A Difficult Conversation

A Difficult Conversation
I hate seeing other doctors regular patients. They have expectations of clinical behaviour of which I am totally ignorant. This lady was no different. I had never met her before. She was middle aged. She ran her own cleaning company.
She breezed in and said to me that phrase that I dread.

“I normally see Dr…This will be quick, I just need a prescription.”
So the conversation went something like this.

“Hello, my Name is Dr Armstrong. How can I help you.”
“Well, I just told you, I just need my usual script.”
“What usual script.”
“I just need my usual Panadeine Forte.”
“may I ask why you need Panadeine Forte?”
“I take it two to three times a week when I cannot sleep. I don’t abuse it. Dr… always gives me some.”

I checked safe script. She was right. Dr … was regularly prescribing it. There were no red flags against her safe script record. It appeared that Dr…was prescribing only small quantities of the drug and no alarms had been triggered in the SafeScript software.

I then asked her, “So you use it to help you sleep, is that right?”
“Yes, I’ve just told you, now please give me the prescription. I am in a hurry.”
She then looked at her watch meaningfully.

I explained to her that I felt that it was my role to manage her appropriately and safely. I explained that I felt that her use of codeine was inappropriate and that it could lead to dependency. I offered to help her deal with her insomnia in a more holistic way.

She then said, “Look Doc. You are being difficult. Are you, or are you not going to prescribe Panadeine Forte for me. Or do I have to go to Dr…?”
I replied, “No I am not.”

“Well you’re a useless waste of space then aren’t you!”

She walked out. An hour later she saw the other doctor. At least he came to me to let me know that he had prescribed for her, on the grounds that her use was not excessive and that a year ago she could have bought it over the counter.
Author: Ferghal Armstrong
Ferghal is an experienced medical educator and teaches the subject of pharmacotherapy to other doctors.
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