Thursday, November 20, 2008

Fool me once...

I had a patient scheduled for a root canal this afternoon, and she no-showed. I was frustrated, because this patient needs a lot of work done and I tried really hard to get her in as efficiently as possible. When I was treatment planning her, she kept saying how anxious she was about having dental work done, so I sent out a medical consult to her doctor to get her a prescription for lorazepam, and harassed the doctor until it got done. She has a past history of prescription drug addiction, but I thought it was necessary to get her through all the work she needed to get done. The patient and I talked over the phone about this appointment (and the ones following) at least three times, so she definitely was aware that today was the day. And then she didn't show, and I couldn't reach her by phone.

I always get irritated with no-shows, just because it's so inconsiderate to me and my schedule. This one particularly bothered me since I'd put in so much time for the patient and tried so hard to meet her needs and help her out... and she has so much work that she needs done and I need to do, to fulfill requirements! I was still mulling it over while cleaning the apartment this evening (out of some misguided need to get something done today) when it hit me like a ton of bricks...

Drug seeker. Shit.

I feel like such an idiot for not getting it. She's on methadone, she says she's been clean for two years, but really that isn't that long. I let the fact that she was so sweet and timid fool me into busting my butt for her to get that prescription, because she knew she wouldn't be able to get one on her own with her history. I'm still so new at all this that I don't take charge of my patients as much as I should, and now I'm paying for it because I spent all this time on this woman and instead of helping her get the dental care she needed, I fed her addiction and now she's gone.

I know this happens and it's not necessarily my fault, and her physician did write the script (not me), but I can't help feeling kind of stupid. Maybe I'm being too hard on her and she has a good excuse, and she'll show up to her next appointment that I've already scheduled... but that's her last chance with me, I'm not getting her any more drugs and I'm not making any more appointments until she decides to show up. I'm just really, really frustrated that I let her deceive me like that!!


Tom & Shannon said...

what a crappy situation...i'm sure that happens to the best of them, though. it must be hard to know when to distinguish between someone who is clean and who needs it and someone who is not clean and NEEDS it. sorry!

Anonymous said...

My first counseling job during grad school was working with methamphetamine addicts, and I too went in wanting to help people and being a bit naive as someone who had never been a drug user. It didn't take too long for me to realize that some clients were taking advantage of my kindness and willingness to give them the benefit of the doubt.

It isn't your fault, and you shouldn't feel bad. It's good that you aren't cynical and suspicious of all your clients...over time you'll realize who is playing a game and who is not. Keep your chin up, and realize that there are a lot of people you are helping get dental care who otherwise wouldn't be helped :-)

Anonymous said...

Make firm boundaries with this woman. She is probably really good at deceiving others which is why she was able to do that with you. I doubt you are the first or the last person that will fall for her tricks. I work in psychiatry and used to work in a clinic that worked with a lot of ex-heroin users who were in a methadone program. Even in a setting in which I was specifically working with that behavior and knew to watch out, there are some really slick people out there and you only realize afterwards. But, trust is important in the relationship you have with your clients/patients so sometimes it happens where you give them the benefit of the doubt and then you find out they are being manipulative. But I agree with the previous post about how over time you will begin to see who is more focused on the rx then all else.