Alcoholic spouse Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
PC
“What brought you in today?”
HPC
Assesses intake (type of alcohol and quantity) - “What type of alcohol does he/she drink?”, “how much do they drink?”
Ascertains whether binge or continuous - “Do they drink a lot everyday, or do they binge drink?”
Asks CAGE questions (G if all 4) to assess severity
Cut down - “Has anyone else told them that they need to cut down?”
Annoyed - “do they get annoyed when people talk about their alcohol intake?”
Guilty - “do they feel guilty about their alcohol intake?”
Eye-opener - “do they have to take a drink first thing in the morning to help them start the day?”
Seeks symptoms of withdrawal – “Have they had any hand tremors, sweating, headaches, nausea or vomiting, restlessness, anxiety?”
Asks about children at home - “Do you have any children at home? Are they being affected by this?”
Asks about domestic violence - “This is a sensitive question. Has your partner ever been physically violent towards you or abused you emotionally/sexually?”
Asks about mood - “How’s your mood been lately?”, “how’s your partner’s mood been lately?”
PMH
“Does your partner have any medical conditions?”
SH
Asks about occupation - “Does your partner currently work?”, “is their alcohol problem affecting their work?”, “what do you do for work?”, “is this going alright?”
Asks about other substance misuse - “Does your partner use any recreational drugs?”, “Have they ever injected drugs?”
ICE
Ideas - “what do you think could be causing your partner’s drinking problems?”
Concern - “is there anything that your worried about regarding your partner’s drinking problem?”
Expectation - “what were you hoping we would do for you today?”
Counselling
Declines to prescribe a “detox” - “I’m really sorry, but at the moment I won’t be able to prescribe a “detox”, but I can offer lots of practical advice on how to help your partner with their drinking”
Offers practical advice:
Cut down, don’t stop suddenly
Suggests alcohol diary - “Your partner could also keep an alcohol diary to check how much their drinking and when they are drinking”
Recognising triggers - “The alcohol diary can be useful in helping them to identify anything that triggers their drinking”
Avoid going to the pub straight after work - “Also they could avoid going to the pub straight after work”
Avoid buying rounds - “and avoid any buying rounds or drinking games”
Drinking a soft drink for every alcoholic drink and eating before drinking - “If they’re tempted to get an alcoholic drink they could buy a soft drink instead, and also eat something before they drink alcohol”
Suggests partner sees GP for exam (e.g. examine eyes, palpate liver) - “It’s important that your partner comes to the GP for an examination so we can check their eyes and have a feel of their liver.”
Suggests partner see GP for blood tests ,e.g. LFTS, GGT, Chol - “we would also like to do some blood tests to check their liver function”
Mentions support services: AA and substance abuse service (both self-referral) - “There are peer support groups available like Alcholics anonymous and you don’t need a referral from a GP to use them”
Considers vitamin B /multivitamins if diet poor - “How’s your partner’s diet like?”, “we would recommend that they take some multivitamins, especially vitamin B if they have a poor diet”
Considers work aspects, esp driving - “Do they drive?”, “we would recommend that they don’t drive when they’ve had something to drink as it can affect their concentration on the road and their reaction time”
Safety-netting
“If you notice any further symptoms like a fit, loss of consciousness, shakes, it’s important that you come back to the surgery urgently or go to A&E for a medical help”
Close consultation
“Thank you so much for speaking with me today. Before you go I’d like to give you a patient information leaflet. A great website to go to is NHS choices, which I’ll write on a piece of paper for you to take home with you.”
