Ethics & Law · patient case question
A patient repeatedly requests a specific opioid by name, reports lost prescriptions and declines a full examination. What is the appropriate response?
Patient case: Behaviour, communication and quitting
demo: Adult patient in a health-promotion consultation
chief: Attends for a check-up and mentions he would like to stop smoking.
history: Smokes 15 cigarettes a day and has done so for twenty years. He has tried to quit twice before without support.
meds: None.
findings: Generalised staining and halitosis. No mucosal lesions on careful examination.
Show answer and explanation
Correct answer: D. Decline to prescribe, offer a full examination and appropriate non-opioid management, and check the prescription monitoring programme
- A. Abrupt dismissal abandons someone who may have a substance use disorder and needs referral. Offer appropriate care and, where indicated, referral to treatment services.
- B. Prescribing to preserve rapport is how these patterns are sustained and puts the patient at risk.
- C. A smaller quantity of an unindicated opioid is still an unindicated opioid.
- D. Correct. Naming a specific drug, reporting lost prescriptions and refusing examination are classic signals. The professional response is neither to accuse nor to accommodate: decline the opioid, offer a proper diagnostic workup, treat the underlying cause, use NSAIDs which outperform opioids for dental pain, and consult the state prescription monitoring programme.