Quebec is tightening the screw in order to reduce waiting lists for surgery and for several diagnostic examinations. Patients who have missed or postponed their intervention for the first time will now be ejected from the waiting list in the event of a second refusal.
This new directive from the Ministry of Health, which came into force on November 2, will apply “until further notice”, in the “context of the scarcity of resources” and the “significant increase” in the current number of patients awaiting surgery or diagnosis, we can read. The directive targets in particular non-urgent operations and routine diagnostic examinations such as endoscopies.
From now on, after a second refusal or failure to appear, the patient will be removed from the waiting list and will have to see his doctor again so that the relevance of his intervention is reassessed.
The same directive also targets patients who declare themselves “not available” for personal reasons. A situation that can only be invoked once, for a maximum of six months. This measure seems to target mainly Quebecers residing in the South or abroad for work or for personal reasons.
Big cleaning
Until March 2021, a user could postpone an intervention three times before being eliminated from a waiting list. Last winter, a directive reduced the number of possible postponements to two. But this time, Quebec only allows one postponement.
Asked to explain this change of direction, the Ministry of Health and Social Services (MSSS) sent to the To have to a statement from the Federation of Specialist Physicians of Quebec, which fully supports this measure aimed at “cleaning up” waiting lists and improving access to surgical operations.
The duty wanted to know the extent of the phenomenon. But at the time these lines were written, the MSSS had not been able to provide data allowing to know the proportion of interventions that are canceled due to reasons attributable to patients.
At the CISSS de Laval, however, it is indicated that of the 3898 patients waiting to go to the operating room, 9% are “not available for personal reasons” and have already refused a first date of operation.
The CISSS de la Montérégie-Ouest, for its part, indicates that “the number of people who postpone surgery more than once for personal unavailability is marginal”. At the Suroît hospital, located in Salaberry-de-Valleyfield, about sixty patients, out of nearly 2,500 undergoing an operation each year, will have more than one postponement, which represents 2% of cases, specifies the CISSS.
Jean-François Joncas, president of the Association d’orthopédie du Québec, struggles to quantify the phenomenon. According to him, the “classic” case is that of snowbird, who refuses to be operated on in the winter, during his stay in the hot Florida sun.
” [Au printemps], we receive telephones from patients returning from the South to tell us that they are available, ”he said. Others cite the impossibility of taking time off from a brand new job, continues Dr.r Joncas. “There are people who are very anxious. They postpone, they postpone. At one point, it’s not bad to see if there was a good understanding of why this intervention was recommended. “
The orthopedist believes that this measure will help to make the most of the operating theaters, but also thinks that it aims to skim the waiting lists to improve “the statistics” of the MSSS.
At the DIX30 Surgery Specialized Medical Center in Brossard, which manages the ophthalmology and endoscopy waiting lists of three hospitals through agreements with the CIUSSS, the directive has already been applied. “We have notified the secretaries,” says its general manager, Normand Laberge. At the second refusal, it’s bye-bye. “
According to him, postponements are “not the norm”. But they are more frequent in “certain fields” where the wait is shorter, in particular in ophthalmology. “It’s easy to postpone [quand le délai supplémentaire] is one month, ”says Laberge. It is less so, he points out, when the next availability is in six months. Refusing two intervention dates will have consequences for the patient, he adds. He will have to see his family doctor again and wait an additional 6 to 12 months to see an ophthalmologist. “We need a new request. “
Wrong target
But for patient advocates, this directive does not get to the heart of the matter.
“We accuse patients of being responsible for waiting times, while we should also point the finger at doctors and hospitals, responsible for the cancellation and postponement of about 80% of surgeries and procedures”, s ‘insurgent Me Paul G. Brunet, President of the Council for the Protection of the Sick.
The latter cites to this effect a study published in 2021 which examines the causes of cancellation of operations performed at the general hospital in Kingston, Ontario, between 2012 and 2016. On average, 14% of all planned operations had been canceled, of which less than 15% for medical or patient reasons. In 83.5% of cases, potentially avoidable administrative reasons were the source of the cancellations.
In Quebec, it is above all the lack of personnel, the lack of available intensive care beds and the availability of doctors or other professionals that are at the origin of postponements in the hospitals. During the pandemic, understaffing and the mobilization of intensive care beds by patients with COVID-19 played a major role in the postponement or cancellation of many interventions.
Quebec has recently made the reduction of waiting lists one of its priorities. Last spring, the Minister of Health, Christian Dubé, said he wanted to reduce to 100,000 people by 2023 the number of patients waiting for surgery. There are now more than 150,000, a third of which has been pending for more than six months.