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Patients with bowel cancer in Southland have experienced delays of up to one year for diagnosis, which happened too late for some.
One patient waited more than three years for a colonoscopy that showed that he was suffering from cancer.
Photo: provided
An independent report commissioned by the Southern District Health Board reviewed 20 cases and found delays in diagnosis.
One patient waited more than three years for a colonoscopy that showed that he had cancer – in part because he had been fired because he had already waited so long that It was thought that "a sinister pathology was unlikely".
Another patient whose diagnosis was diagnosed with a delay of one year (due to the reference letter of his general practitioner having been misplaced) and four others delayed until 10 months had to be referred to palliative care.
Others were only diagnosed once their cancer spread.
The report describes a state of "inter-service warfare" between gut specialists at Dunedin and Southland hospitals, which means that Southland patients benefit from poorer service than those at Dunedin. .
Stricter guidelines for referrals to colonoscopy, which have been introduced to deal with "uncontrollable" waiting lists, are now being used "as a rationing tool," the report says.
In some cases, patients in Southland were refused colonoscopy or experienced significant delays, even when they met the criteria.
"Some access criteria seem to have been applied too rigorously and to have refused access to colonoscopy or CT colonography for cases that might have been accepted on the basis of specialist clinical judgment. "
A study conducted as part of the review at other health boards revealed that some also used national guidelines to manage "a scarce resource", which was not their intention.
"Political risks raise clinical, ethical and medico-legal problems at the national level, national guidelines have never been formally validated as to their effects on health outcomes or their intrinsic utilities."
Patients who have refused colonoscopy because they do not follow local guidelines should be able to request an appointment from a specialist if their doctor deems it "clinically indicated," and specialists should have the discretion to order tests they need to do their job. says the report.
"This approach restores an option for patients who can not afford private health care and would otherwise go without investigation, and it also allows doctors and surgeons who are specialists in the treatment of GI disorders." Exercise their clinical judgment and the endoscopic know-how for which they were trained and employed. "
The listeners also noted that most of the surveyed doctors "showed signs of distress and some were on the verge of tears" and they concluded that they could not "work to their full potential".
"There is a state of inter-service warfare".
"In addition, lack of trust and bad relationships lead to delays in treatment."
Surgeons were concerned that the service would lose accreditation to colonoscopy registries for training registrars due to lack of training opportunities.
The endoscopy service was under tremendous pressure due to a number of factors, including lack of staff and equipment.
Access to colonoscopy services had declined since the launch of the national gut screening program, the report noted.
KG]Of the 20 cases covered by this audit:
Southern DHB has one of the highest rates of colorectal cancer in New Zealand, one of the highest cancer rates that has spread beyond the gut at the time of initial treatment, one of the highest rates higher emergency surgery for bowel cancer and one of the lowest colonoscopy rates.
Chief Medical Officer Nigel Millar said that since the report was written in May, the Southern DHH has been working to ensure that Southland patients receive the same treatment as Dunedin.
In-depth review of other cases
Another review will look at 102 other cases, for which questions arise as to how they were treated.
Dr. Millar stated that it was important to remember that these cases were only a minority among several thousand colonoscopies performed over a number of years.
"Any case of delayed care should be taken seriously, however, it is recognized that intestinal symptoms, such as pain and bloating, are not specific and that, in many people, they do not result from gastrointestinal tumors. -intestinales. "
It was "impractical" to investigate all those with these symptoms, which was why other factors were needed, including the duration of the problem, unexplained bleeding, and the age of the patient.
Expanding access would result in an extinction of waiting lists and would have the unintended consequence of delaying patient access more likely to have cancer, said Dr. Millar. .
"Unfortunately, there is still a possibility that some cases may be missed by people who are referred but not accepted for a publicly funded colonoscopy.
"It's a hard-to-reach balance, and we appreciate the sincere concern that all clinicians experience and share with us in managing this."
Southern DHB joined the national gut screening program and Dr. Millar noted that participation rates in the South were among the highest in the country, especially for Maori.
The program had so far detected 80 cancers that would otherwise have not been detected and polyps (precancerous lesions) in more than 700 patients.
"This is a crucial step in reducing late cancers and gives us an important foundation to move forward."
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