BluegrassRN 1,188 Posts Has 14 years experience. Mar 10, 2010 These are such difficult pts to work with, simply because of the nature of their disease. The cycling of chronic vs acute pain, the shortened lifespan, the financial difficulties that accompany a chronic, debilitating disease; it's so hard.I do think a lot of chronically ill pts "use" the system. I also think a lot of them simply "know" the system. Like another pp, I work with about 4 scc pts routine. I know their food likes and dislikes, which pain meds work best in what combo, etc. When they present, they know what they need. It's not so much that I feel manipulated...it's that they simply know, through years of experience, what works. Most seem to be somewhat of control freaks, in part because there is so much they don't have control over. When control freaks (the chronically ill) meet control freaks (we medical professionals), sometimes it's great meeting of minds, and sometimes it's an ugly butting of heads.Mostly I find these patients difficult to work with because of the difficult nature of their disease. Honestly, these people could do *everything* right, be scary-compliant with all recommendations, and STILL suffer extreme, exquisite pain. You want to be able to help them, but sometimes no matter what, it doesn't work. I would be frustrated if I were them, too. I just want to remind us all, too, that the frequent flyers you see are the ones who, for whatever reason have great difficulty managing their disease. You don't see all the ones who are able to manage their disease well, and rarely if ever present for care. Recently I took care of a SCC pt, age 37, who had not EVER been hospitalized for her disease before. When I admitted her, I assumed she had just moved to the area, since I didn't know her from previous admissions. Imagine my surprise when she told me she had grown up here, she just had never before had a crisis so bad it required admission. When I said something about it being unusual, she just sort of put me in my place, saying "You think everyone with sickle cell is hospitalized all the time? Really? There are hundreds of us in this city, and I'll bet you hardly see any of us." She told me she has three siblings with sickle cell, and only one of them has been hospitalized more than once for it. She was right to scold me like that, I totally deserved it.