Just-in-time medicine

Posted on May 8, 2009 in Governance Debates, Health Debates

TheGlobeandMail.com – Opinions/Editorial – Just-in-time medicine
May 8, 2009.  

Toronto’s Princess Margaret Hospital deserves praise for offering a same-day diagnosis and treatment plan for breast-cancer patients, but what took so long? When will other Canadian hospitals move as quickly, and for other forms of cancer, too?

Canadian health-care authorities have been stuck in a fruitless debate on whether the evidence showed that long waits for a diagnosis and treatment were killing people. The debate itself was evidence of complacency.

The Princess Margaret has pointed the way out. Money helped, as did the will to reorganize the system. Emmanuelle Gattuso, who survived breast cancer, and her husband, Allan Slaight, donated $12.5-million for a pilot project, begun three years ago, which has given nearly 500 patients a prompt diagnosis and treatment plan. The money allows the hospital to offer an accurate diagnosis within hours, in part with the help of expensive equipment that quickly processes the tissue being tested. But changing the system required someone with an idea, and the will to make it happen. David McCready, a surgical oncologist at the hospital, objected to the long waits, typically 37 days for a diagnosis. After that wait, patients would then be forced into one of several separate lineups to receive treatment.

The U.S.-based Mayo Clinic, by contrast, organizes itself for prompt diagnosis and treatment, to reduce stress and allow patients to keep working. Patients come from far away; the clinic’s only choice is to respond quickly. After same-day diagnosis, surgery is possible the next day, though some women prefer to wait and think about it. “In some places it may take three months to get a diagnosis,” says Edith Perez, director of the breast-cancer program at the Mayo Clinic in Jacksonville, Fla. “It can have an impact on survival, but that’s difficult to prove.”

Private U.S. clinics have obvious differences from Canadian medicare, but the Princess Margaret’s success in reducing wait times from several weeks to six or eight hours suggests it’s time for a rethink of what is possible in Canada.

The feeling of being shunted from lineup to lineup, from wait to wait, adds to the stress and suffering of cancer patients. The Princess Margaret has pointed the way ahead for hospitals with the conviction that the mould can be broken.


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