Jedi Mind Trick

She was a pretty typical drug seeker, or so it seemed. There were multiple visits to our ER over the past few weeks, including one on the previous day. Fortunately she'd already had quite an extensive workup, and she had been given adequate prescriptions for powerful narcotics and even a few alternative analgesics. Her husband had called triage looking for her, and he told us that she had been going around to various ERs to obtain narcotics and that she'd just left another hospital across town. It seemed that there really wasn't going to be much that I could do for her except to have an unpleasant discussion.

I asked her the standard open-ended question, "So what can I do for you today?" and she told me her litany of woe without mentioning any of her recent ER visits, perhaps hoping that I hadn't reviewed her prior records. She even requested Dilaudid 4 mg IV, saying that she was a big lady who had built up quite a tolerance for narcotics over the years. She was unfailingly polite and seemed almost embarrassed to ask for her drug of choice, as if she didn't really want it.

When I mentioned that her husband had called, she wasn't upset at all; in fact she seemed relieved. We discussed her pain, her addiction, her family, and her options for more appropriate management of her condition (and her life).

Despite receiving no medications whatsoever during her visit, she thanked me and complimented me by telling me that I was the best doctor she had ever seen.

Sometimes what you want isn't really what you want.