Hospi­tal re­fer­ral sys­tem needs more sta­bil­ity

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Speak­ing from ex­pe­ri­ence, Dr. Bon­is­teel says, “there’s a huge leap from two (staff mem­bers) to three, in terms of life­style or just hav­ing a life.”

Find­ing the money

Com­par­ing the sit­u­a­tion in ob­stet­rics/gy­ne­col­ogy with surgery, he said, ap­par­ently there are two sur­geons cur­rently op­er­at­ing at the Car­bon­ear hospi­tal. They are us­ing locums ever three weeks or monthly to cover off a week­end of call for gen­eral surgery.

“Quite likely they’ ll be able to re­cruit a third per­son (sur­geon) there, so there must be fund­ing for that.

“I don’t see why there couldn’t be fund­ing for a third ob­ste­tri­cian/gy­ne­col­o­gist. It’s a mat­ter of will. Are they will­ing to try? When Os­car How­ell says, ‘we’re do­ing all we can,’ he means we’re do­ing all we can with the re­sources we have cur­rently, not we’re do­ing all we can, and we’re try­ing to look be­yond the re­sources we have and we’re try­ing to ad­vo­cate or lobby for more re­sources. No, it doesn’t have any­thing to do with that. It’s got to do with we’re do­ing all we can to try and re­turn the sta­tus-quo.”

Re­fer­ral sta­bil­ity needed

While East­ern Health says it plans to con­tinue us­ing the ser­vices of locums un­til their full- time staff re­cruit­ment ef­forts have been ful­filled, the cor­po­ra­tion ac­knowl­edges, “locum cov­er­age will be spo­radic over the next cou­ple of months.”

Dr. Bon­is­teel’s take on locum cov­er­age?

“The locums are re­ally only there to pro­vide an emer­gency type of ser­vice, an ur­gent care type of ser­vice. The locum might be there for a month, a week or even a day, and doesn’t pro­vide a sta­ble re­fer­ral base to whom you’d read­ily re­fer.”

That’s why his ob­stet­rics/gy­ne­col­ogy pa­tients are go­ing to St. John’s, he ex­plains.

“Un­til they have a cou­ple of full­time (spe­cial­ists) and we get a sense of what they’re like, there’s not go­ing to be any more re­fer­rals made there (Car­bon­ear).”

The veteran physi­cian says once a com­mu­nity-based physi­cian, fam­ily physi­cian, gen­eral prac­ti­tioner, “es­tab­lishes a pat­tern of re­fer­ral, they tend not to go back on that. So if this goes on long enough, and I es­tab­lish a pat­tern of re­fer­ral to St. John’s, and I’m sat­is­fied with the care … and con­sul­ta­tion pro­vided, it might take more for me to go back to an old pat­tern of re­fer­ral to Carb­n­ear hospi­tal. It’s go­ing to take more ef­fort to get back there, un­less they have some­thing re­ally good to of­fer,” he con­cluded.

GPS do­ing de­liv­er­ies

Point­ing out East­ern Health does not have any pol­icy against GPS be­ing in­volved in ob­stet­rics, Dr. How­ell said last month, “we would like to see GPS who prac­tice in the area back in the hospi­tal and do­ing de­liv­er­ies.”

Dr. How­ell said he is talk­ing to four new GPS they’re hop­ing to re­cruit for Car­bon­ear, some of whom have expressed in­ter­est in do­ing ob­stet­rics.

“The is­sue of GPS opt­ing out of ob­stet­rics is not a lo­cal prob­lem, but a prob­lem right across the coun­try,” Dr. Bon­is­teel said last week.

“The rate of GP par­tic­i­pa­tion in in­tra-par­tum care, do­ing de­liv­er­ies, has fallen off markedly. If they could do in­tra- par­tum ob­stet­rics, that would be great. I’d like to see the hospi­tal sup­port them in that.

“But with the cur­rent gen­er­a­tion of physi­cians more at­tuned to life­style and less likely to punch in 60, 80 and 100 hours a week,” Dr. Bon­is­teel al­lowed, “they’re less likely to fol­low their own ob­stet­rics. Only those who are re­ally com­mit­ted to the pro­vi­sion of that ser­vice are go­ing to do so.”

Un­rea­son­able ex­pec­ta­tions

Since his own prac­tice has turned more to­wards the el­derly, Dr. Bon­is­teel says he now only refers about 50 pa­tients to the city for ob­stet­rics/gy­ne­col­ogy ser­vices.

But some of his col­leagues re­fer more pa­tients to spe­cial­ists.

While there are lots of spe­cial­ists in the city, he points out, “they’re al­ready fairly busy, and the added re­fer­rals from this catch­ment area, with a pop­u­la­tion of 70,000, is only adding to that busy­ness. To ex­pect St. John’s to ab­sorb all of that is not rea­son­able.”

As the ter­tiary care cen­tre for the whole prov­ince, he noted, the city also pro­vides more highly or sub-spe­cial­ized care for all of New­found­land and Labrador.

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