iStock_000010816304XSmallThere are certain things that in my experience can make it easier for a drug-seeker to manipulate a physician. A caveat: we’re not presently referring to ‘pill mills’, which are designed to shovel drugs indiscriminately. We’re concerned with ordinary practitioners in conventional healthcare settings.

Circumstances that facilitate manipulation:

The doctor’s in a hurry. We associate this with busy clinics— after all, it’s not so unusual for a physician to see 4000-6000 patients annually— but there are other contributors as well. A problematic patient in the waiting room who needs prompt attention,  for instance, or the need to make phone calls to other providers to coordinate care, or maybe just an obligation to pick the kid up from soccer practice. The busier the doc, the easier to manipulate. And there’s continuing downward pressure from practice managers to see more patients in less time. I recall when the standard was 30 minutes, later reduced to 20, now down to 15. Physicians whose average visit is even shorter may be rewarded by employers or payers for their exceptional ‘patient management skills’.

The doctor is inexperienced. Young physicians tend to be less confident in their decision-making, which can make them easier to manipulate. Unless they’ve received specific training in dealing with drug-seekers, which can serve as a counter-balance.

The drug-seeker is bold. There’s not really enough time for subtlety, so the addict often adopts a strategy for quick results. Example: arrive in possession of an authoritative medical history, and/or come across as so knowledgeable about your own case that the physician feels obligated to comply with your wishes.

Or with some docs, it’s enough to be so obnoxious or demanding that they give in to get rid of you. That’s a short-term strategy that may work for only a few visits— but that may be all the addict needs.

The physician doesn’t see the patient as ‘the type’. Many practitioners rely on their own mental picture of an addict, and as long as the patient in front of them doesn’t fit that picture— is better-groomed, for instance, with no visible tattoos or piercings— they reflexively exclude that person from the ranks of “potential abusers.” And docs come with class biases, too; some are automatically more suspicious of Medicaid patients than those who have private insurance. Whatever the prejudice, it’s easy for a drug-seeker to take advantage of it.

Given these issues, how do we teach practitioners to avoid manipulation? More in future posts.

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