The requests of 50 to 60% of patients registered on the waiting lists for more than 12 months to consult a specialist, undergo an examination or surgery are no longer valid, shows a purification exercise ordered by the Ministry of Health in three regions of Quebec. Nearly 6,000 patients were taken off the waiting lists in just two medical specialties at the end of this operation, which raises questions about the real extent of the congestion in the network.
At a time when the Legault government is making the reduction of waiting lists one of its priorities, this management exercise is causing a stir in the regions of Laval, Lanaudière and the Laurentians, where this operation was carried out between April and August 2021. .
Thousands of letters have been sent to family physicians to verify the records of each of their patients on the waiting lists for more than 12 months, in order to verify if their condition still required the care, examinations or surgeries requested. The patients targeted were those whose wait was deemed out of time, but whose priority was considered less urgent.
“The purpose of the exercise was not to question the medical diagnosis, but simply to verify whether or not the service had been obtained by the patient, and whether it was still needed. It was found that, for one in two patients, the request was no longer valid. Some patients did not even know they were on a waiting list! »Explains the Dr Stéphane Ledoux, neurologist and medical coordinator at the Service Request Dispatch Center (CRDS) for Laval, the Laurentians and Lanaudière.
In gastroenterology, it is some 2,863 patients out of nearly 4,900 waiting for more than 12 months who have been removed from the list in recent months because their condition no longer required the consultation requested.
The same exercise carried out in otolaryngology (ear, nose, throat care) concluded that nearly 58% of patients on the list no longer needed to see a specialist.
“If we multiply that across the province, that’s tens of thousands of people waiting whose request may no longer be valid. It is said that there are 765,000 people waiting for various consultations and surgeries in Quebec, is this really the reality? If we want to improve access to care, we need to have a fair picture of the situation, ”said this neurologist who has been in charge of the management of the 3L CRDS since 2017.
The ministry confirms
A similar operation carried out in five specialties (urology, neurology, gastroenterology, ENT and ophthalmology) in 2016-2017 and in 2018, in the same regions, had arrived at the same conclusions, confirms the Ministry of Health. “The number of requests withdrawn from the waiting lists varies according to the specialty, but it was between 50% and 60% in the exercises carried out by the CRDS of 3 L”, indicated to the To have to the MSSS communications department. Nearly 3,800 patients out of 6,300 were then removed from the waiting lists.
According to the Ministry of Health, this type of review, which should “be done on a regular basis, two or three times a year”, by establishments, especially for patients “out of time”, reveals that the main reasons justifying their withdrawal waiting lists are, first of all, that the patient has already received the service, that he no longer needs it, that he went to the private sector or that he did not even know he was on a waiting list .
In the fall, however, this exercise of reviewing waiting lists was stopped short, after it had raised the ire of general practitioners. The latter were called upon to participate in this process at a time when the Legault government was threatening to impose a quota of care on them to reduce the number of patients deprived of family doctors.
“There is a shortage of 800 family doctors to take care of patients and we are asked to review all these requests. Couldn’t someone else do that assessment? We all want this system to work, but shifting this administrative task to doctors is not the best use of medical resources at the present time, ”says Dr.r Marc-André Amyot, first vice-president of the FMOQ and general practitioner in the Joliette region.
The problems of access to specialized medical services are however very real, he concedes. “In dermatology, the delays are two years in my region. I have to send the patients to the private sector or to another region. “
The Dr Michel Breton, a general practitioner in Laval, received the famous letter inviting him to recheck the file of each of his patients who have been waiting for more than a year for a consultation with a specialist. “We understand that at the present time, the figures must be shown. But we were all insulted by that, because the deadlines indicated in our requests [exprimant l’ordre de priorité] are never respected. There, it is necessary to dive back into the patient’s file, to regain awareness of his condition. It’s hours of paperwork. A nurse could do this medical follow-up, ”he says.
For its part, the Federation of Specialist Physicians of Quebec (FMSQ) supports tighter management of waiting lists. “It’s okay to take a spin, because there are more than 600,000 requests pending in Quebec, including 150,000 in surgery. This exercise is necessary to constantly reassess priorities, ”says Dr.r Serge Legault, vice-president of the FMSQ.
Are there too many unnecessary requests? The majority of requests are justified, he believes, but not all. He gives the example of a patient waiting for a cesarean who had been on a hospital’s surgery list for… 15 months. Currently, 19,000 patients have been waiting for surgery for more than 12 months. The condition of patients can change for the better or for the worse. “You have to know it, and be up to date. But this watch requires human resources. And there, he lacks arms! “