I rarely do, but once I had one of our frequent flyers who is in his 20s and a pathetic alcoholic who comes in with abdominal pain and wants narcotics. He has had pancreatitis several times, but often his amylase is WNL and he still presents with this manipulative clock watching neediness.
So one night he got the unassigned doctor who has the most old-fashioned views about pain control. For the needy types he always orders it IM and definately doesn't buy into the current thinking on the subject. My patient was whining and wheedling. The doctor wouldn't up his pain med.
Finally, I put my foot down and chewed him out. I told him he should be ashamed of himself for drinking again, that he was self-centered and thoughtless for the well-being of his two young children. I told him that the doctor was not going to give him more pain medicine so he might as well stop ringing his bell because I was busy with other patients who hadn't gone on a drinking binge to land themselves in the hospital.
Didn't hear a peep from him all night, and he's always on his best behavior when he sees me.
