I never thought I’d say this, but I find myself partially sympathizing with Dr. Brian Day.
Day, an orthopedic surgeon, is arguing before the British Columbia Supreme Court that Canadian physicians should be allowed to provide, and patients pay for, medically necessary treatments because the wait times for many treatments in the public system are unacceptably long.
Critics of Day rightly point out that allowing private health care will increase inequities in access to care. But Day is also right that wait times are too long – not just for surgery, but for waits to see most specialists.
My sense is that Canadians are increasingly frustrated with their access to health care. That’s a problem. Without meaningful action in the public system to decrease waits, the private option will seem increasingly attractive to many Canadians.
I worry that some of us working in Canadian health care are so used to long wait times that we have become desensitized to their impact. I recently spoke with a woman who was told she had to wait six weeks for a biopsy of a suspicious breast lump. My first thought was, “Six weeks, that’s not so bad. It’s unlikely, even if it is a cancer, that it will grow much during six weeks.”
However, she reminded me how stressful it is to wait six weeks when one imagines the cancer growing every day. She is right – there is no value in waiting for a biopsy.
The father of a friend of mine was admitted to a teaching hospital with undiagnosed abdominal pain and had some inconclusive investigations. He needed an MRI scan and waited in hospital for almost a week for the scan (some of it over a long weekend). I explained that since his dad was stable this wasn’t really an urgent MRI. He found it puzzling that I would call an MRI that was needed to manage pain in someone sick enough to be admitted to hospital “not urgent.” Good point!
Many of us hear stories from relatives and friends who have had to wait too long to see a specialist. I know someone with new onset of severe migraines who was told it would take more than a year to see a neurologist in an Ontario city with a medical school.
I also know of Toronto family physicians who have tried to refer patients to orthopedic surgeons and neurosurgeons and have been told that the surgeons’ waits are so long they aren’t accepting any new referrals – their patients couldn’t even get on a wait list.
I am increasingly contacted by relatives, friends and distant colleagues who tell me about the distressingly long waits they or their loved ones are experiencing. These people are respectful enough to rarely explicitly ask for help in jumping the queue, but that’s clearly the hope. And I understand why. Sometimes to get good access to health care in Canada one needs to know “how to navigate the system.” Truly equitable access in our publicly funded system is a myth, and my sense is it is getting worse.
Is my experience unique? I doubt it. But the sad fact is we don’t know. In Ontario we know how long people wait for surgery for selected procedures (cataract removal, hip and knee replacements, cancer surgery, cardiac surgery) but even then we only know about the wait from the time the patient and surgeon agree surgery is indicated until the surgery is performed. We have no data about the wait from the time of the primary care providers’ referral to when the surgeon sees the patient for the first time. Both waits are important to patients.
And we have no data on how long people wait to see specialists who are not surgeons, like the migraine example mentioned previously. Hopefully we will be able to have that information soon – Canadians deserve to know.
It is time for those of us who support publicly funded physician and hospital care to not only criticize Dr. Day and the methodologically flawed surveys of the Fraser Institute, but to spend more effort working with and pressuring our health care systems to improve access to specialist care in Canada.
There will be no easy fixes – the solution will likely require a combination of an increase in the number of some specialists, more access to existing operating rooms, a change in how wait lists are managed, greater use of non-physicians where appropriate, more complete data to measure our progress and the innovative use of technology.
However, if we don’t start fixing the problem, I worry Canadians will become increasingly sympathetic to Day’s position.
Dr. Andreas Laupacis is a physician, Executive Director of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto, and editor of www.healthydebate.ca @AndreasLaupacis
Dr. Andreas Laupacis is a physician, Executive Director of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto, and editor of www.healthydebate.ca @AndreasLaupacis
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