covid pandemic saw an increase in drinking, too. Six years on, I’ve noticed that some patients will now admit to me that yes, they do drink, “but not as much as I was drinking in lockdown”.
You can’t really tell whether somebody’s drinking too much just by looking at them. But it’s when I do a liver test or a full blood count, and it’s obvious if a couple of the markers are a bit “off”, that I can catch them out.
Sometimes this can be the wake-up call they need. If I tell them that something is going on in their liver or their red blood cells are a little bloated, you sometimes get a little more honesty – an “Oh yeah, I do probably drink more than I should.” At other times you still get complete denial: “No, no, there must be something else going on.” As a doctor, you have to be careful how you approach the issue because the last thing you want is a patient to feel judged. You’re there to help them.
Of course, occasionally I’ll see a patient and it’s obvious they have been drinking that day. Often their partner will have booked the appointment and will be with them, worried about them. Unfortunately, it depends on whether the patient will admit there is indeed a problem and will engage with getting help – sadly, it’s not always the case.
We may all drink far more than people in any other country but we simply don’t like to admit it. The good news is that I don’t see too many people with serious health issues from alcohol these days.
The dentist: ‘You don’t have to wait for them to open their mouths’
Dr Tarun Nagpal is a dentist and specialist oral surgeon who works in both private practice and hospitals across London, Surrey, Kent and Oxford
I would say that maybe a third to even half of my patients underestimate how much alcohol they drink. And while I’d never say that they lie outright, there’s definitely some generous “rounding down” going on.
Men tend to underestimate more than women, not realising that a “pint here” and a “pint there” can soon add up. But likewise, women who say they’re just having a “tipple” don’t realise that a small glass of wine is one unit.
I’ve noticed that my Gen Z patients mostly don’t drink at all – they all wear smart watches and can tell me their heart rate before they even sit down in the chair and I’ve measured them. They’re so in tune with their bodies and their health.
It’s older patients who have gone into retirement who are drinking far more than they realise. They have time on their hands to meet friends for drinks, or they will be drinking in their spare time. When you add up how much alcohol they consume, often they’ll be shocked.
I don’t see it often, but if a patient has been drinking heavily, I pretty much notice the smell of alcohol as soon as they walk in – you don’t have to wait for them to open their mouths.
But even if they have not been drinking that day, dentists can usually tell the drinkers from the non-drinkers. People who drink frequently tend to have drier mouths and areas where healing has been affected, a bit more bleeding, and these are quite obvious. Frequent drinkers tend to grind their teeth more (“bruxing”) because alcohol disrupts sleep. So we notice lines on the inner cheek and even on the tongue.
Drinkers will also have more acid damage to their teeth from fizzy wines or champagnes, or staining from the tannins in red wine. In the short term – apart from the dryness – there are few effects from alcohol on the mouth. But long term it can be damaging. While in isolation alcohol is not a main driver for an increase in oral cancer, if it’s coupled with other bad habits, such as smoking or tobacco chewing, you’re about twice as much at risk of having cancer formation. The first signs are typically an ulcer that doesn’t heal within two to three weeks and I always suggest that people get this checked out by a dentist rather than a doctor.
I’ve never had to turn down a patient who has drunk too much. For the past eight years I’ve been specialising in treating a lot of anxious patients and I always make it very clear that that little bit of “Dutch courage” isn’t going to help. If anything, a shot of whisky might actually counteract the sedative effects of the drugs we’re giving so it’s really important that they don’t try to self-medicate before treatment.
But I’m never judgmental about a patient and their drinking. I simply want them to be honest so I can look after and treat them properly.
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