But, doc, what will we do about my pain?!?

Anyone that has suffered through an internal medicine or family practice residency has likely had the unfortunate experience of working in clinic. (Sure, I realize other specialties do this as well, but an urology clinic is gonna see a different subset of patients than I do).

So, what is a medicine clinic like, you ask?!? In a nutshell, a complete and utter nightmare.

Basically, the clinic is comprised of patients without insurance or with only Medicaid who are seeking free or nearly free healthcare. Each patient is afflicted with multiple ailments, most of them chronic in nature - none of which they are motivated to manage. Maybe it wouldn't be so bad if....

1. Patients were compliant ....you know, they took their medications, came to their appointments, knew what their medical problems were and how they were being treated
2. Smokers insisted they couldn't afford their $4-per-month medications
3. Patients actually took responsibility for their own healthcare
4. Patients would lose that sense of entitlement so many of them seem to have
5. Patients didn't come in asking for pain medications by name ....(..."the ER gave me this prescription...hmmm, it started with a V...and that really seemed to work, doc. Can I have some of that?!?). I mean, seriously, what kind of idiot do they think I am?

Ok, so maybe I'm being a bit harsh. I have great relationships with a few of my patients. This month, however, I'm focusing solely on clinic and I'm frustrated.

A perfect example why:

Middle-aged white female with history of anxiety, ADHD, chronic pain (RED FLAGS, RED FLAGS!!!!) presented at 4pm on a Friday afternoon (my last patient of the day, of course). Chief complaints of worsening anxiety - she lost her psychiatrist-prescribed klonopin prescription - and pain, of course. And, can she have a prescription for either klonopin or ativan or some other benzo...just to get her through. And, of course, some vicodin. So, I explained all the reasons why I was not giving her either of these things. She proceeded to throw a complete and utter temper tantrum. She cried, she screamed, she advanced on me.

Now, listen, I didn't become a doctor so that I could supply people's habits. I certainly didn't do it so that people could sell my drugs on the street corner. And, there is evidence to believe that this is exactly what this lady was doing. Selling her klonopin and vicodin. Thirty-two providers had fallen for her story. Actually, more likely, thirty-two providers got sick of her antics and wanted her the hell out of the office/ER/urgent care center, so they gave her a prescription for 5 or 10 pills and sent her on her merry way. Dealing with patients like this make my head hurt. And, people wonder why I'm a cynic already.

Luckily, I then see the 77 year old woman with no medical problems and slight ankle pain - and all she wants is reassurance that she can continue to volunteer at 10 different organizations, carry cases of food to the food bank, and visit with her grandchildren without further injuring her ankle. It's these patients that give me hope and warm my heart.