Page 4342 - Week 14 - Wednesday, 27 November 2013
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overdue and people who have only been on the list for a short while. This may well partially be the case. But surely we want surgeons to focus on those people who have been on the list for a long time and who are at risk of being overdue. It does not actually make any sense that surgeons would take people who have just arrived on their lists in order to minimise the number of people who are overdue. In any case, there are reporting requirements for people who are overdue—how many and why—thus it is in everybody’s interest to minimise this number. Is this not actually the aim of the improvements in the scheduling practice? It certainly strikes me that that is the case.
It is certainly possible that some surgeons are choosing to operate on patients in a different order to them being put on the waiting list, even within each category. Perhaps the circumstances around this could be looked into However, it would not seem that this would be done in order to manipulate the data. If individual surgeons have a significant number of people who are overdue on a regular basis, then I agree this should be looked into by ACT Health. It should probably be noted that some surgeons have more patients than others, and this would depend completely on what kinds of surgeons they are, whether they practice in a number of places, on their mix of public and private patients and other matters like that. However, this does not seem like a systemic issue and, therefore, I do not believe it warrants an inquiry.
There has also been a suggestion that there should be a central waiting list for surgery, and it has been said that there once was. However, I argue that this current system of having separate waiting lists for each surgeon seems more logical. There are certainly central waiting lists for each hospital—Canberra Hospital and Calvary—and each hospital manages the patients on their books once the surgeon has referred them. There are a few key reasons why a central list would not really work. Firstly, around 76 surgeons provide services for elective surgery here in the territory and they provide these services across 13 specialist areas. Those areas range from ear, nose and throat to neurosurgery to gynaecology to ophthalmology. The idea of having a centralised list for these surgeons does not seem to make any sense at all.
Even if you could create 13 separate lists for each range of specialist areas, patients generally already have a relationship with their particular doctor and surgeon through the consultation and diagnosis process, so most patients probably do not want another surgeon they have no relationship with and who has no background on their medical history. There is also a process of post-surgery follow-ups with consultations and check-ups. So, again, it really makes sense to keep the consistency and relationship with the individual surgeon and patient.
I note that ACT Health is also doing work to refer some patients to programs that will improve their health and reduce the pressure on the elective surgery lists. This is, of course, only useful in cases where patients have preventable health issues caused by lack of exercise, the need for particular physiotherapy or movement, improvements in diet or perhaps even reducing or stopping smoking or drug or alcohol intake.
In conclusion, I think that overall we have a high quality elective surgery system in the ACT, and despite people sometimes having to waiting longer than they should, I believe surgeons are doing their best to ensure that this is not having a significant negative health impact.
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