This month I got done over by a drug seeker. Tattoo Man basted me like a Christmas turkey, peppered me with garnished praise and slow baked his way through my seasoned outer crust. Bugger.
Usually, when it comes to slamming the script pad shut, I’m all Fort Knox.
Reception deliberately sends all hopeful newcomers down dead-end street to my brick wall. Five minutes later they exit, loudly proclaiming to the waiting room that, in effect, my clinical decisions are being influenced by the rather unlikely combination of both my genitalia and distal GI tract.
Funnily enough, those occasions are relatively easy. My patients in the waiting room know me well enough to guess what might have happened. And everyone knows their role: the receptionists blame me, as instructed, and I blame our Practice Policy—the only thing I’ve ever written which remains unsigned.
“Sorry madam, I’d love to help now that your grandmother mistook your oxycodone for pot plant fertiliser, but Policy says no. Those bureaucrats in Canberra are blighters, aren’t they!”
In my enthusiastic early career, I used to agree to phone the patient’s previous prescriber, as listed on the tattered support letter thrust under my nose.
But inevitably, while waiting for that doctor to return my call, I’d hear a litany of personal misfortune which made Jean Valjean’s life look positively un-miserable.
We doctors are only human. It’s hard to refuse someone chemical solace after having spent ten minutes busily nodding at them in empathetic concurrence.
Even more awkwardly, the previous prescriber might sheepishly confirm he had indeed been serving elephantine doses to this pain-ridden, opioid-deficient chap in front of me. And the benzos were just to take the edge off the meds for adult ADHD—blame that one on the psych.
So I soon decided that brick walls don’t need phones.
These days (except for Tattoo Man) I cut to the chase and play my refusal card early. This trumps the opening gambit of ‘non-morphine poly-allergy syndrome’ even before they play it, and not even their ace of spades (genuine dental caries and operational scars) will dig them out of this treatment hole.
“He came in with his mum.”
But none of my methods worked on Tattoo Man. Nice bloke, rough life, wanted little or nothing at first. He was about to open a tattoo business.
On the second visit he actually came in with his mum and made me feel like I was genuinely helping—who doesn’t need that occasionally?
The following week he even agreed to my medical student writing him up as a case study, and she completed a brilliant bio-psycho-social analysis. (Note to self: must remember to fail her).
By that stage, I had started prescribing.
For the purposes of this article, I’d prefer to keep his actual prescriptions confidential. This is for patient protection and also because it would make his doctor look like a gullible donkey.
I’d let you know precisely how donkeyish, but our Practice Policy now forbids passing on any information that may belittle a senior doctor—I added in that clause yesterday. Let it just be noted that the word ‘prescriptions’ is plural.
How did it all end? Suffice to say that my keen powers of observation finally kicked in when a warning letter from the Drug Dependency Unit appeared on my desk.
The problem with us brick walls is that sometimes we can be a bit thick.