Illustration: Ben Sanders
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.
drjustincoleman 
Impressed that you got a letter from DDU.
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It was an impressive list of recent prescriptions in the letter, too. I don’t know what his tattooing skills were like, but he had clearly mastered his current trade.
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So, at this point you’ll need to discuss harm.rwduxtion with him how did that conversation go?
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*Reduction
The hazards of responding from a phone.
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Somehow, he seemed to guess about the DDU letter – I was half looking forward to the showdown (and half not), but he didn’t ever return.
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a really fine, fun piece of writing, Justin, about a dismal topic. Well done
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Reblogged this on Rural General Practice and commented:
Primum non nocere, and that includes not prescribing drugs of addiction. It is hard to say no, but sometimes it is kindest.
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Behaviours and appearances can be deceptive. I had a 65 year old lady who tricked me, and I would have never known, until I decided to give the DDU a call right after the consult. As a doctor, being “had” is never any fun is it?
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Reblogged this on Genevieve's anthology and commented:
A brilliantly witty piece from Justin Coleman about being duped. I can certainly relate. I once had a regular patient with whom I spent 45 minutes talking about how she would tell her 10 year old daughter that she was dying of metastatic ovarian cancer. She was in tears, I was in tears. Understandably, she was on high doses of opioids for her cancer pain. It was only later I discovered her impressive medical documentation was fake and that she had neither cancer nor a daughter. It was all an elaborate hoax to get prescriptions.
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Your writing had me in stitches and in awe, Justin! Outstanding piece! I can certainly relate. I once had a regular patient with whom I spent 45 minutes talking about how she would tell her 10 year old daughter that she was dying of metastatic ovarian cancer. She was in tears, I was in tears. Understandably, she was on high doses of opioids for her cancer pain. It was only later I discovered her impressive medical documentation was fake and that she had neither cancer nor a daughter. It was all an elaborate hoax to get prescriptions.
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That’s pretty funny Justin – even by your high(ish) standards.
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Thanks Justin for sharing. There’s hope for us mere mortals 😊
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This is such a timely read for me a GPT2 just started in my second practice of shall we say not the best suburb.. have been duped 3x now and only came to my senses when I finally got off my lazy intimidated butt and rang the Shopper line to find my lovely young endometriotic (it’s a word) female had received 1630 tabs of 10 & 20mg Oxycodone EACH. Suffice to say I’m pissed at myself.
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Happens to us all, Pri Krish. The fact that you have insight (and are annoyed at yourself) bodes well for the future. The trick is to make your mistakes less often as you gain experience… but as my case demonstrates, it will still get you from time to time. All the best with your learning curve!
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Belated thanks for the response Justin!!!
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