Table 1.

What Providers Say and What Patients Hear: Appropriate Drinking Level

Themes	Provider respondents	Patient respondents
Stop completely	“quit completely because we don’t know what amount, whether it is one glass of wine a month or one glass of wine a day that causes this increased damage.” (GI Physician Interview 1)	“every doctor that I talked to is totally against it (alcohol). Especially for someone with hepatitis because they said it was a hundred times worse to drink than someone who doesn’t have hepatitis C.” (Patient Interview 260)
Cut down	I really can’t say I run into that many difficulties with nonharmful drinkers. I ask them to cut down, or ask them to hold it for a month, a year, or until their treatment is over, or whatever.” (IM physician focus group)	“my doctor told me that my liver was in such good shape, so just cut down on your drinking.” (Patient Interview 6)
Occasional drink is ok	“I actually tell them, sure special occasions, weddings, holidays, things like that, are OK, but not to make it a habit.” (GI Physician Interview 3).	“One of my doctors says you can drink very moderately. You can have a little wine with your dinner. You can have a beer once in a while. My doctor did tell me that. But I didn’t believe him. I figured abstaining was the best way to go.” (Patient Focus Group 3)
Mixed/ambiguous messages	“I tell them that my suggestion is that they become a tea-totaler! That’s usually followed immediately by ‘You mean I can never have a drink?’ So I tell them that’s it’s probably unlikely that it would cause a great deal of harm if they had an occasional drink, like at Christmas, but I can’t swear to that.” (GI Physician Interview 6)	“Well, after I was diagnosed with hepatitis C, my doctors let me know the consequences of using alcohol. But you know, then again, they told me a glass of wine every now and then with your dinner wouldn’t hurt.” (Patient Focus Group 1)
Never routinely discussed alcohol	“If a patient comes in with symptoms or abnormal labs, then it comes up as part of the discussion, but on just a routine basis, talking about cutting down on alcohol or even the adverse effects of alcohol, takes a pretty minimal role.” (IM Physician Focus Group)	Interviewer: Doctors suggest any changes to lifestyle? Resp: “Just check my blood every 90 days.”Interviewer: “Did doctors or nurses talk to you about drinking alcohol?” Resp: “No” (Patient Interview 151)