I have been a general surgeon for almost 15 years. I spent my first 14 years of practice in Outaouais. Then, last summer, I left.
When I started, things were going well in Outaouais. Not perfectly, but we had access to the technical platforms, to radiology, to the operating room. There were enough nurses to run the different departments adequately. As a surgeon, I could count on at least one operating day per week, sometimes two. There were seven operating rooms running per day, split between the six different surgical specialties. I could focus on caring for my patients, rather than the logistics of care and the workings of the system.
Things began to deteriorate over the years, with a flight of staff, taking with it access to the different technical platforms and quality care in the different departments.
Care eroded so that the functioning of the hospital became precarious. Then came the pandemic, transforming this precarious condition into a real catastrophe.
The flight of staff, especially nurses, but also technicians, technologists, clerks, etc., made the hospital frankly non-functional. The massive departure of operating theater staff meant that we had to cut operating rooms. From seven rooms per day in the good years of the operating room, we went to three or four, then two or three, always shared between all the surgical specialties. I could now only count on one operating day per month, sometimes two.
The massive loss of nursing staff on the floors meant that we had to close the surgery floor. Patients hospitalized in the department found themselves scattered across other floors, without expertise or surgical experience.
The departure of radiology technicians has made it very difficult to obtain essential radiological examinations within an acceptable time frame for preoperative evaluation, for diagnosis, for cancer follow-up.
Deadlines are piling up
The delays became such that, by the time I met a patient about her cancer, we were already behind schedule in her treatment. Late because her first mammogram, her first scan had already taken too long. And if we also had to request additional imaging, the delays would only accumulate. When we requested an operating room for this patient who had already waited too long for her diagnosis, we faced additional delays. All these accumulated delays inevitably led to harm to this patient in terms of her prognosis.
Every day I heard about another nurse leaving. Staff were systematically recruited by the health system in Ontario. By the federal government. By the private.
Practicing my profession has become impossible. It is impossible to do surgery without a team of qualified personnel at all stages of the journey, from surgical planning to emergency, operating room, day surgery, floors, outpatient clinics, care intensive, etc. Impossible to perform surgery without access to technical platforms (imaging, biopsies, pathology, laboratories, etc.).
Rather than focusing on caring for my patients, I could only busy myself trying to find ways to do my job. Going out of your way to get a scan, an echo, an MRI. Find operating rooms. That meant prioritizing one cancer over another. And mild cases, afflictions that won’t kill patients, but ruin their quality of life, well, treating them became a luxury. Patients waiting for stoma closure, for example, will have to wait years before they can be treated. Patients needing breast reconstruction after a mastectomy will need to have it again.
As I spent more time apologizing for delays than treating my patients, the moral injury became too great.
I had all the responsibility for the care of my patients without having any means of providing quality medicine. So I left.
I now still work as a general surgeon, still in Quebec, still in the public. I am in a very functional environment, not perfect, of course, but what a difference! My patients obtain radiological examinations within the prescribed time frame and are operated on within the appropriate time frame. I don’t have to worry about having beds available to hospitalize my patients. I know they will be well treated on the surgical floors.
I not only operate on emergency cases or cancer patients, but also on patients with benign afflictions, who nevertheless require interventions. I operate at least once or twice a week (two to three times more than in Outaouais), and I no longer have to worry about having to move heaven and earth to be able to do my work.
And that is in the same Quebec as that of the population of Outaouais. She who pays as much taxes as the rest of the province, but who nevertheless does not have access to the same care.
And what about Outaouais? The latest news is that at the Gatineau hospital where I worked, the different surgical specialties have to separate two operating rooms per day. In the summer, when the retired staff who come to lend a hand to the nurses in the operating room will take a deserved vacation, when the usual exhausted nurses will take their deserved vacation, we expect a reduction in the surgical supply. One room per day, maybe two, I’m told.
The conditions that caused me to leave last year have only gotten worse since then. The situation is untenable, and I hope that the government will find concrete and intelligent solutions before it is too late.
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reference: www.lapresse.ca