Dunedin Hospital's colonoscopy
panel may be having to make decisions which are too hard
because of limited resources, an East Otago general
practitioner says.
Dr Jeremy Hay and his colleague, Dr Don McKirdy, wrote to the
Otago Daily Times expressing concern about the
direction of recent reporting in the newspaper on colonoscopy
services.
While they shared concerns about the insufficient
availability of colonoscopy services, they said it was
important that the matter of access to colonoscopies was seen
"very much as a resource issue".
They said similar discussions could "easily be happening
about many other services offered through the hospital".
Health Minister Tony Ryall has called for an urgent report
into concerns raised in an informal survey of GPs about
access to colonoscopies at the hospital.
Some GPs were concerned that patients with symptoms of
possible bowel cancer were being denied colonoscopies, and
they cited 25 patients they said were later found to have the
disease.
An audit of the referrals concerned is to be carried out by
the Southern Cancer Network.
Dr Hay said that when services had to be rationed, there was
a risk decision-making could become clinically unsafe, and
the service "must be very, very close to that point".
That meant the panel, which made decisions on all colonoscopy
referrals, could be having to make decisions that were too
hard.
Panel members were doing the best they could, but in any
situation where there was systemic rationing there was the
possibility of missing some cases.
Dr Hay said he felt the people in the gastroenterology
department should be held up as a model for the way they had
tried to ration the available resources fairly and
transparently.
They should not be picked on or criticised at any personal
level, he said.
He would not like there to be a "knee-jerk" reaction to the
concerns raised which diverted resources to colonoscopy
services in a way similar to the Government funding 12-month
Herceptin treatment where "checks and balances are chopped
out and you end up with something a bit unfair". (The
Government decided to fund 12-month Herceptin treatment for
some breast cancer patients, a move which went against the
advice and usual practices of the national drug funding
agency Pharmac.)
If there were to be any reallocation of resources, it needed
to be done carefully to minimise detrimental effects
elsewhere in the system, the GPs said.
Dr Hay said it was easier to get access to some Dunedin
Hospital services as an in-patient, but that was not the case
with colonoscopies and that seemed to be fair - "certain
patients are not jumping to the front".
With some other services, GPs tried to have patients admitted
because they considered they would get better access to
tests.
One area where there had been long waits was for some
ultrasound scans and he was unsure of the process for the
treatment of those referrals, he said.
Hospital staff were gathering information about this in
response to an Otago Daily Times inquiry, but this process
was not yet complete.
Dr Hay said it would be interesting to see what would be
revealed in the audit of patient colonoscopy referrals.
He had a patient in the audit and when he went back to look
at his referral it was slightly different from how he
remembered it.
It was possible some referrals had missed out bits of
information, he said.
One thing which would not be captured in the audit was the
number of doctors who had changed their referral patterns
because they considered they were unlikely to have
colonoscopies granted.
elspeth.mclean@odt.co.nz
