Dr. Rupa Patel

Gaining Control

A Kingston FP took action after realizing that the practice she had just taken over had a large number of patients on high doses of opioids

photo: jonathan sugarman

When Dr. Rupa Patel started work at a Kingston community health centre several years ago, she was in for a surprise – the practice that she had just taken over had a large number of patients on high doses of opioids. Dr. Patel wasn’ t new to the practice of medicine at the time – she had already worked for 20 years as a family practitioner, with a variety of patient populations in different settings. She had done a three-year stint working in a small town in Northern Ontario, followed by academic family medicine, GP-oncology and family medicine obstetrics. But she remembers that her new practice situation came as a shock.“ I just had not realized that this practice had such a high number of patients on very high doses of opioids. I was simply taking on a new job after having worked in oncology for a few years,” she explains. She remembers her sense of disbelief as she looked through the practice’ s medical records.“ There were about 40-50 patients on chronic opioids, some at very high doses … one patient was on 800 mg of oxycontin a day which equals 1200 mg of morphine a day.” Every day of that first year seemed to present a new, uncomfortable experience.“ One patient was very angry when I told her I could not continue to prescribe the opioids that she previously had been on. She had severe COPD and ICU admissions for her breathing problems. I weaned her off opioids but she never forgave me and fired me when she was able to find another doctor. Interestingly, she had no further admissions to hospital after she was weaned but she still fired me. I had only been fired once before in 20 years,” she said. She realized that a handful of patients were

Issue 1, 2017 Dialogue 27