Spine surgery can become much more efficient

TheGlobeandMail.com – news/opinions/editorials
Published Sunday, May. 15, 2011. Last updated May. 16, 2011.

When patients wait in Canada’s health-care system, it’s accepted as the inevitable rationing of medicare. But when thousands of back-pain sufferers queue for months to see a spine surgeon they don’t require, there is a great waste of time and money.

About 90 per cent of back- and neck-pain patients sent to spine surgeons don’t have a medical condition that can be corrected through an operation. The MRI and CT scans done are often useless, as the abnormalities detected have nothing to do with the cause of the pain.

The waste manifested in hospitals across Canada illustrates a central flaw in how health services are organized: around those who provide treatment, not those who require it. Patient-centred care is just a slogan, not a reality.

This inefficiency has a cascading effect. Spine surgeons, faced with long queues and concerned about providing timely care, are closing medical practices to new patients.

Only Saskatchewan has attempted to fix the problem through its recent launch of an online course. Family doctors can learn symptoms and signs of lower back pain that help them decide which patients to refer to surgeons. That crucial piece of education is already seeing a drop in referrals.

In Ontario, Raja Rampersaud, a spine surgeon at the Toronto Western Hospital, has spearheaded a proposal to government that is a rarity in health care: not only is it a fix for one part of the system but it actually saves money.

“We’re going to save the system money,” said Dr. Rampersaud, “Whether it’s $10-million or $30-million, I can’t tell you that, but it will result in cost savings and better patient care.”

Under the proposal, a patient whose back or neck pain hasn’t improved with care after eight to 12 weeks would be sent for triage. Physiotherapists, chiropractors and other health-care providers working in 15 spine-assessment centres would weed out those patients who are surgical candidates from those who require other treatments. Patients would then be tracked.

The cost of $3-million a year for the triage system is a bargain, given that Ontario spends about $24-million a year on unnecessary MRI and CT scans.

But 14 months after receiving this proposal, the Ontario government still has it under review. When improved patient care and cost savings are proposed, the province should leap at it, not get bogged down in bureaucratic processes. Government needs to be nimble in health care.

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