A group of Castlegar physicians is frustrated with the difficulty their patients are having accessing laboratory services and they want Interior Health (IH) to do something about it — now.
In the wake of the COVID-19 pandemic, crowded waiting rooms are no longer acceptable, so IH made changes to the laboratory procedures at the Castlegar and District Health Centre.
Effective the beginning of June, patients are now asked to call and book appointments for laboratory services. At the time IH said they would also still try to accommodate a limited number of walk-ins.
But according to the local physicians group, the system is not working.
The problem starts with making the phone call to book the appointment. The phone line is staffed by the same people doing all of the other tasks in the lab, rather than by a call centre or dedicated staff member. It is also only open five hours a day, and only on weekdays.
The physicians are repeatedly hearing from their patients about problems getting through to the phone line, sometimes having to call repeatedly for days just to schedule their appointment.
The second problem is that once they do get through, there is usually a wait of several more days for an appointment.
Dr. Ellen Smart says the lab was already consistently understaffed for the last year, even before COVID hit.
The physicians sent a letter to IH in which they state that they are in favour of the idea of appointment booking, but “the way it was set up is unwieldy and unsafe for patients.”
Doctors Ellen Smart, Tunde Sanuga, Meghan Jensen, Ranier Aukenbauer, Bbandama Makwati, Denis Thibodeau, Lisa Vasil, Andree-Anne Cromp, George Halse and Megan Taylor signed the letter.
In the letter, the physicians express their frustration that a phone booking system would be set up without setting up a person to answer that phone.
“This was completely foreseeable and there was a great deal of time in the early stages of COVID to come up with a much better plan.”
The physicians asked IH for a speedy resolution before “a patient dies a preventable death, the existing lab staff quits, or both.”
That letter was sent to IH on July 20 — and still nothing has changed.
Dr. Smart called the inaction “malignant neglect.”
She said the situation is especially surprising on the heels of what she says was a fantastic response to COVID-19 by IH.
“They were really nimble, they put things in place so much faster than they ever have before. They were responsive and easy to work with.”
The physicians group is also feeling a lack of respect from IH.
“When you start getting lots of doctors writing letters, usually there is a problem,” said Smart.
“You would hope there is enough respect to include them.”
But there has been a lack of communication from IH with the physicians and lab techs, according to Smart.
“There is a huge problem, there is an outcry — and still you hear nothing,” said Smart.
“You would think that when all of the doctors are saying, ‘The basics aren’t being met,’ [you would see action] … This isn’t high level care — it is the basics of health care.”
“Making that type of access hard is too much,” said Smart. “It is not going to serve the frail folks we take care of and those are the people who need the lab the most.”
“This is hard to understand — it is just not consistent with first-world medicine,” said Smart.
IH has announced that online appointment booking options are coming in the next month at four pilot sites, but Castlegar is not one of those sites.
But even if and when the option does come to Castlegar, Smart says it can’t replace having someone answering the phone — especially for urgent tests and patients who are not tech-savvy.
In a response letter to the physicians, IH acknowledges a long-term “human resource crisis”.
IH also acknowledges that COVID-19 has increased the workload staff is facing due to things like new protocols, door screenings and extra cleaning duties — resulting in less patients being seen each day.
And that was before they were also expected to answer the phone and book appointments.
Unfortunately, the lab techs — who now have more tasks to do — are the ones bearing the brunt of the misplaced ill will of the public, according to the physicians.
IH says it began looking for online appointment booking options towards the beginning of the pandemic and began working with a vendor. But, “After much back and forth, our preferred platform was deemed beyond Interior Health’s financial means and we had to begin again with a different vendor.”
In the letter, IH lab department head Launny Lowden said funding for staff to man the phones was sought.
“We sought approval to create a call centre, hire clerks or use volunteers to answer phones, but were constrained by funding, hiring policies, and union rules.”
Dr. Smart says this is where the the divide begins.
“Interior Health has to manage money, physicians are looking more at patient care.”
IH had a few suggestions for how the physicians could help ease the situation including warning their patients things are different at the lab now and asking them for patience, refraining from sending requisitions by fax if possible, informing patients of test requirements and avoiding ordering “urgent” tests unless required by clinical condition.
One of the suggestions doesn’t sit so well with physicians: “order laboratory tests judiciously and conservatively (choose wisely!).”
“That is not their place,” said Smart. “That is our job to figure out what needs ordered.”
“The problem is not over ordering,” she said.
”The problem is lack of service.”
Castlegar News has reached out to Interior Health for a further response.