When Lied to, Physicians Need to Trust Their Gut

My husband is the one who first uncovered the “Chocolate Milk Cover-up.” In our house, we consider chocolate milk a treat, like a cookie. The kids can have it, but it counts as their dessert. One of our children is not a big fan of milk in general, so doesn’t normally get milk with her school lunch. Quite by accident, my husband discovered her secret when he received an e-mail notifying him that her lunch card balance was running low. He deposited more money but then started wondering how she went through her balance so quickly. So, he asked at the school and found out our daughter had been getting chocolate milk for the previous month.

Unfortunately, she withheld this from us and was also getting another treat for lunch as well. When confronted with the evidence, she admitted her transgression and was given the option of chocolate milk as her treat or something else, but not both. We reminded her of our agreement about school lunches and that she needed to hold up her end of the bargain.

The parallel for me came at work today. One of my patients violated a pain agreement by seeking narcotics from a different provider. My patient denies it happened. I only discovered it by accident. I was reviewing the patient’s chart before our appointment and noted a phone call made to a different provider. I opened the telephone encounter and discovered the request. I double-checked with the other provider who confirmed that the patient had, indeed, made the request.

It’s hard to balance the concern or, in the case of my daughter, the affection you have for someone with the knowledge that rules or agreements need to be maintained. While both of these infractions may be viewed as relatively minor, I believe both standards - chocolate milk is a treat and the primary-care physician is the only one who prescribes chronic pain meds - must be upheld. The rub comes when the trust is broken.

In the case of our daughter, she readily admitted her error and accepted the rather modest punishment of losing treats for a few days. In the case of my patient, the conversation was not nearly as pleasant. Denials and recriminations formed the bulk of our conversation. At the end of the phone call, both of us were frustrated. I was frustrated with her deception and denial. She was frustrated because of my decision to no longer prescribe narcotics. She called me uncaring. She cried and begged. She told me that I would be responsible for the loss of her job, income, and home. All in all, by the end, I felt like the lousiest doctor in the world, despite knowing in my gut I did the right thing.

Isn’t that the case with balance sometimes? You do the right thing. Your gut reassures you that it’s right. But, your heart still breaks a little at the follow-through.

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