Should such treatment not be available within the province/territory, then provinces/territories are expected to pay for the treatment costs for patients who must travel to other jurisdictions to receive services within the wait-time period. While representing only the first step in what must be a concerted and sustained campaign, recent efforts to reduce wait times are encouraging and should be fully supported. Some important participants in the discussion, in particular the College of Family Physicians of Canada, have expressed the view that the determination of wait times should also take into account the time between the patient's first visit with his or her family physician and when required, subsequent visits with consultants, as well as the time it takes for a patient who does not have a family physician to find one.1 Regardless of the definition chosen, the CMPA is of the view that a common, clearly communicated definition is required and such a definition should form the basis for all measurement activities. Require institutions in which physicians work, whether they are hospitals or clinics, to have clearly-established accountabilities and procedures for managing treatment wait times. Many stakeholders have advocated two measures to incorporate government accountability for wait times — the establishment of wait-times guarantees and the withholding of funds when such guarantees are not met. As an example, whether or not a cancer patient will receive radiation therapy within an established benchmark depends on the type of cancer involved, the province/territory within which a patient resides, and the hospital where the patient will receive treatment. Some physicians who treat such patients are also being placed in an untenable position as they struggle to find operating room time or access to care for their patients. Conversely, it might easily give rise to a difficult situation in which a physician is open to accusations that he/she advocated too strongly for an individual patient at the expense of others with a higher clinical prioritization. While generally restricted to a few selective procedures, these guarantees represent a rapid evolution from benchmarks to what are expected to be enforceable standards. The state of the nation's health-care system is an issue of great importance to Canadians. Establish clear accountabilities that encompass all elements of the health-care delivery system, including institutions, physicians and other health-care professionals. Given the demand is not constant, completely eliminating the gap would likely result in excess capacity. Wait times have become the focus of considerable public attention and are, for better or worse, the measure many people now use to grade effectiveness of the health-care system. Consider appropriate ongoing care for the patient during the period while he/she is waiting for the appointment. In law, physicians owe a duty of care to their patients and they may be held accountable and liable for damages suffered by their patients as a result of a failure to fulfill their duty of care. Given the public policy attention devoted to the subject, any and all steps taken to address wait times are likely to attract scrutiny. As an example, the Auditor General for Ontario has recently questioned why provincial wait times calculated for some of the five priority areas combine in-patient and out-patient wait times. Many Canadians, including physicians, have seen first hand that progress in addressing overly long wait times for medical treatment has been inconsistent across both different treatment procedures and different jurisdictions. Depict wait times as benchmarks or targets, not as guarantees. It appears that a similar situation exists across the country. Document all actions taken in each of the above circumstances. While the benefits of "medically reasonable" benchmarks are evident, there are certain risks associated with them. Physicians are trained, oriented and, within a legal context, liable to provide a clearly delineated standard of care to individual patients. Respect the physician's ethical dilemma of serving the individual patient as well as the "wait list.". As resources are increasingly focused on the five priority procedures, there is an increasing perception that other clinical areas are being "cannibalized" to divert resources to the "Big Five.". DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The Association believes implementation of the recommendations outlined above would result in the tangible reduction in the risk to which its members and their patients are currently exposed. These priority procedures are cancer care, cardiac care, diagnostic imaging, joint replacement and sight restoration. These risks largely involve the evolution of performance benchmarks to care guarantees and ultimately standards analogous to standards of care. Average Wait Time to See a Doctor in France Pediatrician or radiologist – three weeks Dentist – one month (average 17 days) Gynecologist – six weeks (average 32 days) Cardiologist – 50 days Dermatologist – two months Ophthalmologist – 80 days If one accepts that the effective management of health-care wait times will be a permanent requirement, then the need to address accountability and liability issues takes on a strong degree of urgency. While there has been an encouraging effort to reduce the length of time a patient has to wait for care, there has been less focus on addressing the real and potential concerns associated with the accountability and liability issues associated with managing wait times. Notify the referring physician of the scheduled appointment dates. As noted above, wait-times management is not just a Canadian problem and our challenges are certainly not unique. Accordingly, the reality is waiting times will never be zero. Wait-times guarantees involve a commitment, on the part of governments, to deliver treatment within a publicly declared wait-time period. While the need to address high-priority procedures as a starting point is widely acknowledged as being a sound approach, it has inevitably led to concerns about resource allocations. A situation in which everyone is accountable often means, in reality, no one is. While the paper highlights accountability and liability concerns that should be addressed, its goal is to contribute to the generation of appropriate solutions. When viewed individually, the majority of these recommendations are generally very sound and, if implemented, would make a useful contribution to reducing wait times. Issues relating to a physician's obligations in relation to the overall management of the waiting list are relatively new territory. There are likely to be both positive and negative patient safety implications from efforts to reduce wait times. The lack of systematic consistency leaves the process open to criticism. The CMPA is committed to working collaboratively with all interested parties to support a sustainable and effective solution to wait-time concerns. Advocate for the procedures necessary to ensure the management of wait times leads to better patient care. Wait Time Alliance for Timely Access to Care. If, at the time of the referral, the wait time exceeds the benchmarks, consider: - Declining the new consultation and recommending referral elsewhere, and. Hardly a week goes by where we don’t see a story on the world’s ever-lengthening patient queues (and trust us, … Again depending on the facts of the case, it may be argued that the referring physician continues to have a duty of care beyond the simple act of referral which may include continued follow-up, monitoring, and advocacy for the patient. Standardize wait-time calculation methodologies and reporting procedures. While lengthy waits are negligible in the United States2, the American system is beset by other access-to-care issues that make simplistic comparisons with Canada problematic. Funding of health care in France. Physicians should be cautious not to sacrifice quality medicine in order to achieve high process rates. One of the principal wait-times challenges facing physicians is the potential conflict between a physician's responsibility to an individual patient and his/her responsibility to other patients on the waiting list.

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