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