Table 2.
Examples of Theme 1: Patients Disclosed Information Regarding Their Drinking, But Providers Often Did Not Explore These Disclosures
| Example 1 |
| Patient A: “Six beers … or maybe even 8 sometimes” |
| Provider 1: “Okay. Okay. Have you been able to take your medication on a regular basis?” |
| No further exploration of patient's drinking during this visit |
| Example 2 |
| Provider 2: “So maybe plain Tylenol would be a better choice …” |
| Patient B: “… I was worried about my liver on that. You said it's bad for your liver and then—” |
| Provider 2: “I'm more concerned—” |
| Patient B: “Well, I've been boozing” |
| Provider 2: “I know. I'm more concerned about your kidney function …” |
| Only reference to alcohol during this visit |
| Example 3 |
| Provider 3: “… you were drinking 4 or 5 drinks a day …” |
| Patient C: “… I—I backed off of that because you talked about weight” |
| Provider 3: “Yeah. Yeah. I noticed your weight's down a bit” |
| (199 lines later …) |
| Patient C: “I took Nyquil until I passed out and busted my fool head open. I fell off a chair” |
| Provider 3: “Oh. Well, we didn't check any lab tests at your last visit” |
| No other reference to patient's drinking during this visit |
| Example 4 |
| Patient D: “I freaked out and tried to self-medicate with alcohol … they got me [to the hospital] … and sobered me up … they took my blood sugar and it was up to 400 something … so I figured this last time when I was drinking that my blood sugar was probably way out of sight … because I drank enough to … raise my blood sugar way up there …” |
| Provider 4: “Well, how have your—have—have you been checking your sugars at all in the last few days?” |
| No further exploration of patient's drinking during this visit |
| Atypical example 1 |
| Provider 5: “I had some concerns after our last visit because you said that you tend to have maybe 6 drinks or so, or 3 doubles or something at night with the …” |
| Patient E: “No. I have—Well, yeah, I guess you'd call them doubles” |
| Provider 5: “Mm-hmm” |
| Patient E: “I have 3 martinis … And that's a regular routine … And I—I enjoy it” |
| Provider 5: “Yeah, I understand that” |
| … |
| Provider 5: “Has she or anybody else ever suggested that you stop or slow down drinking?” |
| Patient E: “Well, you consider that heavy. See, I don't. It's—and …” |
| Provider 5: “But anybody else in your life ever … ever say any…” |
| Patient E: “No. No. No. I'm up by myself until … what? … 12, 1 o'clock in the morning” |
| Provider 5: “Mm-hmm” |
| Patient E: “And I enjoy that time” |
| … |
| Provider 5: “There is the issue of how it interacts with your diabetes … And the blood sugar. And I think we need to maybe get some—we need to get some more objective data, you know, uh, find out what your sugar does, what effects uh, uh, your … your …” |
| Patient E: “Mm-hmm. Well, yeah. I understand it turns into sugar” |
| Provider 5: “… That's the problem with alcohol is that it causes—I mean, it spikes in your blood sugar. And that can be difficult to control even with medication …” |
| … |
| Patient E: “You're actually right [that my drinking is not good given my diabetes]. But I'm 66 (laughs) and …” |
| Provider 5: “Would you be willing today to uh, uh—it's been awhile since we did—you haven't had labs for a long time, actually—to do some labs” |
| Patient E: “Sure. You bet” |
| Provider 5: “And we can also look for some markers on—on the alcohol and see if that's uh—if there's objective, uh, physical findings” |
| Patient E: “Okay. Fine” |
| Provider 5: “Then it might be a problem” |
| Patient E: “That sounds good to me” |