Stuck between administration and the drug seeker

Doctor, I am in a lot of pain!!! The worst pain I have ever been in and I think I might die. I am allergic to ibuprofen, tylenol and anything else without opiates in it. Well the doctor has seen this drug seeking behavior 100's of times and it plays out in a similar fashion on a daily basis in the emergency department. The doctor can give the patient some morphine or other opiate and quickly get the patient discharged until they need another fix, but doctors generally do not like to enable these patients.

Now it get's complicated. If the doctor takes a firm stance and calls the drug seeker to the carpet the drug seeker can often (not always) become enraged and aggravated, yelling and causing a huge scene which requires a lot of other employees to get involved like security, nursing staff and others. Also emergency physicians have patient surveys that the patients fill out and describe how satisfied they were with their doctor. Was the doctor nice? Was the doctor non-judgemental? DId the doctor treat you with respect? There are other questions about patient satisfaction and a nice area for patients to write in their complaints or compliments.

You can imagine what the drug seeker writes on these surveys when he/she does not get their drug of choice. Sometimes it seems that the drug seekers who have been refused are the only patients who take the time to even fill out these surveys. As you can imagine the jilted drug seeker can get pretty creative in their complaints in these surveys. Who cares? Well, these surveys are filed in the doctor's employee file and at some hospitals tie the doctor's pay and bonus based on the patient satisfaction reports. These surveys can influence promotions or even lead to termination. A negative report / survey is filed as a negative report regardless of it credibility. The administration does not know the survey was filled out by a scorned drug seeker or a patient who was truly treated unfairly by the doctor. A negative survey is a negative survey.

What would you do? Give the patient the morphine or drug of choice? Call the patient out and refuse to enable the patient? Choice one gets the doctor out of having a negative survey and may even get him / her a positive survey and gets the patient out of the emergency department in a quick manner requiring less staff and less drama. Choice two gets an outraged often belligerent patient that requires lots of staff time and gets the doctor a negative survey and may even get the doctor in a meeting with the administration and disciplined for a negative survey in his / her file.

I see it play out every shift. Many of these same patients do not pay their bills and often are more likely to sue as well. Obviously I am making generalizations and there are many patients who truly are not drug seekers in similar scenarios but I am talking about the repeat patients that are easily identified as drug seekers not the patient's with a kidney stone in true need of pain control.

Here is a parody video that some ER doctor made and although funny I have seen this exact type of patient many times.

http://www.xtranormal.com/watch/5864157/