Surgical Cancellations

I have always thought, and accepted, that waiting for healthcare services was an acceptable compromise for the public healthcare system in Canada, who tries to provide comprehensive services to all its citizens. This contrasts to the US system, which is able to provide nearly immediate service, but only to well-insured members of its society. I have not found the latter to be a “just” proposition. However, what I do not find acceptable, and is deplorable, is the cancellation of patients who have waited for the service Canada has promised to provide.

The reasons for patients having surgical procedures cancelled are protean. I do not have the knowledge or expertise to discuss them all intelligently. What I can point out is that the healthcare system is chronically underfunded. There has also been an apparent lack of foresight related to human resource needs in the system.

Because the healthcare system in Canada is essentially a monopoly, hospitals have no immediate incentive to fix the “cancellation issue”. For the vast majority of patients, there is nowhere else to go for hi-end, tertiary care surgical services. Although, I am NOT an advocate for privatization, I do think that “pay for performance” and competition within the public system could be healthy for patients.

As surgeons, we tend to ignore or minimize the consequences of cancellations on our patients. Yet the effects can be significant. In my field of practice of pediatric cardiac surgery a cancellation affects families financially. Parents have had to travel, find accommodations, and take time off work. They have had to make arrangements for the care of other children in the household, perhaps affecting extended members of the family. There is not always complete financial assistance from the Provinces.

Equally important is the psychological impact of a surgical cancellation. I believe that patients and families prepare themselves mentally for the upcoming surgery, hospitalization, and convalescence (especially the surgery). A cancellation disrupts this mental preparedness and can be psychologically distressing. It makes families and patients feel vulnerable because they are not in control; it leads to uncertainty; and may even lead to doubt about the ability or competence of the system that is supposed to care for them.

Interestingly and thankfully, I have found patients and families very understanding and accommodating. I always apologize on behalf of the “team”. But I have never heard of or seen an administrator of a hospital go and speak with a patient or family about their surgery being cancelled.

Canadians are generally very happy and satisfied with their care, when it occurs. When it relates to surgical cancellations, I think they are being too forgiving and too tolerant of a significant inadequacy in their healthcare. Just because it is free, that does not mean that we cannot demand some measure reliability when it comes to timing of surgical healthcare delivery. “When we say we will do it, we will.”