Doctor laments loss of services at Buchanan Memorial
‘The whole system is short-staffed’
SYDNEY — Recruiting doctors to northern Cape Breton is only going to get more difficult with the reduction of laboratory and X-ray services at Buchanan Memorial Community Health Centre, a local doctor says.
The Nova Scotia Health Authority has indicated that a medical laboratory technologist recently left the Neils Harbour area. As part of what it calls modernizing laboratory services, it is introducing point-ofcare testing at the hospital, which it says will provide patients with timely access to quality and safe care. In addition, the hospital no longer has evening and weekend X-ray service.
“Both of those reductions in service will make it more difficult to recruit a physician to that post,” Dr. Margaret Fraser, president of the Cape Breton Medical Staff Association, said in an interview. “The work environment in Neils Harbour is already difficult. They are very isolated up there, they’re about two and a half hours from Sydney by road on a good day so if they have a major emergency up there, they’re on their own until they can get the patient stabilized and get them out.”
Buchanan Memorial Community Health Centre is a short-term care facility located in Neils Harbour. It serves the communities of Neils Harbour, Dingwall, Bay St. Lawrence, Meat Cove, Ingonish and the surrounding areas. Fraser said she believes the recent changes threaten the viability of the hospital.
She said two new physicians need to be recruited.
“You can’t recruit physicians to work in a hospital where you have little more than you would have in your office in order to deal with emergencies,” she said.
In an email, Annette Bourgeois-Bent, a spokeswoman with the Nova Scotia Health Authority, said many rural sites in Nova Scotia that have experienced staffing challenges are now using the point-of-care testing model, which was first introduced to a rural site in Nova Scotia 10 years ago.
Bourgeois-Bent wrote that technologists will train nursing staff to perform blood collections, pre-analytical processes for routine testing and point-of-care testing.
Point-of-care testing will be used to meet urgent on-site testing needs at Buchanan Memorial and routine testing will be sent to larger facilities. Bourgeois-Bent said that transportation will be enhanced to support the model, including ondemand service.
But Fraser said a local physician has raised concerns about the effectiveness of point-of-care testing in treatment of critically ill patients, including cases such as diabetic ketoacidosis.
“Point-of-care testing simply isn’t sensitive enough at those extreme ranges to allow for accurate diagnosis of those patients,” Fraser said.
If residents of northern Cape Breton have to rely point-of-care testing for all lab work, which Fraser suggested may eventually be the case, she said it will cause problems in the early diagnosis of conditions such as leukemia.
“A person with leukemia can have a white count in the 40,00050,000 range and that may not show up on a point-of-care test as accurately as it would in a lab test,” Fraser said.
While the Buchanan Memorial lab couldn’t perform all tests, Fraser said it was capable of a broader range of testing than the new system.
Fraser was also critical of health authority efforts to recruit new lab technicians.
“They don’t just need to be recruiting doctors, they need to be recruiting lab techs,” she said. “The whole system is short-staffed.”
As far as the loss of the evening and weekend X-ray service, Fraser noted the prime time for motorists hitting a moose is dawn or dusk.
“If you have a patient who is coming in with a complex pelvic fracture, you may not know that until hours later and that’s something that needs to be diagnosed immediately,” she said.
Bourgeois-Bent wrote that diagnostic on-call coverage changed Dec. 1, and prior to that, there was on-call coverage on a half-time schedule. The X-ray technologist is no longer providing on-call coverage. She indicated that during the last fiscal year there was an average of one call every two weeks. She added that the health authority recognizes there are challenges in providing the service after hours and we continue to explore options.
“If you have a patient who is coming in with a complex pelvic fracture, you may not know that until hours later and that’s something that needs to be diagnosed immediately” Dr. Margaret Fraser