It’s important to trust what our patients tell us. When a patient feels safe and trusts you, they may reveal more of their story and be open to receiving advice. Patients might be hiding something for a variety of reasons including shame/stigma, not wanting to be “lectured” or they are not ready or willing to explore the harms associated with their use. If there is a question of serious harm or risk to themselves or another, especially a child, aim for a full and truthful disclosure.
Maintain appropriate clinical boundaries and practice good prescribing strategies. Ensure your prescribing is rational, defensible, confirmed and that you are comfortable.
To establish boundaries, ensure that your patients understand that appointments are essential (schedule regular appointments and re-schedule missed appointments), the hours you are available, and the appropriate behaviour during the clinical appointments.
Agree with the patient on the medications indicated, a formal treatment plan, and (for those with complex comorbidities, or at high-risk of self-harm or suicide) to participate in psychiatric and/or psychological therapy.
Seek support from a psychiatrist or Addiction Medicine specialist who can help share the decision-making burden of diagnosis and treatment planning. Refer to the Clinical Advisory Service in your State and Territory.