Difficult Patients

I do believe most patients out there are sincere and want to help themselves. But out there, I am certain, are too the people who take advantage of the system.

• Like that patient who is on 'disability' because of her diabetes; I asked her what she did over the weekend and it included a pretty physical camping trip. And yet, for reasons unclear to me she was able to talk her family physician into certifying that she was 'disabled' and is collecting benefits while leading a fairly active life
• Or that patient who got irate at me and had her husband call to yell at my nurses, because I wouldn't write a letter to her employer because she wanted to wear tennis shoes to work. Reasoning: She has diabetes (no neuropathy) and her regular dress shoes give her blisters. She wasn't too taken by my suggestion to get better fitting shoes.
• Or that patient who wanted me to be a witness in a lawsuit blaming his one-week-use of Zyprexa in causing his type 2 diabetes. He said nothing of his underlying BMI of 44.
• Or that diabetic patient who talked me into writing a letter giving her a couple of days off work because she was unwell. She didn't have a family physician, and I was silly enough to agree to write that letter until she found herself a primary care provider. Next thing I knew, she thought she was still too 'unwell' to go to work on day 3 (because her blood pressure was 144/90) and urgently called my office to have me issue another letter with a new date reflecting her extra day or otherwise she would be fired.
• Or that patient with Graves' who wants to work half days for the next 6 weeks while the Methimazole took its time to work. She's too stressed out to work full days, apparently.
• Or that patient who has since recovered from her hip surgery 7 months ago, yet still really enjoys parking in the disabled parking spots.

While I do try to sympathize and offer the best help I can, and try to see each patient with an open, nonjudgmental mind, sometimes when you run into a few bad apples who so take advantage of the system you get jaded, and can't help but to be a bit cautious. So now, when patients bring in all these papers, unless I've gotten to know them well I'm more inclined to politely tell them no.