Ask the right question!

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Sep-2015) appears below with kind permission from DDN.

Marco rarely came to the surgery; he was a 44 year old restaurant owner with two young children but on a routine screen had been picked up as having high blood pressure. He had been given advice to lose a little weight and exercise more but this made no significant difference to his blood pressure. He was started on an anti-hypertensive and his blood pressure improved but 12 months later it was up again and as he was adamant he was taking his medication every day, a second drug was added in. Three months after this he had come back to see one of our registrars and she had noticed his blood pressure was again poorly controlled. She decided to discuss this with me as part of her learning portfolio.

His notes showed he had been overweight but his BMI (Body Mass Index) was now 26 so this was unlikely to be a significant factor, he had stopped smoking when his first child was born 7 years earlier, his renal function was normal and no significant past medical history was recorded. I asked her if he drank alcohol. “I’m not sure,” she said and indeed nothing was recorded in his notes about alcohol consumption. I explained that excessive alcohol use was a major factor for hypertension and cardiovascular disease a fact unknown to many patients – and quite a few medics as well!

He was due for review the following week and told her he drank a bottle of red wine every day, as it was good for his heart! She explained to him about the effect alcohol has on high blood pressure and cardiovascular disease and he had been shocked by this. He decided to try and cut his alcohol down rather than take a third medication. His blood pressure improved over the next few weeks and it was possible to stop one of his tablets.

I was the next person to see him and this time his blood pressure was within the normal limits albeit that he was still taking a single drug to control his blood pressure. He told me he had reduced his alcohol to half a bottle one night during the week and half a bottle each day over the weekend. I wonder how many patients have physical and mental health problems related to their drug or alcohol use that pass unnoticed because a health professional doesn’t ask.

SMMGP have launched an introductory online training module about the Community Management of Alcohol Use Disorders which can be completed free of charge on the SMMGP e-Learning website.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.