Waiting in pain

Waiting is not an idle state. It is not merely the passage of time until one’s name rises to the top of a list. Foundering benchmarks don’t capture the human experience of surgical purgatory. Waiting is painful. It can be physically painful, like for the patient in need of a joint replacement who can barely walk anymore. Waiting can also be emotionally painful, like for the patient with an ovarian mass whose prognosis hangs in the balance of her pathology report.

In this issue of the BCMJ, we are publishing two articles on the state of surgery in our province. In the article on the availability of surgical services in rural British Columbia, Dr Brooke McDonald and colleagues present data that they meticulously collected about procedure volumes in 45 rural communities. Of those communities, 23 did not have a surgical provider and five had family physicians with enhanced surgical and/or obstetric skills as their sole surgical providers.

The article caused me to reflect on how fragile our health care system is in many places, when critical procedures like cesarean sections, appendectomy, abscess management, and colonoscopy depend on one physician for an entire community of people. At a time when many of us in tertiary care settings feel overburdened and burned out, I also wonder about the physical and emotional well-being of these rural colleagues who likely have even less support at their disposal. I imagine that carrying the load of an entire community could feel simultaneously like a great privilege and a great pressure. Please write to the BCMJ and tell me about your experience.

For the other article of this quasi-theme issue, Dr Hwang and colleagues surveyed general surgeons on their staffing needs and wait times. The demand for surgery has increased substantially over the last 10 years, but the number of general surgeons remains in deficit. Having this local data is important because, as they say, what gets measured gets managed. (Or at least we hope it will.)

We know that surgeons are just one part of the huge team required to successfully perform surgery. Nurses, porters, sterile techs, and anesthesiologists are just a few examples of the skilled people essential to a functional operating room. Any one of these indispensable roles can be impacted by training, understaffing, recruitment challenges, etc., and that’s without mentioning the infrastructure itself. This is a complex problem.

In December 2023, Leger, a polling company, published a national survey[1] in which 63% of respondents were living in British Columbia. The results indicated that Canadians’ top priority for health care funding (36%) was to reduce surgical wait times. The online survey was intended to find out about Canadians’ preferences for Pharmacare, but in the end only 18% said they wanted money to go toward creating a new universal single-payer drug coverage plan. Global News reported on the politics currently at play on the topic of health care spending, noting that current proposals do not seem aligned with the stated needs of our population.[2]

In his recent interview with the BCMJ [2024;66:10-13], our new Doctors of BC president, colorectal surgeon Dr Ahmer A. Karimuddin, mentioned that part of the reason he wanted the role was to impact positive change in wait times. Although we are rich in resources in Canada, our system is failing people. Dr Karimuddin comes into the role with energy and enthusiasm for a collaborative approach, using resources like the Specialist Services Committee to leverage change for patients. He recognizes that a lot of people are “at their wits’ end . . . and they [are] going to continue to feel stressed and distressed for their patients and not be able to do much about it.”

Surgery, whether it’s elective or emergent, is essential to good health care. Physicians and patients have identified that access to surgery is a problem. What do you think is one thing that would help?
—Caitlin Dunne, MD, FRCSC

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References

1.    Leger. Report: Pharmacare: Survey of Canadians. 2023. Accessed 19 January 2024. https://leger360.com/wp-content/uploads/2023/12/Leger-X-CP_Pharmacare.pdf.

2.    Osman L. Surgery wait times bigger health priority for Canadians than Pharmacare: Poll. Global News. Updated 20 December 2023. Accessed 19 January 2024. https://globalnews.ca/news/10181516/canada-health-priorities-leger-poll.