08 July 2013


Paramedics brought a patient into the ER who was involved in a motor vehicle collision. She claims she saw an object in the roadway and swerved to avoid it. After rolling an unknown number of times, her car came to rest upside-down. Because she was wearing a seat-belt, she was in pretty good shape when she came in.

Part of the initial panel of labwork for trauma patients is a blood alcohol level. This patient's came back as 0.14: way over the legal limit. I was surprised, because she didn't seem very intoxicated. This suggested something even more worrisome: that she consumed large amounts of alcohol regularly. Given her apparent willingness to drive under the influence, she was a lethal threat to herself and others. Drunk drivers kill.

I asked the patient if she had had anything to drink that day. She said that she had consumed only one drink that day, in the morning. I gently prodded her to see if she would fess up, but she stuck to her guns.

I don't think this patient should be allowed to drive until she gets help. But I was powerless to do anything. Patient confidentiality prevented me from reporting her blood alcohol level to the police. The best I could have done would have been to convince one of the doctors to formally diagnose the patient with alcohol dependency. Then the doctor could notify our state's department of motor vehicles that the patient had a diagnosed disease that threatened her ability to drive. But it's doubtful that the DMV would have done anything. And I don't think I could have convinced any doctors to do it.

Part of patient confidentiality is that we hold people's secrets. But some of these secrets are awful burdens. I wish they could see daylight.