Saturday, March 14, 2009

Family physicians and patients need more information about specialists

Why can’t family physicians easily find the best specialist with the shortest wait time for a new consultation? In BC, information on wait time for certain surgical procedures is available on a provincial Web site. The figures, however, account only for the waiting time once the surgeon has determined that an operation is necessary. Wait times for the initial consultation with a surgeon or with a non-surgical specialist are unavailable.

Lack of coordinated referral networks is an aspect of the Canadian system which has led some to call it a cottage industry. Doctors work in their isolated offices, create local networks for referrals, and have little knowledge of or access to specialists beyond that. This, along with the low physician density in Canada, has contributed to the growth of specialist wait lists.

Without reliable information, family physicians cannot adequately help their patients find the quickest consultation and, if needed, operation. A BC business has exploited this situation and, for a fee, will match a patient with a specialist. The company’s Web site, though, quickly informs the reader that “the need for private medical services is thriving in Canada,” and that the company “is able to expedite most types of private medical services from diagnostics to virtually all types of surgery.” The option of having treatment in a public facility doesn’t seem to merit mention.

Vancouver Sun editorialists recently pointed out this company’s services and asked why the government can’t provide information on availability of specialists to patients and family physicians. Good question! The public is paying for the services, after all, and is entitled to some accountability.

Documenting wait times is a necessary aspect of quality improvement in medicine. Collecting and publishing such information for the public should be part of a universal health care system. Aside from patients, family physicians have the most to gain and should advocate for this despite any resistance from specialists. Commercialization will continue to gain ground in health care if obvious solutions such as registries of specialists’ wait times and pooled wait lists are ignored.

Randall F. White, MD

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