In the ED, you are about to assess a patient with abdominal pain. The consultant mutters that the patient is a frequent flyer seeking more drugs. What should you do first?

In the ED, you are about to assess a patient with abdominal pain. The consultant mutters that the patient is a frequent flyer seeking more drugs. What should you do first?

• A. Acknowledge the consultant's input and proceed with the assessment as usual.
• B. Dismiss the concern and proceed based on your initial impression.
• C. Proceed to administer analgesia without reviewing history.
• D. Call security to remove the patient.

Answer: (A)

When a colleague hints that a patient may be seeking drugs, the appropriate approach is to acknowledge their input and carry on with a careful, unbiased assessment. This respects team communication and keeps the patient at the center of care. Begin with a thorough history and examination, identifying the current abdominal symptoms, onset, quality, location, radiation, timing, aggravating and relieving factors, and any red flags. Review the patient's past medical history, current medications, allergies, prior analgesic use, and any history of substance use. Check available records or prior ED visits to understand patterns, and perform an objective pain assessment using a validated scale. Consider safety and appropriateness of analgesia, documenting the plan clearly and discussing it with the patient and the team. This approach avoids letting bias influence care, minimizes the risk of missing serious pathology, and allows you to tailor analgesia and investigations to the individual, while still being mindful of potential drug-seeking behavior. Avoid dismissing input, acting solely on first impressions, or administering analgesia without history, and reserve security escalation for genuine safety concerns or disruptive behavior.

When a colleague hints that a patient may be seeking drugs, the appropriate approach is to acknowledge their input and carry on with a careful, unbiased assessment. This respects team communication and keeps the patient at the center of care.

Begin with a thorough history and examination, identifying the current abdominal symptoms, onset, quality, location, radiation, timing, aggravating and relieving factors, and any red flags. Review the patient's past medical history, current medications, allergies, prior analgesic use, and any history of substance use. Check available records or prior ED visits to understand patterns, and perform an objective pain assessment using a validated scale. Consider safety and appropriateness of analgesia, documenting the plan clearly and discussing it with the patient and the team.

This approach avoids letting bias influence care, minimizes the risk of missing serious pathology, and allows you to tailor analgesia and investigations to the individual, while still being mindful of potential drug-seeking behavior. Avoid dismissing input, acting solely on first impressions, or administering analgesia without history, and reserve security escalation for genuine safety concerns or disruptive behavior.