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Letter to the Editor - Montreal Gazette
May 4, 2012
Letter to the editor
In response to an article that appeared in The Gazette on May 4, 2012, I would like to clarify that waiting times for colonoscopies at the Jewish General Hospital are determined on a case-by-case basis, depending on the patient’s needs.
As our Chief of Gastroenterology, Dr. Albert Cohen, wrote in this newspaper last year, if a healthy individual undergoes an initial colonoscopy and the results are good, a follow-up appointment is made in five to ten years’ time—a reasonable wait for this individual. However, since people with a higher risk of developing colon cancer may need a colonoscopy more often, they are asked to book an appointment a full year in advance of the desired date.
For patients with abnormal symptoms, wait times are shorter, depending on the severity of the symptoms. Of the total available time slots, more than half are reserved for urgent cases. The goal of the JGH is to ensure that patients in urgent need of a colonoscopy undergo the procedure as promptly as possible.
Delays occur because patient volume has risen sharply. A decade ago, the Jewish General Hospital generally performed about 4,000 colonoscopies a year, compared to approximately 10,000 today. This increase in demand has not been matched by a similar increase in resources in the public healthcare system.
Since wait times are long, the Division of Gastroenterology does not have the resources to accept new patients. New patients are referred back to their family doctors, so that appointments can be booked elsewhere. Rather than risk the possibility that critical treatment might be delayed, the patient is asked to book an appointment elsewhere in the hope that treatment, if needed, can be provided sooner.
Dr. Cohen has worked tirelessly to build a new state-of-the-art endoscopy unit that is now available for use by the Division of Gastroenterology, after a year’s preparation and $1.3 million in support from private donors. However, government approval is still required to obtain funding to staff this additional room. This is critical because gastroenterologists at the Jewish General Hospital have less than one day per week of endoscopy time, far below the Quebec average of two days per week.
Furthermore, the JGH does not support doctors who aggressively promote any activity that might place them in a conflict-of-interest position. Nevertheless, patients may exercise the option to have their colonoscopies performed in the private sector; the choice is theirs.
Some hospital-based physicians have chosen to work in private clinics, because a limit—imposed as a result of budgetary restraint—exists on the number of hours that physicians may work in the hospital. Thus, some doctors choose to fill their remaining work-hours in the private sector.
However, it is also important to note that endoscopy rooms in the hospital never sit idle at times when certain doctors are working in private clinics. Furthermore, doctors at all levels are extremely diligent about their commitment to the JGH with respect to patient care, teaching and administrative duties. Their work in the private clinics is performed only after all of their obligations in the hospital and at McGill University have been met.
Solutions are being sought at the local and provincial levels, including innovative partnerships with other healthcare institutions. Included are proposals to move routine screening colonoscopies out of the hospital and into public medical clinics and other facilities that have excess capacity.
Dr. Joseph Portnoy
Director of Professional Services