The Sydney Morning Herald (SMH 27 May 1997) reported last week that according to local doctors, individual waiting lists kept by surgeons render published waiting times in some major Sydney hospitals useless.

The official average waiting times given to local GPs by the Central Sydney Area Health Service (CSAHS) and the waiting times quoted by individual surgeons can vary by nine months and more, according to the SMH's investigation:

"Annandale GP Dr Norman Walsh was first alerted to the problem when he tried to admit an elderly patient for cataract surgery using official CSAHS waiting time information sent out by the local Division of General Practice".

"The waiting list contact person at the Royal Prince Alfred Hospital (RPAH) quoted a waiting time of between 1 and 2 months for Dr Walsh's preferred surgeon. Dr Walsh's patient returned some time later and said she had been quoted a waiting time of 5 to 6 months. When Dr Walsh contacted the surgeon he was told that it was common practice to keep a separate waiting list".

"The Herald also contacted orthopaedic surgeons referring public patients to RPAH, the Rachel Forster Hospital and Concord Repatriation General Hospital. Average CSAHS orthopaedic elective surgery waiting times for March 1997 sent out to GPs last week are less than 2 weeks for the RPAH and 1.3 months for Rachel Forster Hospital. Yet a surgeon's secretary contacted by the SMH quoted 9 months."

The admission that there are 2 lists tends to confirm that, State/Federal Medicare agreements notwithstanding, the "natural order of things" still prevails in our health system. If you are a private patient you will have your operation as of yesterday but "Medicare only" patients go to the end of the queue.

The purpose of the Medicare agreements between Commonwealth and States is to prevent queue jumping by private patients in the public hospital system. But if, as shown in the SMH article, there are two sets of waiting lists, then surely the Federal/State Medicare agreements are a sham.

Some Sydney surgeons reacted angrily following the SMH report, demanding an end to the 'farce' of producing average waiting times by the NSW Department of Health. "Surgeons are prepared to do as much work in the public hospitals as is available to them but the amount of operating time available to them has been cut down". They admitted that surgeons often quoted totally different waiting times from those published by hospitals and implied that it was sometimes unclear where these figures came from.

The surgeons stopped short of demanding that GPs be given the real lists!

For GPs, this is an intolerable position. We are supposed to direct traffic in the interests of efficiency for both patient and the hospitals. Yet our referrals are based on an antiquated system of 'old school tie' contacts, habit or guesswork.

If there are privacy considerations or the ownership of the lists is in dispute, then the surgeons should come out and say so.

Dr Phil Truskett, Chairman of Department of Surgery at Prince of Wales Hospital was quoted in the Herald regarding the formation of lists:

"I tend to book half a list - always the cancers or the emergencies turn up and push the others out. I try to book no more than 2 to 3 months in advance because if someone gets cancelled because of lack of beds they have to go to the back of the queue again or you have to move everybody else to fit them in. I think just about everybody does it this way these days."

But where is the transparency for the patient and the long suffering GP? How do we explain matters to the patient returning from the specialist, disappointed at the prospect of a long waiting time? Or the patient, booked for elective surgery, who is notified several weeks prior to the long awaited operation that it has to be 'rescheduled'?

At present we are all in the dark. Yes, specialists may lose some of their kudos (i.e. busy surgeons with long lists might get less referrals). But it seems that even the surgeons are now angry enough to demand change along with their humble GP colleagues.

Bear in mind, that the sham waiting lists have been hiding the chronic underfunding of the public system for years. Of course, the Treasury, the health bureaucrats and the politicians have not wanted to expose this state of affairs.

What needs to be done?

The solution is for all surgeons immediately to make known to GPs the full extent of their waiting list. Then we can make sure patients have a real choice regarding the length of time they wait for their operations. GP Divisions must act immediately to ensure that all GPs are given genuine and useful data on which to base their referrals.

Even the bureaucrats must demand change or admit that the Federal/State Medicare agreements are a sham - that there is in fact little opportunity to prevent queue jumping by private patients.

All of us (including surgeons), will gain credibility and public support when arguing for more public hospital funding and elective theatre time, if the real lists become public knowledge.

The DRS calls on the Australian Medical Asscoiation, the Australian Association of General Practice and individual GPs to join us in:

1. Calling on surgeons to provide GPs with accurate waiting lists on an individual surgeon by surgeon basis.

2) A national campaign for increased funding of the public hospitals based on the actual waiting times for elective surgery.

The DRS is interested in your views on this matter. Please contact the DRS national office at drs@nlc.net.au , phone (02) 9264 9084 during business hours or fax us on (02) 9267 4393.

Dr Con Costa
National President, Doctors Reform Society of Australia

Reprinted from Australian Doctor, 4 July 1997.