Moving slowly

For my two week stint in urology, I once again have a very nice preceptor with a good sense of humour. He teaches me quite a bit between surgeries, and not just about medicine. Today he shared his perspective (aka frustration) with me re the inefficiencies of the way the OR is run.

For instance, the differences in how the various staff involved are paid does not lead to everyone having the same goals. Surgeons are paid per procedure, whereas anesthetists (and nurses) are paid for their time. As a result, the time in-between surgeries is ridiculous – often only one 11 minute procedure is able to happen in 1 ½ hours due to set-up and clean up. Originally when I started surgery, I figured that there was some elaborate cleaning that happened that slowed everything down. In talking to him about it however, I learnt that it doesn’t have to be this way. Last year, the government paid private surgical centres to motor through some of the waitlists for the quick procedures like one that he does to help postmenopausal women with stress incontinence (i.e. leaking pee when coughing, etc). It’s a very common problem and with the baby boomers getting older, no doubt one that will be growing in size. In his private surgical centre last year, he was able to do 3 of these procedures in 1 hour or 15-20 on a leisurely Saturday. This year, the government didn’t fund any private centres to do these procedures so the waitlist grows due to the few people they can schedule in the hospital operating rooms. I don't understand how hospital ORs are managed. The surgeons in Victoria generally seem to get 1-2 days of OR time per week, while in Toronto they may get as little as 1 day per month!! Isn't that incredible? I can't imagine that a surgeon could even keep his/her skills up with only 1 day of surgery per month. Yikes. It's not because the ORs are busy operating all night either (they're not)!

He also told me about a device that would greatly speed up another common operation he does. Despite some upfront capital costs, the government in the first year would save $450,000 and subsequently each year thereafter would pay only $1500 per procedure vs the current $5000+ in hospital time (OR and recovery time). He’s made the pitch to government and the local health authority but all he’s been told so far is “We’re looking into it.” Hmm. Very unimpressive response. It sounds like the cost/benefit analysis is already done, is it really just politics that's holding up the show? It sounds like the health authority could use a whole lot more common sense, if they plan to actually manage health care more efficiently in the long run.

It will be interesting to see what happens as a result of the recent lawsuit the private clinics have initiated against the BC government, stating that access to timely medical care is a human rights issue. Just curious to see where it goes from here.