Not Sure

Sometimes, you can't really be sure about what the patients are saying. They will tell you things that they want you to hear. However, how can you know if what they are saying is accurate? It's certainly not good to have to wonder about the validitiy of th einformation that you are given by a patient. People who take narcotics are always suspected of dishonesty. It is very common in the practice of medicine. Usually, I try to give people the respect that I expect. People do have pain. They do need strong medications. However, it is very rare that people actually drop their medications down the drain. Of course, it does happen. It's also very rare for people to have to get theri prescriptions filled in a different pharmacy than usual because of vacation. Sometimes, these things make me feel unsure. After a while, though, I can get pretty sure. No one drops their pills down the drain three times in one year. It's just not something that happens. I know this because in twenty years of practice, no one has ever dropped their entire prescription of antibiotics down the sink. In fact, non-narcotic medications seem to very rarely get lost in any way.
Some physicians have absolutely no tolerance for this. Everyone is lying if they tell you something that you don't want to hear. The problem is that there are too many people who ARE lying. It makes some people very cynical.
I try very hard to believe the patients. But lately, I'm not sure. I'm just not sure these days. I had a very difficult to understand patient today. The pattern of illness is just so strange. I always try to think that if something is very hard to understand it's because it's very hard to understand. The other way to think is the more common way. "If I don't understand it, then it must not be so." However, that assumes that I understand everything, which we know is definietly false. If I don't understand then there are TWO (definitely two) possibilities. Either that is how it is and I don't understand it OR that isn't how it is at all and I'm being deceived. So then you have to ask youreself if you really want to believe the patient or if you even CAN (assuming that you wanted to.)
Today I had a car accident patient who I'm just not sure about. They aren't "narcotic seeking" people. They just want to have a bigger injury than they have for a variety of reasons, the worst of all being deliberate desire to acquire a large settlement. They may tell us (physicians) things that exaggerate their illness. Well, this patient was clearly moving much better when I looked at her out of the window walking outside after our visit than she was in the office. She looked very different. So this makes me pretty sure that there is some exaggeration going on. At this point, I now don't really know what I'm going to do. Initially I just wasn't sure about what was wrong. Now, I'm just not sure about what exactly to do with the patient. If you tell a patient, "I don't think I can help you" they may still insist that you try. The option of telling them directly that there is a lack of trust always exists. But that creates a problem with your "caring" since it causes harm to the patient ("Above all, do no harm"). It is a small harm, of course. Still, it is a deliberate harm, and, in the event that you are wrong despite your certainty possibly a bigger harm than you realize.
I'm just not really sure.