Thursday, July 14, 2011


Waiting Line Reality Check


One of the issues that keeps bothering me is the problem of ending up on a waiting list in Canada with a painful but non-emergent problem. You know, those stories about long waits for joint replacements? Although, knock wood, I don't need surgery, I've gone through enough with my faulty parts to make me identify with patients in pain who don't want to wait for relief.


I was fortunate to be able to interview a Canadian physician whose specialty is roughly like an osteopath -- So he sees people for these painful conditions.


When I asked Dr. King about the problem of wait times, he assumed I meant wait times to get in to see him. In a similar fashion to the prioritizing in hospitals for surgical wait times, Dr. King tries to prioritize the cases that are most urgent. Patients who report being in severe pain can see him within a few days, but it can take a month or two for others.


If one of his patients may need a hip replacement (not a procedure he performs), he tries to anticipate their need for surgery. He'll encourage them to get on a surgeon's waiting list when he thinks a patient is likely to require a hip replacement in the future.


But what about when a patient is having a hard time functioning because of the pain? What kind of flexibility is there with the system? Is a hip replacement simply always low priority if it's not due to a fracture? No, according to Dr. King, it's possible to go to the front of the waiting line if a patient is in severe pain or can't function. Apparently, a specialist can successfully put the pressure on to help out a patient.


I took a look at the handy dandy wait time website for British Columbia: http://www.health.gov.bc.ca/swt/#. For hip replacement surgeries, when I checked the average waits for all of BC, I found 50% are done within about 3 months and 90% are done within about 7 months. There was considerable variation in wait times depending on the doctor a patient chose to see. The website showed some doctors were able to perform 90% of their patients’ hip replacements within a few weeks while other doctors showed 90% receiving the transplant within 14 months.


I also noticed variation in the time to receive some procedures depending on whether treatment was being sought in rural British Columbia or the Vancouver area. Wait times for back surgeries in one of the rural areas were running 90% done within 10-12 months and 50% done in less than 2 months. However, in the Vancouver area, 90% were done within about 4 months with 50% being completed within 3 weeks.


Another complaint one hears frequently is about the wait times for MRIs. Dr. King concurred. "The MRI is a real problem in this country." That is a medical service which can legally be purchased privately, if the patient can afford it. Dr. King said it costs $800-$1,000 to pay privately for a MRI in Vancouver. I spoke to a Vancouver neurologist, Dr. Cashman, who also expressed dismay over the wait for MRIs. When trying to diagnose ALS (Lou Gehrig's Disease), he wants to be able to get a patient in for a MRI right away. But the wait can be impossibly long. On the other hand, when the MRI is being ordered for a patient with a brain tumor, the service is provided promptly.


That being said, both Dr. King and Dr. Cashman like the Canadian health care system very much. In fact, they both came to Canada because they preferred the Canadian system to that of their native countries -- Great Britain and the United States respectively. Clearly, there are trade-offs to be considered with every health care system.

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