Nancy is “beyond frustrated” with how long her family has had to wait to see specialists. She has been waiting 16 months to see a rheumatologist, and has been told there’s a two-year wait to a pain management centre to help with her chronic pain, despite the fact that she’s taking two opioid drugs and is still too disabled to work.
Meanwhile, her husband waited 160 days for a referral to a gastroenterologist after having daily nausea, vomiting, upper abdominal pain and exhaustion. He’s now waiting to get tests in nearby London, Ontario, to see if he has pancreatic cancer.
“We are very fearful that the long wait times for appointments and tests will reduce his chance for survival if he does indeed have a pancreatic tumour,” she says. “What benefit is there to living near exceptional health services if you can’t actually get appointments?”
Canadian wait times for surgery and certain imaging tests have made headlines since the early 2000s, when the provinces agreed to a joint plan that did reduce wait times for priority surgeries after the patient had seen the surgeon. But we’re far less likely to hear about the time patients wait to see a specialist.
“You can get priority surgery wait times down to less than three months, but if it takes a year to see the surgeon before you get on the wait list, we’re really not doing well,” explains Chris Simpson, a cardiologist who also chaired the now-defunct national Wait Time Alliance.
The 2014 Commonwealth Fund Survey of Older Adults found that 70 percent of primary care doctors thought that their patients often had long wait times to see specialists. It also found more than 25 percent of patients surveyed waited at least two months to see a specialist—the worst of all 11 countries surveyed.
The current referral model: perils and pitfalls
Referrals are integral to our health care system, yet they are often done in a disorganized, haphazard way. Here’s what typically happens when a doctor refers patients to a specialist.
Ideally, a primary care provider refers patients to a specialist who has the right skills for the problem. They would send all the necessary information, and the specialist would then triage the patient according to urgency. The specialist sees the patient, and promptly informs the referring doctor of what happened in the appointment. Specialists would also be available for one-off questions about patients who don’t need a referral but could be treated in primary care.
But often, that’s not what happens. In the worst case scenario, the referral, which is often faxed, gets misplaced or lost entirely. That’s what happened in the case of Greg Price, the young Alberta man who died of cancer after his referrals repeatedly fell through the cracks. At one point, he was told by a doctor who suspected he had cancer that he would be referred to a urology centre, and to expect a call from a specialist within a few days. When he didn’t and followed up, they told him to call the specialist himself. He did—and got a recorded message saying that specialist was away and not seeing patients.
That story is an example of how much “variability” there is in how doctors do referrals, says Jodi Glassford, who leads Alberta Netcare eReferral. “Sometimes when I talk to my friends, I’m like, ‘You’ve gotta follow up. You have to be that patient who’s difficult, because who knows?’ You have no transparency into did it get through, am I on the list, will I be seen?”
It’s unusual for an urgent patient to fall through the cracks as Price did. Normally, a family doctor would call or email a specialist directly and express their concerns, and most specialists do a good job of fitting urgent patients in.
But for patients who aren’t urgent, disorganization and miscommunication is not uncommon. If a primary care provider doesn’t know a specialist, they’ll often pick one off a list without even knowing their subspecialty. Sometimes, they’ll find they’ve picked wrong. “I’ll do up a complete assessment on a patient with a really bad knee, refer her to orthopedics, and three months later I hear back that that specialist only does shoulders. Or you send somebody to a neurologist for seizures and they only do headaches. That’s common,” says Rick Glazier, a family doctor at St. Michael’s Hospital’s Academic Family Health Team.
Or, since there’s usually no way of seeing how long the wait list for a specialist is, they might select someone whose wait lists are far longer than their colleagues’. Some of the work in Alberta looked at the current referral process and found that it was common for specialists to simply turn away patients. “They just say, ‘I don’t have enough capacity, I can’t see these patients and put ‘decline’ on it,” she says. “Then it goes back to primary care, and primary care says, ‘It’s been declined five times.’”
The workarounds
To get around these barriers, some primary care providers use what’s called a shotgun approach, where they submit referrals to multiple specialists at once, and hope that one will stick. That might help the patient, but harms the system as a whole, since patients can end up with two specialist appointments as a result, and other patients’ referrals get delayed.
Or the doctor might direct patients to the emergency room—another less-than-ideal solution that can lead to overcrowding in the emergency department. But sometimes that’s the only option, says Glazier. “If my patient has headaches that are getting more and more severe, and they have their neurology appointment [in a few months], and they’re on a cancellation list, I might send them to the emergency department. It becomes plan B for when people are waiting too long.” Patients in a report by the Health Quality Council of Alberta also said their doctors advised them to keep going back to the emergency room after struggling to get them seen by specialists in a timely manner.
Those workarounds, combined with triage from specialists, work most of the time. But “I think we’ve all had the experience where somebody has sat patiently on a waiting list for two months, and really should have been seen sooner,” says Thomas Parker, head of medicine at St. Michael’s Hospital. “Prolonged wait times might be associated with outcomes we’re not aware of. And if you start viewing it from a patient’s perspective, you also want to provide good and timely service to patients.”
Jim Waddell, access to care provincial clinical lead for orthopaedic surgery at Cancer Care Ontario, agrees. “For people who do need treatment, long wait times are unfair,” he says. “First of all, if you have a progressive, degenerative condition, you do get worse while you’re waiting. Secondly, these people have pain, and they’re disabled by their pain. Thirdly, because of that pain, their family physicians often put them on opioids for pain relief, and many of them have a problems afterwards with the drug.”
There is also evidence the scarcity of specialist referrals is an equity issue, with research showing that people with lower socioeconomic status are less likely to see specialists than those who are better off.
The referral process can be frustrating to both primary care providers and specialists. A 2011 CMA survey found the majority of both family physicians and specialists were frustrated by insufficient information in referrals. The top frustrations from family physicians were difficulties in finding available specialists, not getting acknowledgement of referrals, and having it be their job to tell the patient about the appointment. Idiosyncratic referral processes are also a common complaint—a separate Canadian Medical Association report on the issue discussed specialists who only accept referrals on one day each month as an example. Specialists, for their part, are trying to triage patients without enough supporting information, like lab tests, and unclear reasons for the referral.
In response to these issues, pilot projects across the country have popped up trying to streamline the referral process. Advancements in electronic medical records have paved the way for electronic consultations and e-referrals, and many specialists have adopted central intake systems that allow providers to refer to the next available specialist.
But that’s another story—literally. We’ll delve deeper into four ways Canada can reduce wait times for specialists in our next article on the topic. Look for it on February 23.
Read the next article in this series: Four ways Canada can shorten wait times for specialists
The comments section is closed.
I dread every time I need a referral to a Specialist. My issue with the process is that there is a complete and total lack of consideration for the patient and their needs and wishes. Not consulting with the patient first, before embarking on an arbitrary referral assignment only serves to waste everyone’s precious time and resources in an already stretched “sick” Healthcare system. I am never told who I will be referred to, where they are located, what kind of specialist they are, how long it will take to be contacted and who will followup with me. I saw a surgeon for a cyst, waited a year to see them, traveled 2 hrs for a consultation and was never seen for surgery regardless of my followup calls to their office. I was told that I had to travel 8 hrs to see my GP in person, (I had recently moved), in order to obtain a referral to an allergist nearby who was able to see me almost immediately. I did not take the long drive so still waiting. I was referred to a colposcopy clinic without my consent, and didn’t know why I was there. They were unable to diagnose me so I asked for a 2nd opinion hich resulted in identifying invasive cancer, likely avoidable if I was referred to a more qualified colposcopist the first time. I waited almost a year for a referral for a routine colonoscopy. I canceled the first referral after waiting 9 months, with a number of concerns and will likely have to wait another year for colonoscopy. That will make 13 years since my last colonoscopy. Where are you Cancer Care Ontario? I was referred to a Pain Manageme MD arbitrarily. I showed up at this appointment, didn’t know why I was there and the poor doctor had no information about me. It was a complete waste of time. I may be old school but I will not allow anyone to treat me unless I have done my homework about who they are, what kind a reviews and references they have and if that referral will address my needs. I highly resent not being consulted or involved in the referral process. It is highly ineffective. The sickcare system has lost complete sight of who the client is and who is footing the bills. Not the government, me, the taxpayer.
I have been suffering from carpal tunnel since December 19 2020 was referred to hand wrist clinic in PL in Calgary 2 months has passed still waiting for surgery it may sound like a simple operation but left too long leaves you with no use of your hand
Been waiting to see a Nephrologist, gfr 38% have been 32% told to go home and drink water 2 litres
A day, that was a year and 10 months ago, have since found on an older MRI that I have a very large cyst on one kidney and a small one on the other. This is contributing to my kidney failure. So although we pay monthly for health care I can only see my primary care doctor. I could be seen by a nephrologist
but not likely, because I live in BC Canada, and cannot afford private care. Therefore in a year or so I’ll have to have dialysis. Am very depressed at that. Guess I just have to wait till my kidneys fail or die!
Thank you.
My wait time to see the orthopedic surgeon for hip replacement was 4 months. The wait time for surgery before covid was 1.5 years….now with covid it will total 3.4 years in lethbridge, alberta. This absolutely unacceptable and something has to change. Higher taxes is not the answer.
Because of family history, age, etc. FamDoc ordered a couple treadmill stress tests — ECG & nuclear. Both were aborted due to irregular readings. Also possible sketchy imaging. Basically, I could have some kind of heart disease. Refers me to a cardiac spec. The original clinic reply was a wait of 6-8 months. It’s now been nearly 12 months…without a word. That’s about 11.75 months too long.
I called the spec office today and, unlike 4 months ago when you could talk with an actual person, the office now has only an answering machine and the message explicitly explains that they will NOT call you back if you are inquiring about your wait list position. So I can’t talk to them and they aren’t going to talk to me. Awesome system.
A year ago I was a competitive endurance athlete but have since had to stop. As others have said, my life is totally on hold while I wait, and wait, and wait…. Hope I don’t have a heart attack or stroke while I wait for the elusive Dr. Snuffleupagus to see me between vacations and tee times.
Maybe we could fund the heath “care” system with taxes on the increased number of funerals occurring as a result of the system itself.
Good luck to all.
Ohh Ishmael I will pray for you !! This health care system is turning to hell in a hand basket ! I’m faced with ovarian cancer they say but .. I still have to wait another month for the surgery while I have pain and I’m nauseous but it’s ok right bc they gave me painkillers ugh
They can open up that caps/ceilings on for ex. ankle replacements……..current wait is 1.5 years. Does anyone wonder what a person goes through, or how much worse they get waiting this long??
I was recently diagnosed with Chronic Lymphocytic Leukemia, am asymptomatic other than a blood chemistry report, and grateful that the medical recommendation is for observation rather than treatment.
Even so, out of the blue I received a letter from a dermatology clinic I had no prior contact with confirming my appointment (I didn’t know one was requested) but it’s in 2 YEARS and 4 MONTHS! The form letter warns that the wait time at the appointment is between 30 minutes and two hours and if I don’t cancel 24 hours in advance they will charge me $50.
Again, I feel fortunate that my issue isn’t considered urgent, although I have difficulty assessing risk, but I’m only complaining about the system inefficiency that this demonstrates.
No wonder the clinic has no shows. Who really knows where anyone of us will be on a given day 48 months from now?
Their wait list likely contains a large number of appointments that will either be no shows or cancellations and that are occupying a time slot that someone who needs it could have. On the other hand their warning about being up to 2 1/2 hours behind means they don’t believe in their own appointments and are likely double booking to make sure they have enough patients, probably favouring the ones who pay for cosmetic procedures.
How can it be considered effective to constantly make appointments that they already know many patients, and the doctor herself, won’t keep?
The letter is also rude, and the process is high handed but neither the clinic or the referring agency see any problem with this. (I’m the only one who has complained, so that must mean I’m the problem).
The clinic that arranged the appointment says they are comfortable with the wait time, but I have no way of knowing what my risk is, and can’;t understand how something is deemed necessary enough that an appointment is made and that public resources should be spent
I’m an American citizen and our country wants to try this type of Medicare system. My heart goes out to everyone that’s waiting and suffering. This is my biggest fear of a system like this in play and everyone is over looked and never get the care they need.
Our health care system is held together by band-aids. I’ve been through the whole process of lost and incorrect referrals. I’ve had countless drug interactions because of doctors prescribing things for “off-label” uses when they aren’t even sure how the drug works for it’s stated purpose. They throw opioids at pain to account for wait times that can be in excess of a year and even longer with zero thought as to the repercussions to the patient. Then the patient is greeted with suspicion by the pharmacist every time they fill an opioid prescription. I’m getting tired of being treated like a criminal for needing pain relief. By the time I got into a surgeon there was nothing he could do, because I’d waited too long. Now, they have referred me to a physical medicine and rehab specialist, which seems backwards to me. This should have been the first course of action when this presented itself ten years ago. I am now 43, pretty damned disabled for my age, and had someone cared ten years ago I may not have lost my livelihood and independence unnecessarily. Disgusting.
I’m so sorry I feel that drs just throw pain killers at your situation! I’m facing ovarian cancer and I have to wait another month and I’m in pain and nauseous everyday
We have been waiting over a year for a GI Specialist (Pediatric) for my son. He’s been sick much of his life and is now 13. It took years of monthly visits to GP and multiple hospital visits to even get a referral. Apparently, family doctors are reluctant to make referrals for children as the testing can be intrusive and uncomfortable. I just got a call from the GI Specialist at the hospital stating that they were canceling and rescheduling as the doctor was “taking the day off”. The next available appointment is over 2 months away. I could cry.
I thought people could just keep an appointment book and book in order the referrals they receive. Why does anybody have to wait for that? Let them write their own name into the next empty space. What’s the problem? I don’t think an appointment should take more than 10 minutes. If the appointment book is full, either buy a new book or tell the patient when the soonest you can see them is.
There should be no waiting or mystery around an appointment. This does not involve a degree in medicine. It is clerical work, that can be done for minimum wage.
If a clerk or secretary refuses to answer calls, they should be fired. This is not rocket science.
i got a referral to see a neurologist and when i called to ask about my appointment i was told to wait from a year to 2 years to get appointment. i have been waiting for a year and my case is getting worse and still i did not get my appointment.
In USA referrals take a long time as well. Waited 3 months for a thyroid biopsy – had to call someone in another county and ask my doctor to refer instead of her university affiliated colleague.
Now I am waiting 40 days for a biopsy on my face. Original one was scheduled at 3 weeks, then cancelled by doctor and rescheduled for another 2. This is ridiculous. Tried to get referral to pay out of network and after 20 calls I gave up. I am angry that I have to worry for 40 days and now another 7 for results.
If you listen to the way Justin Turdeau tells us how we have one of the best medical systems in the world, then you know why our country is so screwed up. These specialists think they are so special. Instead of seeing patients, many take long holidays. I need to see a doctor for hormone therapy. My doctor made an appointment at the Kelowna Hospital. The problem is, it is in five months. I don’t need surgery, just a prescription. In Mexico, a person can have a hip replacement in less than two weeks. Yes, you have to pay for it, but the costs there are far less than in Canada. Canadian doctors think they should be paid the highest. So if anyone reads this, if you need surgery and cannot wait till you die, there are medical holidays in Mexico that you can take and have surgery a lot sooner.
We Can not afford to leave this problem with the patient. And it is obvious that the doctors ethics to do no harm is false. As well as the Hippocratic oath.
As it now greatly shows, that the only thing that is pressent is the almighty dollar.
I have been waiting 14 weeks to get an appointment with a gynecologist for menorrhagia and 2 polyps. Bleeding in between cycles and for min of 18 days. Constant pain. My frustration is that the receptionist won’t return my calls and I don’t know how to get past that. It’s been 5 weeks since my first voicemail. My doctor resent referral with a note she wanted me seen before 4 weeks. Neither one of us has recieved a call back. I know she has my referral bc I spoke with her at the 5 week mark and she told me she wouldn’t start making appt until 6 week mark had passed. In other words, don’t bother her. How do I get past the receptionist?
Waited a year for an Mri in back pain and bowel weak leg issues. Had nerve studies all negative yet I cannot sit with out weak legs and back pain. Neurologist says I have conversion disorder. Many doctors do not really understand it. Had gone to more specialist no answer. 14 months I am getting weaker and very depressed.
Occipital neuralgia combined with degeneration in the c6 c7 neck region leaves me with crushing tension headaches that come and go randomly. My Neurologist rushes me through the appointment and I’m often left feeling like I’m being misdiagnosed or undermined.
sounds awesome
I went to my dentist’s to have my wisdom tooth removed. Surprise to myself and the dentist, I had an improperly treated cavity that turned into a large bone infection in my jaw that was sitting right on top of the nerve that runs across the jaw bone. The dentist referred me to an oral surgeon. Referral #1: Oral surgeon denied me treatment due to financial status and no coverage. I contacted my GP’s office and explained the situation, requesting help. I gave them my dentist’s information to collect my file and imaging. I inform the dentist’s office that my GP will be requesting my file. Time passes. I call my GP’s office again to inquire about possible referrals. I’m told my GP has a colleague in the same building that he will talk to. Time passes. I check in again. GP has now gone on a week long vacation. Time passes. I check in again only to discover that my file still hasn’t been collected, nor has a referral been written. I inform the GP’s secretary that I will get the file sent over myself. GP’s secretary seems less than happy to hear from me. Attitude ensues. I went to the dentist’s office and gave them my GP’s contact info. GP finally has my file. This process alone was approximately 3 weeks before referral #2 is even written. More time passes. I check in regarding possible referral. Referral #2: ENT refused to see me and tells GP to refer me to Oral surgeon. Well I’ll be damned. Time passes. I check in with GP hoping for luck on another referral. GP’s secretary says “sorry”. Zero intentions of further pursuit to advocate for me. More attitude ensues. I filed a complaint regarding unwarranted attitude. I am then accused of verbal abuse, but only AFTER I have filed said complaint. I still have yet to be seen by my GP. I book my child an appointment for other reasons. I manage to request pills for pain and more antibiotics for myself in said visit as they’ve run out and it’s been some time. No pain pills issued and given antibiotics not cut out to treat a bone infection. I return to my dentist with bad news. Dentist refers me to another oral surgeon. Referral #3: Oral surgeon refuses treatment because I’m on assistance. All the while I’ve been sleep deprived from pain and consumed over 200 pills to try to kill said pain and accidentally overdosed on T1’s and still had excruciating pain. Couldn’t eat without pain. So off I go to the Emerge. A doctor refers me to an ENT. I inform my GP’s office that I’ve gone to emerge due to pain and lack of medical attention. Referral #4: Time passes. I check in with GP’s office. Secretary informs me I was referred to the same ENT that already refused me treatment, so I should expect to be denied yet again. By this time, I’ve already called numerous surgeons on my own, begging for treatment and offering payment plans. No across the board. I’m already emailing OHIP review board and Cheif Medical Officer, among many others, informing them of this situation, requesting help. Referral #5: I finally make enough noise to get seen by an amazing oral surgeon in a different city. Within a month of the initial appointment, I had a high resolution scan on my jaw bone, and had bone grafting surgery. ENT’s secretary calls me after I met my oral surgeon. She informs me that the referral my GP sent said I had a soft tissue infection, but the referral from emerge stated I had a bone infection. ENT’s secretary informed me of this discrepancy and offered to book an appointment for me. I informed her of the success of referral #5. GP never once saw me for this issue. Remember my child’s appointment? I “squeezed” myself in. My GP did not perform a physical exam, and quite clearly failed to hear my words, as well as read my medical file and look at the imaging. This is a problem. HE HAD NO IDEA I HAD A BONE INFECTION. After all this time, pain, and headache. I filed a complaint about the entire situation. Now I’m being denied further health care by my GP, because I filed a complaint, without him having actually fired me as a patient, nor discussing such potential actions. I am still registered as his patient. Funny how that works. … That being said, I’d like to have a doctor who will listen to me and help advocate for my health, and that of my children’s. This is not the first time I have been ignored by a GP. And it is not the first time I have sought medical attention around them.
One of the issues is the doctors themselves. There are many hard working, caring doctors. But, there are also many entitled, lazy doctors who simply don’t want to work or put in the time to take care of their patients. They work 9-3, Mon to Fri and that’s it. It took my mom 3 months to get in for a stress test (she was having DAILY chest pain, which was getting worse by the day – we know there is damage and blockages). Finally got the test, and the doctors said she would be referred to and sent to the cath lab to have an angiogram (she probably needs stents at minimum) within a few weeks. It’s now been 4 weeks, and we have now just found out (through persistent calls each week) that the doctor hasn’t even done his dictation let alone written the referral – and to boot, the doctor hasn’t been in his office for the last 3 weeks – and is gone (not sure where – we get different stories from different receptionists) for another 2 weeks. So we wait. She has talked to the cath lab – they have told her as soon as they get the referral, we’re good to go, but they can’t do anything without the referral from the specialist. Apparently the specialist only does his dictations every couple of months. There is no compassion or explanation – just waiting, praying that my mom’s heart holds out. Doctors should be required to take care of paperwork within a certain time of seeing a patient – and not be allowed to delay it by 3 months.
Cannabis will be here soon……then you can get high and maybe pain free as well.
I have done MRIsin USA have CDs and need referral to a pneurologist to determine what sort of tumor is in my brain. My doctor marked it Urgent.b Six weeks gone no referral appointment
Health-care in this country is beyond abysmal. I wish I had never come here!
This is an important issue in Canada. I too was told the wait time for a specialist will be 10 months. In the mean time I am supposed to wait. My doctors reply that some patients die waiting. This was an unexpected reply and was disappointed. Living here in Canada is not what I expected. There must be some ways to improve this system. We certainly don’t rate well.
My 80-year-old mother was at the emergency 4 months ago for abdominal pain, nausea, bloating and the emergency doctor referred her to a specialist who has yet to call. She is suffering and I am not sure what to do. This is ridiculous that we don’t have sufficient specialist doctors in Canada. There are so many doctors who immigrate here but are not given a chance to practice and we citizens suffer from lack of doctors. When a friend of mine immigrated to Canada she and her family did not have a family doctor for over a year because no doctors close by was accepting new patients. She finally got family doctor practicing in another area. Is this really a great healthcare system for a developed country?
Healthcare is definitely NOT free as so many people in Canada believe….not only are our much taxes higher but more importantly, long wait times in the emergency and to see a doctor/specialist is making our healthcare system “sick”.
Should your specialist’s office be answering phones during regular office hours? I have a specialist that I have to actually travel to the office to make an appointment to see the doc because her receptionist not only NEVER answers the phone during regular office hours but, NEVER returns a message or the in-box is full and you cannot leave a message. The outgoing message states to leave one message and one message only, which I do, clear and concise with a return phone number for any time they call back. Three weeks later and I still get no return phone call even with a problem. I end up in an E.R. where the doctors tell me to get in touch with my specialist. I have spoken to the doctor about this on several occasions where her only answer is, “that’s the way my office runs.” Now, I may be in for surgery but, if something were to go wrong, I’d be left without access to my specialist and often (she’s done another surgery on me where there were issues), an E.R. doc or my family doc will simply return me to my specialists whom I can’t get in touch with. How do I deal with this situation? Is this a usual occurrence with specialists or, should I be looking for another specialist now?
My husband had a DVT and massive pulmonary embolism on April 28th, 2017 which he thankfully survived. Upon discharge of the hospital (Markham Stouffville) in Ontario they were to set up an appointment with a Haematologist. 2 months go by and 4 faxes and nothing. Like the person in your story we called ourselves and were not permitted to make the appointment. The Internal Medicine doctor at Markham Stouffville himself sent a fax for referral. Nothing. We were told to set up an appointment with our G.P. It is now August 29, saw our GP today (who lives in Newmarket). He was in touch with a haematologist but he refused see him because we didn’t live in York County. We are 45 minutes away from this hospital but in Beaverton. There are no hospitals nearby. He said there were new rules and if we didn’t live in York Region he wouldn’t see him and basically too bad. Are you kidding me?? He is now trying to find another specialist who will take him on but seeing one is basically going to take a few more months. The doctors at the emergency rooms in hospitals and our GP’s are doing an amazing job. And then the system falls flat on it’s face. Very Upset Over This!! Thanks for listening.
I sprained my ankle when I was 20. I’m now 22 and finally getting to see a specialist next week to figure out what’s wrong. I also just got my EMG test booked which is another 4 months away. I can’t believe the level of health care that Canada is offering. I haven’t been able to walk for so long, which is taking a toll on me mentally since I am (was) a very active person. Took 8 months to get an MRI initially. Ankle sprains are the most common sports injury and my family doctor says I will live with this pain for the rest of my life. I’m currently saving up money to go overseas and find some genuine health care. If they can reattach fingers and fix spines, they can fix a freaking sprained ankle.
I had a mammogram and ultrasound on July 5th where a lump was discovered. On July 6, my doctor told me that there was some urgency and I would be scheduled for biopsy that week or likely the next. I have heard nothing – so called doctor office – 3 times in last 10 days. My doctor’s receptionist states that radiologist is waiting for images. Phoned True North who stated they received the request on July 11 and sent images July 12. They advised that they would send again – that was July 13. Called doctor office July 17 – receptionist stated the radiologist is waiting for the report. How long do I wait and what further can I do to expedite this? How long should the appointment for a biopsy usually take? I know that if I had my mammogram at the hospital, I would have had the biopsy the same day. If I ever do get in, it is another 2 weeks for the results and then how long before treatment? My whole summer is taken up high emotional roller coaster, heart palpitations, I can’t eat, I can’t sleep. Feel so helpless.
My whole life is on hold – I can’t book holidays, sign up for gym memberships. I don’t even buy clothes or things I may not need in case I am dead in 3 months. Its a form of torture really…
I am so sorry to hear your story”. Hope things will get better gor you. God bless. Rosa
I am so thoroughly disappointed in our Health Repair system. My husband has been on crutches coming up on 9 months in June. He’s been waiting for total hip replacement since October. We called in May and we’re told his surgery would be scheduled for May. Then…no word…no pre op …nothing. So then hospital calls and asks him if he has a date….so I called Dr.again. This time I was told that someone who saw the Dr. On Oct 6 th…will be having their surgery in May. My husband…who has been unable to work since December…will now be going in June. I’m sorry that I have no faith that this will happen. He has worked hard his entire life and now he’s used up his 15 weeks ( what a joke) of sick benefits. If it weren’t for the short term disability amount of 475. 00 a week we would be going under very fast. As it is we have exhausted our savings and are now using our Line of Credit to make ends meet. Does this sound crazy to anyone else?? He is waiting on shoulder replacements in the fall, he has Osteoarthritis. The shoulder doctor called with a cancellation but we couldn’t take it due to the awaiting hip surgery. I am beyond frustrated. My husband can’t take pain meds…the pain is just spreading. His knee, his leg..his groin. He cries out at night in his sleep from moving in bed. Whoever created this message in Ottawa needs to fix it…and while they are at it maybe butt out of the business of Doctoring. No one tells the politicians how much money they can earn…what gives them the right to stick their nose in the Doctors business. My husband and I feel trapped…watching everything we worked for our whole lives crumbling around us. We were getting ready to retire but I guess we will get ready to start paying down debt again rather than thinking of Retirement. Of all the idiot things Donald Trump said…one thing rang true…our medical system is not working. Peoples health is being compromised..some people are losing their battle. And please don’t insult my intelligence by expecting me to believe that favours aren’t done for people who know “someone”. The woman who bumped my husband’s time slot….where did she come from?? Where was she when they were booking his slot…they claim she saw the Dr. two weeks before my husband….then why wasn’t she booked before him….why was she even mentioned to my husband. Something smells fishy. I’m fed up and thoroughly disappointed…like so many of you said before….open up more operating tables…allow Doctors to perform surgery instead of capping the amount they do. People…real live breathing people are in dire need of these surgeons abilities. This system is crippling it all…the patients the doctors and the families trying to survive. Surely to God there is something someone in Ottawa can do.
im here to tell you to be the persistent patient. Call and check on all referrals to specialist and call specialist get on cancellation list and do your own research for your symptons and tell doctors what you know and what you think needs to be done. Keep on your family doctors to do there jobs with referrals and updates to referring specialists when things get worse. if you think your family doctor isn’t doing the right things by you and your needs get a new one right away. ask lots of questions at your appointment s and make the doctor listen to every word. You will be classified as annoying or bothersome by the specialist but you are fighting for your life and your health so fight good. Don’t let the health care system walk over you.
in alberta most referrals go through a central triage coordinator. they sit there in a pile of thousands for weeks before you name is even looked at and then they take their time finding where to send the referral to and then you wait for months and months even when its cancer they suspect. I got ill a year ago and its now determined it was bone cancer after all the first round of tests were normal. after a year of seeing one specialist after another and waiting months in between each specialist that couldn’t find the issue and sent me back to family doctor to get another referral sent to a new specialist. ridiculous now im real real sick everyday vomiting and nausea and excrutiatiing pain in my neck back and shoulders and my chest and basically cant move. in the time waiting to be diagnosed by a bunch of specialist who don’t take the time they should with you to listen and figure out the issue properly I now have the cancer spreading to my lings and my liver as well as my esophagus and larynx. If doctors would have listened to me properly and listened to what I thought it was I would have been diagnosed before the bone cancer spread and could have been saved. I told them since day one at the first emergency trip that it was my bones and my throat but dr didn’t want to put me in hospital and run the tests they should so now I wait for the next specialist and biopsy results before they will even call for an oncologist. AHs runs alberta hospitals and special tests and they do a lousy job at getting people who are extremely sick sick in on time . Early detection is not possible here when you have to wait over 6 months just for an mri. \our hospitals are so full of people going in with the flu so going there unless your dying isn’t an option unless you want to risk catching the flu and dying that way. So in short I couldn’t get the cancer early and I blame ahs for this.Things really need to be fixed in alberta and in Canada it may be free er health care but you really pay in other ways here
Monica…I do volunteer work in my local hospital. Even the nurses have said quietly to me..”It’s not healthcare anymore..it’s healthREPAIR”. Things go on for too long, then surgery is required, or a disease has spread when it all could have been avoided!
I’m a proud Canadian but I’m totally disgusted with the way things are run in our “healthcare” system. We have young under-trained family drs. Some of whom are cocky know-it-alls, & guess as to what’s wrong with the patient rather than send them for testing or to a specialist. I know..I was a ‘victim’ of that.
Maybe a lawsuit or 2 against AHS would change things. If I were you I’d definitely be suing.
The system would work better if Family Medicine was better: if Family Physicians were better trained, they could do more, treating some themselves, and therefore need to refer less, so that specialist would have fewer referrals to care for. Also while patients wait, their care can be continued and escalated: eg patients investigated and first stage treatments used. Some would improve and no longer need the referral. But Canadian Family Physicians have the shortest training in the civilised world, and even worse, the incentives mean that too many work in “walk-in” clinics where they simply refer without thought, rather than care properly for the patient. So we need to start with improving primary care.
The other side of this is that many specialists like to see “trivial” cases: they get full consulting fees for less work than if they were seeing difficult patient problems. So instead of educating the referring physician about how they could do better next time, and not need to refer, many do not write back, often keep the patient attending them regularly for long periods, or encourage further referrals. So change the financial incentives too.
Why can I not pay for health care if I so choose? How is it different from any other commodity? If my dog and I both come down with the same issue…say we both need a knee replacement, which one of us do you think would be fixed up quicker? Thats ridiculous.
Because it enables you to jump the line up, my friend. Why should someone with money get priority over someone without? More insinuously, it reduces the political will to fix the situation. If the better-to-do don’t use the system, they have no motivation to lookout for the powerless. It is just as much a tragedy for a poor mother of two to die unnecessarily, than a mother of two with more resources. It further weakens the system, if they divert public Canadian resources into private use. Because doctors are real human beings, so some will give priority to more profitable “private” patients.
Right. The first option is that health care be better in BC. That means faster, less waits that put people in danger and create more pain and deterioration. Drs should also be honest about wait times. It’s a patients human right to know when time is critical due to terminal illness. They have the right to decide how to be treated if they were honest about how long it will take but they’re not. So people are dying and worsening while waiting when they would have had a better chance of survival if they had accurate information about when they’d be getting the call back. Could make choices about their own care. But this is not the case in BC. The care and times for care should be better but they’re not. So they’re violating the rights to someone accessing potential care that exists for them elsewhere (private) by not being honest that they can’t provide in Canada AND by not offering it in private due to fear of the US two tier system. Sounds like the only option is if the Canadian health care gets better & starts providing which is what people are asking for first. If that doesn’t happen it Canada is violating a human right to access care in his/her own city when he/she has lost all ability due to terminal brain cancer etc. Private should have been an option in the case of my family member. Hands down. We will not be martyrs until they fix the system. Preventing private (therefore accessible) care at the cost of lives is not a way to fight for the public health care system. Lives are lost that could have been saved. That is the truth. There will always be the publicly funded system for those who ‘can’ wait or don’t have the means to take out a second mortgage to pay for survival. I’m sorry to inform you that most people would choose the latter for their loved ones and choose life over death by neglect which is what happens in BC hospitals with many seniors. They hear “terminal” illness and don’t fight for them even though there’s an array of technologies and science out there to prove they can live “longer”. Even a day longer matters to a loved one but B.C. simply can’t afford it so they neglect to bring therapies that are working elsewhere. It’s too expensive. This is Canada and they’re letting people die because it’s cheaper and going to die anyways eventually from the disease. Unfortunately, that’s the hard truth. Ask an American who has lived here. They can’t believe how little fight there is for people here. Few options and the college ‘always’ at all costs protecting the doctors whether they dealt inappropriate or not. Worst healthcare in the world.
Why not have a centralized list of specialist in each health care jurisdiction of the country. This list should be in a Provincial Data base and a Provincial Referral Coordinator should be hired to select from this list and contact the specialist. The problem at the moment is due to the fact that the referrals are made by a GP’s receptionist who is always busy and has to make several calls before confirming an appointment. If the Receptionist can call the Coordinator and pass on the required patient details it removes the hit and miss aspect of arranging a referral with a specific specialist and speeds up the process.
You want to see results and better patient care stop focusing on stats and how it looks on paper. For example, there has been instances where a doctor will see many patients and then gets slapped on the hand for exceeding the amount has he has seen more than he should or it has balance with his surgical time. After all everybody has to answer to somebody.
If the whole medical industrial complex would just recognize that the patients on the bottom of the blood pressure curve have problems too just as the people on the top of the curve do a lot of time would be saved by treating them instead of shunting them around from specialist to specialist as if they’re a curiosity which has never been seen before.
People with low blood pressure are not “fine”. They suffer autonomic nervous system symptoms including POTS. They should be monitored for their anti-cholinergic drug burden. They should be warned to stay away from organophosphates as much as possible, and that includes eye drops at the opthamologist which dilates pupils.
Modern medicine hasn’t kept up with research into the effects of chemicals and drugs have on our bodies. Doctors only tools are surgery and drugs, and that’s not working for a lot of people. People with low blood pressure can’t detoxify their bodies like the rest can. That’s why the most pervasive term we’re going to see for the next 30 years will be Autoimmune Disease. It’s a bugger and it’s preventable and unless doctors get honest and stop passing patients off to a million specialist for their “mystery” disease, it’ll cost us a heck of a lot more money than we have.
It’s about time doctors spoke honestly and publicly about our health care system. I’m looking forward to an article about the truth of what happens in the OR. It’s an unregulated free for all where true emergencies are constantly bumped off the top of the list by doctors who have wealthy clients who want hip or other non-emergency surgery. We need the Ontario ombudsman to have access to evaluating our whole healthcare system.
I agree!…what about the poor woman who was told by her surgeon that she would be in hospital 2-3 days (after having a double-mastectomy). When the nurse was preparing her for the surgery, the nurse told her she would be going home that same day because they didn’t have any beds!!!!!!!! That poor woman was in tears as I walked her to the OR. She asked my opinion..so I asked if there was any possibility she may have misunderstood what her Surgeon told her. “No” she said…”He told me I’d be in hospital 2-3 days, now I’m being told by a nurse that I’m going home TODAY”. My response to her was..”If it were me, & this is just if it were me, before I’d go in there (the OR) I’d tell the nurse or whoever I want to speak to my Surgeon. Then I’d let him know that he told me I was being admitted for 2-3 days, & was told by the nurse I was going home today because there are no beds”. If he were to act surprised, then I’d ask him to rectify the matter, or if he were to say it’s right..there are no beds”, then I’d tell him..
“No beds..Considering I’m having a double-mastectomy, & there are no beds..it seems MY time AND yours has been wasted because I am NOT having this surgery today or until you get me a bed”.
I don’t believe for a second there were no beds for this lady. Assembly lines do occur at the OR’s…believe it or not. In no way should any woman be sent home the same day after having a double mastectomy.
Efficiency is a good thing when it comes to referral systems and health care systems in general. However, we have a VOLUME problem that overwhelms efficiencies.
Added in is the complexity of human behaviour and we have a doozy of a challenge that efficiencies are unlikely to solve.
I think e-records can help organize things but people may be underestimating how much of a problem this will be in the short term and how much we will have accomplished in the long term. I’m a Canadian currently working at a top US University Hospital Centre who has seen a system spend over a billion dollars to implement the best electronic health records system in the country. The advantages of this system have prevented some obvious wastage in reordering testing since the results are now compiled in one place. As a further advancement, the State now requires all the hospitals to form a network to share their information. That way a patient who visits more than one hospital (which is more often the case, than not) can have their records carried forward without the patient carrying a comprehensive collection of all their records (which never happens, even with the most organized patient). This allows the healthcare provider to understand the entire history of the patient and more accurately treat them. So from a health timeline and testing perspective the benefits have been seen. However, another function is to input consultations for various specialists to see patients. This is often where the entire system fails. Regardless of all the bells and whistles programmed into the software, the program can’t change the unpredictable behavior of humans. All too frequently, consultations still need to be followed up with phone calls and emails or they get ignored. And many times, the residents need to name drop an influential physician of their department so the request takes priority, or even consideration. The concern i see with e-referrals is that specialists are just going to keep pushing the patient onwards because they may consider themselves busy, but that is not relatively busier than their colleague. Secondly, the patient may get ushered to another specialist, but it may be to one not subspecialized in their condition (e.g. the hip patient who gets sent to a orthopod who focuses on shoulders, not hips). Despite this, I am not a pessimist disguising as a realist. I sincerely think there is a solution and this article speaking out to the broader public is how to get the broader attention necessary which will convene the attention and resources to making a more efficient process. One thing that I would suggest is integrating more engineers, especially those trained in efficiency management like six sigma trainees, into designing work flows for the healthcare system. Their education is specifically designed to handle similar challenges and in the industries they apply themselves they reduce a lot of waste. A Healthcare Engineer!
I think that from a family and patient’s perspective, one really has to be proactive. One cannot afford to leave it up to the primary physician’s office to follow-up. I think that it is the patient’s responsibility to do this.
My husband suffered from Alzheimer’s Disease(now deceased) and also had some health issues so I had to be proactive. I recall that he had a inguinal hernia and the family physician referred him to a surgeon. After no reply for 6 weeks, I decided to take matters into my own hands. I kept calling practically EVERY DAY to ask for an appointment.
During all of this, I found that there had been a change-over in the Office Assistant. On one of my calls, I guess I got lucky but was able to speak with the new Assistant and I secured an early appointment.
I think that determination is the key.
The gap in that method is for patients who don’t have the benefit of healthy patient advocates able to follow-up and badger as needed. Chronic pain and progressive disability often renders patients so exhausted that daily follow-up calls are too onerous. However it’s true that it does fall to patients and, if they’re lucky, their family members to take matters into their own hands or risk falling through the cracks.
Hi Carol…
I totally agree with you, re following up yourself (patient). I can be impatient at times, because I feel a lot of things are not being done as professionally as they should/could be. In no way should a patient be waiting weeks to hear back about an appointment, then to be told “your appointment is”…(6 months down the road). I for one am suffering with a neurological ailment. I’m “told” the problem is caused by what’s going on in my spine, & that compression surgery is very risky. I was never tested for small fibre neuropathy, no skin biopsy was performed, & EMG/NCD came back negative. No wonder..they were just testing the long fibres. My burning feet & shins are burning now more than ever, along with pins/needles in my legs which I find is tolerable HOWEVER I have the odd pins/needles in my right arm..which likely is being blamed on a minor encroachment in my neck. The question in my mind is..’so what’s causing the odd pins/needles in my face..scalp?” I feel as though I was diagnosed shabbily by the Neurologist, & have had my GP make a referral to the Neurology clinic at the hospital in the city. I’m told by that Neurology Dept. that I may be able to get an appointment in about 2 months, so of course that’s where I want to go, & my GP is making the referral. Now things are progressing a little more..slight numbness (off/on) at the top of my right buttock, & on the left side of my foot. So what do I do? Must I sit & wait for the 2 months & hope my body doesn’t become so bad what I wind up in the Emergency Dept? I have left a message with that Neurology Dept. asking if they have received my Dr’s referral. That was 2 1/2 days ago, & I haven’t heard anything. They don’t answer the phone. How I knew it may be possible to get an appt. 2 months away was a day last week I called, left a message & someone returned my call a few hours later. I will wait ’til next week some time then keep trying to find out anything. Should things worsen., I’ll contact my GP again & ask his advice. Likely when I finally get the appt. the Neurologist there will want to do bloodwork, possibly imaging (MRI) which as you know could take months to have that done. I do expect to have to start from scratch, & hope with all hope that my symptoms don’t progress to the point where Im in big trouble. Truly Carol..I think there are times when we have to be a ‘pain in the butt’ to get some answers. I’m almost tempted to drive to the city to visit that Neurology clinic to see if I can secure any further information. Again, we have to be proactive. I don’t encourage anybody to sit & wait when it’s not necessary. Adopt the attitude that it’s not “I would like” any more…but “I WANT”.
Hi Cheryl,
I completely agree with you when you say “I don’t encourage anybody to sit and wait when it’s not necessary. I sincerely hope that you have been taken care of at the neurology department. If not, consider checking us out. http://www.CanAmericaHealth.com connects Canadian patients with American healthcare providers to get you the treatment or procedure you need on your time. Patients register for free and put in a request for the specified treatment which gets filtered to our healthcare providers. They then bid on your requested treatment and you choose who you connect with.
Hi Dayna,
I was thrilled when I saw your advice about how to find an American doctor to help me with my ankle that I can’t get anyone in Canada to look at. However, that web site so longer does what it apparently did three years ago – it is now some sort of a collection of advertisements and is apparently for sale. Any idea for other ways to find a doctor in the US? Online or by phone, anything would be greatly appreciated!
Calgary has two great programs, a Knee clinic which has been open for several years and a new Shoulder Clinic. Patients are referred to the clinic where Physician extenders such as Athletic Therapists or Physiotherapists to do the initial triage so that simple orthopedic problems get sent to the proper treatment route, thus eliminating people getting to a Specialist, in this case, orthopods that just need proper exercise treatment. Truly surgical or pharmacological interventions are then seen by the Specialist. These types of programs would go a long way to reduce orthopaedic wait times across the country if adopted.
Is there any way you can possibly get me the number for the shoulder clinic in Calgary? I’m from edmonton and have no idea what I’d be looking for. I have a labral tear in my shoulder and I’ve been on the wait list to just see a surgeon for over a year and a half now and I’m starting to lose my mind. My email is arahall19@gmail.com I would appreciate it so much. Thank you.
Who refers you to these clinics
While this article gives many good ideas on how to make referrals more efficient and smooth, much of problem would dissipate if we had the resources to deal with all the patients that require care. If there were enough specialists vying to see patients then the specialists themselves would be instituting changes to get the patients in.
With regard to surgery wait times, just opening up OR time would decrease wait times. When more OR time was opened up a few years ago in Ontario for cataract surgery, the wait times plummeted.
My frustration lies in not knowing the specialty of the specialist. There is a list of specialists and their contact info but no other information. I would ask the College & Physicians of Alberta to improve the list so as to facilitate timely care to patients and save the time of both community practitioners and specialists. A simple fix!
I would like to point out that central intake access services (e.g. cardiac assessment, emergency ophthalmology, etc) provide one central referral intake that priorizes and facilitates the whole process. We could use more of these for almost any specialty.
This is a really important issue. My niece experienced a six month delay waiting for a specialist clinic appointment by which time her ‘very unlikely’ cancer of the adrenal gland was 2 kilograms in size and had spread to nodes that were inoperable as they were related to vital structures. She is 48 and living with a terminal illness. Her case also shows surveillence failure as she had a small adrenal mass two years previously that should have been monitored and was not. She is a nurse, works in the hospital where the clinic was and despite repeated attempts could not speed up the system. What hope is there for the average person. While you are talking about Canada, this was Australia and the situation is no different. We need clinic triage systems that work.
A study in Hamilton found that 21% of referrals receive no response from the specialist’s office (http://bit.ly/2krbrQl) – consider how many phone calls, minutes on hold, and dissatisfaction that generates, let alone health risks as in the tragic Greg Price case. There is no excuse for our system to still be relying on faxes with such a poor response rate, and no audit trail to know what’s going on with a given referral. Moving to an electronic system allows for tracking, patient notification and data collection which is then fed back to the point of care for more informed decisions around referrals, instead of the “shotgun” method described here. There is much room to improve, and fortunately solutions exist which are solving the many problems highlighted so well in this article.