Postponing surgeries in Quebec will cause a snowball effect, an emergency physician says

MONTREAL — A Canadian Medical Association (CMA) emergency room physician fears postponed operations in Quebec hospitals risk having a snowball effect.

To regain the upper hand on waiting lists, the CMA suggests two possible solutions: invest in the health network so that it stops functioning with the bare minimum, and reorganize the list of priorities for pending surgeries.

We must act now, insists Dr. Abdo Shabah, who practices at the CISSS de la Monteregie-Centre.

The offloading of non-emergency hospital activities due to the COVID-19 pandemic the effect of causing the waiting list for surgeries and screening exams to reach a peak of 140,000 people according to the most recent figures from the Ministry of Health - against 114,000 before the health crisis.

Currently, 34 per cent of surgeries are postponed in Quebec.

Elective interventions are delayed every day, such as colon cancer screenings and hip replacements, said Shabah.

With the improving COVID-19 case numbers in Quebec, and the decrease in the number of patients hospitalized for COVID-19, hospitals are preparing to begin - or have started - a gradual reduction in the load shedding in the operating room.

The pace of recovery varies by region.

"The load shedding will be less, but it's still there," said Shabah. "Patients will therefore continue to be added to waiting lists - every day."

According to the doctor, it is difficult to know when Quebec will regain the upper hand.

The pandemic has had a kind of snowball effect.

Delayed surgeries, even if they did not endanger patients' lives, may have caused deterioration in their health or other medical problems, which will be more complex to treat, and as some Quebecers have avoided consultations to avoid being contaminated by COVID-19, their condition may now require more care.

For example, cancer that was not diagnosed at an early stage may now require surgery to remove a tumour, as well as radiation therapy, steps that would not have been necessary had it been caught in time, the emergency physician explains.

"The impacts of non-consultation due to the pandemic will be revealed in the coming months and years. We, as professionals, that worries us," he said.

SOLUTIONS?

Shabah cites the example of British Columbia, which put in place a plan last May to tackle waiting lists. By November, the province succeeded in catching up to 90 per cent of operations postponed during the 1st wave of COVID-19.

To do this, it invested $190 million specifically for this purpose and coordinated - and completely reorganized - priority lists for surgery. The province has also hired and trained staff and calls on the private sector to achieve its objectives.

Is it feasible in Quebec?

"Yes," replied Shabah. "But we need to have a coherent strategy, in particular by reprioritizing and well-targeting interventions during the recovery."

Quebec has already taken action, in particular by signing 22 agreements with private clinics to allow certain surgeries to be performed, which helps reduce waiting lists.

Except that Quebec is still grappling with the problem, raised more than once by Minister of Health Christian Dube, that even if surgeons are available and hospitals open operating theatres day and night, there is a lack of nurses and support professionals.

"Our human resources are limited," said Shabah.

Another possible solution is to review the way the health network operates.

To control costs, the government has adopted "lean" management, he said.

"Perhaps this approach needs to be rethought," said Shabah. "If it can work when the system is at cruising speed, the pandemic has shown that it does not work in times of crisis when the network cracks at the seams and staff are overworked and exhausted."

In short, you have to invest, he said.

He also believes that prevention and public health strategies remain essential.

If COVID-19 cases and hospitalizations do not explode, it will obviously be easier to work on reducing waiting lists for surgery.

Shabah said it's clear that people are suffering and have to live with a reduced quality of life, and interventions to treat medical complications will also be expensive.

-- this report by The Canadian Press was first published Feb. 5, 2021.