I must take exception to the comments of my friend and colleague, Dr. Michael Gross, regarding “Citations and wait-lists: much ado about nothing?”1 (published in the April issue of the Canadian Journal of Surgery). His conclusions, based on the paper of Gaudet and colleagues,2 are broad and inaccurate. Dr. Gaudet’s paper is cause for the profession to feel relieved that patients are prioritized on the basis of need rather than on any other social factors. However, Dr. Gross’s conclusion that this is in some way due to surgeons controlling wait-lists is completely erroneous.
With the Alberta Hip and Knee Replacement Project underway in Alberta, we have found in Edmonton, which has centralization of wait lists, that at least 30% of patients on a wait list are there inappropriately. Many patients are on multiple wait-lists, have already been operated on, are not interested in surgery or have died. The remaining patients on a wait-list also present a very heterogeneous group. Some are awaiting other medical tests or consultations before surgery may be booked. Other patients simply do not want surgery now and would rather wait until it is more convenient for them. Because of this, I feel our wait-lists need to be categorized as patients who are awaiting surgery and who are ready to come in next week and patients who wish to pick a date for surgery in the future or who are not yet ready for surgery.
It is inaccurate to accept a surgeon’s office wait-list, as it requires a great deal of massaging before patients actually get to the operating room. Accurate data collection is important and will further the cause of surgery if we have centralized and standardized databases.
Footnotes
Competing interests: None declared.