Social Policy in Ontario

Nowhere is the fear of waiting greater than in the emergency department (ED), where I work. I can’t eliminate that anxiety, but if I can help you understand the inner workings of the ED, you might wait a little more comfortably. And you’ll also understand why the premiers’ prescription is the wrong medicine.

Imagine you’ve had a strange, new abdominal pain for three days. You’ve never experienced this before. You’re nauseous. It hurts when you move (which unfortunately includes breathing). The triage nurse checks your vital signs: temperature, heart rate, blood pressure, oxygen and breathing rate, and quickly feels your abdomen. One triage nurse tells another that you are a “CTAS 3” and then you are swiftly redirected back to the waiting room. “It’s busy,” they say, “it might be a few hours.”

A few hours!? You might have appendicitis! You remember the Simpson’s episode growing up – doesn’t the appendix explode if it’s not taken out immediately? What about the big project at work? What about the flight you have booked? What about…?

Wait — what’s a “CTAS 3”?

The Canadian Triage and Acuity Scale (CTAS) was first implemented in 1999, and specialized triage nurses are trained to sort patients into five categories depending on how sick they are. A “CTAS 1” requires immediate resuscitation, like a man whose heart has stopped and who is brought in with the paramedics performing CPR. A “CTAS 5” is non-urgent, like a medication refill.

While you’re in the waiting room, an elderly woman is brought by paramedics on a stretcher. Blood pressure low, pulse racing, febrile. The triage nurse rushes through the assessment, and brings this “CTAS 2” patient directly in. She pulls the doctor away from another patient, because in this situation, timely antibiotics impacts survival.

Back in the waiting room, you’re worried your appendix will imminently explode. You’re still waiting for the doctor to tell you if you’re safe. Little do you know, the moment you were waiting for has already come and gone. That moment was at triage, when expertly trained ears listened to your story, and expertly trained eyes examined you. When you were labeled “CTAS 3” what really happened was you were told you were safe to wait.

We need this triage system because doctors are a limited resource. With a finite resource, paying to get to the front of the line just rearranges the line. It’s hard enough to wait when a “CTAS 2” gets rushed in ahead of you – but at least, intuitively, it feels just. Imagine waiting with a “CTAS 3” appendicitis when a “CTAS 5” goes in ahead of you with a hangnail and a platinum credit card.

We have emergent issues to address in our health care system, but most come from its two-tiered part, not its universal part. Thirty per cent of our system is private.

Our health outcomes are impaired by the lack of non-physician public health care: lack of dental care that drives people to the ED for tooth pain, lack of physiotherapy that results in a reliance on opiates for back pain rather than desperately needed manual therapy, and a lack of pharmacare that ends in 1-in-10 Canadians being unable to fill their prescriptions.

Waiting in the ER isn’t comfortable — but an appreciation for equity and accessibility should motivate us to find solutions to increase efficiency and decrease wait times for everyone, rather than abandon these foundational principles and decrease wait times for a few at the expense of the many.

Right now, if you’re lucky, you can afford to wait because you’re healthy. If we don’t safeguard our system, that decision will depend on if you can afford to because you’re wealthy.

Dr. Hasan Sheikh is an emergency doctor in Toronto, and a graduate student at the Harvard Kennedy School of Government.

https://www.thestar.com/opinion/contributors/2018/10/05/the-truth-behind-wait-times-and-private-health-care.html