Honestly, by nature I'm a snarky individual who can be very blunt and apparently has a deamenor that warns others to not even try. I've had patients and families "warn" me that they were demanding patients and were going to make my night hell. My typical response is I worked in psych for 7 yrs so it takes a lot. That alone (especially those who have been on bu before) usually curbs most behaviors. I also don't get into a power struggle... you don't want scds, fine, here's the possible consequence. I use empathy and tell patients the truth... I don't mind calling your pcp regarding pain, however they gave deferred all pain medications changes to chronic pain service who has not been here to see you yet, has noted this, etc.