Helping patients who need doctors the most

Opioid Prescribing Is A Part Of Good Patient Care For Family Physicians

To Dr. Allan McDonald, responsible opioid prescribing means being responsible to the patient, to the community and to yourself. “It’s your responsibility to help treat these people, even though it can be very difficult and time-consuming,” says Dr. McDonald, a family physician at the Associate Medical Clinic in St. Albert.

“Any physician who has a practice has to prescribe all types of medications. A family doctor wouldn’t be a good doctor if he didn’t prescribe antibiotics, antidepressants, blood pressure meds or cholesterol meds,” shares Dr. McDonald. “So, how can a family physician be a good doctor if they don’t prescribe narcotics?”

Dr. McDonald learned much of what he knows from his father, who was a family physician for more than 45 years. One of the most important lessons he learned from his father is that anyone can be a physician to a healthy patient, but you have to be a physician to the sick patients, too.

Dr. McDonald has been caring for chronic patients with complex health needs since he started practising 22 years ago. He recognizes that it is often those patients with complex needs who need doctors the most and that complex needs can mean complex treatment-sometimes requiring prescription opioids.

Like many physicians who prescribe opioids and other TPP Alberta-monitored drugs, Dr. McDonald receives a CPSA MD Snapshot-Prescribing report to help him self-assess his prescribing habits.

Dr. McDonald uses his MD Snapshot-Prescribing reports to monitor his high-prescribed patients and keep track of their doses to ensure their treatment is safe and effective. “I will think about whether or not there’s any meds that can be reduced and I might try, but the reality is sometimes you cannot,” explains Dr. McDonald. “By continuing to prescribe these medications for these people, I am keeping them out of emergency rooms, I am keeping them out of the hospital, I am keeping them out of the system and I am helping them to just function day-to-day.”

Dr. McDonald does not consider himself to be an expert when it comes to opioid prescribing or treating chronic pain patients. However, he recognizes that prescribing opioids, when appropriate, is a form of good patient care. “Pain is a part of family medicine, and it’s our job to treat that,” says Dr. McDonald.

At a recent Primary Care Network meeting, Dr. McDonald shared his perceptions of the MD Snapshot-Prescribing report with fellow physicians who expressed concerns about the tool. “When you’re looking at your MD Snapshot, be proud that you are someone who is helping patients that really need to be helped,” says Dr. McDonald. “You should be proud that you are a doctor who uses a triplicate [TPP Alberta] prescription because the people who are in pain and struggling, or even if they’re addicted, those are the people that need doctors.”

CPSA’s MD Snapshot-Prescribing reports are a tool physicians can use to help treat their chronic pain patients. “The MD snapshots are more just information that we can use, because we know our patients and we know our practice and we know what is truly appropriate and what is not appropriate,” shares Dr. McDonald.

He also knows that dealing with chronic pain patients can be exhausting, and it is important to take care of yourself, too. But if every family physician in the province were to take on their share of complex patients, Dr. McDonald believes the workload would become less stressful.

“Trying to see 30 chronic pain patients a day would be impossible. Everybody can only have so many patients. But if every family doctor took on a share of patients that have chronic pain, then it’s manageable,” says Dr. McDonald.

Resources:

• For support with treating chronic pain, check out the ACFP’s Collaborative Mentorship Network
• If you have questions or concerns about safe prescribing, visit CPSA’s Physician Prescribing Practices
• To access the University of Calgary’s new opioid course, Wise Prescribing and Deprescribing: Opioid Skills for the Frontline Clinician, visit their Continuing Medical Education & Professional Development website.