My last patient this evening was a "temporary resident", a young man with a strong Glaswegian accent who looked stressed and in discomfort. He told me that he had suffered from ulcerative colitis for a long time and had previously had a partial colectomy. He had just fled here from Scotland because he was under threat from a gang back home. He had left his medication behind, and as a result his colitis had flared up. He gave a convincing impression of someone who was upset, in discomfort and had abdominal tenderness, although his pulse was not as raised as I might have expected. His abdomen had an operation scar. I prescribed treatment appropriate for a flare-up of ulcerative colitis. Almost as an afterthought he requested a prescription for tramadol for the pain, which I also issued.
Dear reader, you will have spotted the scam a mile off. The story was outrageous, there was no irrefutable evidence of acute illness, his slight sweating and agitation were probably opiate withdrawal. But it was masterfully done. He played on the fact that GPs are predisposed towards helping patients, and will usually believe them unless there are good reasons to the contrary. He gradually built up the story of the illness and social distress, pushing things as far as they would go without arousing my suspicions. Only at the very end did he slip in the sting, and then made good his escape with the prescription for tramadol (a synthetic opioid with a reasonable black market value). Probably.
I feel pretty stupid. I have always taken the view that if you are so unyielding that you can never be conned, then you are probably doing a disservice to some people with genuine needs. But I still feel pretty stupid. I will ask Myrtle, our canny Practice Manager, to contact the PCT in the morning and ask them to pass his details around local practices in case he tries the same trick elsewhere.
So the day ended on a sour note. This morning's surgery was better. A chap in his seventies, whom I hadn't seen for a while, thanked me for saving his life. I had visited him at home a few years ago and sent him into hospital with pneumonia. He had gone straight to the intensive care unit, and his relatives had been told he probably wouldn't survive. Looking back at the notes I made, he had looked very sick and had barn door signs of pneumonia. A first-year medical student would have known what to do. I think that doctors sometimes imagine that because they have done the patient a service they must be very clever, and that no-one else could have done it (or at least, not done it so well). What rubbish! But nevertheless it is quite pleasant when someone genuinely thanks you for saving his life.
It occurs to me that I am beating myself up about being fooled by a skilled con-man into prescribing one lousy pack of tramadol, while at the same time belittling the heartfelt praise I was given by a patient. You don't suppose that this could be anything to do with why I sometimes get a little downcast about the job, do you?