Drug Seekers: we know when you're faking. No, really. You might can fool us for a short period of time, but you all make the same mistakes over and over again. I could even tell you what those mistakes are and you'd still make them.
One of the most popular diagnoses for a drug-seeking patient to come in with (especially a female) is abdominal pain. It's vague, it has a large number of diagnostic possibilities and it takes time to work up, giving the drug seeker ample time to load up on all sort of IV narcotic goodness. One patient I was seeing was a woman in her late 20's whose abdominal pain defied all workup. Here's another something they don't tell you when we admit you: if we work you up and can't find anything and the problem is not exceptionally debilitating or life-threatening, you go home. This woman learned this first-hand when I tried to discharge her. We already suspected the drug-seeking behavior at this point because the woman would be sleeping whenever you went in to see her, but the moment someone woke her the pain was a 10 out of 10 and she was asking for narcotics. I wrote the discharge orders and left the floor. About 30 minutes later, I received a phone call from the woman's nurse, claiming that she had a pulse oximetry reading in the 70's. I went back up to her room to find the woman's sats 100% on 2 liters of oxygen a minute (very minimal oxygen). As an experiment, I had the nurse put the pulse ox machine back on her and took the nasal cannula off. Sure enough, her oxygen saturations started dropping into the 70 % range. I put the nasal cannula back on her and they instantly shot up to 100% again. I looked over at the nurse, who pointed at the wall where I could read from across the room that the oxygen wasn't turned on. I walked out of the room and wrote one additional order: "cut nasal cannula prongs off of tubing and send home with patient."