INTRODUCING
Eventually I made it back to university and recognized that I had an affinity for medicine . Even after making that decision , I took more time to look around . I was a GP for a couple of years then decided to go back to school and do anesthesia . Looking back , it is hard not to see that whole period as a series of random events that got me to where I am .
What led you to specialize in chronic pain management ? A : I missed the connection with patients that I had experienced as a GP . Even though I transferred from the GP anesthesia program to the specialty stream , I never lost my interest in knowing more about people . I tried to balance general practice with my anesthesia work but it was always a challenge . Trying to help patients with chronic pain was an opportunity to do something similar to primary care .
You have been involved in chronic pain management since 1993 , at a time when pharmaceutical companies were downplaying the addictive properties of opioids . What do you remember from that time ? A : For a period of time , I not only drank the Kool-Aid but I helped to sell it . I think we need to remember that decisions that physicians made then were felt to be in the patient ’ s best interests and aggressive opioid therapy was , at the time , the standard of care . Medical knowledge is always evolving and uncovering new evidence that makes past practice look uninformed . The difficulty here is that as a result of the reliance on opioids , many patients ended up not just unimproved , but outright harmed . The assumption that ‘ pseudoaddiction ’ could be managed with higher and higher doses of opioids was a fundamental mistake in our thinking at the time . I think the response of my colleagues to recognize the problem and to move deliberately to offer solutions should be applauded .
Based upon your experience on the Quality Assurance Committee , what advice do you have for doctors ? A . When you receive the notice that you will be peer assessed , don ' t panic ! The overwhelming majority of physicians who are assessed are severely stressed , but ultimately they end up feeling that the experience was a positive one . When you get your notice , go to the CPSO website where you can find the tools that the assessor will use to review your practice . Starting your own review beforehand allows you to identify your own areas of weakness and gets you out in front of the areas that could be identified as needing improvement during your assessment . It can be difficult to focus on the process as an opportunity for improvement . But by embracing the process and taking ownership of our own strengths and weaknesses , we can all benefit from an outside look at how we can practise medicine better .
What work have you most enjoyed at the College to date ? A : It would have to be my work on the Methadone Committee . As the only member of the Committee who does not treat addiction , it has been a learning experience for me and I like to think that my input has been helpful to the members of the Committee who do treat addiction . Seeing suboxone evolve into the tool it is for treating opioid dependence and / or addiction has been exciting , as so much of my practice has been with complex patients on large doses of opioids . So I am pleased to be a part of the College ’ s balanced approach as we proceed with our strategy on this very challenging issue . It has been gratifying to see my colleagues continue to put patients first when responding to the new directions in the use of opioids . MD
It has been gratifying to see my colleagues continue to put patients first when responding to the new directions in the use of opioids .
ISSUE 4 , 2017 DIALOGUE 23