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Independents' Day

The patients we can’t say no to

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You know who they are. They get angry with you and shout. They tell you with child-like impudence that they’ve come for help to get out and away from their pain. You have to help me, they say, and you have to help me now.

Then they hop from doc to doc, shopping from an abusable list, but they don’t use the respectable names like gabapentin, diazepam and dihydrocodeine. They call them gabas, blueies and diffs.

Eventually, if you’re worn out, broken down and full of doubt, you prescribe them. The gabas are snorted for euphoria, the blueies are necked with vodka and the diffs are taken when they can’t get any gear.

Our patients would never lie to us and we’d never forgive ourselves if we misdiagnosed. So we send them to expensive clinics for expensive scans to get to the bottom of things. And when they return it’s difficult to argue your way out, the hospital flimsy locks you tight into a cast-iron guarantee.

Some of our patients treat us like dealers, to pleasure and to placate, and sometimes it’s difficult to stop, because we have compassion and we’re scared of argument, hate and complaint. 

You know who they are.

We all know who they are. 

Dr Kevin Hinkley is a GP in Aberdeen.

Readers' comments (1)

  • Short answer - just say no.
    "Practice policy is no Benzos, no DHC and if you want anything with gaba in the name then I will refer either to a pain clinic (that should put things off for a while) if its pain or a psychiatrist (sorry CMHT etc) if its anxiety."
    Longer answer:
    If says addicted to DHC - refer to community drugs service. If says addicted to benzos (and not due to long term GP prescribing) there is no evidence that long term prescribing for addiction helps - but a reduction from say up to 30mg diazepam to 0mg by 2-5mg a week may help - but it needs nerves of steel if they say - can I stay on the same dose or go up again....they get one chance for a detox.
    And a tip - give them a good listening to first- and then tell them what your plan is. Never say no as a reflex action before letting them tell their story and asking a few pertinent questions.
    It is still possible to treat people compassionately whilst doing the "right" thing in terms of prescribing.
    If they dont like it then - at least you have done your best and it is their problem.

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