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It's not in our nature to say no, but we must

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‘I want some painkillers for my back.’

With stubble you could have struck a match on, breath that would have made a hyena gag and body odour potent enough to simultaneously raise the dead and strip paint, he was never going to be short listed to play the next James Bond.

If we all try to imagine Jeremy Hunt as a drug addict from now on it will be easier to refuse him

I scrolled down his notes: ‘Opiate dependent do not issue with codeine based analgesia.’ This phrase peppered his notes. This was clearly going to be a challenging consultation.

Probing with even the mildest of questions like ‘how is your back pain worse today?’ revealed this character had a fuse shorter than a second hand firework and was only one can of strong lager away from committing GBH.

During GP training we were warned about the Friday afternoon drug addicts. They don’t wake from their drug induced coma until after lunch and they know Friday afternoons are usually when there are likely to be fewer doctors about and so they have more chance of intimidating their GP into giving them what they want.

I looked up from his notes and calmly explained I could only prescribe him painkillers without codeine in. There was a silence and I looked for signs of pallor. It is paleness in the face not redness that precedes violence as the blood drains from peripheries to muscles. He got up wordlessly and walked out, slamming the door just a little too hard as he exited.

I’m not sure I would have had the confidence to stand up to patients like him at the start of my career. A couple of years working in prisons, where half of your patients are trying to scam a codeine script from you helps develop the ability to say no.

It’s not in our nature or training as GPs to say no as a rule. We are trained to generally believe what the patient is saying, so the fact that some patients are deceitful, manipulative and would happily pimp their nearest and dearest for a vial of morphine is hard for us to get our head around.

Yet say no we must. Like spoiling children, giving in to patients does them and society no good in the long run.

Similarly, we as a profession must start to stand up and say no to whatever health ministers, the Government in general and any other self-important puffed-up authority tries to dump on us or bully us into doing.

It’s a tall order I know, but maybe if we all try to imagine Jeremy Hunt as a drug addict from now on it will be easier to refuse him. We need to think of him as an individual whose every request and action are based around getting something for himself regardless of the cost to others; actually maybe it’s not so hard.

Dr David Turner is a GP in west London

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Readers' comments (6)

  • brilliant

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  • Love your writing but I wonder if more an be done for these patients. There is a lot of patient friendly information on the net for managing pain. I have found some of these patients are ultra rapid metabolisers when you check their cytochrome P450 2D6 status. While I have some sympathy for patients with opioid issues I always say NO to codeine. I agree the profession must, individually and collectively learn to say NO to Hunt and the NHS bureaucracy. In fact I already have.

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  • Is this an appropriate way for a HCP to describe a vulnerable patient showing signs of self neglect?
    'With stubble you could have struck a match on, breath that would have made a hyena gag and body odour potent enough to simultaneously raise the dead and strip paint'
    Hmm...

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  • Funnily in Canada I get a lot f patients coming in for things like this to abuse or sell but they are almost never aggressive here.

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  • Anonymous | Work for third sector12 Aug 2016 5:23pm

    A patient showing no signs of wanting help?

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  • indeed. just drugs to sell/self medicate or get high on.

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