227 | P a g e 33. TOYE 2017[197]: Moral boundary work I have to decide whose pain is ‘real’ before I prescribe. Some patients make demands and won’t take advice. Pain with no biomedical diagnosis, vague symptoms or dissonance between what the patient says and what I see makes me suspicious. If there is an obvious pathology, like cancer, then I know it’s real. I’m constantly asking myself if I am prescribing to the right person. You go by gut feelings. I trusted the wrong patients. You pick it up as you go along. I’m not always a good judge of who to trust. You can’t always judge a book by the cover. HEALTHCARE PROFESSIONALS 34. TOYE 2017[197]: Pain is pain Our main aim is to relieve the pain. Addiction should not be a barrier to opioid prescription. There is a stigma against patients with addiction. If someone’s got chronic pain it doesn’t matter if they’re an addict. Your two end points are different. HEALTHCARE PROFESSIONALS 35. TOYE 2017[197]: Regulations and guidelines The guidelines can interfere with our professional autonomy. You can’t do your job when you are thinking about these things. It sometimes means that people who are in real pain don’t get the help that they need. However, I am worried about reprimands if something goes wrong. My name is on that bottle. Guidelines strike a blow at the patient-clinician relationship. They can create mistrust and hostility. However, they can also establish boundaries and open up discussion. I can also use them to justify my decision to challenging patients. HEALTHCARE PROFESSIONALS
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