Your new patient arrives with her husband and their adorable children, ages 2 and newborn. She is a restricted recipient patient, meaning the insurance company has stipulated that she must see you as the gatekeeper of her care. You learn that your patient was recently released from prison for a drug charge. She is happy to be back with her husband and children. The husband never makes eye contact, but comments without looking at you, saying things such as “Let’s see what this one will do.”
You meet her and her children and learn that she has low back pain. She requests that you prescribe oxycodone. She tells you that the pain is unbearable “20/10″! She tells you that she does not have a stroller for her children and says, “I have to carry my kids everywhere and it hurts.” You prescribe PT and naproxen and recommend that she come back if this doesn’t work. She is not happy with this plan of care, but agrees to come back.
You secure a stroller through social services and bring it to the clinic for her next visit. The patient is angry and says, “I don’t need the stroller, I need some oxycodone”. My back is killing me! She adds, “What do you know anyway? You’re not a real doctor! I want to see a real doctor. ”
(True story) What would you do?
