Views & Reviews From the Frontline

The importance of mistrust: drugs of diversion

BMJ 2011; 342 doi: (Published 20 April 2011) Cite this as: BMJ 2011;342:d2465
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

We are not police officers; we have no undercover operatives, no batons or powers of arrest. Our relationship with patients is based on an old fashioned notion—trust. But the unspoken reality is that many patients are economical with the truth. This might stretch from exaggerating symptoms to improve welfare benefits, to applications for car disability badges. All this is perhaps no worse than exaggerating insurance claims or fiddling expenses. Courses and textbooks on communication, however, never have chapters on scepticism.

Another area common for manipulation is medication. Drugs such as dihydrocodeine, tramadol, sildenafil, diazepam, zopiclone, …

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