I wish I could say that every patient encounter worked out well, that all my patients went home happy and satisfied. It would be nice, but unfortunately that is not true at all. There are many patients who present with unrealistic expectations or an agenda which is non-therapeutic and I am relatively straightforward and unapologetic about correcting patient's misconceptions about the care that is or is not appropriate in the ED. Unsurprisingly, this often, though not always, involves narcotic medications.
Which is not to say that I am a jerk. I try to be compassionate, and I try to find alternative solutions, and I have been told that I can turn away a drug-seeker more nicely than any other doctor in the department. But when it is time to say "no," I say "no," firmly and without evasions or excuses.