The Ostrich Syndrome

There is an interesting article in the June/06 issue of the Canadian Journal of Gastroenterology----interesting and disturbing. The specific article is titled “Canadian Consensus on Medically Acceptable Wait Times in Digestive Health Care”. First, I’ll give kudos to the editor and the submitters of this article for having the courage to honestly put forward information (as best as is possible) on the issue of wait times and state “comparisons of these bench marks and actual wait times will identify limitations in access to digestive health in Canada. Secondly, they should be reprimanded for not having the courage to categorically state, with the present day knowledge available, that they recommend the wait times put forward in their article. Instead they “cop out” and throw in the caveat “These wait times should be considered targets for future health care improvements and are not considered to be clinical practice guidelines”.
Another obvious negative on the part of the article is the fact that there is so little information available on the impact of waiting on certain medical conditions in gastroenterology (in spite of the authors looking for information in “Medscape”
and other scientific publications), and still the authors, as medical people, did not raise this as a concern. They certainly mentioned this lack of research in the article make no specific comments or recommendations regarding this fact.. If anything, they have the gall in their two month waiting category to list many conditions that have a prevalence of 5% to 10% incidence of colon cancer. I feel that most people would not accept a waiting time of two months if they were told they had a ten percent chance of colon cancer. The article states that to “confirm” colon cancer, (the diagnosis has been suggested strongly by some other modality, eg barium enema) a two week wait should be the maximum since waiting in that situation could be detrimental to the patient’s well being. Obviously, if you are one of the ten percent with colon cancer on the first waiting list, the two month wait has been detrimental to your health.
I found it interesting that, in doing their research, this group found considerable information on the “cost effectiveness” of doing procedures in a given time frame but no information on that same condition as to the harmful effects to the patient of delays in doing the procedure at a given time. Good examples of this are patients with significant lower bowel bleeding when they are an in-patient. Doing a colonoscopy within twenty four hours gets the patient out of hospital quicker and therefore is cost effective. Since only 5% to 10% of these patients have colon cancer, a statement could not be made as to the benefits to the patient of doing the colonoscopy on an urgent basis.
The critics of private health care alternatives always point out that the private system is “profit driven”. It becomes clear from this article that the public system is “cost effect” driven, and in the big picture amounts to the same thing. Money “saved” in the health care system can be then spent to garner votes from other special interest groups, competing social issues, infrastructure, education, etc. If a parallel private system existed, the patient could shop for options. In our monopolistic present day health care system, there is only one game in town.
What is clear in this article also is that we, as a society and a profession, really don’t want to look at, or have too many studies, on the impact of our waiting lists on our citizens. Like our attitudes in many other areas, the “ostrich head in the sand” routine has become a Canadian Value.