Shrinking pool of specialists decline new patients
David Rider
The Ottawa Citizen
Wednesday, September 10, 2003
Like many former patients of Dr. Martin Gillen, chronic pain sufferer Debora Bertrand pulls no punches about what will happen if anything comes between her and the powerful drugs that temporarily tame her full-body agony.
"I'm going to become suicidal," says the 52-year-old former postal worker, one of many patients and doctors who told the Citizen an already alarming shortage of pain specialists has hit the boiling point since Dr. Gillen was forced to surrender his licence in June.
Ottawa has a small and shrinking pool of pain specialists and they are not taking new patients, generating waiting lists of up to two years. The pain clinics at the Civic and General campuses of the Ottawa Hospital are so overwhelmed they have scrapped waiting lists altogether and are turning away all non-cancer referrals -- hundreds of people.
"It's very difficult to say no. It's very disheartening. That isn't what I got into this business to do," said Dr. John Watson, a pain specialist at the Civic, adding there's a "spot of hope" because his clinic recently hired a third physician.
Dr. Ellen Thompson, a prominent pain specialist who, like most in her field, is also an anesthetist, has closed her Ottawa pain clinic and now sees only a fraction of her former patients at an office in her home.
"I've been burned out for so long. I cannot honestly do anything for all the desperate people who have been left high and dry," she said.
"Those of us who are left are just struggling. It's desperate."
Both doctors say Ottawa needs a well-funded pain clinic with sufficient doctors, nurses and other staff, like ones in Toronto, Hamilton, Halifax and many other Canadian cities.
The relatively new and somewhat controversial chronic pain specialty employs drugs -- including morphine-like opioids, as well as nerve-blocking injections and psychological techniques -- to try to give sufferers as normal a life as possible.
Family doctors can and do treat ongoing pain. However, many are afraid to prescribe opioids regularly because the drugs are powerful and addictive and improper treatment with them can lead to severe penalties from the College of Physicians and Surgeons of Ontario.
The shortage of specialists is so acute -- and Dr. Gillen so well-liked -- that many ex-patients say they would gladly continue seeing him although he admitted to sexual misconduct involving a female patient. They're furious at Ontario's medical watchdog for not allowing him to continue seeing patients under strict supervision.
"I personally call us the living dead. If we had cancer we'd get more attention. Nobody wants to take us," said Nikki Samuels, who has periodically felt like a blowtorch is being aimed at her throat and face since pain spontaneously erupted after a 2002 dental visit.
"Dr. Gillen saved my life. Perhaps the college's policies or practices need to be reviewed. We're in a crisis situation."
Wendy Miller, another ex-patient of Dr. Gillen, has shed one-third of her weight since 1993, when the first of two car accidents left her with a rail-thin body wracked with arthritis-like aches, ending her career as a craft maker.
"Without him, we've all been suffering. Dr. Gillen is the best," she said.
In fact, many of them do see Dr. Gillen, but not as a physician. He's now a receptionist in the Innes Road office of Dr. Marcel Guilmet, who himself suffers from fibromyalgia, a pain and fatigue disorder, and who took on hundreds of Dr. Gillen's patients.
Dr. Gillen wasn't the first Eastern Ontario pain specialist to become acquainted with the college.
In April 2001, Dr. Frank Adams, a leader in the field, moved his practice from Kingston to Texas after the college found him guilty of professional misconduct and incompetence for prescribing large doses of opioids without conducting what college officials believed to be proper diagnoses, examinations and monitoring.
Some physicians accused the college of reacting to a new specialty by organizing a witch hunt that would make all doctors afraid of prescribing the drugs. Dr. Adams's patients scrambled for treatment, some ending up with Dr. Gillen as well as Ottawa's Dr. Dan Sweet.
Then, in August 2002, the college stripped Dr. Sweet of his right to prescribe drugs after he admitted giving addicts access to narcotics as part of a program of "harm reduction" aimed at letting them live as normal a life as possible with their habit.
Some of his pain patients went to Dr. Gillen and then, when he lost his licence, to Dr. Guilmet.
Dr. Thompson, who has in the past been scathingly critical of the college and its effect on the practise of pain management, said yesterday the college has made strides by issuing guidelines on opioids to help family doctors prescribe them properly and without fear.
"What we're trying to deal with now is the hangover effect," from the past, she said.
