Wait time targets miss the mark with patients

The comments section is closed.

  • Gloria says:

    The wait times for a hip replacement in Nova Scotia is way above the 6 month mark. For the surgeon I have been referred to in Halifax, it is 3 years. I have been waiting close to 2 years and being told I have another year to wait. It all depends on the surgeon you get referred to and the area you live in. This wait did not include the time it took to get a GP as my had retired or the cat scan and MRI and rheumatology wait. My life has been put on hold.

  • Margaret deMello says:

    Tight gatekeeping is in fact a method of health care rationing. It produces long wait lists to avoid flooding health services with treatment needs that cannot be met, due to shortage of facilities and health care professionals. I submit that gatekeeping adversely impacts individual and population health in this country. Long restrictive waitlists must be removed. The practice of physician gatekeeping must be re-designed as an appropriate triage protocol rather than a strategy to restrict access and withhold treatment.
    The more sinister effect of gatekeeping policy is how it affects physician attitudes and patients’ self perceptions. It also affects what kind of research is undertaken, funded and applied in the field. Waitlisted patients, and those waiting for the waitlist, are identified by their own doctors as not needing or deserving remedial care. Patients begin to self identify as not ill enough or not disabled enough to require active treatment. That is one reason why patients don’t complain.
    A patient’s illness, pain and suffering is often misconstrued as primarily somatic or interpersonal leading to inappropriate treatments that could even exacerbate their condition, such as prescribing major tranquilizers to treat pain, instead of restorative surgery. With their gatekeeper hat on, doctors often make recommendations that patients cannot afford or that don’t match their stage of illness. I suggest that a few single case studies would support these observations.

  • Peter G M Cox says:

    I fully support the thrust of this and the “Related Faces of Health Care” articles but the elephant in the room doesn’t even get a mention – the immutable law of supply and demand. We may be able to make modest improvements by better prioritization and improved procedures and systems but until we have a sufficient number of doctors, particularly specialists (where the shortage is most acute) to cope with the needs of the patient population we cannot hope to achieve significant reductions in waiting times.
    I believe the evidence to support this view is overwhelming”: recent OECD figures indicate that we have 25% fewer doctors per capita than the average of comparable (European) countries and fewer than any of them; The March 2014 Healthy Debate article “Physician health: reducing stigma and improving care” by Nathan Stall, Jill Konkin and Joshua Tepper reported that “… nearly half … (of Canadian doctors) … are in the advanced stages of burnout …” – clearly indicative of the consequences of this doctor shortage.
    Setting unrealistic waiting time targets in this context only adds to the pressure that doctors are under and is counterproductive to improving care. Until we clearly identify the underlying causes of excessive waiting times and take steps to correct the inadequacies, particularly concerning the “supply shortage(s)”, any target-setting is futile.
    I should very much like to think that I am wrong in this view but so far this seems to have been a perennial problem which continues to go unaddressed.
    I am not a doctor – merely a concerned observer of our healthcare system!

  • Margaret says:

    This writer is absolutely correct. Indeed, have patient outcomes even been provincially researched? I suggest that physician gatekeeping, at least in BC, is doing harm. Gatekeeping practices directly violate physician ethics and their college mandate.
    I further suggest that gatekeeping is a method of refusing treatment. It is more than triaging. Rather, it is actually withholding and restricting access to remedial care. Physician gatekeeping (ie withholding care) produces long wait lists, contributes to early disability, to prolonged suffering and to chronicity. Without the benefit of stats, I suggest that current policy increases health costs for both the province and for individuals. Many physicians in BC take advantage of this situation, and have set up private practices. They argue that private practice will shorten wait lists for public Medicare. Unfortunately, physicians who enter private practice are not replaced, therefore lengthening wait times in the public sector. They are doing a great disservice to Medicare patients, they are further disabling our once envied health care system. It is galling to me that routine but necessary surgeries can be had within days or weeks from private clinics, while the rest of us wait years for the same operation.
    I can see only one solution to this – that patient lobby groups and individual patients need to launch legal appeals to challenge current gatekeeping practices. After 20 years of declining health care, and now at the edge of losing Medicare altogether, it is apparent that strong concerted action is needed to illicit any movement from our Parliaments in this regard.
    Margaret deMello MSW

  • Kathy Petterson says:

    What nonsense. How typical of this website to approach every issue from the health provider’s perspective. “The research says patients are ok with waiting.” No, people are not ok with waiting. I envy Americans that can see specialists and get quality care so quickly and get on with their lives. I notice that family doctors and specialists in this country get paid extraordinary salaries but don’t have very good hours of operation. Monday-Thursday 8am-12pm. Pardon? And there is no coordination between doctors.

    People need to have options when they are in pain and their life is on hold, which is why introducing a private option in our system is a good idea. Our system could benefit from a healthy dose of competition.

  • Denyse Lynch says:

    The issue of having patients, carers at the table when discussing the why, what, how, where, when, how often of “health care” delivery MUST include patients, carers (the receivers) at the discussion table. Their exclusion over the last ’20’ or so number of years in trying to improve the health system is clear EVIDENCE that not all the “right” people have been included in the discussions. Let’s acknowledge/accept that our brightest and best Health Professionals and Managers of the health system (government) are “insufficient representation” to be successful in achieving a quality, cost effective, sustainable health system. The system must be explored from all perspectives. The health system recipients’ perspectives, have to be explored and understood as only they have comprehensive, continuous experiences across the health care system continuum. What’s missing from the discussion table are receivers. They, suffer the consequences, costs, of a poorly co-ordinated, poorly integrated system. These ‘costs’ include physical, mental and emotional pain, not thoroughly “calculated/quantified/measured”. If they were, system suppliers would be able to see that the patient/caregiver/receivers’ costs, are why costs to the health system, the suppliers, government and all taxpayers are unsustainable and lead to crisis. Time for “all” stakeholders to gather round the table, listen for understanding/comprehension/appreciation of all perspectives and work together to fix it. We have the intellectual capital, assets to do this, but only, by full representation and working together. It simpler than rocket science, requiring only a willingness from everyone who is able, to participate.

  • Pamela Jansen says:

    What is more frustrating to me is how long this conversation has gone on. Twenty years ago I was having this discussion with doctors because my mother had to wait so long for a knee replacement. Fifteen years ago I needed a replacement so badly that I couldn’t walk anymore. The only way I could see the surgeon to talk to him in less than 2 years was to pay, so I did. I was on crutches and was told the soonest surgery date was another 2 years. The day they told me that I cried, then got on the internet and found one of best surgeons in the world who would repair my hip in 7 weeks. I’ve had that hip ever since and it’s still going strong. For the price of used car I regained at least 4 years of ,my life and saved so much other damage I would have done over the 4 years. The waits times are not that long now, but they are still long and I know people who are told 7 months until surgery and 7 months later they are still waiting many more months. I feel like it’s a never ending conversation held mostly between people who haven’t a clue what 24/7 pain and lack of mobility is like. Those people don’t understand that pain can be a severe disability. We truly need more action and less talk, and we really need to talk to the people who are suffering not the theorists.


Karen Palmer


Karen is the Destination Development and Marketing Coordinator at The Corporation of the County of Prince Edward.

Mike Tierney


Mike is the Vice President of Clinical Programs at Ottawa Hospital.

Michael Nolan


Michael Nolan has served Canadians through many facets of Paramedic Services.  He is currently the Director and Chief of the Paramedic Service for the County of Renfrew and strategic advisor to Healthy Debate

Republish this article

Republish this article on your website under the creative commons licence.

Learn more