I am not your Pez dispenser

Some patients never fail to amaze me.  I will start this by saying that I have absolutely NO PROBLEM giving pain medications to appropriate patients.  If you've had your hip replaced, you get pain meds.  If you have been sliced and diced by a surgeon, you get pain meds.  If you have cancer, you get pain meds. 

So where does that leave my patient with a "raging headache" from excessive coughing?  I'll also add that her coughing is from bronchitis which is a direct result of her smoking like a chimney.  The answer to the question is wanting more and more Dilaudid.  She's not getting it of course, but she sure wants it.   The "I'm allergic to every pain med except the ones that start with D" sign was readily apparent in this person when she basically refused to go home from the ER.  Being a good little hospitalist, I admitted the patient for observation (babysitting/shifting the responsibility/whatever you call it) and pain control.  Now we're coming up with a new symptom every day in an effort to garner more pain meds and testing.  I spend 20 minutes a day explaining why Dilaudid isn't appropriate for her headache and is probably making it worse.  On principle I should just discontinue it completely, but I do live in the real world.  If that happens, I (or my partners) get paged incessantly by the everchanging covering nurse for "intractable pain" better known as patient whining excessively.

Again, none of this has anything to do with the legitimate pain patients.

I also love when patients figure out a way to know who's on call at night and act accordingly.  It's inevitable that in the first hour or so I take call for my partners I will get calls about patients I don't know with complaints of "intractable pain".  Generally they've been weaned off of their big gun narcotics and just want them back.  I'm sure we get nasty comments about our "lack of compassion" or similar BS because the answer is almost always no.

Or maybe I'm just a jerk.