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ss nucleus - spring 2004,  Ethical Enigma 6

Ethical Enigma 6

Response to Enigma 6: A 35 year old man comes to see you and asks for diazepam tablets. He says he hasn’t had a drink for 24 hours and is starting to feel rough. On questioning he admits to a bottle of vodka a day. He is unemployed and lives in a flat next door to a pub. How can you start to meet his needs?

There is no straightforward answer to this one and it is not an uncommon scenario for a GP. Many doctors would consider this as a ‘heartsink patient’. Our attitudes as Christians have got to be different though.

The man before you is loved by God and, however desperate his situation appears to you, God has a purpose for him and his life. This is unlikely to be the last time you see him and your ongoing commitment to helping him must not be based purely on the chances of your interventions working. A Catholic gastrointestinal physician at our local hospital has a revolving door of alcohol detox patients who he admits over and over again, much to the exasperation of his juniors. However, after seeing his persistence over the past five years, I can’t fail to be amazed at his dogged perseverance. That must be a pale reflection of Christ’s perseverance with us.

So you want to help this man? Firstly you need to convince him that his reported 200 units of vodka a week is a problem. You might try this by a number of methods. You could ask him whether he knows what the recommended maximum weekly intake is (21 units over five days with two days off). Or you could ask him when he last had a day without a drink. Many alcoholics will not have had a drink-free day in years.

You are unlikely to persuade him in one consultation that he has a drink problem and are even less likely to be able to get him do something about it. You should aim to wake him up gently to the reality of the situation. I saw a 19 year old who had been drinking ten cans of lager a day for two years. He wanted a note to excuse him from work because he was depressed. I negotiated a one week note with him and asked him to go away and think about:

  1. whether he wanted to come off the drink
  2. what he wanted out of life
  3. what the purpose of his life was

He came back a week later and said he was prepared to give detox a go to cut down his intake. He has now completed it and is receiving follow up counselling. I am not saying he is cured; he may well relapse, but giving patients the time to think about their situation and what they want to do is important. And of course you can pray in your head during the consultation and in your daily prayer times for God’s help in the life of your patient.

You need to think about the diazepam prescription carefully. If you see it as a short term solution you are missing the point. It is bad practice to get patients dependent on benzodiazepines and your colleagues won’t thank you for it. A non-benzodiazepine drug such as zopiclone may be more appropriate, as it is less likely to cause dependence. You also need to consider why else he may want the diazepam. There is a surprisingly good black market for the tablets and patients may sell them to fund drug habits.

In some areas there are local protocols available to establish a contract between patient and doctor, which require the patient to produce a urine sample at each visit. This is sent off to check for the presence of the prescribed drug and illicit substances, confirming that the patient has taken them. The patient accepts that if the sample is negative for diazepam and/or positive for banned substances the prescription will terminate.

Finally this man lives next door to a pub. It is not the end of the world as most of us live within walking distance of the local pub and supermarkets have shelves loaded with cheap alcohol! However, depending on your opinion of an individual patient, you can decide which option of home detox versus hospital, or Christian hostel detox, will be most appropriate.

I have not covered all the aspects here; John Latham’s previous Nucleus article[1] considers the spiritual and practical aspects of addiction in greater depth.

Acknowledgment: Thanks to Rob Dent, final year student at Manchester, for his thoughts on this enigma.


Enigma 7

A middle aged gentleman who is very health conscious has recently been diagnosed with discoid eczema. When offered a prescription for a steroid cream he accepted reluctantly despite reassurances with regard to its side effects. He returns a week later saying he would prefer a referral to a GP in your area who offers homeopathy consultations privately. How do you deal with this request?

Please email responses to john.wenham@orange.net


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